TY  - JOUR
ID  - 128417320
T1  - Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses - United States, July 2016-September 2017.
AU  - Vivolo-Kantor, Alana M.
AU  - Seth, Puja
AU  - Gladden, R. Matthew
AU  - Mattson, Christine L.
AU  - Baldwin, Grant T.
AU  - Kite-Powell, Aaron
AU  - Coletta, Michael A.
Y1  - 2018/03/09/
N1  - Accession Number: 128417320. Language: English. Entry Date: 20180318. Revision Date: 20180318. Publication Type: journal article. Journal Subset: Biomedical; Public Health; USA. NLM UID: 7802429. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Overdose -- Epidemiology
KW  - Emergency Service -- Utilization
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Young Adult
KW  - Adolescence
KW  - Male
KW  - Emergency Service -- Trends
KW  - United States
SP  - 279
EP  - 285
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 67
IS  - 9
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
AB  - Introduction: From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a worsening of the opioid overdose epidemic and highlighting the importance of rapid data collection, analysis, and dissemination.Methods: Emergency department (ED) syndromic and hospital billing data on opioid-involved overdoses during July 2016-September 2017 were examined. Temporal trends in opioid overdoses from 52 jurisdictions in 45 states were analyzed at the regional level and by demographic characteristics. To assess trends based on urban development, data from 16 states were analyzed by state and urbanization level.Results: From July 2016 through September 2017, a total of 142,557 ED visits (15.7 per 10,000 visits) from 52 jurisdictions in 45 states were suspected opioid-involved overdoses. This rate increased on average by 5.6% per quarter. Rates increased across demographic groups and all five U.S. regions, with largest increases in the Southwest, Midwest, and West (approximately 7%-11% per quarter). In 16 states, 119,198 ED visits (26.7 per 10,000 visits) were suspected opioid-involved overdoses. Ten states (Delaware, Illinois, Indiana, Maine, Missouri, Nevada, North Carolina, Ohio, Pennsylvania, and Wisconsin) experienced significant quarterly rate increases from third quarter 2016 to third quarter 2017, and in one state (Kentucky), rates decreased significantly. The highest rate increases occurred in large central metropolitan areas.Conclusions and Implications For Public Health Practice: With continued increases in opioid overdoses, availability of timely data are important to inform actions taken by EDs and public health practitioners. Increases in opioid overdoses varied by region and urbanization level, indicating a need for localized responses. Educating ED physicians and staff members about appropriate services for immediate care and treatment and implementing a post-overdose protocol that includes naloxone provision and linking persons into treatment could assist EDs with preventing overdose.
SN  - 0149-2195
AD  - Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC
AD  - Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, CDC
U2  - PMID: 29518069.
DO  - 10.15585/mmwr.mm6709e1
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 114015868
T1  - Use of Naloxone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts.
AU  - Sumner, Steven Allan
AU  - Mercado-Crespo, Melissa C.
AU  - Spelke, M. Bridget
AU  - Paulozzi, Leonard
AU  - Sugerman, David E.
AU  - Hillis, Susan D.
AU  - Stanley, Christina
Y1  - 2016/03//Mar/Apr2016
N1  - Accession Number: 114015868. Language: English. Entry Date: 20160509. Revision Date: 20170823. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Emergency Medical Services
KW  - Overdose -- Diagnosis
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Emergency Care
KW  - Prehospital Care
KW  - Human
KW  - Naloxone -- Therapeutic Use
KW  - Resuscitation -- Methods
KW  - Cross Sectional Studies
KW  - Public Health
KW  - Emergency Medical Technicians -- Education
KW  - Health Knowledge
KW  - Data Analysis
KW  - Confidence Intervals
KW  - Substance Abuse -- Diagnosis
KW  - Prescribing Patterns
KW  - Drug and Narcotic Control
KW  - Drugs, Prescription
KW  - Street Drugs
KW  - Substance Abuse -- Mortality
KW  - Chi Square Test
KW  - Fisher's Exact Test
KW  - T-Tests
KW  - Data Analysis Software
KW  - Heroin -- Administration and Dosage
KW  - Heroin -- Adverse Effects
KW  - Substance Abusers
KW  - Race Factors
KW  - Ethnic Groups
KW  - Body Mass Index -- Evaluation
KW  - Odds Ratio
KW  - Male
KW  - Female
SP  - 220
EP  - 225
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 20
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a public health response to an outbreak of opioid overdoses in Rhode Island, we examined missed opportunities for naloxone administration and factors potentially influencing EMS providers’ decision to administer naloxone. We reviewed medical examiner files on all individuals who died of an opioid-related drug overdose in Rhode Island from January 1, 2012 through March 31, 2014, underwent attempted resuscitation by EMS providers, and had records available to assess for naloxone administration. We evaluated whether these individuals received naloxone as part of their resuscitation efforts and compared patient and scene characteristics of those who received naloxone to those who did not receive naloxone via chi-square, t-test, and logistic regression analyses. One hundred and twenty-four individuals who underwent attempted EMS resuscitation died due to opioid overdose. Naloxone was administered during EMS resuscitation attempts in 82 (66.1%) of cases. Females were nearly three-fold as likely not to receive naloxone as males (OR 2.9; 95% CI 1.2–7.0;p-value 0.02). Additionally, patients without signs of potential drug abuse also had a greater than three-fold odds of not receiving naloxone (OR 3.3; 95% CI 1.2–9.2;p-value 0.02). Older individuals, particularly those over age 50, were more likely not to receive naloxone than victims younger than age 30 (OR 4.8; 95% CI 1.3–17.4;p-value 0.02). Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts. Heightened clinical suspicion for opioid overdose is important given the recent increase in overdoses among patients due to prescription opioids.
SN  - 1090-3127
DO  - 10.3109/10903127.2015.1076096
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128375748
T1  - Basic and Advanced EMS Providers Are Equally Effective in Naloxone Administration for Opioid Overdose in Northern New England.
AU  - Gulec, Nazey
AU  - Lahey, Joseph
AU  - Suozzi, James C.
AU  - Sholl, Matthew
AU  - MacLean, Charles D.
AU  - Wolfson, Daniel L.
Y1  - 2018/03//Mar/Apr2018
N1  - Accession Number: 128375748. Language: English. Entry Date: 20180315. Revision Date: 20180315. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Instrumentation: Glasgow Coma Scale (GCS). NLM UID: 9703530. 
KW  - Emergency Medical Technicians -- Classification
KW  - Life Support Care -- Classification
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Treatment Outcomes
KW  - New England
KW  - Human
KW  - Female
KW  - Male
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - P-Value
KW  - Chi Square Test
KW  - Fisher's Exact Test
KW  - Wilcoxon Rank Sum Test
KW  - Retrospective Design
KW  - Prehospital Care
KW  - Overdose -- Mortality
KW  - Adult
KW  - Middle Age
KW  - T-Tests
KW  - Glasgow Coma Scale
KW  - Scales
KW  - Narcotics -- Poisoning
KW  - Scope of Practice -- New England
SP  - 163
EP  - 169
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 22
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Objective: Overdose mortality from illicit and prescription opioids has reached epidemic proportions in the United States, especially in rural areas. Naloxone is a safe and effective agent that has been shown to successfully reverse the effects of opioid overdose in the prehospital setting. The <italic>National EMS Scope of Practice Model</italic> currently only recommends advanced life support (ALS) providers to administer naloxone; however, some individual states have expanded this scope of practice to include intranasal (IN) administration of naloxone by basic life support (BLS) providers, including the Northern New England states. This study compares the effectiveness and appropriateness of naloxone administration between BLS and ALS providers. Methods: All Vermont, New Hampshire, and Maine EMS patient encounters between April 1, 2014 and December 31, 2016 where naloxone was administered were examined and 3,219 patients were identified. The proportion of successful reversals of opioid overdose, based on improvement in the Glasgow Coma Scale (GCS), respiratory rate (RR), and provider global assessment (GA) of response to medication was compared between BLS and ALS providers using a Chi-Squared statistic, Fisher's exact or Wilcoxon rank-sum test. Results: There was no significant difference in the percent improvement in GCS between BLS and ALS (64% and 64% P = 0.94). There was no significant difference in the percentage of improvement in RR between BLS and ALS (45% and 48% P = 0.43). There was a significant difference in the percentage of improvement of GA between BLS and ALS (80% and 67% P < 0.001). There was no significant difference in determining appropriate cases to administer naloxone where RR < 12 and GCS < 15 between BLS and ALS (42% and 43% P = 0.94). Conclusions: BLS providers were as effective as ALS providers in improving patient outcome measures after naloxone administration and in identifying patients for whom administration of naloxone is appropriate. These findings support expanding the National EMS Scope of Practice Model to include BLS administration of intranasal naloxone for suspected opioid overdoses.
SN  - 1090-3127
AD  - Received May 9, 2017 from Robert D. Larner College of Medicine at The University of Vermont, Burlington, Vermont (NG, JL); Department of Medicine, Robert D. Larner College of Medicine at the University of Vermont (CDM); Department of Surgery, Division of Emergency Medicine, Robert D. Larner MD College of Medicine at the University of Vermont; and, Vermont Department of Health Division of Emergency Preparedness, Response & Injury Prevention (DLW); New Hampshire Bureau of EMS, Division of Fire Standards and Training & Emergency Medical Services, Bureau of Emergency Medical Services, Concord, New Hampshire (JCS); Maine Medical Center, Portland, Maine (MS); Maine State EMS, Portland, Maine (MS); Vermont Department of Health, Division of Emergency Preparedness, Response and Injury Prevention, Burlington, Vermont (DLW). Revision received July 28, 2017; accepted for publication August 18, 2017
DO  - 10.1080/10903127.2017.1371262
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127444448
T1  - Naloxone Administration for Opioid Overdose Reversal in the Prehospital Setting: Implications for Pharmacists.
AU  - Weaver, Landon
AU  - Palombi, Laura
AU  - Bastianelli, Karen M. S.
Y1  - 2018/02//
N1  - Accession Number: 127444448. Language: English. Entry Date: 20180203. Revision Date: 20180323. Publication Type: Article; research; systematic review. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. NLM UID: 8900945. 
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Narcotics -- Administration and Dosage
KW  - Prehospital Care
KW  - Pharmacists
KW  - Naloxone -- Therapeutic Use
KW  - Human
KW  - PubMed
KW  - Patient Safety
KW  - Administration, Intranasal -- Economics
KW  - Systematic Review
SP  - 91
EP  - 98
JO  - Journal of Pharmacy Practice
JF  - Journal of Pharmacy Practice
JA  - J PHARM PRACT
VL  - 31
IS  - 1
CY  - Thousand Oaks, California
PB  - Sage Publications Inc.
AB  - Background: Fatalities from opioid overdose have risen by 117% over the past 10 years. Increasing access to the opioid antagonist, naloxone can combat this trend and saves lives. This study investigates the various routes of naloxone administration for opioid reversal in the prehospital setting. Methods: PubMed, Ovid, and Google Scholar were searched for references that included the words naloxone and prehospital. Inclusion criteria were peer reviewed publications after 1995, English language, studies conducted in an outpatient setting, and intramuscular, intranasal, intravenous, or subcutaneous formulations; exclusion criteria were review articles or editorials. Results: 8 articles met the inclusion criteria: intramuscular, intranasal, intravenous, and subcutaneous dosage forms of naloxone were analyzed to compare their time to administration, time to efficacy, financial impact, administrator safety, and administrator preference. Conclusion: There is little consensus on the optimal route of naloxone administration in the prehospital setting. Little training is required for proper administration of the intramuscular auto-injector; however, the high price of this device is a barrier to access. Intranasal naloxone appears to be the optimal dosage form when considering cost, effectiveness, and administrator safety. Pharmacists must be aware of trends in naloxone use, dosage forms, and administration when caring for patients and their communities.
SN  - 0897-1900
AD  - CentraCare Health–St Cloud, University of Minnesota Ambulatory Care Residency, St Cloud, MN, USA
AD  - Department of Pharmacy Practice and Pharmaceutical Science, University of Minnesota College of Pharmacy, Duluth, MN, USA
DO  - 10.1177/0897190017702304
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121774630
T1  - Naloxone administration for suspected opioid overdose: An expanded scope of practice by a basic life support collegiate-based emergency medical services agency.
AU  - Jeffery, Ryan M.
AU  - Dickinson, Laura
AU  - Ng, Nicholas D.
AU  - DeGeorge, Lindsey M.
AU  - Nable, Jose V.
Y1  - 2017/04//
N1  - Accession Number: 121774630. Language: English. Entry Date: 20170315. Revision Date: 20170321. Publication Type: Article; case study; protocol; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 7503059. 
KW  - Substance Abuse -- Complications
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Prehospital Care
KW  - Emergency Medical Technicians
KW  - Scope of Practice
KW  - Student Health Services
KW  - Emergency Medical Services
KW  - Students, College
KW  - Protocols
KW  - Overdose -- Mortality
KW  - Colleges and Universities
KW  - District of Columbia
KW  - Naloxone -- Pharmacodynamics
KW  - Naloxone -- Pharmacokinetics
KW  - Staff Development
SP  - 212
EP  - 216
JO  - Journal of American College Health
JF  - Journal of American College Health
JA  - J AM COLL HEALTH
VL  - 65
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Opioid abuse is a growing and significant public health concern in the United States. Naloxone is an opioid antagonist that can rapidly reverse the respiratory depression associated with opioid toxicity. Georgetown University's collegiate-based emergency medical services (EMS) agency recently adopted a protocol, allowing providers to administer intranasal naloxone for patients with suspected opioid overdose. While normally not within the scope of practice of basic life support prehospital agencies, the recognition of an increasing epidemic of opioid abuse has led many states, including the District of Columbia, to expand access to naloxone for prehospital providers of all levels of training. In particular, intranasal naloxone is a method of administering this medication that potentially avoids needlestick injuries among EMS providers. Universities with collegiate-based EMS agencies are well positioned to provide life-saving treatments for patients acutely ill from opioid overdose.
SN  - 0744-8481
AD  - Georgetown Emergency Response Medical Service, Georgetown University, Washington, District of Columbia, USA
AD  - MedStar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia, USA
AD  - Department of Emergency Medicine, MedStar Georgetown University Hospital, Georgetown University School of Medicine, Washington, District of Columbia, USA
DO  - 10.1080/07448481.2016.1277730
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126130353
T1  - INCIDENCE OF NALOXONE REDOSING IN THE AGE OF THE NEW OPIOID EPIDEMIC.
AU  - Klebacher, Ronald
AU  - Harris, Matthew I.
AU  - Ariyaprakai, Navin
AU  - Tagore, Ammundeep
AU  - Robbins, Vince
AU  - Dudley, Larissa Sophia
AU  - Bauter, Robert
AU  - Koneru, Susmith
AU  - Hill, Ryan D.
AU  - Wasserman, Eric
AU  - Shanes, Andrew
AU  - Merlin, Mark A.
Y1  - 2017/11//Nov/Dec2017
N1  - Accession Number: 126130353. Language: English. Entry Date: 20171117. Revision Date: 20171117. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Analgesics, Opioid
KW  - Administration, Intranasal
KW  - Prehospital Care
KW  - Drug Toxicity -- Prevention and Control
KW  - Human
KW  - Retrospective Design
KW  - Record Review
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - Interrater Reliability
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
SP  - 682
EP  - 687
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 21
IS  - 6
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Study Objective:Naloxone, an opioid-antagonist deliverable by an intra-nasal route, has become widely available and utilized by law enforcement officers as well as basic life support (BLS) providers in the prehospital setting. This study aimed to determine the frequency of repeat naloxone dosing in suspected narcotic overdose (OD) patients and identify patient characteristics. Methods:Aretrospective chart review of patients over 17 years of age with suspected opioid overdose, treated with an initial intranasal (IN) dose of naloxone and subsequently managed by paramedics, was performed from April 2014 to June 2016. Demographic data was analyzed using descriptive statistics to identify those aspects of the history, physical exam findings. Results: A sample size of 2166 patients with suspected opioid OD received naloxone from first responders. No patients who achieved GCS 15 after treatment required redosing; 195 (9%) received twodoses and 53 patients received three doses of naloxone by advanced life support. Patients were primarily male (75.4%), Caucasian (88.2%), with a mean age of 36.4 years. A total of 76.7% of patients were found in the home, 23.1% had a suspected mixed ingestion, and 27.2% had a previous OD. Two percent of all patients required a third dose of naloxone. Conclusion: In this prehospital study, we confirmed that intranasal naloxone is effective in reversing suspected opioid toxicity. Nine percent of patients required two ormore doses of naloxone to achieve clinical reversal of suspected opioid toxicity. Two percent of patients received a third dose of naloxone.
SN  - 1090-3127
AD  - Newark Beth Israel Medical Center, Emergency Medicine, Newark, New Jersey
AD  - Monmouth Ocean Hospital Service Corporation, Wall Township, New Jersey
AD  - MONOC, EMS, Neptune, New Jersey
AD  - Newark Beth Israel
DO  - 10.1080/10903127.2017.1335818
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125417299
T1  - Heroin and pharmaceutical opioid overdose events: Emergency medical response characteristics.
AU  - Banta-Green, Caleb J.
AU  - Coffin, Phillip O.
AU  - Schoeppe, Jennie A.
AU  - Merrill, Joseph O.
AU  - Whiteside, Lauren K.
AU  - Ebersol, Abigail K.
Y1  - 2017/09//
N1  - Accession Number: 125417299. Language: English. Entry Date: 20180322. Revision Date: 20180413. Publication Type: journal article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Barthel Index; Impact of Events Scale (IES); Glasgow Coma Scale (GCS). NLM UID: 7513587. 
KW  - Emergency Medical Services -- Statistics and Numerical Data
KW  - Overdose -- Epidemiology
KW  - Analgesics, Opioid -- Poisoning
KW  - Heroin -- Poisoning
KW  - Young Adult
KW  - Washington
KW  - Middle Age
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Female
KW  - Sex Factors
KW  - Incidence
KW  - Adult
KW  - Male
KW  - Age Factors
KW  - Barthel Index
KW  - Glasgow Coma Scale
KW  - Impact of Events Scale
KW  - Scales
SP  - 1
EP  - 6
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 178
PB  - Elsevier B.V.
AB  - Background: Emergency Medical Services (EMS) data may provide insight into opioid overdose incidence, clinical characteristics, and medical response. This analysis describes patient characteristics, clinical features, and EMS response to opioid overdoses, comparing heroin and pharmaceutical opioid (PO) overdoses, using a structured opioid overdose case criteria definition.Methods: A case series study was conducted. EMS medical staff screened cases for possible overdoses and study staff categorized the likelihood of opioid overdose. Medical form data were abstracted. Patient characteristics, clinical presentation, and medical response to heroin and PO-involved overdoses were compared with bi-variate test statistics.Results: We identified 229 definite or probable opioid overdose cases over six months: heroin in 98 (43%) cases (10 also involved PO), PO without heroin in 85 (37%) cases, and 46 (20%) that could not be categorized and were excluded from analyses. Heroin overdose patients were younger than PO (median age 33 v 41 (p<0.05)), more often male (80% v 61% (p=<0.01)), intubated less (8% v 22%, p<0.01) and more likely to be administered naloxone (72% v 51%, p<0.01). No significant differences were found between heroin and PO overdoses for initial respiratory rate, Glasgow Coma Scale score, or co-ingestants, but heroin users were more likely to have miotic pupils (p<0.01).Conclusions: While heroin and PO events presented similarly, heroin-involved cases were more likely to receive naloxone and less likely to be intubated. Standardized case definitions and data documentation could aid opioid overdose surveillance as well as provide data for measuring the impact of professional and lay interventions.
SN  - 0376-8716
AD  - Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
AD  - Harborview Injury Prevention and Research Center, Seattle WA, USA
AD  - San Francisco Department of Public Health, San Francisco, CA, USA
AD  - Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
AD  - Group Health Research Institute, Seattle, WA, USA
AD  - Division of Emergency Medicine, University of Washington Seattle WA, USA
U2  - PMID: 28623805.
DO  - 10.1016/j.drugalcdep.2017.04.021
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121375702
T1  - Factors Associated With Participation in an Emergency Department-Based Take-Home Naloxone Program for At-Risk Opioid Users.
AU  - Kestler, Andrew
AU  - Buxton, Jane
AU  - Meckling, Gray
AU  - Giesler, Amanda
AU  - Lee, Michelle
AU  - Fuller, Kirsten
AU  - Quian, Hong
AU  - Marks, Dalya
AU  - Scheuermeyer, Frank
Y1  - 2017/03//
N1  - Accession Number: 121375702. Language: English. Entry Date: 20170701. Revision Date: 20170730. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Instrumentation: Home Observation for Measurement of the Environment (HOME) (Bradley and Caldwell); Global Assessment of Functioning Scale (GAF). NLM UID: 8002646. 
KW  - Naloxone -- Therapeutic Use
KW  - Emergency Service
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Substance Use Disorders -- Prevention and Control
KW  - Patient Attitudes
KW  - Patient Education
KW  - Self Care -- Methods
KW  - Adult
KW  - Male
KW  - Overdose -- Drug Therapy
KW  - Female
KW  - Scales
SP  - 340
EP  - 346
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 69
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance.Methods: At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone. The primary outcome was acceptance of take-home naloxone, including the kit and standardized patient training. Univariate and multivariable logistic analyses were used to evaluate factors associated with acceptance.Results: Of 241 eligible patients approached, 201 (83.4%) completed the questionnaire. Three-quarters of respondents used injection drugs, 37% were women, and 26% identified as "Indigenous." Of 201 respondents, 137 (68.2%; 95% confidence interval [CI] 61.7% to 74.7%) accepted take-home naloxone. Multivariable analysis revealed that factors associated with take-home naloxone acceptance included witnessing overdose in others (odds ratio [OR] 4.77; 95% CI 2.25 to 10.09), concern about own overdose death (OR 3.71; 95% CI 1.34 to 10.23), female sex (OR 2.50; 95% CI 1.21 to 5.17), and injection drug use (OR 2.22; 95% CI 1.06 to 4.67).Conclusion: A two-thirds ED take-home naloxone acceptance rate in patients using opioids should encourage all EDs to dispense take-home naloxone. ED-based take-home naloxone programs have the potential to improve access to take-home naloxone and awareness in individuals most vulnerable to overdoses.
SN  - 0196-0644
AD  - Department of Emergency Medicine, St Paul’s Hospital, Vancouver, British Columbia, Canada
AD  - Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
AD  - School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
AD  - British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
AD  - Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
AD  - School of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
AD  - Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
AD  - London School of Tropical Medicine & Hygiene
U2  - PMID: 27745764.
DO  - 10.1016/j.annemergmed.2016.07.027
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121375702&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126891081
T1  - Emergency Medical Services Naloxone Administration: Many Unknowns and Opportunities.
AU  - Oliva, Elizabeth M.
AU  - Bounthavong, Mark
Y1  - 2017/12/19/
N1  - Accession Number: 126891081. Language: English. Entry Date: In Process. Revision Date: 20171229. Publication Type: journal article. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0372351. 
SP  - 890
EP  - 891
JO  - Annals of Internal Medicine
JF  - Annals of Internal Medicine
JA  - ANN INTERN MED
VL  - 167
IS  - 12
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
AB  - The article reflects on review of management of suspected opioid overdose with naloxone in out-of-hospital settings and emergency medical services. It mentions route of naloxone administration, titration of naloxone to respiration versus consciousness and transport versus nontransport of patients to a health care facility. It also mentions opioid crisis has been deemed a national public health emergency and prominence of the event in the electronic health record.
SN  - 0003-4819
AD  - VA Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, VA Center for Innovation to Implementation, Menlo Park, California.
AD  - VHA Pharmacy Benefits Management Services, Academic Detailing Service, Seattle, Washington.
U2  - PMID: 29181541.
DO  - 10.7326/M17-2963
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126891081&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124023681
T1  - Multiple Naloxone Administrations Among Emergency Medical Service Providers is Increasing.
AU  - Faul, Mark
AU  - Lurie, Peter
AU  - Kinsman, Jeremiah M.
AU  - Dailey, Michael W.
AU  - Crabaugh, Charmaine
AU  - Sasser, Scott M.
Y1  - 2017/07//Jul/Aug2017
N1  - Accession Number: 124023681. Language: English. Entry Date: 20170731. Revision Date: 20170731. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Drug Utilization -- Trends
KW  - Prehospital Care
KW  - Professional Practice
KW  - Emergency Medical Services
KW  - Emergency Service Information Systems
KW  - Secondary Analysis
KW  - Databases, Health
KW  - Trend Studies
KW  - Multiple Regression
KW  - Emergency Patients
KW  - Socioeconomic Factors
KW  - Chi Square Test
KW  - P-Value
KW  - Logistic Regression
KW  - Odds Ratio
KW  - Confidence Intervals
KW  - Health Services Research
KW  - Data Analysis Software
KW  - United States
KW  - Infant, Newborn
KW  - Infant
KW  - Child, Preschool
KW  - Child
KW  - Adolescence
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Male
KW  - Female
KW  - Urban Areas
KW  - Suburban Areas
KW  - Rural Areas
KW  - Ambulances
KW  - Treatment Outcomes
KW  - Overdose -- Symptoms
KW  - Transportation of Patients
KW  - Naloxone -- Pharmacokinetics
KW  - Descriptive Statistics
KW  - Outpatients
KW  - Human
SP  - 411
EP  - 419
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 21
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background: Opioid overdoses are at epidemic levels in the United States. Emergency Medical Service (EMS) providers may administer naloxone to restore patient breathing and prevent respiratory arrest. There was a need for contemporary data to examine the number of naloxone administrations in an EMS encounter.Methods: Using data from the National Emergency Medical Services Information System, we examined data from 2012–5 to determine trends in patients receiving multiple naloxone administrations (MNAs). Logistic regression including demographic, clinical, and operational information was used to examine factors associated with MNA.Results: Among all events where naloxone was administered only 16.7% of the 911 calls specifically identified the medical emergency as a drug ingestion or poisoning event. The percentage of patients receiving MNA increased from 14.5% in 2012 to 18.2% in 2015, which represents a 26% increase in MNA in 4 years. Patients aged 20–29 had the highest percentage of MNA (21.1%). Patients in the Northeast and the Midwest had the highest relative MNA (Chi Squared = 539.5, p < 0.01 and Chi Squared = 351.2, p < 0.01, respectively). The logistic regression model showed that the adjusted odds ratios (aOR) for MNA were greatest among people who live in the Northeast (aOR = 1.18, 95% CI = 1.13–1.22) and for men (aOR = 1.13, 95% CI = 1.10–1.16), but lower for suburban and rural areas (aOR = 0.76, 95% CI = 0.72–0.80 and aOR = 0.85, 95% CI = 0.80–0.89) and lowest for wilderness areas (aOR = 0.76, 95% CI = 0.68–0.84). Higher adjusted odds of MNA occurred when an advanced life support (ALS 2) level of service was provided compared to basic life support (BLS) ambulances (aOR = 2.15, 95% CI = 1.45–3.16) and when the dispatch complaint indicated there was a drug poisoning event (aOR = 1.12, 95% CI = 1.09–1.16). Reported layperson naloxone administration prior to EMS arrival was rare (1%).Conclusion: This study shows that frequency of MNA is growing over time and is regionally dependent. MNA may be a barometer of the potency of the opioid involved in the overdose. The increase in MNA provides support for a dosage review. Better identification of opioid related events in the dispatch system could lead to a better match of services with patient needs.
SN  - 1090-3127
DO  - 10.1080/10903127.2017.1315203
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125177200
T1  - Why are some people who have received overdose education and naloxone reticent to call Emergency Medical Services in the event of overdose?
AU  - Koester, Stephen
AU  - Mueller, Shane R.
AU  - Raville, Lisa
AU  - Langegger, Sig
AU  - Binswanger, Ingrid A.
Y1  - 2017/10//
N1  - Accession Number: 125177200. Language: English. Entry Date: In Process. Revision Date: 20180302. Publication Type: journal article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: UL1 TR001082/TR/NCATS NIH HHS/United States. NLM UID: 9014759. 
SP  - 115
EP  - 124
JO  - International Journal of Drug Policy
JF  - International Journal of Drug Policy
JA  - INT J DRUG POLICY
VL  - 48
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Background: Overdose Education and Naloxone Distribution (OEND) training for persons who inject drugs (PWID) underlines the importance of summoning emergency medical services (EMS). To encourage PWID to do so, Colorado enacted a Good Samaritan law providing limited immunity from prosecution for possession of a controlled substance and/or drug paraphernalia to the overdose victim and the witnesses who in good faith provide emergency assistance. This paper examines the law's influence by describing OEND trained PWIDs' experience reversing overdoses and their decision about calling for EMS support.Methods: Findings from two complementary studies, a qualitative study based on semi-structured interviews with OEND trained PWID who had reversed one or more overdoses, and an on-going fieldwork-based project examining PWIDs' self-identified health concerns were triangulated to describe and explain participants' decision to call for EMS.Results: In most overdose reversals described, no EMS call was made. Participants reported several reasons for not doing so. Most frequent was the fear that despite the Good Samaritan law, a police response would result in arrest of the victim and/or witness for outstanding warrants, or sentence violations. Fears were based on individual and collective experience, and reinforced by the city of Denver's aggressive approach to managing homelessness through increased enforcement of misdemeanors and the imposition of more recent ordinances, including a camping ban, to control space. The city's homeless crisis was reflected as well in the concern expressed by housed PWID that an EMS intervention would jeopardize their public housing.Conclusion: Results suggest that the immunity provided by the Good Samaritan law does not address PWIDs' fear that their current legal status as well as the victim's will result in arrest and incarceration. As currently conceived, the Good Samaritan law does not provide immunity for PWIDs' already enmeshed in the criminal justice system, or PWID fearful of losing their housing.
SN  - 0955-3959
AD  - Department of Anthropology, University of Colorado Denver, Denver, CO, USA
AD  - Department of Health & Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
AD  - Division of General Internal Medicine, University of Colorado School of Medicine, 12631 E. 17th Ave. B-180 Aurora, CO 80045, USA 1
AD  - Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA 2
AD  - Harm Reduction Action Center, 231 E Colfax Ave, Denver, CO 80203, USA
AD  - Faculty of International Liberal Arts, Akita International University, Japan
U2  - PMID: 28734745.
DO  - 10.1016/j.drugpo.2017.06.008
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125177200&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109839770
T1  - Naloxone-does over-antagonism matter? Evidence of iatrogenic harm after emergency treatment of heroin/opioid overdose.
AU  - Neale, Joanne
AU  - Strang, John
Y1  - 2015/10//
N1  - Accession Number: 109839770. Language: English. Entry Date: 20150910. Revision Date: 20160930. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Psychiatry/Psychology. Grant Information: The original study was funded by the Scottish Office. NLM UID: 9304118. 
KW  - Overdose -- Drug Therapy -- Scotland
KW  - Naloxone -- Administration and Dosage
KW  - Attitude to Health
KW  - Health Knowledge
KW  - Funding Source
KW  - Human
KW  - Male
KW  - Female
KW  - Scotland
KW  - Interviews
KW  - Attitude to Risk
KW  - Substance Dependence
KW  - Qualitative Studies
KW  - Young Adult
KW  - Adult
KW  - Middle Age
KW  - Audiorecording
KW  - Data Analysis Software
KW  - Social Attitudes
SP  - 1644
EP  - 1652
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 110
IS  - 10
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Aim To analyse drug users' views and experiences of naloxone during emergency resuscitation after illicit opiate overdose to identify (i) any evidence of harm caused by excessive naloxone dosing ('over-antagonism'); and (ii) implications for the medical administration of naloxone within contemporary emergency settings. Design Re-analysis of a large qualitative data set comprising 70 face-to-face interviews conducted within a few hours of heroin/opioid overdose occurring, observations from hospital settings and a further 130 interviews with illicit opiate users. Data were generated between 1997 and 1999. Setting Emergency departments, drug services and pharmacies in two Scottish cities. Participants Two hundred illicit opiate users: 131 males and 69 females. Findings Participants had limited knowledge of naloxone and its pharmacology, yet described it routinely in negative terms and were critical of its medical administration. In particular, they complained that naloxone induced acute withdrawal symptoms, causing patients to refuse treatment, become aggressive, discharge themselves from hospital and take additional street drugs to counter the naloxone effects. Participants believed that hospital staff should administer naloxone selectively and cautiously, and prescribe counter-naloxone medication if dosing precipitated withdrawals. In contrast, observational data indicated that participants did not always know that they had received naloxone and hospital doctors did not necessarily administer it incautiously. Conclusions Opiate users in urban Scotland repeatedly report harm caused by naloxone over-antagonism, although this is not evident in observational data. The concept of contemporary legend (a form of folklore that can be based on fact and provides a means of communicating and negotiating anxiety) helps to explain why naloxone has such a feared reputation among opiate users.
SN  - 0965-2140
AD  - Reader in Qualitative and Mixed Methods Research, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience
AD  - Professor of the Addictions, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience
U2  - PMID: 26119038.
DO  - 10.1111/add.13027
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109839770&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128442048
T1  - By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department.
AU  - Santistevan, Jamie R.
AU  - Sharp, Brian R.
AU  - Hamedani, Azita G.
AU  - Fruhan, Scott
AU  - Lee, Andrew W.
AU  - Patterson, Brian W.
Y1  - 2018/03//
N1  - Accession Number: 128442048. Language: English. Entry Date: 20180405. Revision Date: 20180405. Publication Type: Article. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101476450. 
KW  - Emergency Service
KW  - Prescriptions, Drug
KW  - Narcotics
KW  - Electronic Health Records
KW  - Human
KW  - Retrospective Design
KW  - Nonexperimental Studies
KW  - Academic Medical Centers
KW  - Hospitals, Urban
KW  - Office Visits
KW  - Adult
KW  - Adolescence
KW  - Young Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Patient Discharge
KW  - Tablets
KW  - Codeine -- Pharmacodynamics
KW  - Oxycodone -- Pharmacodynamics
KW  - Acetaminophen -- Pharmacodynamics
KW  - Drug Combinations
KW  - Prescribing Patterns
KW  - Wilcoxon Rank Sum Test
KW  - Chi Square Test
KW  - Data Analysis, Statistical
KW  - Confidence Intervals
KW  - Medical Practice
KW  - Patient Care
SP  - 392
EP  - 397
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 19
IS  - 2
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Introduction: Opioid prescribing patterns have come under increasing scrutiny with the recent rise in opioid prescriptions, opioid misuse and abuse, and opioid-related adverse events. To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. Our goal was to evaluate opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry. Methods: We performed a retrospective observational study at a single academic, urban ED with 58,000 annual visits. We identified all adult patients (18 years or older) seen in the ED and discharged home with prescriptions for tablet forms of hydrocodone and oxycodone (including mixed formulations with acetaminophen). We compared the quantity of tablets prescribed per opioid prescription 12 months before and 10 months after the electronic order-entry prescription default quantity of 20 tablets was removed and replaced with no default quantity. No specific messaging was given to providers, to avoid influencing prescribing patterns. We used two-sample Wilcoxon rank-sum test, two-sample test of proportions, and Pearson's chi-squared tests where appropriate for statistical analysis. Results: A total of 4,104 adult patients received discharge prescriptions for opioids in the preintervention period (151.6 prescriptions per 1,000 discharged adult patients), and 2,464 postintervention (106.69 prescriptions per 1,000 discharged adult patients). The median quantity of opioid tablets prescribed decreased from 20 (interquartile ration [IQR] 10-20) to 15 (IQR 10-20) (p<0.0001) after removal of the default quantity. While the most frequent quantity of tablets received in both groups was 20 tablets, the proportion of patients who received prescriptions on discharge that contained 20 tablets decreased from 0.5 (95% confidence interval [CI] [0.48-0.52]) to 0.23 (95% CI [0.21-0.24]) (p<0.001) after default quantity removal. Conclusion: Although the median number of tablets differed significantly before and after the intervention, the clinical significance of this is unclear. An observed wider distribution of the quantity of tablets prescribed after removal of the default quantity of 20 may reflect more appropriate prescribing patterns (i.e., less severe indications receiving fewer tabs and more severe indications receiving more). A default value of 20 tablets for opioid prescriptions may be an example of the electronic medical record's ability to reduce practice variability in medication orders actually counteracting optimal patient care.
SN  - 1936-900X
AD  - University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
AD  - University of California San Francisco, Zuckerberg San Francisco General
AD  - Kaiser Permanente Oakland Medical Center, Emergency Department, Oakland, California
AD  - Health Innovation Program, University of Wisconsin-Madison, Madison, Wisconsin
DO  - 10.5811/westjem.2017.10.33798
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128442048&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125308960
T1  - Opioid Overdose Outbreak - West Virginia, August 2016.
AU  - Massey, Joel
AU  - Kilkenny, Michael
AU  - Batdorf, Samantha
AU  - Sanders, Sarah K.
AU  - Ellison, Debra
AU  - Halpin, John
AU  - Gladden, R. Matthew
AU  - Bixler, Danae
AU  - Haddy, Loretta
AU  - Gupta, Rahul
Y1  - 2017/09/22/
N1  - Accession Number: 125308960. Language: English. Entry Date: 20170929. Revision Date: 20180123. Publication Type: journal article. Journal Subset: Biomedical; Public Health; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 7802429. 
KW  - Substance Use Disorders -- Epidemiology
KW  - Analgesics, Opioid
KW  - Overdose -- Epidemiology
KW  - Disease Outbreaks
KW  - West Virginia
KW  - Fentanyl -- Analogs and Derivatives
KW  - Naloxone -- Therapeutic Use
KW  - Overdose -- Drug Therapy
KW  - Adult
KW  - Substance Use Disorders -- Drug Therapy
KW  - Fentanyl
KW  - Young Adult
KW  - Female
KW  - Designer Drugs
KW  - Male
KW  - Emergency Medical Services -- Statistics and Numerical Data
KW  - Adolescence
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Middle Age
KW  - Scales
SP  - 975
EP  - 980
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 66
IS  - 37
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
AB  - On August 15, 2016, the Mayor's Office of Drug Control Policy in Huntington, West Virginia, notified the Cabell-Huntington Health Department (CHHD) of multiple calls regarding opioid overdose received by the emergency medical system (EMS) during 3 p.m.-8 p.m. that day. A public health investigation and response conducted by the West Virginia Bureau for Public Health (BPH) and CHHD identified 20 opioid overdose cases within a 53-hour period in Cabell County; all cases included emergency department (ED) encounters. EMS personnel, other first responders, and ED providers administered the opioid antidote naloxone to 16 (80%) patients, six of whom were administered multiple doses, suggesting exposure to a highly potent opioid. No patients received referral for recovery support services. In addition to the public health investigation, a public safety investigation was conducted; comprehensive opioid toxicology testing of clinical specimens identified the synthetic opioid fentanyl* and novel fentanyl analogs, including carfentanil,† which had been used by patients who overdosed in Huntington. Results of these two investigations highlight the importance of collaboration between public health and public safety agencies to provide in-depth surveillance data from opioid overdose outbreaks that involve high-potency fentanyl analogs. These data facilitated a public health response through increased awareness of powerful opioid substances requiring multiple naloxone doses for reversal, and improved patient linkage to recovery support services and a harm reduction program from the ED after opioid overdose.
SN  - 0149-2195
AD  - Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC
AD  - Bureau for Public Health, West Virginia Department of Health and Human Resources
AD  - Cabell-Huntington Health Department, West Virginia
AD  - Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC
U2  - PMID: 28934186.
DO  - 10.15585/mmwr.mm6637a3
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125308960&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117471794
T1  - Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain.
AU  - Coffin, Phillip O.
AU  - Behar, Emily
AU  - Rowe, Christopher
AU  - Santos, Glenn-Milo
AU  - Coffa, Diana
AU  - Bald, Matthew
AU  - Vittinghoff, Eric
Y1  - 2016/08/16/
N1  - Accession Number: 117471794. Language: English. Entry Date: 20170504. Revision Date: 20180129. Publication Type: journal article; research. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Craig Handicap Assessment and Reporting Technique (CHART); California Verbal Learning Test (CVLT). Grant Information: R21 DA036776/DA/NIDA NIH HHS/United States. NLM UID: 0372351. 
KW  - Overdose -- Prevention and Control
KW  - Chronic Pain -- Drug Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Primary Health Care
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - California
KW  - Adult
KW  - Female
KW  - Human
KW  - Male
KW  - Overdose -- Etiology
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Middle Age
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Clinical Assessment Tools
SP  - 245
EP  - 252
JO  - Annals of Internal Medicine
JF  - Annals of Internal Medicine
JA  - ANN INTERN MED
VL  - 165
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
AB  - Background: Unintentional overdose involving opioid analgesics is a leading cause of injury-related death in the United States.Objective: To evaluate the feasibility and effect of implementing naloxone prescription to patients prescribed opioids for chronic pain.Design: 2-year nonrandomized intervention study.Setting: 6 safety-net primary care clinics in San Francisco, California.Participants: 1985 adults receiving long-term opioid therapy for pain.Intervention: Providers and clinic staff were trained and supported in naloxone prescribing.Measurements: Outcomes were proportion of patients prescribed naloxone, opioid-related emergency department (ED) visits, and prescribed opioid dose based on chart review.Results: 38.2% of 1985 patients receiving long-term opioids were prescribed naloxone. Patients prescribed higher doses of opioids and with an opioid-related ED visit in the past 12 months were independently more likely to be prescribed naloxone. Patients who received a naloxone prescription had 47% fewer opioid-related ED visits per month in the 6 months after receipt of the prescription (incidence rate ratio [IRR], 0.53 [95% CI, 0.34 to 0.83]; P = 0.005) and 63% fewer visits after 1 year (IRR, 0.37 [CI, 0.22 to 0.64]; P < 0.001) compared with patients who did not receive naloxone. There was no net change over time in opioid dose among those who received naloxone and those who did not (IRR, 1.03 [CI, 0.91 to 1.27]; P = 0.61).Limitation: Results are observational and may not be generalizable beyond safety-net settings.Conclusion: Naloxone can be coprescribed to primary care patients prescribed opioids for pain. When advised to offer naloxone to all patients receiving opioids, providers may prioritize those with established risk factors. Providing naloxone in primary care settings may have ancillary benefits, such as reducing opioid-related adverse events.Primary Funding Source: National Institutes of Health.
SN  - 0003-4819
AD  - San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102.
U2  - PMID: 27366987.
DO  - 10.7326/M15-2771
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117471794&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104531333
T1  - Can Nebulized Naloxone Be Used Safely and Effectively by Emergency Medical Services for Suspected Opioid Overdose??
AU  - Weber, Joseph M.
AU  - Tataris, Katie L.
AU  - Hoffman, Joyce D.
AU  - Aks, Steven E.
AU  - Mycyk, Mark B.
Y1  - 2012/04//
N1  - Accession Number: 104531333. Language: English. Entry Date: 20120420. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Emergency Medical Services
KW  - Naloxone -- Administration and Dosage
KW  - Nebulizers and Vaporizers
KW  - Overdose -- Therapy
KW  - Safety
KW  - Emergency Medicine
KW  - Firefighters
KW  - Human
KW  - Naloxone -- Therapeutic Use
KW  - Prehospital Care
KW  - Retrospective Design
SP  - 289
EP  - 292
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 16
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background. Emergency medical services (EMS) traditionally administer naloxone using a needle. Needleless naloxone may be easier when intravenous (IV) access is difficult and may decrease occupational blood-borne exposure in this high-risk population. Several studies have examined intranasal naloxone, but nebulized naloxone as an alternative needleless route has not been examined in the prehospital setting. Objective. We sought to determine whether nebulized naloxone can be used safely and effectively by prehospital providers for patients with suspected opioid overdose. Methods. We performed a retrospective analysis of all consecutive cases administered nebulized naloxone from January 1 to June 30, 2010, by the Chicago Fire Department. All clinical data were entered in real time into a structured EMS database and data abstraction was performed in a systematic manner. Included were cases of suspected opioid overdose, altered mental status, and respiratory depression; excluded were cases where nebulized naloxone was given for opioid-triggered asthma and cases with incomplete outcome data. The primary outcome was patient response to nebulized naloxone. Secondary outcomes included need for rescue naloxone (IV or intramuscular), need for assisted ventilation, and adverse antidote events. Kappa interrater reliability was calculated and study data were analyzed using descriptive statistics. Results. Out of 129 cases, 105 met the inclusion criteria. Of these, 23 (22%) had complete response, 62 (59%) had partial response, and 20 (19%) had no response. Eleven cases (10%) received rescue naloxone, no case required assisted ventilation, and no adverse events occurred. The kappa score was 0.993. Conclusion. Nebulized naloxone is a safe and effective needleless alternative for prehospital treatment of suspected opioid overdose in patients with spontaneous respirations.
SN  - 1090-3127
AD  - Department of Emergency Medicine, Cook County Hospital, Chicago, Illinois
U2  - PMID: 22191727.
DO  - 10.3109/10903127.2011.640763
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126155128
T1  - Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial.
AU  - Chang, Andrew K.
AU  - Bijur, Polly E.
AU  - Esses, David
AU  - Barnaby, Douglas P.
AU  - Baer, Jesse
Y1  - 2017/11/07/
N1  - Accession Number: 126155128. Language: English. Entry Date: 20171117. Revision Date: 20180302. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. Instrumentation: Checklist Individual Strength (CIS); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: K23 AG033100/AG/NIA NIH HHS/United States. NLM UID: 7501160. 
KW  - Analgesics, Nonnarcotic -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Emergency Service
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Administration, Oral
KW  - Extremities
KW  - Drug Combinations
KW  - Male
KW  - Human
KW  - Adult
KW  - Young Adult
KW  - Female
KW  - Middle Age
KW  - Codeine -- Administration and Dosage
KW  - Oxycodone -- Administration and Dosage
KW  - Pain Measurement
KW  - Acetaminophen -- Administration and Dosage
KW  - Ibuprofen -- Administration and Dosage
KW  - Double-Blind Studies
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Randomized Controlled Trials
KW  - Checklists
KW  - Scales
SP  - 1661
EP  - 1667
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 318
IS  - 17
CY  - Chicago, Illinois
PB  - American Medical Association
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.
SN  - 0098-7484
AD  - Department of Emergency Medicine, Albany Medical College, Albany, New York.
AD  - Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
U2  - PMID: 29114833.
DO  - 10.1001/jama.2017.16190
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126065238
T1  - Acceptability of an Opioid Relapse Prevention Text-message Intervention for Emergency Department Patients.
AU  - Suffoletto, Brian
AU  - Yanta, Joseph
AU  - Kurtz, Ryan
AU  - Cochran, Gerald
AU  - Douaihy, Antoine
AU  - Chung, Tammy
Y1  - 2017/11//Nov/Dec2017
N1  - Accession Number: 126065238. Language: English. Entry Date: 20171117. Revision Date: 20171117. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 101306759. 
KW  - Substance Use Disorders -- Prevention and Control
KW  - Recurrence -- Prevention and Control
KW  - Text Messaging -- Standards
KW  - Human
KW  - Young Adult
KW  - Female
KW  - Male
KW  - Whites
KW  - Emergency Service
KW  - Feedback
KW  - Text Messaging -- Utilization
KW  - Craving
KW  - Patient Discharge
KW  - Optimism
KW  - Goals and Objectives
SP  - 475
EP  - 482
JO  - Journal of Addiction Medicine
JF  - Journal of Addiction Medicine
JA  - J ADDICT MED
VL  - 11
IS  - 6
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Objective: To explore whether a text message-based relapse prevention intervention (Preventing and Interrupting Early Relapse [PIER]1) is acceptable to treatment-seeking adults with opioid use disorder (OUD) after Emergency Department (ED) discharge using mixed-methods design. Methods: Adults seeking care in an urban ED for OUD (n = 20; mean age 22; 55% female; 75% white race) completed a baseline survey, and were invited to enroll in PIER1, which was delivered in 7- day blocks, with the option to re-enroll at the end of each block, up to 4 blocks. PIER1 included a morning ''push'' message focused on positive thinking, adaptive coping feedback tailored to twice-daily assessments of craving severity and contextual correlates of craving, and end-of-day feedback on daily opioid use and goal commitment. Participants were asked to complete a follow-up phone interview after the first 7 days of PIER1. Transcripts were thematically coded. Results: Seventeen out of 20 participants enrolled in PIER1. In the first 7 days, response rates to text-message assessments averaged 30%. Ten out of 17 participants re-enrolled after 7 days. Main themes from follow-up interviews (n = 9) included ease of use, social connection, and self-empowerment. Participants desired more personalized support and the ability to communicate through text messaging with another person about their struggles. Event-level data suggest that higher craving severity increased risk of opioid lapses. Conclusions: In this mixed-methods intervention development study, we found conflicting evidence supporting an automated text-message intervention providing relapse prevention support for treatment-seeking individuals with OUD discharged from the ED. Qualitative feedback suggests that PIER1 could be useful and acceptability enhanced through personalized human support.
SN  - 1932-0620
AD  - Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
AD  - School of Social Work, University of Pittsburgh, Pittsburgh, PA
AD  - Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
DO  - 10.1097/ADM.0000000000000351
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128837809
T1  - Association between Electronic Medical Record Implementation of Default Opioid Prescription Quantities and Prescribing Behavior in Two Emergency Departments.
AU  - Shofer, Frances S.
AU  - Edwards, Christopher
AU  - Perrone, Jeanmarie
AU  - Delgado, M. Kit
AU  - Meisel, Zachary F.
AU  - Halpern, Scott
AU  - Patel, Mitesh S.
Y1  - 2018/04//
N1  - Accession Number: 128837809. Language: English. Entry Date: In Process. Revision Date: 20180413. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Europe. Grant Information: P30 DA040500/DA/NIDA NIH HHS/United States. NLM UID: 8605834. 
SP  - 409
EP  - 411
JO  - JGIM: Journal of General Internal Medicine
JF  - JGIM: Journal of General Internal Medicine
JA  - J GEN INTERN MED
VL  - 33
IS  - 4
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
AB  - The article focuses on the effort to prevent the impact of continued prescription of opioid tablets, which leads to misuse and diversion. Topics discussed include referring to electronic medical records (EMR) before prescription in the emergency department (ED), reduction in dosage for post intervention period, and chart on discharge order from the ED.
SN  - 0884-8734
AD  - Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
AD  - Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
AD  - Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
AD  - Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
AD  - Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
AD  - Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
U2  - PMID: 29340937.
DO  - 10.1007/s11606-017-4286-5
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125837881
T1  - Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain.
AU  - Hoppe, Jason A.
AU  - McStay, Christopher
AU  - Sun, Benjamin C.
AU  - Capp, Roberta
Y1  - 2017/10//
N1  - Accession Number: 125837881. Language: English. Entry Date: 20171107. Revision Date: 20171107. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101476450. 
KW  - Emergency Service
KW  - Medical Staff, Hospital
KW  - Drugs, Prescription
KW  - Narcotics
KW  - Low Back Pain
KW  - Human
KW  - Retrospective Design
KW  - Descriptive Statistics
KW  - Logistic Regression
KW  - Female
KW  - Male
KW  - Guideline Adherence
KW  - Alternative Therapies
KW  - Outcomes (Health Care)
SP  - 1135
EP  - 1142
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 18
IS  - 6
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Introduction: Despite treatment guidelines suggesting alternatives, as well as evidence of a lack of benefit and evidence of poor long-term outcomes, opioid analgesics are commonly prescribed for back pain from the emergency department (ED). Variability in opioid prescribing suggests a lack of consensus and an opportunity to standardize and improve care. We evaluated the variation in attending emergency physician (EP) opioid prescribing for patients with uncomplicated, low acuity back pain (LABP). Methods: This retrospective study evaluated the provider-specific proportion of LABP patients discharged from an urban academic ED over a seven-month period with a prescription for opioids. LABP was strictly defined as (1) back pain chief complaint, (2) discharged from ED with no interventions and (3) predefined discharge diagnosis of back pain. We excluded providers if they had less than 25 LABP patients in the study period. The primary outcome was the physician-specific proportion of LABP patients discharged with an opioid analgesic prescription. We performed a descriptive analysis and then risk standardized prescribing proportion by adjusting for patient and clinical characteristics using hierarchical logistic regression. Results: During the seven-month study period, 23 EPs treated and discharged at least 25 LABP patients and were included. Eight (34.8%) were female and six (26.1%) were junior attendings (⩽ 5 years after residency graduation). There were 943 LABP patients included in the analysis. Providerspecific proportions ranged from 3.7% to 88.1% (mean 58.4% [SD +/- 22.2]), and we found a 22-fold variation in prescribing proportions. There was a six-fold variation in the adjusted, risk-standardized prescribing proportion with a range from 12.0% to 78.2% [mean 50.4% (SD +/-16.4)]. Conclusion: We found large variability in opioid prescribing practices for LABP that persisted after adjustment for patient and clinical characteristics. Our findings support the need to further standardize and improve adherence to treatment guidelines and evidence suggesting alternatives to opioids.
SN  - 1936-900X
AD  - University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
AD  - Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon
DO  - 10.5811/westjem.2017.7.33306
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127425253
T1  - Emergency physicians' attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments.
AU  - Lacroix, Lauren
AU  - Thurgur, Lisa
AU  - Orkin, Aaron M.
AU  - Perry, Jeffrey J.
AU  - Stiell, Ian G.
Y1  - 2018/01//
N1  - Accession Number: 127425253. Language: English. Entry Date: 20180202. Revision Date: 20180202. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 100893237. 
KW  - Physicians, Emergency -- Canada
KW  - Physician Attitudes
KW  - Program Implementation
KW  - Emergency Service -- Canada
KW  - Naloxone -- Therapeutic Use
KW  - Canada
KW  - Surveys
KW  - Validity
KW  - Email
KW  - Prescriptions, Drug
KW  - Patient Education
KW  - Prescriptions, Drug -- Education
KW  - Narcotics
SP  - 46
EP  - 52
JO  - CJEM: Canadian Journal of Emergency Medicine
JF  - CJEM: Canadian Journal of Emergency Medicine
JA  - CAN J EMERG MED
VL  - 20
IS  - 1
PB  - Cambridge University Press
AB  - Objectives: Rates of opioid-related deaths have reached the level of national public health crisis in Canada. Communitybased opioid overdose education and naloxone distribution (OEND) programs distribute naloxone to people at risk, and the emergency department (ED) may be an underutilized setting to deliver naloxone to these people. The goal of this study was to identify Canadian emergency physicians' attitudes and perceived barriers to the implementation of take-home naloxone programs. Methods: This was an anonymous Web-based survey of members of the Canadian Association of Emergency Physicians. Survey questions were developed by the research team and piloted for face validity and clarity. Two reminder emails were sent to non-responders at 2-week intervals. Respondent demographics were collected, and Likert scales were used to assess attitudes and barriers to the prescription of naloxone from the ED. Results: A total of 459 physicians responded. The majority of respondents were male (64%), worked in urban tertiary centres (58.3%), and lived in Ontario (50.6%). Overall, attitudes to OEND were strongly positive; 86% identified a willingness to prescribe naloxone from the ED. Perceived barriers included support for patient education (57%), access to follow-up (44%), and inadequate time (37%). In addition to people at risk of overdose, 77% of respondents identified that friends and family members may also benefit. Conclusions: Canadian emergency physicians are willing to distribute take-home naloxone, but thoughtful systems are required to facilitate opioid OEND implementation. These data will inform the development of these programs, with emphasis on multidisciplinary training and education.
AB  - Introduction: La mortalité liée à la prise d'opioïdes au Canada a pris une telle ampleur qu'elle est devenue une crise nationale en matière de santé publique. Les programmes communautaires d'enseignement sur les surdoses d'opioïdes et de distribution de naloxone rendent possible la remise de ce médicament aux personnes à risque, et le service des urgences (SU) serait un lieu sous-utilisé de distribution de naloxone aux personnes concernées. L'étude avait donc pour but de cerner les attitudes des médecins d'urgence au Canada à l'égard des programmes de distribution de naloxone ainsi que la perception des obstacles possibles à leur mise en oeuvre. Méthode: Il s'agit d'une enquête anonyme, menée sur le Web parmi les membres de l'Association canadienne des médecins d'urgence. L'équipe de recherche a travaillé à l'élaboration des questions, puis a vérifié la validité apparente et la clarté du questionnaire. Deux rappels ont été envoyés par courriel aux non-répondants, à deux semaines d'intervalle. Il y a eu collecte de données démographiques sur les répondants, et les attitudes des urgentologues à l'égard de la prescription de naloxone à partir des SU ainsi que les obstacles à cette nouvelle pratique ont été évalués à l'aide d'échelles de Likert. Résultats: Au total, 459 médecins ont répondu à l'enquête. La majorité d'entre eux étaient des hommes (64 %), travaillaient dans des centres de soins tertiaires en milieu urbain (58,3 %) et demeuraient en Ontario (50,6 %). Les répondants se sont montrés, en général, grandement favorables à l'égard de ces programmes : en effet, 86 % étaient disposés à prescrire de la naloxone à partir du SU. Toutefois, les obstacles perçus à la mise en oeuvre de ces programmes comprenaient le manque de soutien pour l'enseignement aux patients (57 %), la difficulté du suivi (44 %) et le manque de temps (37 %). Par ailleurs, 77 % des répondants ont indiqué que, outre les personnes susceptibles de subir une surdose, les parents et les amis pouvaient profiter de ces programmes. Conclusions: Les médecins d'urgence au Canada se montrent disposés à distribuer de la naloxone pour usage ultérieur, mais, pour ce faire, il faut mettre en place des systèmes bien conçus afin de faciliter l'enseignement sur les surdoses d'opioïdes et la distribution de naloxone. Les données recueillies aideront à l'élaboration de ces programmes, accompagnés d'un volet important de formation et d'enseignement multidisciplinaires.
SN  - 1481-8035
AD  - Department of Emergency Medicine
AD  - Schwartz/Reisman Emergency Medicine Institute, Mount Sinai, Toronto, ON
AD  - Dalla Lana School of Public Health and Department of Family and Community Medicine, University of Toronto, Toronto, ON
AD  - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
DO  - 10.1017/cem.2017.390
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125488359
T1  - Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients With Acute Pain.
AU  - Patel, Pina M.
AU  - Goodman, Lauren F.
AU  - Knepel, Sheri A.
AU  - Miller, Charles C.
AU  - Azimi, Asma
AU  - Phillips, Gary
AU  - Gustin, Jillian L.
AU  - Hartman, Amber
Y1  - 2017/10//
N1  - Accession Number: 125488359. Language: English. Entry Date: In Process. Revision Date: 20171009. Publication Type: journal article. Journal Subset: Biomedical; Core Nursing; Nursing; Peer Reviewed; USA. NLM UID: 8605836. 
SP  - 501
EP  - 507
JO  - Journal of Pain & Symptom Management
JF  - Journal of Pain & Symptom Management
JA  - J PAIN SYMPTOM MANAGE
VL  - 54
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Context: There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during emergency department (ED) encounters.Objectives: To determine if opioid-tolerant cancer patients presenting with acute pain exacerbations receive adequate initial doses of as needed (PRN) opioids during ED encounters based on home oral morphine equivalent (OME) use.Methods: We performed a retrospective cohort study of opioid-tolerant cancer patients who received opioids in our ED over a two-year period. The percentage of patients who received an adequate initial dose of PRN opioid (defined as ≥10% of total 24-hour ambulatory OME) was evaluated. Logistic regression was used to establish the relationship between 24-hour ambulatory OME and initial ED OME to assess whether higher home usage was associated with higher likelihood of being undertreated.Results: Out of 216 patients, 61.1% of patients received an adequate initial PRN dose of opioids in the ED. Of patients taking <200 OMEs per day at home, 77.4% received an adequate initial dose; however, only 3.2% of patients taking >400 OMEs per day at home received an adequate dose. Patients with ambulatory 24-hour OME greater than 400 had 99% lower odds of receiving an adequate initial dose of PRN opioid in the ED compared to patients with ambulatory 24-hour OME less than 100 (OR <0.01, CI 0.00-0.02, P < 0.001).Conclusions: Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated.
SN  - 0885-3924
AD  - Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
AD  - Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
AD  - The Ohio State University Center for Biostatistics, Columbus, Ohio, United States
AD  - Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
U2  - PMID: 28729010.
DO  - 10.1016/j.jpainsymman.2017.07.013
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125553108
T1  - Opioid Abuse And Poisoning: Trends In Inpatient And Emergency Department Discharges.
AU  - Tedesco, Dario
AU  - Asch, Steven M.
AU  - Curtin, Catherine
AU  - Hah, Jennifer
AU  - McDonald, Kathryn M.
AU  - Fantini, Maria P.
AU  - Hernandez-Boussard, Tina
Y1  - 2017/10//
N1  - Accession Number: 125553108. Language: English. Entry Date: 20171011. Revision Date: 20180201. Publication Type: Article; research; tables/charts. Journal Subset: Health Services Administration; Peer Reviewed; USA. Grant Information: This project wassupported by the Agency for HealthcareResearch and Quality (GrantNo. R01HS024096).. NLM UID: 8303128. 
KW  - Analgesics, Opioid
KW  - Disease Outbreaks
KW  - Overdose -- Trends
KW  - Human
KW  - Emergency Care
KW  - P-Value
KW  - Chi Square Test
KW  - Data Analysis Software
KW  - Female
KW  - Male
KW  - Adolescence
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Funding Source
KW  - Patient Discharge
SP  - 1748
EP  - 1753
JO  - Health Affairs
JF  - Health Affairs
JA  - HEALTH AFF
VL  - 36
IS  - 10
CY  - Bethesda, Maryland
PB  - Project HOPE/HEALTH AFFAIRS
AB  - The article discussed a study which investigated trends in emergency department (ED) and inpatient discharges for opioid abuse, dependence and poisoning in the U.S. Topics discussed include a comparison of discharge rates between non-prescription and prescription opioids, the overall increase in inpatient and ED discharge rates for opioid abuse, dependence and poisoning, and the public health implications of trends in opioid-related discharges.
SN  - 0278-2715
AD  - Postdoctoral scholar in the Department of Medicine, Stanford University, in California
AD  - Director of the Center for Innovation to Implementation at the Veterans Affairs Palo Alto Health Care System
AD  - Vice chief of the Division of Primary Care and Population Health at Stanford University
AD  - Associate professor of surgery at Palo Alto Veterans Affairs Hospital and at Stanford University School of Medicine
AD  - Instructor of anesthesiology at Stanford University School of Medicine
AD  - Executive director of the Center for Health Policy and the Center for Primary Care Outcomes Research at Stanford University
AD  - Professor of hygiene and public health in the Department of Biomedical and Neuromotor Sciences at the University of Bologna, in Italy
AD  - Associate professor of medicine, biomedical data sciences, and surgery at Stanford University School of Medicine
DO  - 10.1377/hlthaff.2017.0260
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 114015869
T1  - Effective Use of Naloxone by Law Enforcement in Response to Multiple Opioid Overdoses.
AU  - Kitch, Bryan B.
AU  - Portela, Roberto C.
Y1  - 2016/03//Mar/Apr2016
N1  - Accession Number: 114015869. Language: English. Entry Date: 20160509. Revision Date: 20170823. Publication Type: Article; case study; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Police
KW  - Overdose -- Therapy
KW  - Emergency Care
KW  - Prehospital Care
KW  - Human
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Overdose -- Diagnosis
KW  - North Carolina
KW  - Heroin -- Adverse Effects
KW  - Emergency Medical Services
KW  - Substance Abuse -- Diagnosis
KW  - Substance Abusers
KW  - United States
KW  - Analgesics, Opioid -- Classification
KW  - Emergency Medical Technicians
KW  - Professional Organizations
KW  - Health Services Accessibility -- Evaluation
KW  - Male
KW  - Aged
KW  - Glasgow Coma Scale -- Evaluation
KW  - Adult
KW  - Respiration
KW  - Heroin -- Administration and Dosage
KW  - Administration, Intravenous
SP  - 226
EP  - 229
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 20
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Objective:Growing rates of opioid abuse and overdose throughout the nation have lead some community organizations to develop naloxone administration programs.Methods:In Pitt County North Carolina, two of our law enforcement agencies were trained in the identification of opioid overdose and use of naloxone therapy.Results:Attributed partially to introduction of fentanyl into the illicit drug market, our community experienced a 48-hour period in which officers successfully deployed five doses of antagonist medication to four individuals.Conclusion:This article presents case descriptions demonstrating the feasibility and safety of law enforcement naloxone programs.Key words:opioid; heroin; EMS; naloxone; overdose; substance abuse
SN  - 1090-3127
DO  - 10.3109/10903127.2015.1076097
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124440214
T1  - The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland.
AU  - O’Halloran, Charlotte
AU  - Cullen, Katelyn
AU  - Njoroge, Jaquelyn
AU  - Jessop, Lucy
AU  - Smith, Josie
AU  - Hope, Vivian
AU  - Ncube, Fortune
AU  - O'Halloran, Charlotte
Y1  - 2017/08//
N1  - Accession Number: 124440214. Language: English. Entry Date: In Process. Revision Date: 20170817. Publication Type: journal article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9014759. 
SP  - 34
EP  - 40
JO  - International Journal of Drug Policy
JF  - International Journal of Drug Policy
JA  - INT J DRUG POLICY
VL  - 46
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Background: Overdose is a major cause of death among PWID, and for opioid overdoses naloxone administration can reduce harm. However, globally there is limited national level data on the extent of non-fatal overdose and naloxone uptake. The first national level data on the extent of self-reported overdose and self-reported receipt of naloxone among UK PWID, providing a baseline to monitor the impact of the recent policy change regarding naloxone availability, is presented.Methods: Data on self-reported overdose and receipt of naloxone during the preceding year for 2013-2014 from a national survey of PWID was analysed. Participants who reported injecting during the preceding year were included.Results: Participants (3850) were predominantly male (75%); mean age was 36 years. The most commonly injected drugs were: heroin (91%), crack (45%) and amphetamine (29%). 15% (591) reported overdosing during the preceding year. There were no differences in the proportion reporting overdose by age or gender, but overdose was more common among those who: injected multiple drugs; recently ceased addiction treatment; injected with used needles/syringes; ever had transactional sex; had used a sexual health clinic or emergency department and lived in Wales or Northern Ireland. Among those reporting an overdose during the preceding year, a third reported two to four overdoses and 7.5% five or more overdoses; half reported receiving naloxone. Those reporting naloxone receipt in the preceding year were more likely to: live in Wales or Northern Ireland; ever received used needles/syringes; ever been imprisoned; and less likely to have injected two drug types.Conclusion: These data provide a baseline for monitoring the impact of the 2015 UK policy change to improve take-home naloxone access. Interventions tackling overdose should promote naloxone awareness and access, and target those who; are poly-drug injectors, have ceased treatment, share needles/syringes and whose drug use links to sexual activity.
SN  - 0955-3959
AD  - HIV & STI Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
AD  - Public Health Agency, Health Protection Service, 12-22 Linenhall Street, Belfast BT2 8BS, Northern Ireland, UK
AD  - Public Health Wales, Temple of Peace & Health, Cathays Park, Cardiff CF10 3NW, UK
AD  - HIV & STI Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
U2  - PMID: 28586701.
DO  - 10.1016/j.drugpo.2017.05.017
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124440214&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122411215
T1  - State Emergency Department Opioid Guidelines: Current Status.
AU  - Broida, Robert I.
AU  - Gronowski, Tanner
AU  - Kalnow, Andrew F.
AU  - Little, Andrew G.
AU  - Lloyd, Christopher M.
Y1  - 2017/04//
N1  - Accession Number: 122411215. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; practice guidelines; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Emergency Medicine -- Education
KW  - Emergency Service
KW  - Emergency Medicine
KW  - Patient Abuse
KW  - Pain
KW  - Practice Guidelines
SP  - 340
EP  - 344
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 18
IS  - 3
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Introduction: The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM). Methods: We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP. Results: We found that 17 states had emergency department-specific guidelines. We further organized the guidelines into four categories: limiting prescriptions for opioids with 67 total recommendations; preventing/diverting abuse with 56 total recommendations; addiction-related guidelines with 29 total recommendations; and a community resources section with 24 total recommendations. Our results showed that current state guidelines focus on providers limiting opioid pain prescriptions and vetting patients for possible abuse/diversion. Conclusion: This study highlights the 17 states that have addressed opioid prescribing guidelines and categorizes their efforts to date. It is hoped that this study will provide the basis for similar efforts in other states.
SN  - 1936-900X
AD  - US Acute Care Solutions, Risk Management Department, Canton, Ohio.
AD  - Doctors Hospital, Department of Emergency Medicine, Columbus, Ohio.
DO  - 10.5811/westjem.2016.12.30854
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111894438
T1  - The Changing Use of Intravenous Opioids in an Emergency Department.
AU  - Sutter, Mark E.
AU  - Roche, Bailey M.
AU  - Chenoweth, James A.
AU  - Albertson, Timothy E.
AU  - Wintemute, Garen J.
AU  - Clarke, Samuel O.
AU  - Gutierrez, Rory
Y1  - 2015/12//
N1  - Accession Number: 111894438. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Joint Commission
KW  - Narcotics
KW  - Dihydromorphinone
KW  - Morphine
KW  - Emergency Service
KW  - Adult
SP  - 1079
EP  - 1083
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 16
IS  - 7
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Introduction: Government agencies are increasingly emphasizing opioid safety in hospitals. In 2012, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) started a sentinel event program, the "Safe Use of Opioids in Hospitals." We sought to determine if opioid use patterns in our emergency department (ED) changed from 2011, before the program began, to 2013, after start of the program. Methods: This was a retrospective study of all adult ED patients who received an intravenous opioid and had a serum creatinine measured. We recorded opioids used, dose prescribed, and serum creatinine. As an index of the safety of opioids, uses of naloxone after administration of an opioid was recorded. Results: Morphine is still the most commonly used opioid by doses given, but its percentage of opioids used decreased from 68.9% in 2011 to 52.8% in 2013. During the same period, use of hydromorphone increased from 27.5% to 42.9%, while the use of fentanyl changed little (3.6% to 4.3%). Naloxone administration was rare after an opioid had been given. Opioids were not dosed in an equipotent manner. Conclusion: The use of hydromorphone in our ED increased by 56% (absolute increase of 15.4%), while the use of morphine decreased by 30.5% (absolute decrease 16.1%) of total opioid use from 2011 to 2013. The JCAHO program likely was at least indirectly responsible for this change in relative dosing of the opioids. Based on frequency of naloxone administered after administration of an opioid, the use of opioids was safe.
SN  - 1936-900X
AD  - University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California
AD  - VA Northern California Health Care System, Mather, California
AD  - University of California, Davis, Department of Internal Medicine, Sacramento, California
AD  - Department of Cell Biology, New York University Medical Center, New York, New York, U.S.A
DO  - 10.5811/westjem.2015.10.28454
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128649584
T1  - The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System.
AU  - Suffoletto, Brian
AU  - Lynch, Michael
AU  - Pacella, Charissa B.
AU  - Yealy, Donald M.
AU  - Callaway, Clifton W.
Y1  - 2018/04//
N1  - Accession Number: 128649584. Language: English. Entry Date: In Process. Revision Date: 20180330. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: K23 AA023284/AA/NIAAA NIH HHS/United States. NLM UID: 100898657. 
SP  - 430
EP  - 438
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 19
IS  - 4
PB  - Churchill Livingstone, Inc.
AB  - Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, -.38% to -.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis.Perspective: This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death.
SN  - 1526-5900
AD  - Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
U2  - PMID: 29241835.
DO  - 10.1016/j.jpain.2017.11.010
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123202973
T1  - Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention.
AU  - D'Onofrio, Gail
AU  - Chawarski, Marek
AU  - O'Connor, Patrick
AU  - Pantalon, Michael
AU  - Busch, Susan
AU  - Owens, Patricia
AU  - Hawk, Kathryn
AU  - Bernstein, Steven
AU  - Fiellin, David
AU  - Chawarski, Marek C
AU  - O'Connor, Patrick G
AU  - Pantalon, Michael V
AU  - Busch, Susan H
AU  - Owens, Patricia H
AU  - Bernstein, Steven L
AU  - Fiellin, David A
Y1  - 2017/06//
N1  - Accession Number: 123202973. Language: English. Entry Date: In Process. Revision Date: 20180318. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Continental Europe; Europe. Special Interest: Evidence-Based Practice. Instrumentation: Behavior Rating Inventory of Executive Function (BRIEF). NLM UID: 8605834. 
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Buprenorphine -- Therapeutic Use
KW  - Substance Use Disorders -- Drug Therapy
KW  - Primary Health Care -- Methods
KW  - Prospective Studies
KW  - Outcome Assessment
KW  - Emergency Service
KW  - Female
KW  - Male
KW  - Substance Use Disorders -- Urine
KW  - Human
KW  - Adult
KW  - Young Adult
KW  - Self Report
KW  - Referral and Consultation
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Randomized Controlled Trials
KW  - Clinical Assessment Tools
SP  - 660
EP  - 666
JO  - JGIM: Journal of General Internal Medicine
JF  - JGIM: Journal of General Internal Medicine
JA  - J GEN INTERN MED
VL  - 32
IS  - 6
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
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.
SN  - 0884-8734
AD  - Department of Emergency Medicine , Yale School of Medicine , New Haven USA
AD  - Department of General Medicine , Yale School of Medicine , New Haven USA
AD  - Yale School of Public Health , New Haven USA
AD  - Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
AD  - Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
AD  - Department of General Medicine, Yale School of Medicine, New Haven, CT, USA
AD  - Yale School of Public Health, New Haven, CT, USA
U2  - PMID: 28194688.
DO  - 10.1007/s11606-017-3993-2
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109669572
T1  - Naloxone therapy in opioid overdose patients: intranasal or intravenous? A randomized clinical trial.
AU  - Sabzghabaee, Ali Mohammad
AU  - Eizadi-Mood, Nastaran
AU  - Yaraghi, Ahmad
AU  - Zandifar, Samaneh
Y1  - 2014/05/12/2014 May 12
N1  - Accession Number: 109669572. Language: English. Entry Date: 20150923. Revision Date: 20161222. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Europe. NLM UID: 101258257. 
SP  - 309
EP  - 314
JO  - Archives of Medical Science
JF  - Archives of Medical Science
JA  - ARCH MED SCI
VL  - 10
IS  - 2
CY  - , <Blank>
PB  - Termedia Publishing House
AB  - Introduction: This study was designed to compare the effects of intranasal (IN) and intravenous (IV) administration of naloxone in patients who had overdosed on opioids.Material and Methods: This randomized clinical trial study was conducted in the Department of Poisoning Emergencies at Noor and Ali Asghar (PBUH) University Hospital. One hundred opioid overdose patients were assigned by random allocation software into two study groups (n = 50). Both groups received 0.4 mg naloxone: one group IN and the other IV. Outcomes included change in the level of consciousness (measured using a descriptive scale and the Glasgow Coma Scale (GCS)), time to response, vital signs (blood pressure, heart rate and respiratory rate), arterial blood O2 saturation before and after naloxone administration, side-effects (agitation) and length of hospital stay.Results: Patients who had been administered IN naloxone demonstrated significantly higher levels of consciousness than those in the IV group using both descriptive and GCS scales (p < 0.001). There was a significant difference in the heart rate between IN and IV groups (p = 0.003). However, blood pressure, respiratory rate and arterial O2 saturation were not significantly different between the two groups after naloxone administration (p = 0.18, p = 0.17, p = 0.32). There was also no significant difference in the length of hospital stay between the two groups (p = 0.14).Conclusions: Intranasal naloxone is as effective as IV naloxone in reversing both respiratory depression and depressive effects on the central nervous system caused by opioid overdose.
SN  - 1734-1922
U2  - PMID: 24904666.
DO  - 10.5114/aoms.2014.42584
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124134448
T1  - Patient Could Allege Opioids Given by EP Sparked Addiction.
Y1  - 2017/08//
N1  - Accession Number: 124134448. Language: English. Entry Date: 20170718. Revision Date: 20170719. Publication Type: Article. Journal Subset: Biomedical; USA. Special Interest: Pain and Pain Management; Psychiatry/Psychology. NLM UID: 9889446. 
KW  - Physicians, Emergency
KW  - Medical Practice
KW  - Prescriptions, Drug -- Legislation and Jurisprudence -- United States
KW  - Narcotics -- Adverse Effects
KW  - Substance Dependence -- Legislation and Jurisprudence -- United States
KW  - Negligence -- Legislation and Jurisprudence -- United States
KW  - Emergency Care -- Legislation and Jurisprudence -- United States
KW  - Liability, Legal
KW  - United States
SP  - 1
EP  - 4
JO  - ED Legal Letter
JF  - ED Legal Letter
JA  - ED LEGAL LETT
VL  - 28
IS  - 8
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - The article discusses study by Michael L. Barnett of Harvard T.H. Chan School of Public Health and others on link of receiving an opioid at just one encounter such as in the emergency department (ED) setting to future adverse outcomes. It include comments from Michael D. Anderson of Medical Insurance Exchange of California (MIEC) on use of pain medications, opioid use disorder and addiction and overdose; and false marketing.
SN  - 1087-7341
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126188510
T1  - Common marijuana-related cases encountered in the emergency department.
AU  - Heard, Kennon
AU  - Marlin, Michael B.
AU  - Nappe, Thomas
AU  - Hoyte, Christopher O.
Y1  - 2017/11/15/
N1  - Accession Number: 126188510. Language: English. Entry Date: 20171115. Revision Date: 20171115. Publication Type: Article; case study; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. 
KW  - Cannabis -- Adverse Effects
KW  - Emergency Service
KW  - Adverse Drug Event -- Epidemiology -- Colorado
KW  - Child
KW  - Colorado
KW  - Medical Marijuana -- Legislation and Jurisprudence -- United States
KW  - United States
KW  - Drug Toxicity
KW  - Candy
KW  - Naloxone -- Administration and Dosage
KW  - Child, Preschool
KW  - Middle Age
KW  - Adult
SP  - 1904
EP  - 1908
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 74
IS  - 22
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - The authors comment on common marijuana-related cases encountered in emergency departments of hospitals across the U.S. They discuss the risk of cannabis toxicity in pediatric patients and the prevalence of marijuana toxicity in adults that are attributable to the ingestion of edibles. They also explore the consumption of synthetic cannabinoids reported by emergency patients.
SN  - 1079-2082
AD  - University of Colorado School of Medicine, Denver, CO
AD  - Rocky Mountain Poison and Drug Center, Denver, CO
DO  - 10.2146/ajhp160715
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126570742
T1  - Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department.
AU  - Silvestre, Julio
AU  - Reddy, Akhila
AU  - de la Cruz, Maxine
AU  - Wu, Jimin
AU  - Liu, Diane
AU  - Bruera, Eduardo
AU  - Todd, Knox H.
Y1  - 2017/12//
N1  - Accession Number: 126570742. Language: English. Entry Date: In Process. Revision Date: 20171209. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 101232529. 
SP  - 638
EP  - 643
JO  - Palliative & Supportive Care
JF  - Palliative & Supportive Care
JA  - PALLIAT SUPPORT CARE
VL  - 15
IS  - 6
PB  - Cambridge University Press
AB  - Objective: Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance, which may be a consequence of improper opioid storage, use, disposal, and lack of patient education. We aimed to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency department (ED) of a comprehensive cancer center.Method: We surveyed 113 patients receiving opioids for at least 2 months upon presenting to the ED and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing opioids in plain sight, and unsafe use was defined as sharing or losing opioids.Results: The median age was 53 years, 55% were female, 64% were white, and 86% had advanced cancer. Of those surveyed, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. However, 73% agreed that they would use a lockbox if given one. Patients who reported that others had asked them for their pain medications (p = 0.004) and those who would use a lockbox if given one (p = 0.019) were more likely to keep them locked. Some 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported being prescribed more pain pills than required (p = 0.032) were more likely to practice unsafe use. Most (78%) were unaware of proper opioid disposal methods, 6% believed they were prescribed more medication than required, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Overall, 77% (87) of patients reported unsafe storage, unsafe use, or possessed unused opioids at home.Significance Of Results: Many cancer patients presenting to the ED improperly and unsafely store, use, or dispose of opioids, thus highlighting a need to investigate the impact of patient education on such practices.
SN  - 1478-9515
AD  - Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
AD  - Department of Medicine, Geriatrics, and Palliative Care, University of Virginia Health System, Charlottesville, Virginia
AD  - Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
AD  - Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
U2  - PMID: 27071690.
DO  - 10.1017/S1478951516000158
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126114324
T1  - The Contribution of the Emergency Department To Opioid Pain Reliever Misuse And Diversion: A Critical Review.
AU  - Lyapustina, Tatyana
AU  - Castillo, Renan
AU  - Omaki, Elise
AU  - Shields, Wendy
AU  - McDonald, Eileen
AU  - Rothman, Richard
AU  - Gielen, Andrea
Y1  - 2017/11//
N1  - Accession Number: 126114324. Language: English. Entry Date: 20171113. Revision Date: 20171113. Publication Type: Article; research; systematic review; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. NLM UID: 101130835. 
KW  - Analgesics, Opioid
KW  - Prescriptions, Drug
KW  - Substance Abuse -- Complications
KW  - Emergency Service
KW  - Inappropriate Prescribing
KW  - Human
KW  - Systematic Review
KW  - Public Health
KW  - United States
KW  - Mortality
KW  - Morbidity
KW  - Substance Abuse -- Prevention and Control
SP  - 1097
EP  - 1104
JO  - Pain Practice
JF  - Pain Practice
JA  - PAIN PRACTICE
VL  - 17
IS  - 8
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Prescription opioid pain reliever ( OPR) misuse and diversion is an important and growing public health problem in the United States that is responsible for significant morbidity and mortality. Emergency physicians are among the top prescribers of OPRs, yet the relative contribution of emergency department ( ED) OPR prescriptions to the overall opioid abuse epidemic remains unclear. This study critically reviews seven peer-reviewed studies that specifically identified the ED as a source of OPRs. Of the OPRs prescribed in the ED, approximately 10% are associated with indicators of inappropriate prescribing, and approximately 42% may ultimately be misused; of the OPRs that are diverted, approximately 10% originate from an ED prescription. Among patients who suffer an OPR-related death, approximately 1.8% of the OPR pills given to the decedents will have come from the ED. In addition to the need for more research, the existing literature suggests an urgent need for interventions in the ED to reduce OPR misuse and diversion.
SN  - 1530-7085
AD  - University of Connecticut Health Center
AD  - Johns Hopkins School of Medicine
AD  - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
AD  - Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
AD  - Division of Emergency Medicine, Johns Hopkins Medicine
DO  - 10.1111/papr.12568
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126114324&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 128749348
T1  - Percentage of Emergency Department Visits That Had an Opioid Ordered or Prescribed, by Age Group -- National Hospital Ambulatory Medical Care Survey, United States, 2006-2015.
AU  - Yacisin, Kari
AU  - O'Connor, Kathleen S.
AU  - Akinseye, Akintunde
Y1  - 2018/03/23/
N1  - Accession Number: 128749348. Language: English. Entry Date: In Process. Revision Date: 20180403. Publication Type: Chart/Diagram/Graph. Journal Subset: Biomedical; Public Health; USA. NLM UID: 7802429. 
SP  - 344
EP  - 344
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 67
IS  - 11
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
SN  - 0149-2195
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121512672
T1  - Persistent pain after motor vehicle collision: comparative effectiveness of opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency department-a propensity matched analysis.
AU  - Beaudoin, Francesca L.
AU  - Gutman, Roee
AU  - Merchant, Roland C.
AU  - Clark, Melissa A.
AU  - Swor, Robert A.
AU  - Jones, Jeffrey S.
AU  - Lee, David C.
AU  - Peak, David A.
AU  - Domeier, Robert M.
AU  - Rathlev, Niels K.
AU  - McLean, Samuel A.
Y1  - 2017/02//
N1  - Accession Number: 121512672. Language: English. Entry Date: 20170614. Revision Date: 20180205. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. Special Interest: Evidence-Based Practice. Instrumentation: Home Observation for Measurement of the Environment (HOME) (Bradley and Caldwell). Grant Information: K12 HS022998/HS/AHRQ HHS/United States. NLM UID: 7508686. 
KW  - Antiinflammatory Agents, Non-Steroidal -- Therapeutic Use
KW  - Accidents, Traffic
KW  - Pain -- Epidemiology
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Young Adult
KW  - Adult
KW  - Aged
KW  - Adolescence
KW  - Prospective Studies
KW  - Female
KW  - Outcome Assessment
KW  - Middle Age
KW  - Self Report
KW  - Human
KW  - Male
KW  - Pain Measurement
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Randomized Controlled Trials
SP  - 289
EP  - 295
JO  - Pain (03043959)
JF  - Pain (03043959)
JA  - PAIN
VL  - 158
IS  - 2
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Each year millions of Americans present to the emergency department (ED) for care after a motor vehicle collision (MVC); the majority (>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.
SN  - 0304-3959
AD  - Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
AD  - Departments of Epidemiology, Brown University, Providence, RI, USA
AD  - Departments of Biostatistics, Brown University, Providence, RI, USA
AD  - Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, USA
AD  - Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA
AD  - Department of Emergency Medicine, Spectrum Health Butterworth Campus, Grand Rapids, MI, USA
AD  - Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
AD  - Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
AD  - Department of Emergency Medicine, St Joseph Mercy Hospital, Yipsilanti, MI, USA
AD  - Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
AD  - Departments of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
AD  - Departments of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
AD  - Departments of TRYUMPH Research Program, University Of North Carolina, Chapel Hill, NC, USA
U2  - PMID: 28092325.
DO  - 10.1097/j.pain.0000000000000756
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120660141
T1  - Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time-series analysis.
AU  - McAuley, Andrew
AU  - Bouttell, Janet
AU  - Barnsdale, Lee
AU  - Mackay, Daniel
AU  - Lewsey, Jim
AU  - Hunter, Carole
AU  - Robinson, Mark
Y1  - 2017/02//
N1  - Accession Number: 120660141. Language: English. Entry Date: 20170123. Revision Date: 20180201. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: This study was funded by NHS Health Scotland.. NLM UID: 9304118. 
KW  - Naloxone -- Supply and Distribution -- Scotland
KW  - Overdose -- Trends -- Scotland
KW  - Death, Accidental -- Prevention and Control
KW  - Ambulances -- Utilization
KW  - Government Programs -- Evaluation
KW  - Scotland
KW  - Association (Research)
KW  - Pretest-Posttest Design
KW  - Narcotics -- Adverse Effects
KW  - Human
KW  - Female
KW  - Male
KW  - Time Series
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - P-Value
KW  - Regression
KW  - Confidence Intervals
KW  - Odds Ratio
KW  - Funding Source
SP  - 301
EP  - 308
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 112
IS  - 2
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Background and Aims It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid-related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid-related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call-outs to opioid-related overdose incidents and the cumulative number of 'take-home naloxone' (THN) kits in issue; and is there evidence of an association between ambulance call-outs to opioid-related overdose incidents in early adopter (pilot) or later adopting (non-pilot) regions and the cumulative number of THN kits issued in those areas? Design Controlled time-series analysis. Setting Scotland, UK, 2008-15. Participants Pre-NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post-implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid-related overdose were recorded for the pre-NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post-implementation period (mean 24.8 attendances per week). Intervention Scotland's NNP; formally implemented on 1 April 2011. Measurements Primary outcome measure was weekly incidence (counts) of call-outs to opioid-related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call-outs to heroin-related overdose in the London Borough area acquired from the London Ambulance Service. Findings There was no significant association between SAS call-outs to opioid-related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% confidence intervals = −0.01, 0.03, P = 0.39). In addition, the magnitude of association between THN kits and SAS call-outs did not differ significantly between pilot and non-pilot regions (interaction test, P = 0.62). Conclusions The supply of take-home naloxone kits through a National Naloxone Programme in Scotland was not associated clearly with a decrease in ambulance attendance at opioid-related overdose incidents in the 4-year period after it was implemented in April 2011.
SN  - 0965-2140
AD  - Health Protection Scotland, Meridian Court
AD  - School of Health and Life Sciences, Glasgow Caledonian University
AD  - Institute of Health and Wellbeing, University of Glasgow
AD  - NHS National Services Scotland, Information Services Division
AD  - NHS Greater Glasgow and Clyde, Possilpark Health and Care Centre
AD  - Public Health Science Directorate, NHS Health Scotland, Meridian Court
DO  - 10.1111/add.13602
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119398434
T1  - Impact of Prior Therapeutic Opioid Use by Emergency Department Providers on Opioid Prescribing Decisions.
AU  - Pomerleau, Adam C.
AU  - Perrone, Jeanmarie
AU  - Hoppe, Jason A.
AU  - Salzman, Matthew
AU  - Weiss, Paul S.
AU  - Nelson, Lewis S.
Y1  - 2016/11//
N1  - Accession Number: 119398434. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Family
KW  - Emergency Service
KW  - Ankle Sprain
KW  - Ankle Fractures
KW  - Osteoarthritis
KW  - Adult
SP  - 791
EP  - 797
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 17
IS  - 6
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Introduction: Our study sought to examine the opioid analgesic (OA) prescribing decisions of emergency department (ED) providers who have themselves used OA therapeutically and those who have not. A second objective was to determine if OA prescribing decisions would differ based on the patient's relationship to the provider. Methods: We distributed an electronic survey to a random sample of ED providers at participating centers in a nationwide research consortium. Question topics included provider attitudes about OA prescribing, prior personal therapeutic use of OAs (indications, dosing, and disposal of leftover medication), and hypothetical analgesicprescribing decisions for their patients, family members, and themselves for different painful conditions. Results: The total survey population was 957 individuals; 515 responded to the survey, a 54% response rate. Prior personal therapeutic OA use was reported in 63% (95% CI = [58-68]). A majority of these providers (82%; 95% CI = [77-87]) took fewer than half the number of pills prescribed. Regarding provider attitudes towards OA prescribing, 66% (95% CI = [61-71]) agreed that OA could lead to addiction even with short-term use. When providers were asked if they would prescribe OA to a patient with 10/10 pain from an ankle sprain, 21% (95% CI = [17-25]) would for an adult patient, 13% (95% CI = [10-16]) would for an adult family member, and 6% (95% CI = [4-8]) indicated they themselves would take an opioid for the same pain. When the scenario involved an ankle fracture, 86% (95% CI = [83-89]) would prescribe OA for an adult patient, 75% (95% CI = [71-79]) for an adult family member, and 52% (95% CI = [47-57]) would themselves take OA. Providers who have personally used OA to treat their pain were found to make similar prescribing decisions compared to those who had not. Conclusion: No consistent differences in prescribing decisions were found between ED providers based on their prior therapeutic use of OA. When making OA prescribing decisions, ED providers report that they are less likely to prescribe opioids to their family members, or themselves, than to an ED patient with the same painful condition.
SN  - 1936-900X
AD  - Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
AD  - University of Pennsylvania, Perelman School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
AD  - University of Colorado, Department of Emergency Medicine, Aurora, Colorado
AD  - Rocky Mountain Poison and Drug Center, Denver, Colorado
AD  - Rowman University, Cooper Medical School, Department of Emergency Medicine, Camden, New Jersey
AD  - Emory University, Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, Georgia
AD  - New York University School of Medicine, Department of Emergency Medicine, New York, New York
DO  - 10.5811/westjem.2016.8.30965
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122763402
T1  - Use of Intranasal Naloxone by Basic Life Support Providers.
AU  - Weiner, Scott G.
AU  - Mitchell, Patricia M.
AU  - Temin, Elizabeth S.
AU  - Langlois, Breanne K.
AU  - Dyer, K. Sophia
Y1  - 2017/05//May/Jun2017
N1  - Accession Number: 122763402. Language: English. Entry Date: 20170510. Revision Date: 20170510. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intranasal -- Methods
KW  - Emergency Care
KW  - Emergency Medical Technicians
KW  - Overdose -- Drug Therapy
KW  - Life Support Care
KW  - Prehospital Care
KW  - Human
KW  - Retrospective Design
KW  - Record Review
KW  - Descriptive Statistics
KW  - Adult
KW  - Male
KW  - Female
KW  - Heroin -- Adverse Effects
KW  - Massachusetts
KW  - Data Analysis Software
KW  - Prospective Studies
KW  - Naloxone -- Adverse Effects
KW  - Emergency Service
SP  - 322
EP  - 326
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 21
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Study Objectives:Intranasal delivery of naloxone to reverse the effects of opioid overdose by Advanced Life Support (ALS) providers has been studied in several prehospital settings. In 2006, in response to the increase in opioid-related overdoses, a special waiver from the state allowed administration of intranasal naloxone by Basic Life Support (BLS) providers in our city. This study aimed to determine: 1) if patients who received a 2-mg dose of nasal naloxone administered by BLS required repeat dosing while in the emergency department (ED), and 2) the disposition of these patients.Methods:This was a retrospective review of patients transported by an inner-city municipal ambulance service to one of three academic medical centers. We included patients aged 18 and older that were transported by ambulance between 1/1/2006 and 12/12/2012 and who received intranasal naloxone by BLS providers as per a state approved protocol. Site investigators matched EMS run data to patients from each hospital's EMR and performed a chart review to confirm that the patient was correctly identified and to record the outcomes of interest. Descriptive statistics were then generated.Results:A total of 793 patients received nasal naloxone by BLS and were transported to three hospitals. ALS intervened and transported 116 (14.6%) patients, and 11 (1.4%) were intubated in the field. There were 724 (91.3%) patients successfully matched to an ED chart. Hospital A received 336 (46.4%) patients, Hospital B received 210 (29.0%) patients, and Hospital C received 178 (24.6%) patients. Mean age was 36.2 (SD 10.5) years and 522 (72.1%) were male; 702 (97.1%) were reported to have abused heroin while 21 (2.9%) used other opioids. Nasal naloxone had an effect per the prehospital record in 689 (95.2%) patients. An additional naloxone dose was given in the ED to 64 (8.8%) patients. ED dispositions were: 507 (70.0%) discharged, 105 (14.5%) admitted, and 112 (15.5%) other (e.g., left against medical advice, left without being seen, or transferred).Conclusions:Only a small percentage of patients receiving prehospital administration of nasal naloxone by BLS providers required additional doses of naloxone in the ED and the majority of patients were discharged.
SN  - 1090-3127
DO  - 10.1080/10903127.2017.1282562
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127792746
T1  - Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness.
AU  - Robertson, Allison G.
AU  - Easter, Michele M.
AU  - Lin, Hsiu-Ju
AU  - Frisman, Linda K.
AU  - Swanson, Jeffrey W.
AU  - Swartz, Marvin S.
Y1  - 2018/03//
N1  - Accession Number: 127792746. Language: English. Entry Date: In Process. Revision Date: 20180220. Publication Type: journal article. Journal Subset: Biomedical; USA. Grant Information: K01 MH100544/MH/NIMH NIH HHS/United States. NLM UID: 8500909. 
SP  - 17
EP  - 25
JO  - Journal of Substance Abuse Treatment
JF  - Journal of Substance Abuse Treatment
JA  - J SUBST ABUSE TREAT
VL  - 86
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Adults suffering from a serious mental illness (SMI) and a substance use disorder are at especially high risk for poor clinical outcomes and also arrest and incarceration. Pharmacotherapies for treating opioid dependence could be a particularly important mode of treatment for opioid-dependent adults with SMI to lower their risk for overdose, high-cost hospitalizations, repeated emergency department visits, and incarceration, given relapse rates are very high following detoxification in the absence of one of the three FDA-approved pharmacotherapies. This study estimates the effects of methadone, buprenorphine, and oral naltrexone on clinical and justice-related outcomes in a sample of justice-involved adults with SMI, opioid dependence, and criminal justice involvement. Administrative data were merged from several public agencies in Connecticut for 8736 adults 18years of age or older with schizophrenia spectrum disorder, bipolar disorder, or major depression; co-occurring moderate to severe opioid dependence; and who also had at least one night in jail during 2002-2009. Longitudinal multivariable regression models estimated the effect of opioid-dependence pharmacotherapy as compared to outpatient substance abuse treatment without opioid-dependence pharmacotherapy on inpatient substance abuse or mental health treatment, emergency department visits, criminal convictions, and incarcerations, analyzing instances of each outcome 12months before and after an index treatment episode. Several baseline differences between the study groups (opioid-dependence pharmacotherapy group versus outpatient treatment without opioid-dependence pharmacotherapy) were adjusted for in the regression models. All three opioid-dependence pharmacotherapies were associated with reductions in inpatient substance abuse treatment, and among the oral naltrexone subgroup, also reductions in inpatient mental health treatment, as well as improved adherence to SMI medications. Overall, the opioid-dependence pharmacotherapy group had higher rates of arrest and incarceration in the follow-up period than the comparison group; but those using oral naltrexone had lower rates of arrest (including felonies). The analysis of observational administrative data provides useful population-level estimates but also has important limitations that preclude conclusive causal inferences. Large reductions in crisis-driven service utilization associated with opioid-dependence pharmacotherapy in this study suggest that evidence-based medications for treating opioid dependence can be used successfully in adults with SMI and should be considered more systematically during assessments of treatment needs for this population.
SN  - 0740-5472
AD  - Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, United States
AD  - Connecticut Department of Mental Health and Addiction Services, University of Connecticut School of Social Work, United States
U2  - PMID: 29415846.
DO  - 10.1016/j.jsat.2017.12.003
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127036449
T1  - Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual.
AU  - IIISoares, William E.
AU  - Wilson, Donna
AU  - Rathlev, Niels
AU  - Lee, Joshua D.
AU  - Gordon, Michael
AU  - Nunes, Edward V.
AU  - O'Brien, Charles P.
AU  - Friedmann, Peter D.
AU  - Soares, William E 3rd
AU  - O'Brien, Charles P
Y1  - 2018/02//
N1  - Accession Number: 127036449. Language: English. Entry Date: In Process. Revision Date: 20180104. Publication Type: journal article. Journal Subset: Biomedical; USA. NLM UID: 8500909. 
SP  - 66
EP  - 69
JO  - Journal of Substance Abuse Treatment
JF  - Journal of Substance Abuse Treatment
JA  - J SUBST ABUSE TREAT
VL  - 85
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up.Methods: This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions.Results: Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63-1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32-2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30-1.00, p=0.05) during the course of the entire study.Conclusions: XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders.
SN  - 0740-5472
AD  - Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut St. Springfield, MA 01199, United States
AD  - Baystate Medical Center, 759 Chestnut St. Springfield, MA 01199, United States
AD  - Department of Population Health, New York University, 227 E. 30th St., New York, NY 10016, United States
AD  - Friends Research Institute, 1040 Park Avenue, Baltimore, MD 21201, United States
AD  - Columbia University Medical Center, 617 West End Avenue, New York, NY 10024, United States
AD  - Department of Psychiatry, University of Pennsylvania, Department of Behavior Health, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States
U2  - PMID: 28576389.
DO  - 10.1016/j.jsat.2017.05.009
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128597550
T1  - Buprenorphine alone or with naloxone: Which is safer?
AU  - Kelty, Erin
AU  - Cumming, Craig
AU  - Troeung, Lakhhina
AU  - Hulse, Gary
Y1  - 2018/03//
N1  - Accession Number: 128597550. Language: English. Entry Date: In Process. Revision Date: 20180410. Publication Type: Article. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 8907828. 
SP  - 344
EP  - 352
JO  - Journal of Psychopharmacology
JF  - Journal of Psychopharmacology
JA  - J PSYCHOPHARMACOL
VL  - 32
IS  - 3
PB  - Sage Publications, Ltd.
AB  - To address concerns regarding the intravenous diversion of buprenorphine, a combined buprenorphine-naloxone (BUP-NLX) preparation was developed. The aim of this study is to compare health outcomes in opioid dependent patients treated with BUP and BUP-NLX. All patients treated with BUP and/or BUP-NLX in Western Australia between 2001 and 2010 were included in the study ( N = 3455). Patients were identified via State prescribing records and matched against the State mortality, hospital, and emergency department records. Rates of health events were examined and compared using Cox Proportional Hazard Models and Generalized Estimating Equations. While on treatment there was no significant difference between mortality rates in the two groups, mortality rates following the cessation of treatment were significantly higher in patients treated with BUP-NLX (adjusted hazard ratio: 1.59). Rates of hospitalization were significantly elevated in BUP-NLX patients (adjusted odds ratio: 1.17) compared with BUP treated patients; however, rates of hospitalization with a skin/subcutaneous diagnosis were significantly lower in BUP-NLX treated patients (adjusted odds ratio: 0.65). Off-treatment rates of both all-cause hospital admissions (adjusted odds ratio: 1.53) and hospital admissions with an opioid poisoning diagnosis (adjusted odds ratio: 1.59) were significantly elevated in BUP-NLX treated patients compared with BUP treated patients. The addition of naloxone does not appear to improve the safety profile of buprenorphine.
SN  - 0269-8811
AD  - Division of Psychiatry, University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
AD  - School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
AD  - National Drug Research Institute, Curtin University, Bentley, WA, Australia
AD  - School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
U2  - PMID: 29433352.
DO  - 10.1177/0269881118756015
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128597550&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 115889843
T1  - Opioid prescription fill rates after emergency department discharge.
AU  - Kim, Howard S.
AU  - Heard, Kennon J.
AU  - Heard, Susan
Y1  - 2016/06/15/
N1  - Accession Number: 115889843. Language: English. Entry Date: 20160607. Revision Date: 20160610. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. 
KW  - Prescriptions, Drug
KW  - Analgesics, Opioid
KW  - Patient Discharge
KW  - Drug Utilization -- Evaluation
KW  - Pain -- Drug Therapy
KW  - Human
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Chi Square Test
KW  - P-Value
KW  - Emergency Care
KW  - Motivation
KW  - Emergency Service
KW  - Logistic Regression
KW  - Cox Proportional Hazards Model
SP  - 902
EP  - 907
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 73
IS  - 12
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - Purpose. Opioid prescription fill rates and the time to fill after emergency department (ED) discharge were studied. Methods. Data were evaluated for all patients discharged from the ED between September 1, 2011, who were February 1, 2012, who were diagnosed with one of the following: dental pain, jaw pain, flank pain, abdominal pain, pelvic pain, back pain, neck pain, knee pain, headache, fracture, or sprain. Clinical information was abstracted via computer algorithm, and prescription filling within 100 days of prescription writing was determined by cross-referencing patient demographics with the state prescription drug monitoring program. Logistic regression analysis and a Cox proportional hazards model were used to determine if any clinical and demographic characteristics were associated with fill rates or the time to fill, respectively. Results. Of the 2243 patients who received an opioid prescription at ED discharge, 1775 (79%) filled it, with a median time to fill of 0 days. On adjusted analysis, characteristics associated with filling the opioid prescriptions included Caucasian race, being insured by the federal government or through a state indigent assistance program, a chief complaint of back pain, and a history of filling an opioid prescription within the past year. No characteristics were predictive of a prolonged time to filling. Conclusion. One in five patients who received an opioid prescription at discharge from an urban academic ED did not fill it. Several factors may be associated with a greater likelihood of filling, such as insurance status and history of filling an opioid prescription within the past year.
SN  - 1079-2082
AD  - Department of Emergency Medicine, Center for Education in Health Sciences, Northwestern University, Chicago, IL
AD  - Section of Medical Pharmacology and Toxicology, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
AD  - Rocky Mountain Poison and Drug Center, Denver, CO
AD  - Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO
DO  - 10.2146/ajhp150528
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115889843&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125541509
T1  - Cost-effectiveness of emergency department-initiated treatment for opioid dependence.
AU  - Busch, Susan H.
AU  - Fiellin, David A.
AU  - Chawarski, Marek C.
AU  - Owens, Patricia H.
AU  - Pantalon, Michael V.
AU  - Hawk, Kathryn
AU  - Bernstein, Steven L.
AU  - O'Connor, Patrick G.
AU  - D'Onofrio, Gail
Y1  - 2017/11//
N1  - Accession Number: 125541509. Language: English. Entry Date: 20171013. Revision Date: 20171017. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Cost Benefit Analysis
KW  - Substance Dependence -- Drug Therapy
KW  - Narcotics
KW  - Buprenorphine -- Administration and Dosage
KW  - Emergency Service -- Utilization
KW  - Community Health Services -- Utilization
KW  - Referral and Consultation
KW  - Human
KW  - Female
KW  - Male
KW  - Adolescence
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Secondary Analysis
SP  - 2002
EP  - 2010
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 112
IS  - 11
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Background and Aims In a recent randomized trial, patients with opioid dependence receiving brief intervention, emergency department (ED)-initiated buprenorphine and ongoing follow-up in primary care with buprenorphine (buprenorphine) were twice as likely to be engaged in addiction treatment compared with referral to community-based treatment (referral) or brief intervention and referral (brief intervention). Our aim was to evaluate the relative cost-effectiveness of these three methods of intervening on opioid dependence in the ED. Design Measured health-care use was converted to dollar values. We considered a health-care system perspective and constructed cost-effectiveness acceptability curves that indicate the probability each treatment is cost-effective under different thresholds of willingness-to-pay for outcomes studied. Setting An urban ED in the United States. Participants Opioid-dependent patients aged 18 years or older. Measurements Self-reported 30-day assessment data were used to construct cost-effectiveness acceptability curves for patient engagement in formal addiction treatment at 30 days and the number of days illicit opioid-free in the past week. Findings Considering only health-care system costs, cost-effectiveness acceptability curves indicate that at all positive willingness-to-pay values, ED-initiated buprenorphine treatment was more cost-effective than brief intervention or referral. For example, at a willingness-to-pay threshold of $1000 for 30-day treatment engagement, we are 79% certain ED-initiated buprenorphine is most cost-effective compared with other studied treatments. Similar results were found for days illicit opioid-free in the past week. Results were robust to secondary analyses that included patients with missing cost data, included crime and patient time costs in the numerator, and to changes in unit price estimates. Conclusion In the United States, emergency department-initiated buprenorphine intervention for patients with opioid dependence provides high value compared with referral to community-based treatment or combined brief intervention and referral.
SN  - 0965-2140
AD  - Department of Health Policy and Management, Yale School of Public Health
AD  - Department of Internal Medicine, Yale School of Medicine
AD  - Department of Psychiatry, Yale School of Medicine
AD  - Department of Emergency Medicine, Yale School of Medicine
AD  - Department of Chronic Disease Epidemiology, Yale School of Public Health
DO  - 10.1111/add.13900
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121668908
T1  - Pharmacists turn naloxone training programs into video for broad audience.
AU  - Thompson, Cheryl A.
Y1  - 2017/03/15/
N1  - Accession Number: 121668908. Language: English. Entry Date: 20170315. Revision Date: 20170315. Publication Type: Article; pictorial. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. 
KW  - Emergency Medical Technicians -- Education
KW  - Naloxone
KW  - Police -- Education
KW  - Videorecording
KW  - Pharmacists
SP  - 363
EP  - 366
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 74
IS  - 6
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - The article offers information on the video titled "Opioid Overdose and Naloxone Reversal," which can be accessed on YouTube. The release of this video is part of the pharmacy project that aims to train emergency medical services (EMS) and law enforcement personnel on administration of naloxone. The video, which was produced at Red Lake Indian Health Service Hospital in Minnesota, was narrated by clinical pharmacist Kailee L. Fretland.
SN  - 1079-2082
DO  - 10.2146/news170018
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121668908&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127015496
T1  - Emergency Legal Authority and the Opioid Crisis.
AU  - Rutkow, Lainie
AU  - Vernick, Jon S.
Y1  - 2017/12/28/
N1  - Accession Number: 127015496. Language: English. Entry Date: 20180104. Revision Date: 20180121. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0255562. 
KW  - Overdose -- Epidemiology
KW  - State Government
KW  - Health Policy -- Legislation and Jurisprudence
KW  - Drug and Narcotic Control -- Legislation and Jurisprudence
KW  - Analgesics, Opioid -- Poisoning
KW  - Overdose -- Prevention and Control
KW  - United States
KW  - Overdose -- Mortality
KW  - Federal Government
KW  - Disease Outbreaks
SP  - 2512
EP  - 2514
JO  - New England Journal of Medicine
JF  - New England Journal of Medicine
JA  - N ENGL J MED
VL  - 377
IS  - 26
CY  - Waltham, Massachusetts
PB  - New England Journal of Medicine
SN  - 0028-4793
AD  - Department of Health Policy and Management and the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore
U2  - PMID: 29140760.
DO  - 10.1056/NEJMp1710862
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127273330
T1  - Emergency Department Provider Perspectives on Benzodiazepine–Opioid Coprescribing: A Qualitative Study.
AU  - Kim, Howard S.
AU  - McCarthy, Danielle M.
AU  - Hoppe, Jason A.
AU  - Mark Courtney, D.
AU  - Lambert, Bruce L.
Y1  - 2018/01//
N1  - Accession Number: 127273330. Language: English. Entry Date: 20180119. Revision Date: 20180119. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Antianxiety Agents, Benzodiazepine
KW  - Narcotics
KW  - Prescribing Patterns
KW  - Qualitative Studies
KW  - Human
KW  - Focus Groups
KW  - Content Analysis
SP  - 15
EP  - 24
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 25
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Abstract: Objective: Benzodiazepines and opioids are prescribed simultaneously (i.e., “coprescribed”) in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepine–opioid coprescribing occurs and providers’ reasons for coprescribing. Methods: We conducted focus groups with emergency department (ED) providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semistructured interviews to elicit perspectives on benzodiazepine–opioid coprescribing. Discussions were audio‐recorded and transcribed. We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach, aiming to identify priority categories that describe the phenomenon of benzodiazepine–opioid coprescribing. Results: Participants acknowledged coprescribing rarely and reluctantly and often provided specific discharge instructions when coprescribing. The decision to coprescribe is multifactorial, often isolated to specific clinical and situational contexts (e.g., low back pain, failed solitary opioid therapy) and strongly influenced by a provider's beliefs about the efficacy of combination therapy. The decision to coprescribe is further influenced by a self‐imposed pressure to escalate care or avoid hospital admission. When considering potential interventions to reduce the incidence of coprescribing, participants opposed computerized alerts but were supportive of a pharmacist‐assisted intervention. Many providers found the process of participating in peer discussions on prescribing habits to be beneficial. Conclusions: In this qualitative study of ED providers, we found that benzodiazepine–opioid coprescribing occurs in specific clinical and situational contexts, such as the treatment of low back pain or failed solitary opioid therapy. The decision to coprescribe is strongly influenced by a provider's beliefs and by self‐imposed pressure to escalate care or avoid admission.
SN  - 1069-6563
AD  - Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
AD  - Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
AD  - Rocky Mountain Poison & Drug Center, Denver, CO
AD  - Department of Communication Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
AD  - Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
DO  - 10.1111/acem.13273
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128376023
T1  - Randomized pilot trial measuring knowledge acquisition of opioid education in emergency department patients using a novel media platform.
AU  - Chakravarthy, Bharath
AU  - Somasundaram, Shashank
AU  - Mogi, Jennifer
AU  - Burns, Roshan
AU  - Hoonpongsimanont, Wirachin
AU  - Wiechmann, Warren
AU  - Lotfipour, Shahram
Y1  - 2018/01//
N1  - Accession Number: 128376023. Language: English. Entry Date: 20180402. Revision Date: 20180402. Publication Type: Article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8808537. 
KW  - Knowledge Management
KW  - Substance Use Disorders -- Education
KW  - Emergency Service -- Education
KW  - Emergency Patients -- Education
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Organizations, Nonprofit
KW  - Quality of Health Care
KW  - Narcotics -- Therapeutic Use
KW  - Social Media
KW  - Human
KW  - Adolescence
KW  - Young Adult
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Prescriptions, Drug
KW  - Patient Discharge
KW  - Unpaired T-Tests
KW  - Motion Pictures
SP  - 27
EP  - 31
JO  - Substance Abuse
JF  - Substance Abuse
JA  - SUBST ABUSE
VL  - 39
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - <italic>Background</italic>: The number of active opioid analgesic prescriptions has risen steadily, causing increases in nonmedical opioid use, addiction, and overdose. Insufficient focus on patient discharge instructions has contributed to lack of patient awareness regarding dangers of opioids. This study examines whether an educational Khan Academy-style animation discharge instruction on the dangers and safe usage of opioid analgesics elicits higher knowledge acquisition than current standard of care. Additionally, it measures the feasibility of implementing this video discharge instruction in the emergency department (ED). <italic>Methods</italic>: Fifty-two English-speaking patients aged 18 years or older receiving an opioid prescription were enrolled in this study. Patients were randomized into 2 groups. The standard of care group received verbal instruction and an informational sheet, whereas the video animation group received a 6-minute video on proper usage of opioids in addition to standard of care. Video content was sourced from samhsa.gov and administered within the ED prior to discharge. Both groups received a 26-question test regarding the dangers and safe usage of opioids immediately after education. An unpaired <italic>t</italic> test compared knowledge acquisition between the 2 groups. <italic>Results</italic>: Fifty-four patients were approached, 52 patients enrolled; 27 in the standard group and 25 in the animation group. The standard of care group averaged 65% knowledge acquisition (16.8/26 correct), whereas the animation group averaged 82% acquisition (21.2/26 correct). The video animation significantly increased patient knowledge acquisition about opioid medications' risks and proper usage and disposal (<italic>P</italic> =.001). <italic>Conclusion</italic>: It can be concluded that medical knowledge acquisition is improved in the video animation group compared with the current standard of care (<italic>P</italic> =.001). It can also be concluded that it is feasible to implement a novel media platform to educate patients receiving opioid analgesics in the ED (96.1%).
SN  - 0889-7077
AD  - Department of Emergency Medicine, University of California, Irvine, Irvine, California, USA
AD  - School of Biological Sciences, University of California Irvine, Irvine, California, USA
DO  - 10.1080/08897077.2017.1375061
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128376009
T1  - Alcohol, marijuana, and opioid use disorders: 5-Year patterns and characteristics of emergency department encounters.
AU  - Bahorik, Amber L.
AU  - Satre, Derek D.
AU  - Kline-Simon, Andrea H.
AU  - Weisner, Constance M.
AU  - Young-Wolff, Kelly C.
AU  - Campbell, Cynthia I.
Y1  - 2018/01//
N1  - Accession Number: 128376009. Language: English. Entry Date: 20180402. Revision Date: 20180402. Publication Type: Article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8808537. 
KW  - Alcohol Abuse
KW  - Cannabis
KW  - Narcotics
KW  - Substance Use Disorders
KW  - Emergency Service
KW  - Human
KW  - Retrospective Design
KW  - Electronic Health Records
KW  - Logistic Regression
KW  - Odds Ratio
KW  - Comorbidity
KW  - Insurance Coverage
KW  - Health Care Delivery, Integrated
SP  - 59
EP  - 68
JO  - Substance Abuse
JF  - Substance Abuse
JA  - SUBST ABUSE
VL  - 39
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - <italic>Background</italic>: Changes in substance use patterns stemming from opioid misuse, ongoing drinking problems, and marijuana legalization may result in new populations of patients with substance use disorders (SUDs) using emergency department (ED) resources. This study examined ED admission trends in a large sample of patients with alcohol, marijuana, and opioid use disorders in an integrated health system. <italic>Methods</italic>: In a retrospective design, electronic health record (EHR) data identified patients with ≥1 of 3 common SUDs in 2010 (<italic>n</italic> = 17,574; alcohol, marijuana, or opioid use disorder) and patients without SUD (<italic>n</italic> = 17,574). Logistic regressions determined odds of ED use between patients with SUD versus controls (2010-2014); mixed-effect models examined 5-year differences in utilization; moderator models identified subsamples for which patients with SUD may have a greater impact on ED resources. <italic>Results</italic>: Odds of ED use were higher at each time point (2010-2014) for patients with alcohol (odds ratio [OR] range: 5.31-2.13, <italic>P</italic>s <.001), marijuana (OR range: 5.45-1.97, <italic>P</italic>s <.001), and opioid (OR range: 7.63-4.19, <italic>P</italic>s <.001) use disorders compared with controls; odds decreased over time (<italic>P</italic>s <.001). Patients with opioid use disorder were at risk of high ED utilization; patients were 7.63 times more likely to have an ED visit in 2010 compared with controls and remained 5.00 (average) times more likely to use ED services. ED use increased at greater rates for patients with alcohol and opioid use disorders with medical comorbidities relative to controls (<italic>P</italic>s <.045). <italic>Conclusions</italic>: ED use is frequent in patients with SUDs who have access to private insurance coverage and integrated medical services. ED settings provide important opportunities in health systems to identify patients with SUDs, particularly patients with opioid use disorder, to initiate treatment and facilitate ongoing care, which may be effective for reducing excess medical emergencies and ED encounters.
SN  - 0889-7077
AD  - Department of Psychiatry, University of California, San Francisco, California, USA
AD  - Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
DO  - 10.1080/08897077.2017.1356789
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127425251
T1  - The impact of opioid medications on subsequent fractures in discharged emergency department patients with peripheral vertigo.
AU  - Grewal, Keerat
AU  - Austin, Peter C.
AU  - Kapral, Moira K.
AU  - Hong Lu
AU  - Atzema, Clare L.
Y1  - 2018/01//
N1  - Accession Number: 127425251. Language: English. Entry Date: 20180202. Revision Date: 20180202. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 100893237. 
KW  - Narcotics -- Therapeutic Use
KW  - Emergency Service
KW  - Vertigo -- Drug Therapy
KW  - Fractures
KW  - Patient Discharge
KW  - Urinary Tract Infections
KW  - Regression
KW  - Confidence Intervals
KW  - Analgesics, Opioid
SP  - 28
EP  - 35
JO  - CJEM: Canadian Journal of Emergency Medicine
JF  - CJEM: Canadian Journal of Emergency Medicine
JA  - CAN J EMERG MED
VL  - 20
IS  - 1
PB  - Cambridge University Press
AB  - Background: Vertigo is common in the emergency department (ED). Most aetiologies are peripheral and do not require hospitalization, but many patients still fear falling. Some patients may be taking opioid analgesic medications (for other reasons); the risk of falls leading to fractures among patients with vertigo could be potentiated by the simultaneous use of opioids. Objectives: To examine the risk of fractures in discharged ED patients with peripheral vertigo who were being prescribed opioids during the same time period. Methods: Linked administrative databases from Ontario were used to compare discharged ED patients aged =65 with peripheral vertigo to patients with urinary tract infection (UTI) from 2006 to 2011. We used Cox regression analysis with an interaction term to estimate the modifying effect of an opioid prescription on the hazard of fracture within 90 days. Results: There were 13,012 patients with a peripheral vertigo syndrome and 76,885 with a UTI. Thirteen percent of the vertigo cohort and 25% of the UTI cohort had access to a filled opioid prescription. Compared to vertigo patients who did not fill an opioid prescription, the adjusted hazard of fracture among vertigo patients who did fill a prescription was 3.59 (95% CI 1.97-6.13). Among UTI patients who filled an opioid prescription the hazard ratio was 1.68 (95% CI 1.43-1.97) compared to UTI patients who did not. Conclusions: Patients discharged from the ED with peripheral vertigo who were also being prescribed opioids had a higher hazard of subsequent fracture compared to those who were not, and the effect was much greater than among UTI patients. These results suggest that in the acutely vertiginous older patient, opioid analgesic medications should be modified, where possible.
AB  - Contexte : Les vertiges sont une cause fréquente de consultation au service des urgences (SU). La plupart sont d'origine périphérique et ne nécessitent pas d'hospitalisation, mais bon nombre de patients craignent toujours de faire des chutes. Certains malades peuvent prendre des analgésiques opioïdes (pour d'autres raisons), et le risque de chute causant des fractures chez les patients qui souffrent de vertiges pourrait être aggravé par la prise concomitante d'opioïdes. Objectifs : L'étude visait à examiner le risque de fracture chez les patients ayant obtenu leur congé du SU mais éprouvant des vertiges d'origine périphérique, à qui l'on avait prescrit des opioïdes durant la même période. Méthode : Nous avons établi des liens entre des bases de données administratives en Ontario afin de comparer des patients âgés de 65 ans et plus, atteints de vertiges d'origine périphérique mais ayant obtenu leur congé du SU, avec des patients souffrant d'une infection urinaire (IU), pour la période de 2006 à 2011. Une analyse de régression de Cox avec paramètre d'interaction a permis d'estimer l'effet modificateur des prescriptions d'opioïdes sur le risque de fracture au cours des 90 jours suivants. Résultats : L'étude comptait 13 012 patients éprouvant des vertiges d'origine périphérique et 76 885 patients souffrant d'une IU. Treize pour cent de ceux qui se trouvaient dans la cohorte des malaises vertigineux et 25 % de ceux qui se trouvaient dans la cohorte des IU ont fait exécuter une ordonnance d'opioïdes. Le risque rajusté de fracture chez les patients qui avaient des vertiges et qui avaient fait exécuter une ordonnance d'opioïdes comparativement à ceux qui ne l'avaient pas fait était de 3,59 (IC à 95 % : 1,97-6,13). Quant aux patients souffrant d'une IU, le rapport des risques instantanés était de 1,68 (IC à 95 % : 1,43-1,97) entre ceux qui avaient fait exécuter une ordonnance d'opioïdes et ceux qui ne l'avaient pas fait. Conclusions : Le risque de fracture consécutif à la prise d'opioïdes était plus élevé chez les patients éprouvant des vertiges d'origine périphérique mais ayant obtenu leur congé du SU, à qui l'on avait prescrit des opioïdes que chez ceux à qui l'on n'en avait pas prescrit, et l'effet était beaucoup plus grand que chez les patients souffrant d'une IU. Les résultatsdonnent à penser qu'il faudrait modifier, dans la mesure du possible, les opioïdes chez les patients âgés qui éprouvent des vertiges importants.
SN  - 1481-8035
AD  - Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON
AD  - Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Toronto, ON
AD  - Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON
AD  - Institute for Clinical Evaluative Sciences, Toronto, ON
AD  - University Health Network, University of Toronto, Toronto, ON
DO  - 10.1017/cem.2017.37
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118836831
T1  - Emergency department visits by pediatric patients for poisoning by prescription opioids.
AU  - Tadros, Allison
AU  - Layman, Shelley M.
AU  - Davis, Stephen M.
AU  - Bozeman, Rachel
AU  - Davidov, Danielle M.
Y1  - 2016/09//
N1  - Accession Number: 118836831. Language: English. Entry Date: 20171114. Revision Date: 20180330. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Impact of Events Scale (IES). Grant Information: U54 GM104942/GM/NIGMS NIH HHS/United States. NLM UID: 7502510. 
KW  - Drugs, Prescription -- Poisoning
KW  - Analgesics, Opioid -- Poisoning
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Infant
KW  - Female
KW  - Health Care Costs -- Statistics and Numerical Data
KW  - Child
KW  - United States
KW  - Child, Preschool
KW  - Male
KW  - Analgesics, Opioid -- Economics
KW  - Drugs, Prescription -- Economics
KW  - Adolescence
KW  - Infant, Newborn
KW  - Retrospective Design
KW  - Impact of Events Scale
KW  - Scales
SP  - 550
EP  - 555
JO  - American Journal of Drug & Alcohol Abuse
JF  - American Journal of Drug & Alcohol Abuse
JA  - AM J DRUG ALCOHOL ABUSE
VL  - 42
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background: Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied.Objectives: We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients.Methods: This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012.Results: There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges.Conclusion: Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts.
SN  - 0095-2990
AD  - Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
U2  - PMID: 27398815.
DO  - 10.1080/00952990.2016.1194851
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126945259
T1  - The Effects of Kentucky's Comprehensive Opioid Legislation on Patients Presenting with Prescription Opioid or Heroin Abuse to One Urban Emergency Department.
AU  - Faryar, Kiran A.
AU  - Freeman, Clifford L.
AU  - Persaud, Annuradha K.
AU  - Furmanek, Stephen P.
AU  - Guinn, Brian E.
AU  - Mattingly, William A.
AU  - Wiemken, Timothy L.
AU  - Buckner, Kimberley A.
AU  - Huecker, Martin R.
Y1  - 2017/12//
N1  - Accession Number: 126945259. Language: English. Entry Date: In Process. Revision Date: 20171228. Publication Type: Article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8412174. 
SP  - 805
EP  - 814
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 53
IS  - 6
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Prescription opioid abuse has increased to epidemic proportions in the United States. Kentucky, along with other states, passed comprehensive legislation to monitor and curb opioid prescribing.Objectives: This paper characterizes patients who presented to the emergency department (ED) after abusing prescription opioids and heroin prior to and after the passage of House Bill 1 (HB1) in April 2012.Methods: Based on a retrospective review of ED visits from 2009-2014 in one urban adult facility, patients were included if the chief complaint or diagnosis was directly related to prescription opioid or heroin abuse. The primary outcome is the number and type of substance abused by each ED patient.Results: From 2009-2014, 2945 patients presented to the ED after prescription opioid or heroin abuse. The number of prescription opioid patients decreased from 215 (of 276 patients) in 2009 to 203 (of 697 patients) in 2014; 77.9% of patients abused opioids in 2009, vs. 29% in 2014 (a 63% decrease). The number of heroin patients increased from 61 in 2009 to 494 in 2014; 22% of patients in 2009 abused heroin, vs. 71% in 2014 (a 221% increase). Both piecewise regression and autoregressive integrated moving average trend models showed an increased trend in patient heroin abuse beginning in 2011-2012.Conclusions: Our facility experienced a decrease in the number of patients who abused prescription opioids and an increase in the number of patients who abused heroin over the study period. The transition seemed to occur just prior to, or concurrent with, enforcement of statewide opioid legislation.
SN  - 0736-4679
AD  - Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, Kentucky
AD  - Division of Infectious Diseases Clinical Research Support Program, University of Louisville School of Medicine, Louisville, Kentucky
U2  - PMID: 29102093.
DO  - 10.1016/j.jemermed.2017.08.066
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103792101
T1  - Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.
AU  - D'Onofrio, Gail
AU  - O'Connor, Patrick G
AU  - Pantalon, Michael V
AU  - Chawarski, Marek C
AU  - Busch, Susan H
AU  - Owens, Patricia H
AU  - Bernstein, Steven L
AU  - Fiellin, David A
Y1  - 2015/04/28/
N1  - Accession Number: 103792101. Language: English. Entry Date: 20150522. Revision Date: 20161223. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: R01 DA025991/DA/NIDA NIH HHS/United States. NLM UID: 7501160. 
KW  - Buprenorphine -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Adult
KW  - Emergency Service
KW  - Female
KW  - HIV Infections -- Epidemiology
KW  - Health Services -- Utilization
KW  - Academic Medical Centers
KW  - Hospitals, Urban
KW  - Human
KW  - Experimental Studies
KW  - Male
KW  - Naloxone -- Therapeutic Use
KW  - Substance Use Disorders -- Drug Therapy
KW  - Referral and Consultation
KW  - Relative Risk
KW  - Young Adult
SP  - 1636
EP  - 1644
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 313
IS  - 16
CY  - Chicago, Illinois
PB  - American Medical Association
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 per week 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.
SN  - 0098-7484
AD  - Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
AD  - Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
AD  - Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
AD  - Yale School of Public Health, New Haven, Connecticut.
AD  - Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut4Yale School of Public Health, New Haven, Connecticut.
U2  - PMID: 25919527.
DO  - 10.1001/jama.2015.3474
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127768267
T1  - Initial Pain Management in Pediatric Acute Pancreatitis: Opioid Versus Non-opioid.
AU  - Grover, Amit S.
AU  - Mitchell, Paul D.
AU  - Manzi, Shannon F.
AU  - Fox, Victor L.
Y1  - 2018/02//
N1  - Accession Number: 127768267. Language: English. Entry Date: In Process. Revision Date: 20180207. Publication Type: journal article. Journal Subset: Allied Health; USA. NLM UID: 8211545. 
SP  - 295
EP  - 298
JO  - Journal of Pediatric Gastroenterology & Nutrition
JF  - Journal of Pediatric Gastroenterology & Nutrition
JA  - J PEDIATR GASTROENTEROL NUTR
VL  - 66
IS  - 2
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Nearly all patients with acute pancreatitis (AP) experience some degree of abdominal pain that is severe enough to prompt medical evaluation and necessitate analgesia. Effective analgesia is a priority in caring for such patients. Despite its importance, strategies for pain management in AP have been poorly studied, particularly in the field of pediatrics. Presently, no published data examine the management of pain because of AP in children at the time of initial presentation. Management approaches are often extrapolated from adult practice and based on anecdotal experience in the absence of objective data. The aim of our study was to examine the initial provision of analgesia to children who presented to a pediatric emergency department with AP.
SN  - 0277-2116
AD  - Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
AD  - Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA
AD  - Department of Pharmacy, Division of Genetics & Genomics, Clinical Pharmacogenomics Service, Boston Children's Hospital, Harvard Medical School, Boston, MA
U2  - PMID: 29077648.
DO  - 10.1097/MPG.0000000000001809
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126164093
T1  - Use of Prophylactic Ondansetron with Intravenous Opioids in Emergency Department Patients: A Prospective Observational Pilot Study.
AU  - Culver, Mark A.
AU  - Richards, Emily C.
AU  - Jarrell, Daniel H.
AU  - Edwards, Christopher J.
Y1  - 2017/11//
N1  - Accession Number: 126164093. Language: English. Entry Date: In Process. Revision Date: 20171115. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8412174. 
SP  - 629
EP  - 634
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 53
IS  - 5
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: The current literature suggests that the prophylactic use of antiemetics is ineffective at preventing nausea or vomiting caused by opioids in the emergency department (ED). While there is no data evaluating ondansetron's efficacy for preventing opioid-induced nausea and vomiting, this practice remains common despite a lack of supporting evidence.Objectives: This study aimed to identify if prophylactic ondansetron administered with intravenous (IV) opioids prevents opioid-induced nausea or vomiting.Methods: This prospective observational study was conducted in the ED at two academic medical institutions. Patients were eligible for enrollment if they were prescribed an IV opioid with or without IV ondansetron and absence of baseline nausea. Patients' level of nausea was evaluated at baseline, 5 min, and 30 min after an IV opioid was administered and then observed for 2 hours.Results: One hundred thirty-three patients were enrolled, with 90% of patients presenting with a chief complaint of pain. Sixty-four (48.1%) patients received an IV opioid alone and 69 (51.9%) patients received both IV ondansetron and an IV opioid. Twenty-three (17.3%) patients developed nausea caused by opioid administration. One (0.75%) patient had an emetic event and 3 (2.3%) patients required rescue antiemetics during their observation period. Rate of nausea was similar between treatment groups 5 min after the opioid was administered (p = 0.153). There was no statistical difference in emesis, rescue medication requirements, or nausea severity between treatment groups.Conclusion: Our trial found that ondansetron did not appear to be effective at preventing opioid-induced nausea or vomiting. These findings and previous literature suggest prophylactic ondansetron should not be given to ED patients who are receiving IV opioids.
SN  - 0736-4679
AD  - Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona
AD  - Department of Pharmacy, Banner University Medical Center Tucson, Tucson, Arizona
U2  - PMID: 28987314.
DO  - 10.1016/j.jemermed.2017.06.040
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119096481
T1  - A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits.
AU  - Neven, Darin
AU  - Paulozzi, Leonard
AU  - Howell, Donelle
AU  - McPherson, Sterling
AU  - Murphy, Sean M.
AU  - Grohs, Becky
AU  - Marsh, Linda
AU  - Lederhos, Crystal
AU  - Roll, John
Y1  - 2016/11//
N1  - Accession Number: 119096481. Language: English. Entry Date: 20171021. Revision Date: 20171105. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. Grant Information: P30 DA040500/DA/NIDA NIH HHS/United States. NLM UID: 8412174. 
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Overdose -- Prevention and Control
KW  - Cooperative Behavior
KW  - Emergency Service -- Utilization
KW  - Continuity of Patient Care -- Statistics and Numerical Data
KW  - Female
KW  - Chi Square Test
KW  - Washington
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Male
KW  - Emergency Service -- Administration
KW  - Adult
KW  - Human
KW  - Drug Therapy -- Adverse Effects
KW  - Pain -- Drug Therapy
KW  - Continuity of Patient Care -- Trends
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Randomized Controlled Trials
SP  - 498
EP  - 507
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 51
IS  - 5
PB  - Pergamon Press - An Imprint of Elsevier Science
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.
SN  - 0736-4679
AD  - Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington
AD  - Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
AD  - National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
AD  - Department of Health Policy and Administration, Washington State University College of Nursing, Spokane, Washington
AD  - Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington
U2  - PMID: 27624507.
DO  - 10.1016/j.jemermed.2016.06.057
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128575211
T1  - Associations of Early Opioid Use With Patient-reported Outcomes and Health Care Utilization Among Older Adults With Low Back Pain.
AU  - Gold, Laura S.
AU  - Hansen, Ryan N.
AU  - Avins, Andrew L.
AU  - Bauer, Zoya
AU  - Comstock, Bryan A.
AU  - Deyo, Richard A.
AU  - Heagerty, Patrick J.
AU  - Rundell, Sean D.
AU  - Suri, Pradeep
AU  - Turner, Judith A.
AU  - Jarvik, Jeffrey G.
Y1  - 2018/04//
N1  - Accession Number: 128575211. Language: English. Entry Date: In Process. Revision Date: 20180413. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: R01 HS019222/HS/AHRQ HHS/United States. NLM UID: 8507389. 
SP  - 297
EP  - 305
JO  - Clinical Journal of Pain
JF  - Clinical Journal of Pain
JA  - CLIN J PAIN
VL  - 34
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Objectives: The objective of this study was to compare outcomes and health care utilization of older patients who did versus did not fill opioid prescriptions within 90 days of initiating care for low back pain.Materials and Methods: For patients ≥65 years with new back pain visits, we used propensity scores to match those who filled no opioid prescriptions to those who filled ≥2 opioid prescriptions within 90 days (and the first opioid prescription within 30 d) of the index visit. Over 24 months, we examined patient-reported outcomes, health care utilization, and subsequent opioid prescription fills.Results: Among 1954 patients eligible for matching, 238 (12%) filled ≥2 opioid prescriptions within 90 days; 200 of these were matched to controls. Patients with versus without early opioid prescriptions had similar patient-reported outcomes but were more likely to have filled ≥1 opioid prescription 18 to 24 months after the index visit (odds ratio [95% confidence interval]=2.4 [1.5-3.9]) and to have had ≥1 visit to the emergency department in the subsequent 24 months (OR, 1.6; 95% confidence interval, 1.0-2.5).Discussion: Among older patients with new back pain visits, filling ≥2 opioid prescriptions within 90 days of the visit was associated with similar back pain-related outcomes but increased likelihood of filling opioid prescriptions 18 to 24 months later compared with matched patients who did not fill early opioid prescriptions.
SN  - 0749-8047
AD  - Department of Radiology, Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, WA
AD  - Pharmaceutical Outcomes Research and Policy Program Department of Pharmacy, University of Washington, Seattle, WA
AD  - Department of Health Services, University of Washington, Seattle, WA
AD  - Division of Research, Northern California Kaiser-Permanente, San Francisco, CA
AD  - Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA
AD  - Departments of Family Medicine, Internal Medicine, Public Health and Preventive Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR
AD  - Department of Rehabilitation Medicine, University of Washington, Seattle, WA
AD  - Veteran's Administration Puget Sound Health Care System, Seattle, WA
AD  - Department of Psychiatry and Behavioral Sciences, Seattle, WA
AD  - Department of Neurological Surgery, University of Washington, Seattle, WA
U2  - PMID: 28915153.
DO  - 10.1097/AJP.0000000000000557
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128375746
T1  - Scene Safety and Force Protection in the Era of Ultra-Potent Opioids.
AU  - Lynch, Michael J.
AU  - Suyama, Joe
AU  - Guyette, Francis X.
Y1  - 2018/03//Mar/Apr2018
N1  - Accession Number: 128375746. Language: English. Entry Date: 20180315. Revision Date: 20180315. Publication Type: Article; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Prehospital Care -- Adverse Effects
KW  - Occupational Exposure
KW  - Occupational Safety
KW  - Fentanyl -- Pharmacokinetics
KW  - United States
KW  - Skin
KW  - Absorption
KW  - Protective Clothing -- Utilization
SP  - 157
EP  - 162
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 22
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Ultra-potent opioids (fentanyl, carfentanil) are now widely available and fueling an epidemic of overdose. First responders are increasingly exposed to these potent narcotics necessitating guidance for scene safety and force protection from medical directors. Reports in lay media have sensationalized accounts of exposure and harm that may lead providers to fear providing care to patients suspected of opioid overdose. The likelihood of prehospital providers suffering ill effects from opioid exposure during routine emergency medical services (EMS) operations is extremely low. We propose recommendation to assist medical directors in providing guidance and education to their providers minimizing the risk of provider exposure while allowing the delivery of prompt and appropriate care to patients with suspected overdose.
SN  - 1090-3127
AD  - Received July 6, 2016 from University of Pittsburgh, Emergency Medicine, Division of Toxicology, Pittsburgh, Pennsylvania (MJL); University of Pittsburgh, Emergency Medicine, Pittsburgh, Pennsylvania (JS); University of Pittsburgh, Emergency Medicine, Division of EMS, Pittsburgh, Pennsylvania (FXG). Revision received June 25, 2017; accepted for publication June 25, 2017
DO  - 10.1080/10903127.2017.1367446
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128044588
T1  - Features of prescription drug monitoring programs associated with reduced rates of prescription opioid-related poisonings.
AU  - Pauly, N.J.
AU  - Slavova, S.
AU  - Delcher, C.
AU  - Freeman, P.R.
AU  - Talbert, J.
Y1  - 2018/03//
N1  - Accession Number: 128044588. Language: English. Entry Date: In Process. Revision Date: 20180320. Publication Type: journal article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: UL1 TR001998/TR/NCATS NIH HHS/United States. NLM UID: 7513587. 
SP  - 26
EP  - 32
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 184
PB  - Elsevier B.V.
AB  - Background: The United States is in the midst of an opioid epidemic. In addition to other system-level interventions, all states have responded during the crisis by implementing prescription drug monitoring programs (PDMPs). This study examines associations between specific administrative features of PDMPs and changes in the risk of prescription opioid-related poisoning (RxORP) over time.Methods: This longitudinal, observational study utilized a 'natural experiment' design to assess associations between PDMP features and risk of RxORP in a nationally-representative population of privately-insured adults from 2004 to 2014. Administrative health claims data were used to identify inpatient hospital admissions and emergency department visits related to RxORP. Generalized estimating equation Poisson regression models were used to examine associations between specific PDMP features and changes in relative risk (RR) of RxORP over time.Results: In adjusted analyses, states without PDMPs experienced an average annual increase in the rate of RxORP of 9.51% over the study period, while states with operational PDMPs experienced an average annual increase of 3.17%. The increase in RR of RxORP over time in states with operational PDMPs was significantly less than increases in states without PDMPs. States with specific features, including those that monitored more schedules or required more frequent data reporting, experienced stronger protective effects on the RR of RxORP over time.Conclusion: This study examined associations between specific PDMP features and RxORP rates in a nationally-representative population of privately-insured adults. Results of this study may be used as empirical evidence to guide PDMP best practices.
SN  - 0376-8716
AD  - Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, 789 South Limestone, Lexington, KY 40536, United States
AD  - Department of Biostatistics, University of Kentucky College of Public Health, 333 Waller Avenue, Suite 242, Lexington, KY 40504, United States
AD  - Department of Health Outcomes and Policy, University of Florida, 2004 Mowry Road, Suite 2237, P.O. Box 100177, Gainesville, FL 32610, United States
U2  - PMID: 29402676.
DO  - 10.1016/j.drugalcdep.2017.12.002
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127943321
T1  - 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.
AU  - Peckham, Alyssa M.
AU  - Fairman, Kathleen A.
AU  - Sclar, David A.
Y1  - 2018/02//
N1  - Accession Number: 127943321. Language: English. Entry Date: In Process. Revision Date: 20180228. Publication Type: journal article. Journal Subset: Australia & New Zealand; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 9002928. 
SP  - 213
EP  - 228
JO  - Drug Safety
JF  - Drug Safety
JA  - DRUG SAF
VL  - 41
IS  - 2
PB  - Springer Science & Business Media B.V.
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.
SN  - 0114-5916
AD  - Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, 19555 N. 59th Avenue, 85308, Glendale, AZ, USA
U2  - PMID: 28956286.
DO  - 10.1007/s40264-017-0595-1
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123428944
T1  - Opioid analgesic administration in patients with suspected drug use.
AU  - Giorio Dutra Kreling, Maria Clara
AU  - Andrucioli De Mattos-Pimenta, Cibele
Y1  - 2017/05//mai/jun2017
N1  - Accession Number: 123428944. Language: English. Entry Date: 20170708. Revision Date: 20170708. Publication Type: Article; research; tables/charts. Journal Subset: Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Mexico & Central/South America; Nursing; Peer Reviewed. Grant Information: This research received financial support from the National Council for Scientific and Technological Development.. NLM UID: 7910105. 
KW  - Nursing Staff, Hospital
KW  - Judgment
KW  - Substance Abuse
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Human
KW  - Cross Sectional Studies
KW  - Chi Square Test
KW  - Fisher's Exact Test
KW  - Prevalence
KW  - Descriptive Statistics
KW  - Pain -- Drug Therapy
KW  - Academic Medical Centers
KW  - Brazil
KW  - Interviews
KW  - Inpatients
KW  - Adolescence
KW  - Data Analysis Software
KW  - Nonparametric Statistics
KW  - Mann-Whitney U Test
KW  - Female
KW  - Male
KW  - Adult
KW  - Middle Age
KW  - Funding Source
SP  - 626
EP  - 632
JO  - Revista Brasileira de Enfermagem
JF  - Revista Brasileira de Enfermagem
JA  - REV BRASIL ENFERMAGEM
VL  - 70
IS  - 3
PB  - Associacao Brasileira de Enfermagem
AB  - Objective: To identify the prevalence of patients suspected of drug use according to the nursing professionals' judgement, and compare the behavior of these professionals in opioid administration when there is or there is no suspicion that patient is a drug user. Method: A cross-sectional study with 507 patients and 199 nursing professionals responsible for administering drugs to these patients. The Chi-Square test, Fisher's Exact and a significance level of 5% were used for the analyzes. Results: The prevalence of suspected patients was 6.7%. The prevalence ratio of administration of opioid analgesics 'if necessary' is twice higher among patients suspected of drug use compared to patients not suspected of drug use (p = 0.037). Conclusion: The prevalence of patients suspected of drug use was similar to that of studies performed in emergency departments. Patients suspected of drug use receive more opioids than patients not suspected of drug use.:.
AB  - Objetivo: Identificar la prevalencia de pacientes con sospecha de uso de drogas de acuerdo con la opinión de los profesionales de enfermería y comparar el comportamiento de estos profesionales en la administración de opioides cuando hay o no hay sospecha de que el paciente sea un consumidor de drogas. Método: Estudio transversal con 507 pacientes y 199 enfermeras responsables de la administración de medicamentos a estos pacientes. Para el análisis se utilizó la prueba de Chi-cuadrado, la prueba exacta de Fisher y un nivel de significación del 5%. Resultados: La prevalencia de pacientes con sospecha de uso de drogas fue del 6,7%. La razón de prevalencia de la administración de analgésicos opioides 'si es necesario' es dos veces mayor entre los pacientes con sospecha de uso de drogas en comparación a las personas sin sospecha de uso de drogas (p = 0,037). Conclusión: La prevalencia de los sospechosos fue similar a los estudios llevados a cabo en los servicios de urgencias. Los pacientes sospechosos de uso de drogas reciben más opioides que los no sospechosos.
AB  - Objetivo: Identificar a prevalência de pacientes com suspeita de uso de drogas conforme opinião de profissionais de enfermagem e comparar a conduta desses profissionais na administração de opioides quando há ou não suspeita de que o paciente seja usuário de drogas. Método: Estudo transversal com 507 pacientes e 199 profissionais de enfermagem responsáveis pela administração de medicamentos a esses pacientes. Para as análises foram utilizados os testes de Qui-Quadrado, Exato de Fisher e um nível de significância de 5%. Resultados: A prevalência de pacientes suspeitos foi 6,7%. A razão de prevalência de administração de analgésicos opioides "se necessário" é duas vezes maior entre os pacientes suspeitos em relação aos não suspeitos (p = 0,037). Conclusão: A prevalência de suspeitos foi semelhante à de estudos realizados em departamentos de emergência. Os suspeitos de serem usuários de drogas recebem mais opioides do que os não suspeitos.
SN  - 0034-7167
AD  - Universidade de São Paulo, School of Nursing, Postgraduate Program in Nursing in Adult Health. São Paulo, Brazil
DO  - 10.1590/0034-7167-2016-0501
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122576083
T1  - Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department.
AU  - Rowe, Christopher
AU  - Vittinghoff, Eric
AU  - Santos, Glenn-Milo
AU  - Behar, Emily
AU  - Turner, Caitlin
AU  - Coffin, Phillip O.
Y1  - 2017/04//
N1  - Accession Number: 122576083. Language: English. Entry Date: 20170424. Revision Date: 20180402. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Emergency Service
KW  - Analgesics, Opioid
KW  - Overdose -- Epidemiology -- United States
KW  - International Classification of Diseases -- Utilization
KW  - Coding -- Utilization
KW  - Instrument Validation
KW  - Human
KW  - United States
KW  - Sensitivity and Specificity
KW  - Descriptive Statistics
KW  - Record Review
KW  - Logistic Regression
KW  - California
KW  - Confidence Intervals
KW  - P-Value
SP  - 475
EP  - 483
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 24
IS  - 4
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objectives Opioid overdose mortality has tripled in the United States since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease ( ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events. The present study aimed to validate the use of ICD, 9th revision, Clinical Modification ( ICD-9- CM) codes in identifying opioid overdose events in the emergency department ( ED) by examining multiple performance measures, including sensitivity and specificity. Methods Data on ED visits from January 1, 2012, to December 31, 2014, including clinical determination of whether the visit constituted an opioid overdose event, were abstracted from electronic medical records for patients prescribed long-term opioids for pain from any of six safety net primary care clinics in San Francisco, California. Combinations of ICD-9- CM codes were validated in the detection of overdose events as determined by medical chart review. Both sensitivity and specificity of different combinations of ICD-9- CM codes were calculated. Unadjusted logistic regression models with robust standard errors and accounting for clustering by patient were used to explore whether overdose ED visits with certain characteristics were more or less likely to be assigned an opioid poisoning ICD-9- CM code by the documenting physician. Results Forty-four (1.4%) of 3,203 ED visits among 804 patients were determined to be opioid overdose events. Opioid-poisoning ICD-9- CM codes (E850.2-E850.2, 965.00-965.09) identified overdose ED visits with a sensitivity of 25.0% (95% confidence interval [ CI] = 13.6% to 37.8%) and specificity of 99.9% (95% CI = 99.8% to 100.0%). Expanding the ICD-9- CM codes to include both nonspecified and general (i.e., without a decimal modifier) drug poisoning and drug abuse codes identified overdose ED visits with a sensitivity of 56.8% (95% CI = 43.6%-72.7%) and specificity of 96.2% (95% CI = 94.8%-97.2%). Additional ICD-9- CM codes not explicitly relevant to opioid overdose were necessary to further enhance sensitivity. Among the 44 overdose ED visits, neither naloxone administration during the visit, whether the patient responded to the naloxone, nor the specific opioids involved were associated with the assignment of an opioid poisoning ICD-9- CM code (p ≥ 0.05). Conclusions Tracking opioid overdose ED visits by diagnostic coding is fairly specific but insensitive, and coding was not influenced by administration of naloxone or the specific opioids involved. The reason for the high rate of missed cases is uncertain, although these results suggest that a more clearly defined case definition for overdose may be necessary to ensure effective opioid overdose surveillance. Changes in coding practices under ICD-10 might help to address these deficiencies.
SN  - 1069-6563
AD  - Center for Public Health Research, San Francisco Department of Public Health
AD  - School of Medicine, Department of Epidemiology and Biostatistics
AD  - School of Nursing, Department of Community Health Systems
AD  - Department of Global Health Sciences
AD  - School of Medicine, Division of HIV, ID, and Global Health, University of California San Francisco
DO  - 10.1111/acem.13121
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124746720
T1  - Effect Of A "No Superuser Opioid Prescription" Policy On ED Visits And Statewide Opioid Prescription.
AU  - Kahler, Zachary P.
AU  - Musey, Paul I.
AU  - Schaffer, Jason T.
AU  - Johnson, Annelyssa N.
AU  - Strachan, Christian C.
AU  - Shufflebarger, Charles M.
Y1  - 2017/08//
N1  - Accession Number: 124746720. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Chronic Pain
KW  - Resource Allocation
KW  - Electronic Health Records
KW  - Emergency Service
KW  - Case Management
KW  - Mann-Whitney U Test
KW  - Randomized Controlled Trials
KW  - Data Analysis
KW  - Child
KW  - Inpatients
KW  - Record Review
KW  - Descriptive Statistics
KW  - Random Sample
KW  - Outpatients
KW  - Prospective Studies
KW  - Study Design
KW  - Paired T-Tests
KW  - Unpaired T-Tests
KW  - Data Collection
KW  - Median Test
KW  - Reliability
KW  - Interviews
KW  - Scales
SP  - 894
EP  - 902
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 18
IS  - 5
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Introduction: The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department-(ED) based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol's effect on superusers' annual ED visits. Secondary outcomes included a quantitative evaluation of statewide opioid prescriptions for these patients, unique prescribers of controlled substances, and ancillary testing. Methods: Patients were referred to the program with the following inclusion criteria: = 6 visits per year to the ED; at least one visit identified by the attendi ng physician as primarily driven by opioid-seeking behavior; and a review by a committee comprising ED administration and case management. Patients were referred to a pain management clinic and informed that they would no longer receive opioid prescriptions from visits to the ED for chronic pain complaints. Electronic medical record (EMR) alerts notified ED providers of the patient's referral at subsequent visits. We analyzed one year of data pre- and post-referral. Results: A total of 243 patients had one year of data post-referral for analysis. Median annual ED visits decreased from 14 to 4 (58% decrease, 95% CI [50 to 66]). We also found statistically significant decreases for these patients' state prescription drug monitoring program (PDMP) opioid prescriptions (21 to 13), total unique controlled-substance prescribers (11 to 7), computed tomography imaging (2 to 0), radiographs (5 to 1), electrocardiograms (12 to 4), and labs run (47 to 13). Conclusion: This program and the EMR-based alerts were successful at decreasing local ED visits, annual opioid prescriptions, and hospital resource allocation for this population of patients. There is no evidence that these patients diverted their visits to neighboring EDs after being informed that they would not receive opioids at this hospital, as opioid prescriptions obtained by these patients decreased on a statewide level. This implies that individual ED protocols can have significant impact on the behavior of patients.
SN  - 1936-900X
AD  - Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
AD  - University of South Carolina, Greenville School of Medicine, Department of Emergency Medicine, Greenville, South Carolina
AD  - Indiana University Health Methodist Hospital, Indianapolis, Indiana
DO  - 10.5811/westjem.2017.6.33414
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104710204
T1  - No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose.
AU  - Wampler, David A.
AU  - Molina, D. Kimberley
AU  - McManus, John
AU  - Laws, Philip
AU  - Manifold, Craig A.
Y1  - 2011/07//Jul-Sep2011
N1  - Accession Number: 104710204. Language: English. Entry Date: 20110701. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Diagnosis
KW  - Transportation of Patients -- Methods
KW  - Treatment Refusal -- Methods
KW  - Demography
KW  - Emergency Medical Services
KW  - Heroin -- Adverse Effects
KW  - Prehospital Care
KW  - Protocols
KW  - Record Review -- Methods
KW  - Safety
KW  - Substance Abuse
SP  - 320
EP  - 324
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 15
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Introduction. Naloxone is widely used in the treatment and reversal of opioid overdose. Most emergency medical services (EMS) systems administer naloxone by standing order, and titrate only to reverse respiratory depression without fully reversing sedation. Some EMS systems routinely administer sufficient naloxone to fully reverse the effects of opioid overdose. Frequently patients refuse further medical evaluation or intervention, including transport. Objectives. The purpose of this study was to evaluate the safety of this practice and determine whether increased mortality is associated with full reversal of opioids. As a component of a comprehensive quality assurance initiative, we assessed mortality during the 48 hours after patients received naloxone to reverse opioid overdose followed by patient-initiated refusal of transportation. Methods. The setting was a large urban fire-based EMS system. Investigators provided the Bexar County Medical Examiner's Office (MEO) with a list of patients who were treated by the San Antonio Fire Department with naloxone, and not transported. Inclusion criteria were administration of naloxone and patient-initiated refusal. Patient dispositions also included aid only, referral to the MEO, or referral to law enforcement. The list was then compared with the MEO database. A chart review was completed on all patients treated and subsequently presented to the MEO within two days. A secondary time period of 30 days was also assessed. Results. The list identified 592 patients treated with naloxone and not transported to the emergency department. Five-hundred fifty-two patients received naloxone and refused transport or were not transported. The remaining 40 patients all presented to EMS in cardiac arrest, naloxone was administered during the course of resuscitation, and subsequent efforts were terminated in the field. None of the patients receiving naloxone with a subsequent patient-initiated refusal were examined at the MEO within the two-day end point. The 30-day assessment revealed that nine individuals were treated with naloxone and subsequently died, but the shortest time interval between date of service and date of death was four days. Conclusion. The primary outcome was that no patients who were treated with naloxone for opioid overdose and then refused care were examined by the MEO within a 48-hour time frame.
SN  - 1090-3127
AD  - Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
AD  - Bexar County Medical Examiner's Office, San Antonio, Texas
AD  - Brook Army Medical Center, Fort Sam Houston, Texas
AD  - San Antonio Fire Department, San Antonio, Texas
U2  - PMID: 21612385.
DO  - 10.3109/10903127.2011.569854
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 120660127
T1  - Commentary on McAuley et al. (2017): Naloxone programs must reduce marginalization and improve access to comprehensive emergency care.
AU  - M. Orkin, Aaron
AU  - Buchman, Daniel Z.
Y1  - 2017/02//
N1  - Accession Number: 120660127. Language: English. Entry Date: 20170123. Revision Date: 20180201. Publication Type: Opinion; commentary. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Naloxone -- Supply and Distribution -- Scotland
KW  - Overdose -- Education
KW  - Substance Abusers -- Psychosocial Factors -- Scotland
KW  - Health Services Accessibility
KW  - Emergency Care
KW  - Scotland
KW  - Government Programs -- Scotland
KW  - Overdose -- Prevention and Control
SP  - 309
EP  - 310
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 112
IS  - 2
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Effective overdose education and naloxone distribution programs must reduce opioid-related deaths without further stigmatizing and distancing vulnerable and underserved populations from comprehensive health-care services, including emergency care.
SN  - 0965-2140
AD  - Schwartz/Reisman Emergency Medicine Institute, Sinai Health System
AD  - Dalla Lana School of Public Health, University of Toronto
AD  - University Health Network
AD  - Joint Centre for Bioethics, University of Toronto
DO  - 10.1111/add.13662
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126684688
T1  - Risk factors for severe respiratory depression from prescription opioid overdose.
AU  - Fox, Lindsay M.
AU  - Hoffman, Robert S.
AU  - Vlahov, David
AU  - Manini, Alex F.
Y1  - 2018/01//
N1  - Accession Number: 126684688. Language: English. Entry Date: 20171215. Revision Date: 20171221. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Respiration Disorders -- Risk Factors
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Overdose
KW  - Severity of Illness
KW  - Emergency Patients
KW  - Secondary Analysis
KW  - Human
KW  - Female
KW  - Male
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - P-Value
KW  - Confidence Intervals
KW  - Odds Ratio
KW  - Multicenter Studies
KW  - Academic Medical Centers -- New York
KW  - Emergency Service -- New York
KW  - New York
KW  - Adult
KW  - Respiration Disorders -- Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Intubation, Intratracheal
KW  - Age Factors
KW  - Outcomes (Health Care)
KW  - Inpatients
SP  - 59
EP  - 66
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 113
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Background and aims Prescription opioid overdose is a leading cause of injury-related morbidity and mortality in the United States. We aimed to identify characteristics associated with clinical severity in emergency department patients with prescription opioid overdose. Design This was a secondary data analysis of adult prescription opioid overdoses from a large prospective cohort of acute overdoses. We examined elements of a typical emergency department evaluation using a multivariable model to determine which characteristics were associated with clinical severity, specifically severe respiratory depression (SRD). Setting This study was conducted at two urban academic emergency departments in New York City, USA. Participants Adult patients who presented with acute prescription opioid overdose between 2009 and 2013 were included in the current study. We analyzed 307 patients (mean age = 44.7, 42% female, 2.0% mortality). Measurements Patient demographics, reported substances ingested, suspected intent for ingesting the substance, vital signs, laboratory data, treatments including antidotes and intubation and outcome of death were recorded by trained research assistants. Intent was categorized into four mutually exclusive categories: suicide, misuse, therapeutic error and undetermined. The primary outcome was SRD, defined as administration of either (a) naloxone or (b) endotracheal intubation (ETI). Findings A total of 109 patients suffered SRD with 90 patients receiving naloxone alone, nine ETI alone and 10 both naloxone and ETI. The most common opioids were oxycodone ( n = 124) and methadone ( n = 116). Mean age was higher in patients with SRD (51.1 versus 41.1, P < 0.001). Opioid misuse was associated with SRD in the multivariable analysis [odds ratio (OR) = 2.07, 95% confidence interval (CI) = 1.21-3.55]. The unadjusted relative risk of SRD was high for fentanyl (83.3% SRD) and lowest for codeine (3.6% SRD). Conclusion In emergency department patients in the United States with prescription opioid overdose, worse clinical severity was associated with opioid misuse, increased with age and was widely variable, depending on the specific opioid medication involved.
SN  - 0965-2140
AD  - Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine
AD  - Yale School of Nursing
AD  - Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center
DO  - 10.1111/add.13925
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126536547
T1  - NEWS IN BRIEF. Opioids declared a US health emergency.
Y1  - 2017/12//Dec2017/Jan2018
N1  - Accession Number: 126536547. Language: English. Entry Date: 20171207. Revision Date: 20171207. Publication Type: Article; brief item. Supplement Title: Dec2017/Jan2018. Journal Subset: Australia & New Zealand; Nursing; Peer Reviewed. Special Interest: Public Health. NLM UID: 0015376. 
KW  - Substance Use Disorders -- Epidemiology -- United States
KW  - Narcotics -- Poisoning
KW  - Health Policy
KW  - Health Resource Allocation
KW  - United States
SP  - 33
EP  - 33
JO  - Lamp
JF  - Lamp
JA  - LAMP
VL  - 74
IS  - 11
PB  - New South Wales Nurses' Association
AB  - The article reports that U.S. President Donald Trump has ordered the declaration of a public health emergency over opioid epidemic but failed to commit funds.
SN  - 0047-3936
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DP  - EBSCOhost
DB  - ccm
ER  - 

ID  - 126154438
T1  - Opioid vs Nonopioid Acute Pain Management in the Emergency Department.
AU  - Kyriacou, Demetrios N.
Y1  - 2017/11/07/
N1  - Accession Number: 126154438. Language: English. Entry Date: 20171117. Revision Date: 20171207. Publication Type: Editorial; commentary. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Analgesics, Opioid
KW  - Analgesics, Nonnarcotic
KW  - Emergency Service
SP  - 1655
EP  - 1656
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 318
IS  - 17
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - An editorial is presented which addresses various aspects of the use of opioids and nonopioid medications to treat acute pain in hospital emergency room patients, and it mentions an opioid-related drug addition epidemic in the U.S., as well as the therapeutic use of drugs such as oxycodone and hydrocodone. Emergency physicians are examined, along with an article by A.K. Chang and others which appears in the same issue of the journal and deals with the efficacy of nonopioid medications.
SN  - 0098-7484
AD  - Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
U2  - PMID: 29114813.
DO  - 10.1001/jama.2017.16725
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111323455
T1  - Development of an opioid reduction protocol in an emergency department.
AU  - COHEN, VICTOR
AU  - MOTOV, SERGEY
AU  - ROCKOFF, BRADLEY
AU  - SMITH, ANDREW
AU  - FROMM, CHRISTIAN
AU  - BOSOY, DIMITRI
AU  - HOSSAIN, RUKHSANA
AU  - LIKOUREZOS, ANTONIOS
AU  - JELLINEK-COHEN, SAMANTHA P.
AU  - MARSHALL, JOHN
Y1  - 2015/12//12/1/2015
N1  - Accession Number: 111323455. Language: English. Entry Date: 20151204. Revision Date: 20151213. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. Instrumentation: Numeric Pain Rating Scale (NPRS). NLM UID: 9503023. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service
KW  - Pain -- Drug Therapy
KW  - Protocols
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Human
KW  - Pain Measurement
KW  - Scales
KW  - Descriptive Statistics
KW  - Analgesics -- Administration and Dosage
KW  - Ketorolac -- Administration and Dosage
KW  - Ibuprofen -- Administration and Dosage
KW  - New York
KW  - Academic Medical Centers
KW  - Adolescence
KW  - Adult
KW  - Time Factors
KW  - Program Implementation
KW  - Program Evaluation
SP  - 2080
EP  - 2086
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 72
IS  - 23
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - Purpose. Results of a study of an opioid-sparing protocol for acute pain management in the emergency department (ED) are reported. Methods. The ED of a large hospital conducted a project, the "Opioid-Free Shift," to test a multimodal pharmacologic approach to analgesic therapy as an alternative to routine use of opioids. During a specified eight-hour period, all adults arriving at the ED with a complaint of pain were treated according to an opioid-sparing protocol based on principles of channel enzyme receptor-targeted analgesia (CERTA). Pain severity was assessed at baseline and at 30 and 60 minutes after analgesia administration using a validated rating scale. Results. Seventeen patients were treated in the ED for acute or chronic pain during the study period. The median pain score on the 11-point rating scale was 8 (range, 10) at baseline, declining to 6 (range, 0-10) at 30 minutes and to 5 (range, 1-10) at 60 minutes. At 30 minutes, 7 patients [41%) had a pain score reduction of ≥30% and 3 (18%) had a reduction of ≥50%. Six of the 15 patients (40%) reassessed at 60 minutes had a pain score reduction of ≥30%; patients (27%) had a reduction of ≥50%. More than 80% of patients were satisfied with the pain relief provided through the CERTA-based protocol, and no adverse drug reactions were reported. Conclusion. The 17 patients treated for acute or chronic pain during the opioid-free shift were managed mainly with i.v. ketorolac and oral ibuprofen, with only 1 patient requiring rescue opioid therapy
SN  - 1079-2082
AD  - Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY
AD  - Assistant Program Director, Department of Emergency Medicine, Maimonides Medical Center
AD  - Research Fellow, Department of Emergency Medicine, Maimonides Medical Center
AD  - PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center
AD  - Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences
AD  - Director of Emergency Medicine Research, Department of Emergency Medicine, Maimonides Medical Center
AD  - Emergency Medicine Attending, Department of Emergency Medicine, Maimonides Medical Center
AD  - Research Assistant, Department of Emergency Medicine, Maimonides Medical Center
AD  - Research Manager, Department of Emergency Medicine, Maimonides Medical Center
AD  - Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences
AD  - Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York
AD  - Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center
DO  - 10.2146/ajhp140903
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117639912
T1  - Gender Differences in Emergency Department Visits and Detox Referrals for Illicit Drug Use and Nonmedical Use of Opioids.
AU  - Hyeon-Ju Ryoo
AU  - Choo, Esther K.
Y1  - 2016/05//
N1  - Accession Number: 117639912. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Diagnosis, Dual (Psychiatry)
KW  - Street Drugs
KW  - Emergency Service
KW  - Substance Abuse
KW  - Referral and Consultation
KW  - Role Playing
KW  - Female
KW  - Male
SP  - 295
EP  - 301
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 17
IS  - 3
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Introduction: Visits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. Methods: We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient "seeking detox," or patient explicitly requesting for detox referral. Results: Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02-1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15-1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17-1.43]). This significant association prevailed after controlling for "seeking detox." Conclusion: Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are "seeking detox." Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes.
SN  - 1936-900X
AD  - Warren Alpert Medical School of Brown University, Providence, Rhode Island
AD  - Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
DO  - 10.5811/westjem.2016.2.29425
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117639906
T1  - Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing.
AU  - Burton, John H.
AU  - Hoppe, Jason A.
AU  - Echternach, Jeff M.
AU  - Rodgers, Justin M.
AU  - Donato, Michael
Y1  - 2016/05//
N1  - Accession Number: 117639906. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Physicians, Emergency
KW  - Emergency Medicine
KW  - Quality Improvement
KW  - Analgesics, Opioid
KW  - Physicians
SP  - 258
EP  - 263
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 17
IS  - 3
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Introduction: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED); unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI) initiative aimed to reduce variability in ED opioid analgesic prescribing. Methods: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1 : Retrospective baseline period (nine months). Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months). Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2) they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider). Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. Results: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01), and Stage 3 mean 8% (60% reduction, p<0.01). The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01), and 13 pills in Stage 3 (18% reduction, p<0.01). The group mean prescribing rate also decreased through each stage: 20% in Stage 1, 13% in Stage 2 (46% reduction, p<0.01), and 8% in Stage 3 (60% reduction, p<0.01). Conclusion: ED physician opioid prescribing variability can be decreased through the systematic application of sharing of peer prescribing rates and prescriber specific normative feedback.
SN  - 1936-900X
AD  - Carilion Clinic, Department of Emergency Medicine, Roanoke, Virginia
AD  - University of Colorado Denver School of Medicine, Department of Emergency Medicine, Aurora, Colorado
AD  - Rocky Mountain Poison and Drug Center, Denver, Colorado
DO  - 10.5811/westjem.2016.3.29692
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117202950
T1  - Prevalence and Detection of Prescription Opioid Misuse and Prescription Opioid Use Disorder Among Emergency Department Patients 50 Years of Age and Older: Performance of the Prescription Drug Use Questionnaire, Patient Version.
AU  - Beaudoin, Francesca L.
AU  - Merchant, Roland C.
AU  - Clark, Melissa A.
Y1  - 2016/08//
N1  - Accession Number: 117202950. Language: English. Entry Date: 20180211. Revision Date: 20180211. Publication Type: journal article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Screen for Caregiver Burden (SCB); Work Environment Scale (WES) (Moos et al). NLM UID: 9309609. 
KW  - Substance Use Disorders -- Epidemiology
KW  - Substance Use Disorders -- Diagnosis
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Sensitivity and Specificity
KW  - Rhode Island
KW  - Cross Sectional Studies
KW  - Human
KW  - Middle Age
KW  - Male
KW  - Female
KW  - Aged
KW  - ROC Curve
KW  - Chronic Pain -- Drug Therapy
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Scales
SP  - 627
EP  - 636
JO  - American Journal of Geriatric Psychiatry
JF  - American Journal of Geriatric Psychiatry
JA  - AM J GERIATR PSYCHIATRY
VL  - 24
IS  - 8
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Background: Despite increased concern about prescription opioid misuse among older adults, there is limited work examining the best means to identify misuse by older adults. The goal of this investigation was to examine the performance the Prescription Drug Use Questionnaire Patient Version (PDUQp), in detecting prescription opioid misuse and prescription opioid use disorders among adult emergency department (ED) patients aged 50 years and older.Methods: This was a cross-sectional study of a random sample of adult ED patients, aged 50 years and older. All participants were without cognitive impairment and reported prescription opioid use within the past 30 days. We evaluated the sensitivity, specificity, predictive values, and receiver operating characteristics of the PDUQp against a standard definition of opioid misuse and DSM-5 criteria for prescription opioid use disorder.Results: Overall, 112 participants completed the study; 74 were aged 50-64 years and 38 were aged 65 years and older. Over half of the participants satisfied DSM-5 criteria for prescription opioid use disorder, with slightly less participants reporting misuse. Overall, the respective sensitivity and specificity of the PDUQp was: 44% and 79% (Receiver Operating Characteristic [ROC] area under the curve: 0.61) for prescription opioid misuse, 38% and 81% (ROC area under the curve: 0.64) for the presence of any prescription opioid use disorder, and 56% and 75% (ROC area under the curve: 0.71) for moderate to severe prescription opioid use disorder.Conclusions: Based on this preliminary work, the PDUQp may be a viable instrument to screen for prescription opioid misuse and prescription opioid use disorder, but it likely requires modifications to optimize its predictive ability in adults over age 50 years.
SN  - 1064-7481
AD  - Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
AD  - Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
U2  - PMID: 27426210.
DO  - 10.1016/j.jagp.2016.03.010
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126065239
T1  - Prescriptions Written for Opioid Pain Medication in the Veterans Health Administration Between 2000 and 2016.
AU  - Grasso, Michael A.
AU  - Grasso, Clare T.
AU  - Jerrard, David A.
Y1  - 2017/11//Nov/Dec2017
N1  - Accession Number: 126065239. Language: English. Entry Date: 20171117. Revision Date: 20171117. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 101306759. 
KW  - Prescribing Patterns -- Trends
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - United States Department of Veterans Affairs -- Legislation and Jurisprudence
KW  - Human
KW  - Time Factors
KW  - Prospective Studies
KW  - Emergency Service
KW  - Ambulatory Care Facilities
KW  - Pharmacy Service
KW  - Health Education
KW  - Data Analytics
KW  - Practice Guidelines
KW  - Drugs, Prescription
SP  - 483
EP  - 488
JO  - Journal of Addiction Medicine
JF  - Journal of Addiction Medicine
JA  - J ADDICT MED
VL  - 11
IS  - 6
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Objectives: The purpose of this study was to identify national opioid pain medication (OPM) prescribing trends within the Veterans Health Administration (VA), and assess the impact of educational campaigns introduced in 2010 and 2013. Methods: We created a national cohort that documents more than 21 million patient records and 97 million outpatient OPM prescriptions covering a 17-year period. We examined OPM prescriptions in emergency departments, outpatient clinics, and inpatient settings. Results: The cohort accounted for 2.5 billion outpatient clinic visits, 18.9 million emergency department visits, and 12.4 million hospital admissions. The number of OPM prescriptions peaked in 2011, when they were provided during 5% of all outpatient visits and 15% of all emergency department visits. The morphine milligram equivalents (MMEs) peaked in 2014 at almost 17 billion in outpatient clinics and at 137 million in emergency departments. In 2016, OPM prescriptions were down 37% in outpatient clinics and 23% in emergency departments, and MMEs were down 30% in both settings. Prescriptions for hydrocodone and tramadol increased markedly between 2011 and 2015. OPM doses in inpatient settings continued to rise until 2015. Conclusions: We used a large national cohort to study trends in OPM prescriptions within the VA. Educational efforts to reduce the number of OPM prescriptions coincided with these reductions, but were initially associated with an increase in OPM dosage, an increase in the use of tramadol and hydrocodone, and an increase in the use of OPMs in inpatient settings.
SN  - 1932-0620
AD  - University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, MD
AD  - University of Maryland Baltimore County, Department of Computer Science and Electrical Engineering, Baltimore, MD
DO  - 10.1097/ADM.0000000000000352
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128277363
T1  - Sheltering risks: Implementation of harm reduction in homeless shelters during an overdose emergency.
AU  - Wallace, Bruce
AU  - Barber, Katrina
AU  - Pauly, Bernadette (Bernie)
Y1  - 2018/03//
N1  - Accession Number: 128277363. Language: English. Entry Date: In Process. Revision Date: 20180307. Publication Type: journal article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9014759. 
SP  - 83
EP  - 89
JO  - International Journal of Drug Policy
JF  - International Journal of Drug Policy
JA  - INT J DRUG POLICY
VL  - 53
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Background: The current opioid overdose crisis in North America is heightening awareness of the need for and the challenges of implementing harm reduction, notably within complex and diverse settings such as homeless shelters. In this paper, we explore the implementation of harm reduction in homeless shelters during an emerging overdose emergency.Methods: The objective of this qualitative study was to identify and understand micro-environment level factors within emergency shelters responding to homelessness and substance use, and the macro-level influences that produce and sustain structural vulnerabilities. We conducted eight focus groups with a total of 49 participants during an emerging overdose emergency. These included shelter residents (n = 23), shelter staff (n = 13), and harm reduction workers (n = 13).Results: The findings illustrate the challenges of implementing an overdose response when substance use is prohibited onsite, without an expectation of abstinence, and where harm reduction services are limited to the distribution of supplies. In this context, harm reduction is partially implemented and incomplete. Shelters can be a site of risks and trauma for residents and staff due to experiencing, witnessing, and responding to overdoses.Conclusion: The current overdose crisis heightens the challenges of implementing harm reduction, particularly within complex and diverse settings such as homeless shelters. When harm reduction is limited to the distribution of supplies such as clean equipment and naloxone, important principles of engagement and the development of trust necessary to the provision of services are overlooked with negative implications for service users.
SN  - 0955-3959
AD  - School of Social Work, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada
AD  - Social Dimensions of Health, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada
AD  - School of Nursing, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada
U2  - PMID: 29289871.
DO  - 10.1016/j.drugpo.2017.12.011
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125981142
T1  - Achieving the Institute of Medicine’s 6 Aims for Quality in the Midst of the Opioid Crisis: Considerations for the Emergency Department.
AU  - Waszak, Daria L.
AU  - Fennimore, Laura A.
Y1  - 2017/11//
N1  - Accession Number: 125981142. Language: English. Entry Date: 20171202. Revision Date: 20171202. Publication Type: Article. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 7605913. 
KW  - Emergency Care
KW  - Quality of Health Care
KW  - Narcotics
KW  - Substance Abuse
KW  - Overdose
KW  - Emergency Service
KW  - Institute of Medicine (U.S.)
KW  - Goals and Objectives
SP  - 512
EP  - 518
JO  - JEN: Journal of Emergency Nursing
JF  - JEN: Journal of Emergency Nursing
JA  - J EMERG NURS
VL  - 43
IS  - 6
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0099-1767
AD  - Lodi, NJ
AD  - Pittsburgh, PA
DO  - 10.1016/j.jen.2017.05.008
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 127961664
T1  - Trends in opioid prescribing before and after implementation of an emergency department opioid prescribing policy.
AU  - Beaudoin, Francesca L.
AU  - Janicki, Adam
AU  - Zhai, Wanting
AU  - Choo, Esther K.
Y1  - 2018/02//
N1  - Accession Number: 127961664. Language: English. Entry Date: In Process. Revision Date: 20180228. Publication Type: letter. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Grant Information: K23 DA031881/DA/NIDA NIH HHS/United States. NLM UID: 8309942. 
SP  - 329
EP  - 331
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 36
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0735-6757
AD  - The Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States
AD  - The Department of Emergency Medicine, University of Pittsburg, Pittsburg, PA, United States
AD  - The Department of Biostatistics, Brown University, Providence, RI, United States
AD  - The Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States
U2  - PMID: 28760380.
DO  - 10.1016/j.ajem.2017.07.068
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128198877
T1  - What Role Has Emergency Medicine Played in the Opioid Epidemic: Partner in Crime or Canary in the Coal Mine?: March 2018 Annals of Emergency Medicine Journal Club.
AU  - Barrett, Tyler W
AU  - Bellew, Shawna D
Y1  - 2018/03//
N1  - Accession Number: 128198877. Language: English. Entry Date: In Process. Revision Date: 20180228. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - 426
EP  - 428
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 71
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Vanderbilt University Medical Center, Nashville, TN
U2  - PMID: 29458802.
DO  - 10.1016/j.annemergmed.2018.01.033
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125417311
T1  - A retrospective review of unintentional opioid overdose risk and mitigating factors among acutely injured trauma patients.
AU  - Baird, Jannette
AU  - Faul, Mark
AU  - Green, Traci C.
AU  - Howland, Jonathan
AU  - Adams, Charles A.
AU  - George, Ann
AU  - Mello, Michael J.
Y1  - 2017/09//
N1  - Accession Number: 125417311. Language: English. Entry Date: 20180322. Revision Date: 20180413. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); General Health Questionnaire (GHQ). Grant Information: /CC/CDC HHS/United States. NLM UID: 7513587. 
KW  - Overdose -- Epidemiology
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Trauma Centers -- Trends
KW  - Prescriptions, Drug
KW  - Substance Use Disorders -- Drug Therapy
KW  - Retrospective Design
KW  - Overdose -- Drug Therapy
KW  - Middle Age
KW  - Male
KW  - Risk Factors
KW  - Aged
KW  - Aged, 80 and Over
KW  - Young Adult
KW  - Substance Use Disorders -- Diagnosis
KW  - Adolescence
KW  - Human
KW  - Overdose -- Diagnosis
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Substance Use Disorders -- Epidemiology
KW  - Adult
KW  - Female
KW  - Naloxone -- Therapeutic Use
KW  - Patient Discharge -- Trends
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Questionnaires
KW  - Scales
SP  - 130
EP  - 135
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 178
PB  - Elsevier B.V.
AB  - Background: Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primary purpose of this study was to assess the prevalence of substance use and unintentional opioid overdose risk among acutely injured trauma patients, and to examine the frequency and predictors of high opioid dose at discharge.Methods: A retrospective electronic medical record (EMR) review of three-months of data from two Level 1 trauma centers. We assessed the prevalence of substance misuse, unintentional opioid overdose risk, and presence of documentation of clinical strategies to mitigate these risks, such as co-prescription of the opioid agonist naloxone.Results: In total, 352 patient EMRs were examined. Over 40% of the patients reviewed had at least one indication of substance misuse (42.5% [95%CI: 37.3, 47.7]); at least 1 unintentional opioid overdose risk factor was identified in 240 EMR reviewed (68.2% [95%CI: 63.3, 73.1]). Dose of opioid medication was not significantly different for patients with substance misuse versus those without. There was no co-prescription of naloxone for any of the discharged patients.Conclusions: Our results indicate that despite the high rates of substance misuse, the potential for misuse, dependence and unintentional overdose risk from prescribed opioid medications are prevalent among acutely injured trauma patients. Prescribing after acute trauma care should address these risk factors.
SN  - 0376-8716
AD  - Warren Alpert School of Medicine at Brown University, United States
AD  - Centers for Disease Control and Prevention, United States
AD  - Boston University School of Medicine, United States
AD  - Rhode Island Hospital, Division of Trauma and Surgical Critical Care, United States
AD  - University Surgical Associates, United States
AD  - Brown University School of Public Health, United States
U2  - PMID: 28647680.
DO  - 10.1016/j.drugalcdep.2017.04.030
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124137733
T1  - Use of Emergency Department Data to Monitor and Respond to an Increase in Opioid Overdoses in New Hampshire, 2011-2015.
AU  - Daly, Elizabeth R.
AU  - Dufault, Kenneth
AU  - Swenson, David J.
AU  - Lakevicius, Paul
AU  - Metcalf, Erin
AU  - Chan, Benjamin P.
Y1  - 2017/07/02/2017 Supplement 1
N1  - Accession Number: 124137733. Language: English. Entry Date: 20170719. Revision Date: 20170719. Publication Type: Article; research; tables/charts. Supplement Title: 2017 Supplement 1. Journal Subset: Biomedical; Peer Reviewed; Public Health; USA. Grant Information: Thiswork was supported, in part, by the Centers for Disease Controland Prevention, National Syndromic Surveillance Program, and theHospital Preparedness Program and Public Health Emergency Pre-paredness cooperative agreements (grants 1U50OE000065-01 and5U90TP000535-04).. NLM UID: 9716844. 
KW  - Emergency Service
KW  - Data Collection
KW  - Overdose -- Diagnosis
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Human
KW  - Substance Abuse
KW  - New Hampshire
KW  - Geographic Locations
KW  - United States
KW  - Data Analysis -- Methods
KW  - Disease Surveillance
KW  - Fentanyl
KW  - International Classification of Diseases
KW  - Age Factors
KW  - Male
KW  - Female
KW  - Office Visits
KW  - Public Health
KW  - Substance Abusers
KW  - Hospitals
KW  - Access to Information
KW  - Adolescence
KW  - Adult
KW  - Middle Age
KW  - Heroin -- Adverse Effects
KW  - Coding
KW  - Data Analysis Software
KW  - Funding Source
SP  - 73S
EP  - 79S
JO  - Public Health Reports
JF  - Public Health Reports
JA  - PUBLIC HEALTH REP
VL  - 132
PB  - Sage Publications Inc.
AB  - Objectives: Opioid-related overdoses and deaths in New Hampshire have increased substantially in recent years, similar to increases observed across the United States. We queried emergency department (ED) data in New Hampshire to monitor opioid-related ED encounters as part of the public health response to this health problem. Methods: We obtained data on opioid-related ED encounters for the period January 1, 2011, through December 31, 2015, from New Hampshire's syndromic surveillance ED data system by querying for (1) chief complaint text related to the words "fentanyl," "heroin," "opiate," and "opioid" and (2) opioid-related International Classification of Diseases (ICD) codes. We then analyzed the data to calculate frequencies of opioid-related ED encounters by age, sex, residence, chief complaint text values, and ICD codes. Results: Opioid-related ED encounters increased by 70% during the study period, from 3300 in 201 1 to 5603 in 2015; the largest increases occurred in adults aged 18-29 and in males. Of 20994 total opioid-related ED visits, we identified 18 554 (88%) using ICD code alone, 690 (3%) using chief complaint text alone, and 1750 (8%) using both chief complaint text and ICD code. For those encounters identified by ICD code only, the corresponding chief complaint text included varied and nonspecific words, with the most common being "pain" (n = 3335, 18%), "overdose" (n = 1555, 8%), "suicidal" (n = 816, 4%), "drug" (n = 803, 4%), and "detox" (n = 750, 4%). Heroin-specific encounters increased by 827%, from 4% of opioid-related encounters in 201 1 to 24% of encounters in 2015. Conclusions: Opioid-related ED encounters in New Hampshire increased substantially from 201 1 to 2015. Data from New Hampshire's ED syndromic surveillance system provided timely situational awareness to public health partners to support the overall response to the opioid epidemic.
SN  - 0033-3549
AD  - New Hampshire Department of Health and Human Services, Concord, NH, USA
DO  - 10.1177/0033354917707934
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123060251
T1  - The Impact of Prescription Drug Monitoring Programs and Prescribing Guidelines on Emergency Department Opioid Prescribing: A Multi-Center Survey.
AU  - Pomerleau, Adam C.
AU  - Nelson, Lewis S.
AU  - Hoppe, Jason A.
AU  - Salzman, Matthew
AU  - Weiss, Paul S.
AU  - Perrone, Jeanmarie
Y1  - 2017/05//
N1  - Accession Number: 123060251. Language: English. Entry Date: 20170518. Revision Date: 20180327. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 100894201. 
KW  - Emergency Service
KW  - Practice Patterns
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Decision Making, Clinical
KW  - Practice Guidelines -- Utilization
KW  - Multicenter Studies
KW  - Cross Sectional Studies
KW  - Surveys
KW  - Questionnaires
KW  - Chi Square Test
KW  - Descriptive Statistics
KW  - Human
SP  - 889
EP  - 897
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 18
IS  - 5
PB  - Oxford University Press / USA
AB  - Objective. Emergency department (ED) providers are high volume but low quantity prescribers of opioid analgesics (OA). Few studies have examined differences in opioid prescribing decisions specifically among ED providers. The aim of this study was to describe OA prescribing decisions of ED providers at geographically diverse centers, including utilization of prescribing guidelines and prescription drug monitoring programs (PDMP). Methods. This was a multi-center cross-sectional Web-based survey of ED providers who prescribe OA. Respondents were asked about their OA prescribing decisions, their use of PDMPs, and their use of prescribing guidelines. Data was analyzed using descriptive statistics and chi-square tests of association were used to assess the relationship between providers' opioid prescribing decisions and independent covariates. Results. The total survey population was 957 individuals and 515 responded to the survey for an overall response rate of 54%. The frequency of respondents who prescribed different types of pain medication was variable between centers. Fifty-nine percent (219/ 369) of respondents were registered to access a PDMP, and 5% (18/369) were not aware whether their state had a PDMP. Forty percent (172/426) of respondents used OA prescribing guidelines, while 24% (103/426) did not, and 35% (151/426) were unaware of prescribing guidelines. Sixteen percent (68/439) of respondents indicated they have prescribed OA to expedite patient discharge, and 12% (54/439) to improve patient satisfaction. No significant differences in OA prescribing decisions were found between groups either by use of PDMP or by guideline adherence. Conclusions. In this multi-center survey study of ED clinicians, OA prescribing decisions varied between centers and found some providers occasionally prescribe OA for non-medical reasons including expediting ED discharge and increasing patient satisfaction. The utilization of prescribing guidelines and PDMPs was not associated with differences in OA prescribing decisions.
SN  - 1526-2375
AD  - Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
AD  - Department of Emergency Medicine, New York University School of Medicine, New York
AD  - Department of Emergency Medicine, University of Colorado, Aurora, Colorado
AD  - Rocky Mountain Poison and Drug Center, Denver, Colorado
AD  - Department of Emergency Medicine, Cooper Medical School at Rowan University, Camden, New Jersey
AD  - Rollins School of Public Health, Emory University, Atlanta, Georgia
AD  - Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
DO  - 10.1093/pm/pnw032
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124562584
T1  - Impact of Hospital 'Best Practice' Mandates on Prescription Opioid Dispensing After an Emergency Department Visit.
AU  - Sun, Benjamin C.
AU  - Lupulescu-Mann, Nicoleta
AU  - Charlesworth, Christina J.
AU  - Kim, Hyunjee
AU  - Hartung, Daniel M.
AU  - Deyo, Richard A.
AU  - John McConnell, K.
Y1  - 2017/08//
N1  - Accession Number: 124562584. Language: English. Entry Date: 20170818. Revision Date: 20170818. Publication Type: Article; equations & formulas; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Narcotics -- Therapeutic Use
KW  - Prescriptions, Drug -- Evaluation
KW  - Prescribing Patterns -- Evaluation
KW  - Physicians, Emergency
KW  - Emergency Care
KW  - Medical Practice
KW  - Health Policy
KW  - Washington
KW  - Drug Utilization
KW  - Substance Dependence -- Prevention and Control
KW  - Emergency Service
KW  - Retrospective Design
KW  - Interrupted Time Series Analysis
KW  - Medicaid
KW  - Fee for Service Plans
KW  - Morphine
KW  - Confidence Intervals
KW  - Descriptive Statistics
KW  - Emergency Patients
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Outpatients
KW  - Human
SP  - 905
EP  - 913
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 24
IS  - 8
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objective Washington State mandated seven hospital 'best practices' in July 2012, several of which may affect emergency department ( ED) opioid prescribing and provide a policy template for addressing the opioid prescription epidemic. We tested the hypothesis that the mandates would reduce opioid dispensing after an ED visit. We further assessed for a selective effect in patients with prior risky or chronic opioid use. Methods We performed a retrospective, observational analysis of ED visits by Medicaid fee-for-service beneficiaries in Washington State, between July 1, 2011, and June 30, 2013. We used an interrupted time-series design to control for temporal trends and patient characteristics. The primary outcome was any opioid dispensing within 3 days after an ED visit. The secondary outcome was total morphine milligram equivalents ( MMEs) dispensed within 3 days. Results We analyzed 266,614 ED visits. Mandates were associated with a small reduction in opioid dispensing after an ED visit (-1.5%, 95% confidence interval [ CI] = -2.8% to -0.15%). The mandates were associated with decreased opioid dispensing in 42,496 ED visits by patients with prior risky opioid use behavior (-4.7%, 95% CI = -7.1% to -2.3%) and in 20,238 visits by patients with chronic opioid use (-3.6%, 95% CI = -5.6% to -1.7%). Mandates were not associated with reductions in MMEs per dispense in the overall cohort or in either subgroup. Conclusions Washington State best practice mandates were associated with small but nonselective reductions in opioid prescribing rates. States should focus on alternative policies to further reduce opioid dispensing in subgroups of high-risk and chronic users.
SN  - 1069-6563
AD  - Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University
AD  - Center for Health Systems Effectiveness, Oregon Health and Science University
AD  - College of Pharmacy Oregon State University/Oregon Health and Science University
AD  - Department of Family Medicine, Department of Medicine, Department of Public Health and Preventive Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health and Science University
DO  - 10.1111/acem.13230
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124608669
T1  - A Randomized Controlled Trial of a Citywide Emergency Department Care-Coordination Program to Reduce Prescription Opioid-Related Visits: An Economic Evaluation.
AU  - Murphy, Sean M.
AU  - Howell, Donelle
AU  - McPherson, Sterling
AU  - Grohs, Rebecca
AU  - Roll, John
AU  - Neven, Darin
Y1  - 2017/08//
N1  - Accession Number: 124608669. Language: English. Entry Date: 20171129. Revision Date: 20170903. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: P30 DA040500/DA/NIDA NIH HHS/United States. NLM UID: 8412174. 
SP  - 186
EP  - 194
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 53
IS  - 2
PB  - Pergamon Press - An Imprint of Elsevier Science
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.
SN  - 0736-4679
AD  - Department of Health Policy and Administration, Washington State University, Spokane, Washington
AD  - Program of Excellence in Addictions Research, Washington State University, Spokane, Washington
U2  - PMID: 28410960.
DO  - 10.1016/j.jemermed.2017.02.014
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118034935
T1  - Opioid-related Policies in New England Emergency Departments.
AU  - Weiner, Scott G.
AU  - Raja, Ali S.
AU  - Bittner, Jane C.
AU  - Curtis, Kevin M.
AU  - Weimersheimer, Peter
AU  - Hasegawa, Kohei
AU  - Espinola, Janice A.
AU  - Camargo, Carlos A.
Y1  - 2016/09//
N1  - Accession Number: 118034935. Language: English. Entry Date: 20160916. Revision Date: 20170901. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Policy Making
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Emergency Service
KW  - New England
KW  - Emergency Medicine
KW  - Substance Abuse -- Prevention and Control
KW  - United States
KW  - Disease Outbreaks
KW  - Practice Guidelines
KW  - Physicians, Emergency
KW  - Human
KW  - Government Regulations
KW  - Surveys
KW  - Patient Assessment
KW  - Urban Areas
KW  - Recovery
KW  - Substance Abusers -- Evaluation
KW  - Confidence Intervals
KW  - Electronic Health Records
KW  - Data Analysis
KW  - Fisher's Exact Test
KW  - Kruskal-Wallis Test
SP  - 1086
EP  - 1090
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 23
IS  - 9
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objectives The opioid abuse and overdose epidemic in the United States has led to the need for new practice policies to guide clinicians. We describe implementation of opioid-related policies in emergency departments ( EDs) in New England to gauge progress and determine where further work is needed. Methods This study analyzed data from the 2015 National Emergency Department Inventory-New England survey. The survey queried directors of every ED ( n = 195) in the six New England states to determine the implementation of five specific policies related to opioid management. ED characteristics (e.g., annual visits, location, and admission rates) were also obtained and a multivariable analysis was conducted to identify ED characteristics independently associated with the number of opioid-related policies implemented. Results Overall, 169 EDs (87%) responded, with a >80% response rate in each state. Implementation of opioid-related policies varied as follows: 1) use of a screening tool for patients with suspected prescription opioid abuse potential ( n = 30, 18%), 2) access state prescription drug monitoring program ( PDMP) before prescribing opioids ( n = 132, 78%), 3) notify the primary opioid prescriber when prescribing opioids for ED patients with chronic pain ( n = 69, 41%), 4) refer patients with opioid abuse to recovery resources ( n = 117, 70%), and 5) prescribe naloxone to patients at risk of opioid overdose after ED discharge ( n = 19, 12%). EDs located in metropolitan areas and with at least one attending physician on duty 24/7 were less likely to implement opioid policies (incident rate ratio [ IRR] = 0.65, 95% confidence interval [ CI] = 0.48-0.89; and IRR = 0.78, 95% CI = 0.6-1.0, respectively) while EDs with ≥15% hospitalization rate that used electronic computerized medication ordering and those in Rhode Island were more likely to implement opioid policies ( IRR = 1.23, 95% CI = 1.03-1.48; IRR = 1.95, 95% CI = 1.19-3.22; and IRR = 1.30, 95% CI = 1.08-1.56, respectively). Conclusions The implementation of opioid-related policies varies among New England EDs. The presence of policies recommending use of screening tools and prescribing naloxone for at-risk patients was low, whereas those regarding utilization of the PDMP and referral of patients with opioid abuse to recovery resources were more common. These data provide important benchmarks for future evaluations and recommendations.
SN  - 1069-6563
AD  - Department of Emergency Medicine, Brigham and Women's Hospital Harvard Medical School
AD  - Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School
AD  - Section of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth
AD  - Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center University of Vermont College of Medicine
DO  - 10.1111/acem.12992
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 115549452
T1  - A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose.
AU  - Bohnert, Amy S.B.
AU  - Bonar, Erin E.
AU  - Cunningham, Rebecca
AU  - Greenwald, Mark K.
AU  - Thomas, Laura
AU  - Chermack, Stephen
AU  - Blow, Frederic C.
AU  - Walton, Maureen
Y1  - 2016/06//
N1  - Accession Number: 115549452. Language: English. Entry Date: 20171007. Revision Date: 20180127. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. Instrumentation: Arthritis Impact Measurement Scale (AIMS) (Meenan); Impact of Events Scale (IES); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 7513587. 
KW  - Motivational Interviewing -- Methods
KW  - Emergency Service
KW  - Drug Therapy
KW  - Overdose -- Therapy
KW  - Substance Use Disorders -- Therapy
KW  - Early Intervention -- Methods
KW  - Adult
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Female
KW  - Substance Use Disorders -- Diagnosis
KW  - Self Report
KW  - Pilot Studies
KW  - Middle Age
KW  - Risk Factors
KW  - Substance Use Disorders -- Psychosocial Factors
KW  - Overdose -- Psychosocial Factors
KW  - Risk Taking Behavior
KW  - Drug Therapy -- Psychosocial Factors
KW  - Male
KW  - Prospective Studies
KW  - Overdose -- Diagnosis
KW  - Human
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Randomized Controlled Trials
KW  - Arthritis Impact Measurement Scales
KW  - Impact of Events Scale
KW  - Scales
SP  - 40
EP  - 47
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 163
PB  - Elsevier B.V.
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.
SN  - 0376-8716
AD  - Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA
AD  - VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA
AD  - University of Michigan Injury Center, University of Michigan Medical School, 2800 Plymouth Rd., Bldg. 10, Ann Arbor, MI 48109, USA
AD  - Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA
AD  - Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
AD  - Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
AD  - Department of Psychiatry and Behavioral Neurosciences, and Department of Pharmacy Practice, 3901Chrysler Service Drive, Suite 2A, Wayne State University, Detroit, MI 48201, USA
U2  - PMID: 27062245.
DO  - 10.1016/j.drugalcdep.2016.03.018
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127480993
T1  - Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management - White Paper 2017.
AU  - Yin Fan, Arthur
AU  - Miller, David W.
AU  - Bolash, Bonnie
AU  - Bauer, Matthew
AU  - McDonald, John
AU  - Faggert, Sarah
AU  - Hongjian He
AU  - Yong Ming Li
AU  - Matecki, Amy
AU  - Camardella, Lindy
AU  - Koppelman, Mel Hopper
AU  - Stone, Jennifer A. M.
AU  - Meade, Lindsay
AU  - Pang, John
Y1  - 2018///Winter2018
N1  - Accession Number: 127480993. Language: English. Entry Date: 20180207. Revision Date: 20180207. Publication Type: Article; pictorial; tables/charts. Journal Subset: Alternative/Complementary Therapies. 
KW  - Acupuncture
KW  - Analgesics, Opioid
KW  - Substance Dependence -- Prevention and Control
KW  - Medical Practice, Evidence-Based
KW  - Cost Benefit Analysis
KW  - Health Services Accessibility
KW  - Pain -- Therapy
KW  - Pain Management
KW  - United States
KW  - Health Care Costs
KW  - Insurance Coverage
KW  - United States Department of Veterans Affairs
KW  - Military Medicine
KW  - Safety
KW  - Treatment Outcomes
KW  - Analgesia
KW  - Chronic Pain -- Therapy
KW  - Neuronal Plasticity
KW  - Coping
KW  - Substance Abuse -- Therapy
SP  - 13
EP  - 52
JO  - Meridians: The Journal of Acupuncture & Oriental Medicine
JF  - Meridians: The Journal of Acupuncture & Oriental Medicine
VL  - 5
IS  - 1
CY  - Sacramento, California
PB  - Meridians: The Journal of Acupuncture & Oriental Medicine
AB  - The United States is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture's cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfill these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
SN  - 2377-3723
AD  - The American TCM Association, Vienna, VA 22182, USA
AD  - The American Society of Acupuncturists, Chicago, IL 60618, USA
AD  - The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA
AD  - Pacific College of Oriental Medicine, Chicago, IL 60601, USA
AD  - The Acupuncture Now Foundation, La Verne, CA 91750, USA
AD  - The Acupuncture Evidence Project, Providence, RI 02860, USA
AD  - The Acupuncture Society of Virginia, Vienna, VA 22182, USA
AD  - The National Federation of Chinese TCM Organizations, New York, NY 11501, USA
AD  - The American Alliance for Professional Acupuncture Safety, Greenwich, CT 06878, USA
AD  - The American Traditional Chinese Medicine Society, New York, NY 11501, USA
AD  - Highland Hospital, Alameda Health System, Oakland, CA 94602, USA
AD  - Indiana University School of Medicine, Indianapolis, IN 46202, USA
AD  - University of California, San Diego School of Medicine, San Diego, CA 92093, USA
DO  - 10.1016/S2095-4964(17)60378-9
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122979973
T1  - Opioid overdose prevention training with naloxone, an adjunct to basic life support training for first-year medical students.
AU  - Berland, Noah
AU  - Fox, Aaron
AU  - Tofighi, Babak
AU  - Hanley, Kathleen
Y1  - 2017/04//Apr-Jun2017
N1  - Accession Number: 122979973. Language: English. Entry Date: 20170523. Revision Date: 20170523. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8808537. 
KW  - Overdose -- Prevention and Control
KW  - Naloxone
KW  - Students, Medical
KW  - Drugs, Prescription -- Adverse Effects
KW  - Emergency Care -- Education
KW  - Human
KW  - Substance Abuse
SP  - 123
EP  - 128
JO  - Substance Abuse
JF  - Substance Abuse
JA  - SUBST ABUSE
VL  - 38
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background: Opioid overdose deaths have reached epidemic proportions in the United States. This problem stems from both licit and illicit opioid use. Prescribing opioids, recognizing risky use, and initiating prevention, including opioid overdose prevention training (OOPT), are key roles physicians play. The American Heart Association (AHA) modified their basic life support (BLS) algorithms to consider naloxone in high-risk populations and when a pulse is appreciated; however, the AHA did not provide OOPT. The authors' intervention filled this training deficiency by teaching medical students opioid overdose resuscitation with a Train-the-Trainer model as part of mandatory BLS training.Methods: The authors introduced OOPT, following a Train-the-Trainer model, into the required basic life support (BLS) training for first-year medical students at a single medical school in a large urban area. The authors administered pre- and post-evaluations to assess the effects of the training on opioid overdose knowledge, self-reported preparedness to respond to opioid overdoses, and attitudes towards patients with substance use disorders (SUDs).Results: In the fall 2014, 120 first-year medical students received OOPT. Seventy-three students completed both pre- and posttraining evaluations. Improvements in knowledge about and preparedness to respond to opioid overdoses were statistically significant (P< .01) and large (Cohen'sD= 2.70 and Cohen'sD= 2.10, respectively). There was no statistically significant change in attitudes toward patients with SUDs.Conclusions: The authors demonstrated the effectiveness of OOPT as an adjunct to BLS in increasing knowledge about and preparedness to respond to opioid overdoses; improving attitudes toward patients with SUDs likely requires additional intervention. The authors will characterize knowledge and preparedness durability, program sustainability, and long-term changes in attitudes in future evaluations. These results support dissemination of OOPT as a part of BLS training for all medical students, and potentially all BLS providers.
SN  - 0889-7077
AD  - New York University School of Medicine, New York, New York, USA
AD  - Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
AD  - Department of Population Health, New York University School of Medicine, New York, New York, USA
AD  - Department of Medicine, New York University School of Medicine, New York, New York, USA
AD  - Primary Care Residency Program, New York University School of Medicine, New York, New York, USA
DO  - 10.1080/08897077.2016.1275925
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 114436455
T1  - Emergency Department-based Opioid Harm Reduction: Moving Physicians From Willing to Doing.
AU  - Samuels, Elizabeth A.
AU  - Dwyer, Kristin
AU  - Mello, Michael J.
AU  - Baird, Janette
AU  - Kellogg, Adam R.
AU  - Bernstein, Edward
Y1  - 2016/04//
N1  - Accession Number: 114436455. Language: English. Entry Date: 20160412. Revision Date: 20170403. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Emergency Service
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Physicians, Emergency
KW  - Emergency Medicine
KW  - Human
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Physicians, Emergency -- Evaluation
KW  - Surveys
KW  - Medical Practice
KW  - Physician Attitudes -- Evaluation
KW  - Social Media
KW  - Behavior
KW  - Linear Regression
KW  - Overdose -- Diagnosis
KW  - Death
KW  - Heroin -- Adverse Effects
KW  - Cross Sectional Studies
KW  - Internship and Residency
KW  - Research Subject Recruitment
KW  - Questionnaires
KW  - Interns and Residents
KW  - Prescribing Patterns
KW  - Confidence
KW  - Health Knowledge
KW  - Data Analysis
KW  - Data Analysis Software
KW  - Confidence Intervals
SP  - 455
EP  - 465
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 23
IS  - 4
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
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.
SN  - 1069-6563
AD  - Department of Emergency Medicine, Brown University
AD  - Department of Emergency Medicine, Boston Medical Center
AD  - Department of Emergency Medicine, Baystate Medical Center
DO  - 10.1111/acem.12910
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112544140
T1  - Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder.
AU  - Rathlev, Niels
AU  - Almomen, Reda
AU  - Deutsch, Ashley
AU  - Smithline, Howard
AU  - Haiping Li
AU  - Visintainer, Paul
Y1  - 2016/01//
N1  - Accession Number: 112544140. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; care plan; research; tables/charts; randomized controlled trial. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Electronic Health Records
KW  - Emergency Service
KW  - Magnetic Resonance Imaging
KW  - Patient Discharge
KW  - Caring
KW  - Randomized Controlled Trials
KW  - Inpatients
KW  - Fisher's Exact Test
KW  - Systematic Review
KW  - Study Design
KW  - Repeated Measures
KW  - Confidence Intervals
KW  - Data Analysis
KW  - Prospective Studies
KW  - Clinical Trials
KW  - Effect Size
KW  - Record Review
KW  - Data Collection
KW  - Surveys
KW  - Regression
SP  - 28
EP  - 34
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 17
IS  - 1
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
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.
SN  - 1936-900X
AD  - Baystate Medical Center and Tufts University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts
AD  - ARAMCO, Department of Emergency Medicine, Dharan, Saudi Arabia
AD  - Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts
AD  - Baystate Medical Center, Department of Academic Affairs Administration, Springfield, Massachusetts
DO  - 10.5811/westjem.2015.11.28319
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121904927
T1  - The development and feasibility of a pharmacy-delivered opioid intervention in the emergency department.
AU  - Winstanley, Erin L.
AU  - Mashni, Rebecca
AU  - Schnee, Sydney
AU  - Miller, Nate
AU  - Mashni, Susan M.
Y1  - 2017/03/02/2017 Supplement
N1  - Accession Number: 121904927. Language: English. Entry Date: 20170910. Revision Date: 20170910. Publication Type: journal article. Supplement Title: 2017 Supplement. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: General Health Questionnaire (GHQ); Behavior Rating Inventory of Executive Function (BRIEF). Grant Information: U54 GM104942/GM/NIGMS NIH HHS/United States. NLM UID: 101176252. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Overdose -- Prevention and Control
KW  - Pharmacy Service -- Administration
KW  - Pharmacists -- Administration
KW  - Emergency Service
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Pilot Studies
KW  - Attitude to Health
KW  - Counseling -- Methods
KW  - Students, Pharmacy
KW  - Patient Education -- Methods
KW  - Substance Use Disorders -- Prevention and Control
KW  - Substance Use Disorders -- Epidemiology
KW  - Clinical Assessment Tools
KW  - Questionnaires
SP  - S87
EP  - S91
JO  - Journal of the American Pharmacists Association: JAPhA
JF  - Journal of the American Pharmacists Association: JAPhA
JA  - J AM PHARM ASSOC
VL  - 57
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Objectives: To develop a brief intervention and to assess the feasibility of pharmacy-delivered education on opioid safety and overdose prevention in the emergency department.Methods: A convenience sample of patients (n = 102) approached between May and June 2016 at a single community-based suburban emergency department located in the Midwest.Results: The intervention included scripted counseling to be delivered in person and 2 educational brochures. The counseling took approximately 5 minutes, and only 2 patients refused the counseling. All the patients were satisfied with the intervention, and 97.4% of them reported that the counseling improved their knowledge of opioid side effects. The majority of patients thought that their own risk of addiction was significantly less than the general public's risk of addiction when taking opioids.Conclusion: This study provides preliminary evidence that student pharmacists or pharmacists are able to deliver opioid safety and overdose education in the emergency department.
SN  - 1544-3191
AD  - School of Pharmacy and Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV
AD  - Research Assistant, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
AD  - Student Pharmacist, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
AD  - PharmD, Chief Pharmacy Officer, Mercy Health, Cincinnati, OH
U2  - PMID: 28292506.
DO  - 10.1016/j.japh.2017.01.021
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121304423
T1  - Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use.
AU  - Barnett, Michael L.
AU  - Olenski, Andrew R.
AU  - Jena, Anupam B.
Y1  - 2017/02/16/
N1  - Accession Number: 121304423. Language: English. Entry Date: 20170228. Revision Date: 20170820. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Wide Range Achievement Test (WRAT). Grant Information: DP5 OD017897/OD/NIH HHS/United States. NLM UID: 0255562. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Medicine -- Statistics and Numerical Data
KW  - Drug Utilization -- Statistics and Numerical Data
KW  - Female
KW  - Inappropriate Prescribing -- Statistics and Numerical Data
KW  - Wounds and Injuries -- Drug Therapy
KW  - Male
KW  - Chronic Disease
KW  - Medicare
KW  - Middle Age
KW  - Aged
KW  - United States
KW  - Odds Ratio
SP  - 663
EP  - 673
JO  - New England Journal of Medicine
JF  - New England Journal of Medicine
JA  - N ENGL J MED
VL  - 376
IS  - 7
CY  - Waltham, Massachusetts
PB  - New England Journal of Medicine
AB  - Background: Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown.Methods: We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to 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 after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics.Results: Our sample consisted of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers (7.3% vs. 24.1%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses.Conclusions: Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. (Funded by the National Institutes of Health.).
SN  - 0028-4793
AD  - Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston
AD  - Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston
AD  - Department of Health Care Policy, Harvard Medical School, Boston
AD  - Department of Medicine, Massachusetts General Hospital, Boston
AD  - National Bureau of Economic Research, Cambridge, Massachusetts
U2  - PMID: 28199807.
DO  - 10.1056/NEJMsa1610524
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110660002
T1  - Prescription monitoring programs and emergency department visits involving opioids, 2004-2011.
AU  - Maughan, Brandon C.
AU  - Bachhuber, Marcus A.
AU  - Mitra, Nandita
AU  - Starrels, Joanna L.
Y1  - 2015/11//
N1  - Accession Number: 110660002. Language: English. Entry Date: 20160622. Revision Date: 20171003. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: K23DA027719/DA/NIDA NIH HHS/United States. NLM UID: 7513587. 
KW  - Drug and Narcotic Control -- Statistics and Numerical Data
KW  - Inappropriate Prescribing -- Statistics and Numerical Data
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Utilization
KW  - Data Collection
KW  - Female
KW  - Drug and Narcotic Control -- Trends
KW  - Male
KW  - Young Adult
KW  - Hospitals, Urban -- Utilization
KW  - Referral and Consultation -- Trends
KW  - Inappropriate Prescribing -- Trends
KW  - Urban Population
KW  - Middle Age
KW  - Adolescence
KW  - United States
KW  - Utilization Review
KW  - Referral and Consultation -- Utilization
KW  - Human
KW  - Retrospective Design
KW  - Adult
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
SP  - 282
EP  - 288
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 156
PB  - Elsevier B.V.
AB  - Objective: To determine the association between prescription drug monitoring program (PDMP) implementation and emergency department (ED) visits involving opioid analgesics.Methods: Rates of ED visits involving opioid analgesics per 100,000 residents were estimated from the Drug Abuse Warning Network dataset for 11 geographically diverse metropolitan areas in the United States on a quarterly basis from 2004 to 2011. Generalized estimating equations assessed whether implementation of a prescriber-accessible PDMP was associated with a difference in ED visits involving opioid analgesics. Models were adjusted for calendar quarter, metropolitan area, metropolitan area-specific linear time trends, and unemployment rate.Results: Rates of ED visits involving opioid analgesics increased in all metropolitan areas. PDMP implementation was not associated with a difference in ED visits involving opioid analgesics (mean difference of 0.8 visits [95% CI: -3.7 to 5.2] per 100,000 residents per quarter).Conclusions: During 2004-2011, PDMP implementation was not associated with a change in opioid-related morbidity, as measured by emergency department visits involving opioid analgesics. Urgent investigation is needed to determine the optimal PDMP structure and capabilities to improve opioid analgesic safety.
SN  - 0376-8716
AD  - Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
AD  - Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
AD  - Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
AD  - Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
AD  - Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
U2  - PMID: 26454836.
DO  - 10.1016/j.drugalcdep.2015.09.024
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124740320
T1  - Effect of an emergency department opioid prescription policy on prescribing patterns.
AU  - Chacko, Jerel
AU  - Greenstein, Josh
AU  - Ardolic, Brahim
AU  - Berwald, Nicole
Y1  - 2017/09//
N1  - Accession Number: 124740320. Language: English. Entry Date: 20170917. Revision Date: 20170902. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
SP  - 1327
EP  - 1329
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 35
IS  - 9
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Background: Staten Island University Hospital is located in NYC, where the opioid epidemic has resulted in significant mortalities from unintentional overdoses. In 2013 as a response to the rising threat to our community, our Emergency Department (ED) administration adopted a clinical practice policy focused on decreasing the prescription of controlled substances. The effects of this policy on our provider prescription patterns are presented here.Methods: A retrospective chart review of patients prescribed opioids from the ED before and after policy implementation was performed. Dates chosen for analysis was November 1, 2012 through January 31, 2013 and November 1, 2013 through January 31, 2014; these time periods were used to serve as a seasonally comparative group pre and post clinical practice policy implementation. Opioids written for the treatment of cough, and for children under eighteen were excluded from analysis. Patient age, sex, diagnoses, and prescription formulation, strength, and pill number was recorded for each patient receiving an opioid prescription.Results: There was a drop in the total prescriptions from 1756 to 1128 without a change in the average number of pills (12.78 vs 12.44) or average total dose prescribed (69.39 vs 68.98) mg of morphine equivalent per prescription. Additionally, there were sizable reductions in opioid prescriptions written for arthralgias/myalgias, dental pain, soft tissue injuries, and headaches.Conclusion: The opioid clinical policy had a clear effect in decreasing the number of patients prescribed opioids. Such policies may be the key to reducing the epidemic and saving lives from unintentional opioid overdoses.
SN  - 0735-6757
AD  - Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States
U2  - PMID: 28663006.
DO  - 10.1016/j.ajem.2017.06.024
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127425258
T1  - Creating opioid dependence in the emergency department.
AU  - Upadhye, Suneel
Y1  - 2018/01//
N1  - Accession Number: 127425258. Language: English. Entry Date: 20180202. Revision Date: 20180202. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 100893237. 
KW  - Narcotics
KW  - Emergency Service
KW  - Retrospective Design
KW  - Prescriptions, Drug
KW  - Odds Ratio
KW  - Confidence Intervals
SP  - 100
EP  - 103
JO  - CJEM: Canadian Journal of Emergency Medicine
JF  - CJEM: Canadian Journal of Emergency Medicine
JA  - CAN J EMERG MED
VL  - 20
IS  - 1
PB  - Cambridge University Press
SN  - 1481-8035
AD  - Division of Emergency Medicine, McMaster University, Hamilton, ON
DO  - 10.1017/cem.2017.370
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119505882
T1  - Notes from the Field: Pediatric Emergency Department Visits for Buprenorphine/Naloxone Ingestion - United States, 2008-2015.
AU  - Budnitz, Daniel S
AU  - Lovegrove, Maribeth C
AU  - Sapiano, Mathew R P
AU  - Mathew, Justin
AU  - Kegler, Scott R
AU  - Geller, Andrew I
AU  - Hampp, Christian
Y1  - 2016/10/21/
N1  - Accession Number: 119505882. Language: English. Entry Date: In Process. Revision Date: 20170122. Publication Type: journal article. Journal Subset: Biomedical; Public Health; USA. NLM UID: 7802429. 
KW  - Buprenorphine
KW  - Pediatrics
KW  - Naloxone
KW  - Emergency Service -- Utilization
KW  - United States
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Drug Packaging
KW  - Child, Preschool
KW  - Male
KW  - Female
KW  - Eating
KW  - Infant
SP  - 1148
EP  - 1149
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 65
IS  - 41
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
AB  - Expanding access to office-based medication-assisted treatment with buprenorphine/naloxone for opioid dependence is a key part of the national strategy to address the opioid abuse epidemic (1). However, as buprenorphine/naloxone prescribing increased, emergency department (ED) visits and hospitalizations for unsupervised ingestions by young children began to increase, with buprenorphine/naloxone ingestions becoming the most common cause of hospitalization for medication ingestions by young children during 2010-2011 (2). Buprenorphine ingestions might be asymptomatic or can cause drowsiness, vomiting, or respiratory depression, which if untreated can result in death (3). Buprenorphine/naloxone was available only as tablets in multidose child-resistant bottles (Suboxone) until late 2010, when film strips packaged in unit-dose, child-resistant pouches were introduced. In 2013, tablets became available in unit-dose packaging (Zubsolv). Because unit-dose, child-resistant packaging encloses each dose until opened, it might limit unintended ingestions by young children compared with traditional child-resistant bottles that must be resecured after every use (4). This study compared ED visits for pediatric buprenorphine/naloxone ingestions before and after these product packaging/formulation changes.
SN  - 0149-2195
U2  - PMID: 27764078.
DO  - 10.15585/mmwr.mm6541a5
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128370433
T1  - A Practical Approach to Neonatal Opiate Withdrawal Syndrome.
AU  - Devlin, Lori A.
AU  - Davis, Jonathan M.
Y1  - 2018/03/15/
N1  - Accession Number: 128370433. Language: English. Entry Date: 20180330. Revision Date: 20180330. Publication Type: Article. Journal Subset: Biomedical; Double Blind Peer Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8405212. 
KW  - Narcotics -- Economics
KW  - Infant, Newborn
KW  - Substance Withdrawal Syndrome
KW  - Public Health
KW  - Emergency Service
KW  - Female
KW  - Research, Interdisciplinary
SP  - 324
EP  - 330
JO  - American Journal of Perinatology
JF  - American Journal of Perinatology
JA  - AM J PERINATOL
VL  - 35
IS  - 4
CY  - New York, New York
PB  - Thieme Medical Publishing Inc.
AB  - Perinatal opioid misuse and neonatal opioid withdrawal syndrome (NOWS) are a significant public health problem that has grown exponentially over the past decade. In the United States, a woman seeks emergency room care for prescription opioid misuse every 3 minutes and approximately every 25 minutes, a child is born with signs of drug withdrawal. The economic impact of perinatal opioid misuse is significant with annual hospital charges for NOWS in 2012 as $1.5 billion dollars. Perinatal opioid misuse is a complex, multifaceted problem that demands a multidisciplinary cross specialty approach. This article will review the current state of NOWS and provide medical practitioners with a practical guide to enhance evidence based practice.
SN  - 0735-1631
AD  - Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
AD  - Department of Pediatrics, The Floating Hospital at Tufts Medical Center and the Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
DO  - 10.1055/s-0037-1608630
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126703771
T1  - Opioid Crisis Affects Sickle Cell Patients Presenting With Related Pain.
Y1  - 2018/01//
N1  - Accession Number: 126703771. Language: English. Entry Date: 20171214. Revision Date: 20171214. Publication Type: Article. Journal Subset: Nursing; USA. Special Interest: Pain and Pain Management. NLM UID: 9425690. 
KW  - Anemia, Sickle Cell
KW  - Pain -- Drug Therapy
KW  - Narcotics -- Therapeutic Use
KW  - Emergency Service
KW  - Narcotics -- Poisoning
KW  - Overdose
KW  - Substance Abuse
KW  - Physicians
KW  - Prescribing Patterns
KW  - Narcotics -- Adverse Effects
KW  - Patient Care Plans
SP  - 9
EP  - 13
JO  - ED Management
JF  - ED Management
JA  - ED MANAGE
VL  - 30
IS  - 1
CY  - Atlanta, Georgia
PB  - AHC Media LLC
SN  - 1044-9167
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126703771&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128766840
T1  - Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies.
AU  - Bisaga, Adam
AU  - Mannelli, Paolo
AU  - Sullivan, Maria A.
AU  - Vosburg, Suzanne K.
AU  - Compton, Peggy
AU  - Woody, George E.
AU  - Kosten, Thomas R.
Y1  - 2018/04//
N1  - Accession Number: 128766840. Language: English. Entry Date: In Process. Revision Date: 20180406. Publication Type: Article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 9208821. 
SP  - 177
EP  - 187
JO  - American Journal on Addictions
JF  - American Journal on Addictions
JA  - AM J ADDICT
VL  - 27
IS  - 3
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Background and Objectives: Opioid use disorder (OUD) is a chronic condition with potentially severe health and social consequences. Many who develop moderate to severe OUD will repeatedly seek treatment or interact with medical care via emergency department visits or hospitalizations. Thus, there is an urgent need to develop feasible and effective approaches to help persons with OUD achieve and maintain abstinence from opioids. Treatment that includes one of the three FDA-approved medications is an evidence-based strategy to manage OUD. The purpose of this review is to address practices for managing persons with moderate to severe OUD with a focus on opioid withdrawal and naltrexone-based relapse-prevention treatment.Methods: Literature available on PubMed was used to review the evolution of treatment strategies from the 1960s onward to manage opioid withdrawal and initiate treatment with naltrexone.Results: Emerging practices for extended-release naltrexone induction include the use of agonist tapers and adjuvant medications. Clinical challenges frequently encountered when initiating this therapy include managing withdrawal and ongoing opioid use during treatment. Clinical factors may inform decisions regarding patient selection and length of naltrexone treatment, such as recent opioid use and patient preferences.Conclusions and Scientific Significance: Treatment strategies to manage opioid withdrawal have evolved, but many patients with OUD do not receive medication for the prevention of relapse. Clinical strategies for induction onto extended-release naltrexone are now available and can be safely and effectively implemented in specialty and select primary care settings. (© 2018 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP);27:177-187).
SN  - 1055-0496
AD  - Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
AD  - Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
AD  - Alkermes Inc., Waltham, Massachusetts
AD  - Scientific Consultant, Edgewater, New Jersey
AD  - Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
AD  - Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
AD  - Baylor College of Medicine, Houston, Texas
U2  - PMID: 29596725.
DO  - 10.1111/ajad.12711
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123200214
T1  - Rates of Hospital and Emergency Department Attendances in Opiate-dependent Patients Treated With Implant Naltrexone, Methadone, or Buprenorphine.
AU  - Kelty, Erin
AU  - Hulse, Gary
Y1  - 2017/06//
N1  - Accession Number: 123200214. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101148822. 
KW  - Methadone
KW  - Buprenorphine
KW  - Naltrexone
KW  - Narcotics
KW  - Emergency Service
KW  - Inpatients
SP  - 39
EP  - 48
JO  - Addictive Disorders & Their Treatment
JF  - Addictive Disorders & Their Treatment
JA  - ADDICT DISORD THEIR TREAT
VL  - 16
IS  - 2
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Objective: To compare rates of hospital and emergency department (ED) attendance in opiate-dependent patients treated implant naltrexone, with patients treated with methadone and buprenorphine. Materials and Methods: Treatment records for opiate-dependent patients treated with implant naltrexone, methadone, or buprenorphine were linked with routine, prospectively collected health data sets. Rates of hospital and ED attendances were calculated for each cohort and compared using generalized estimating equations. Results: Following the commencement of treatment, rates of hospitalizations was significantly higher in patients treated with implant naltrexone compared with both methadone [risk ratio (RR), 0.83, confidence interval (CI), 0.77-0.89] and buprenorphine (RR, 0.92, CI, 0.85-0.99), as were rates of ED attendances in methadone-treated patients (RR, 0.85, CI, 0.780.92), whereas rates of ED attendances in buprenorphine patients were comparable (RR, 0.92, CI, 0.851.01). The difference was largely attributable to the induction period (0 to 28 d), where rates of hospital and ED attendances in naltrexone-treated patients were almost double that of both methadone and buprenorphine. However, after the initial period and following the cessation of treatment, rates of hospital and ED attendances in naltrexone-treated patients were less than or equivalent to methadone or buprenorphine patients. Conclusions: Rates of morbidity in opiate-dependent patients treated with implant naltrexone were significantly elevated compared with methadone and buprenorphine in the first 28 days of treatment, however, are comparable after this initial period.
SN  - 1531-5754
AD  - School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
AD  - School of Population Health, The University of Western Australia, Crawley, WA, Australia
DO  - 10.1097/ADT.0000000000000101
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 118174266
T1  - Addressing the Challenge of Emergency Department Analgesia: Innovation in the Use of Opioid Alternatives.
AU  - Goett, Rebecca
AU  - Todd, Knox H.
AU  - Nelson, Lewis S.
Y1  - 2016/09//
N1  - Accession Number: 118174266. Language: English. Entry Date: 20160930. Revision Date: 20180223. Publication Type: Opinion. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 101125608. 
KW  - Emergency Service -- United States
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Analgesics, Nonnarcotic -- Administration and Dosage
KW  - Prescribing Patterns -- United States
KW  - United States
SP  - 225
EP  - 227
JO  - Journal of Pain & Palliative Care Pharmacotherapy
JF  - Journal of Pain & Palliative Care Pharmacotherapy
JA  - J PAIN PALLIAT CARE PHARMACOTHER
VL  - 30
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - The current epidemic of opioid toxicity and deaths has led clinicians and policy-makers to explore alternatives to opioids for management of moderate to severe pain. One environment in which opioid use has been questioned is the emergency department (ED). This commentary addresses the proposal for “opioid-free EDs” and discusses the risk-to-benefit ratios of opioid and alternative pharmacotherapy for acutely injured patients requiring analgesia. The authors recognize that a truly opioid-free ED is not practical and that alternative analgesic approaches also carry risks. Innovations in managing pain in the ED are needed. But excessive restriction on opioid pharmacotherapy in emergency medicine carries the risk of replacing overprescribing with underprescribing of opioids. The commentary supports the need to establish a core of evidence to support efforts to increase the use of nonopioid and nonpharmacologic modalities for those suffering from pain.
SN  - 1536-0288
DO  - 10.1080/15360288.2016.1209612
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193335
T1  - 1EMF Take-Home Naloxone Rescue Kits Following Heroin Overdose in the Emergency Department to Prevent Opioid Overdose-Related Repeat Emergency Department Visits, Hospitalization, and Death: A Pilot Study.
AU  - Papp, J.
AU  - Schrock, J.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193335. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S170
EP  - S170
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Metrohealth Medical Center, Cleveland, OH
DO  - 10.1016/j.annemergmed.2017.07.315
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193354
T1  - 402 One-Year Mortality of Opioid Overdose Victims Who Received Naloxone by Emergency Medical Services.
AU  - Weiner, S.G.
AU  - Baker, O.
AU  - Bernson, D.
AU  - Schuur, J.D.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193354. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S158
EP  - S158
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Brigham and Women's Hospital, Boston, MA
AD  - Massachusetts Department of Public Health, Boston, MA
DO  - 10.1016/j.annemergmed.2017.07.281
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123348136
T1  - Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department: A Randomized Controlled Trial.
AU  - Bowers, Karen J.
AU  - McAllister, Kelly B.
AU  - Ray, Meredith
AU  - Heitz, Corey
Y1  - 2017/06//
N1  - Accession Number: 123348136. Language: English. Entry Date: 20170603. Revision Date: 20170603. Publication Type: Article; research; tables/charts; randomized controlled trial. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 9418450. 
KW  - Ketamine -- Therapeutic Use
KW  - Pain -- Drug Therapy
KW  - Narcotics -- Therapeutic Use
KW  - Human
KW  - Emergency Service
KW  - Ketamine -- Administration and Dosage
KW  - Randomized Controlled Trials
KW  - Pain Measurement
KW  - Patient Satisfaction
KW  - Double-Blind Studies
KW  - Placebos
KW  - Drug Therapy, Combination
KW  - Sedation
KW  - Ketamine -- Adverse Effects
KW  - Treatment Outcomes
SP  - 676
EP  - 685
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 24
IS  - 6
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
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.
SN  - 1069-6563
AD  - Virginia Tech Carilion School of Medicine
AD  - Department of Emergency Medicine, Emory University School of Medicine
AD  - Department of Pharmacy, Carilion Clinic
AD  - Department of Epidemiology, Biostatistics and Environmental Health University of Memphis
AD  - Department of Emergency Medicine, Carilion Clinic
DO  - 10.1111/acem.13172
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110660132
T1  - Prescription of opioid analgesics for nontraumatic dental conditions in emergency departments.
AU  - Okunseri, Christopher
AU  - Dionne, Raymond A.
AU  - Gordon, Sharon M.
AU  - Okunseri, Elaye
AU  - Szabo, Aniko
Y1  - 2015/11//
N1  - Accession Number: 110660132. Language: English. Entry Date: 20160622. Revision Date: 20171003. Publication Type: journal article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: R03 DE024494/DE/NIDCR NIH HHS/United States. NLM UID: 7513587. 
KW  - Codeine -- Therapeutic Use
KW  - Tooth Diseases -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Inappropriate Prescribing -- Statistics and Numerical Data
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Oxycodone -- Therapeutic Use
KW  - Toothache -- Drug Therapy
KW  - Male
KW  - Infant
KW  - Adult
KW  - Child, Preschool
KW  - Young Adult
KW  - United States
KW  - Aged
KW  - Child
KW  - Cross Sectional Studies
KW  - Surveys
KW  - Female
KW  - Middle Age
KW  - Adolescence
SP  - 261
EP  - 266
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 156
PB  - Elsevier B.V.
AB  - Background: Opioid analgesics prescribed for nontraumatic dental conditions (NTDCs) by emergency physicians continue to receive attention because of the associated potential for misuse, abuse and addiction. This study examined rates of prescription of opioid analgesics and types of opioid analgesics prescribed for NTDC visits in U.S. emergency departments.Methods: Data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2010 were analyzed. Descriptive statistics and logistic regression analysis were performed and adjusted for the survey design.Results: NTDCs made up 1.7% of all ED visits from 2007 to 2010. The prescription of opioid analgesics was 50.3% for NTDC and 14.8% for non-NTDC visits. The overall rate of opioid analgesics prescribed for NTDCs remained fairly stable from 2007 through 2010. Prescription of opioids was highest among patients aged 19-33 years (56.8%), self-paying (57.1%), and non-Hispanic Whites (53.2%). The probability of being prescribed hydrocodone was highest among uninsured patients (68.7%) and for oxycodone, it was highest among private insurance patients (33.6%). Compared to 34-52 year olds, children 0-4 years were significantly more likely to be prescribed codeine and less likely to be prescribed oxycodone. Compared to non-Hispanic Whites, non-Hispanic Blacks had significantly higher odds of been prescribed codeine and somewhat lower odds of been prescribed oxycodone, but it was not statistically significant.Conclusions: There was no significant change in the rates of opioid analgesics prescribed over time for NTDC visits to EDs. Age, payer type and race/ethnicity were significant predictors for the prescription of different opioid analgesics by emergency physicians for NTDC visits.
SN  - 0376-8716
AD  - Department of Clinical Services, School of Dentistry, P.O. Box 1881, Marquette University, Milwaukee, WI 53201, United States
AD  - Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC 27834, United States
AD  - Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States
AD  - Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, United States
U2  - PMID: 26471416.
DO  - 10.1016/j.drugalcdep.2015.09.023
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122701608
T1  - Comparing Healthcare Utilization and Costs Among Medicaid-Insured Patients with Chronic Noncancer Pain with and without Opioid-Induced Constipation: A Retrospective Analysis.
AU  - Olufade, Tope
AU  - Kong, Amanda M.
AU  - Princic, Nicole
AU  - Juneau, Paul
AU  - Kulkarni, Rucha
AU  - Kui Zhang
AU  - Datto, Catherine
Y1  - 2017/04//
N1  - Accession Number: 122701608. Language: English. Entry Date: 20170504. Revision Date: 20170504. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Special Interest: Pain and Pain Management. 
KW  - Health Resource Utilization
KW  - Health Care Costs
KW  - Medicaid
KW  - Chronic Pain -- Drug Therapy
KW  - Narcotics -- Adverse Effects
KW  - Constipation -- Chemically Induced
KW  - Constipation -- Economics
KW  - Prospective Studies
KW  - Retrospective Design
KW  - Human
KW  - Comparative Studies
KW  - Resource Databases, Health
KW  - Record Review
KW  - Socioeconomic Factors
KW  - Male
KW  - Female
KW  - Middle Age
KW  - Patient Admission
KW  - Emergency Service -- Utilization
KW  - Confidence Intervals
SP  - 79
EP  - 85
JO  - American Health & Drug Benefits
JF  - American Health & Drug Benefits
JA  - AM HEALTH DRUG BENEFITS
VL  - 10
IS  - 2
CY  - Cranbury, New Jersey
PB  - Engage Healthcare Communications, LLC
AB  - BACKGROUND: Constipation is a common adverse effect of opioid use and has been associated with increased healthcare utilization and costs among patients receiving opioids for pain management. OBJECTIVE: To compare the healthcare utilization and costs of Medicaid patients with chronic non- cancer pain with and without constipation who were receiving opioids. METHODS: This retrospective, claims-based study was conducted using data from the Truven Health MarketScan Medicaid Multi-State database. Patients with no evidence of cancer who initiated opioid therapy between January 1, 2009, and June 30, 2013, were eligible for the study. Patients had to have continuous enrollment in the database in the 6 months before and 12 months after opioid initiation, with no evidence of substance abuse or functional or inflammatory bowel disease. Medical and pharmacy claims during the 12 months after opioid initiation were evaluated for a diagnosis of constipation or for prescription or over-the-counter medications indicative of constipation. All-cause healthcare utilization and costs were measured over the same period and were compared between propensity score-matched cohorts of patients with evidence of constipation and patients without constipation. RESULTS: Of the 25,744 patients meeting the study inclusion criteria, 2716 (10.5%) had evidence of constipation. After 1:1 propensity score matching, the 2 cohorts had similar demographic and clinical characteristics (ie, mean age, 47 years; 26%-27% male). During the 12-month follow-up period, healthcare utilization was more frequent among patients with constipation, including inpatient admissions and emergency department visits, than in the matched patients without constipation. The total all-cause mean healthcare costs were substantially higher among the patients with constipation ($28,234; 95% confidence interval [CI], $24,307-$32,160) than in the patients without constipation ($13,709; 95% CI, $12,618-$14,801), with a median cost difference of $4166 per patient (P <.001). CONCLUSION: Among Medicaid enrollees who receive opioids for chronic noncancer pain, constipation is associated with increased all-cause healthcare utilization and costs.
SN  - 1942-2962
AD  - Director, Health Economics & Outcomes Research, AstraZeneca, Wilmington, DE
AD  - Research Leader, Truven Health Analytics, an IBM Company, Bethesda
AD  - Manager Research Analyst, Truven Health Analytics, an IBM Company, Bethesda
AD  - Senior Statistician, Truven Health Analytics, an IBM Company, Bethesda
AD  - Research Analyst, Truven Health Analytics, an IBM Company, Bethesda
AD  - Senior Programmer/Analyst, Truven Health Analytics, an IBM Company, Bethesda
AD  - US Medical Lead, AstraZeneca
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128130710
T1  - The Opioid Overdose Epidemic: A State of Emergency.
AU  - York, Cynthia
Y1  - 2018/03//
N1  - Accession Number: 128130710. Language: English. Entry Date: 20180303. Revision Date: 20180303. Publication Type: Article; brief item. Journal Subset: Nursing; USA. Special Interest: Psychiatry/Psychology; Public Health. NLM UID: 19530550R. 
KW  - Narcotics -- Poisoning
KW  - Overdose -- Epidemiology -- Louisiana
KW  - Louisiana
KW  - Overdose -- Mortality
SP  - 4
EP  - 4
JO  - Pelican News
JF  - Pelican News
JA  - PELICAN NEWS
VL  - 74
IS  - 1
CY  - Baton Rouge, Louisiana
PB  - Louisiana State Nurses Association
SN  - 0031-4161
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124742627
T1  - Initiating Medication-assisted Treatment for Patients Presenting With Opioid Withdrawal.
Y1  - 2017/09//
N1  - Accession Number: 124742627. Language: English. Entry Date: 20170828. Revision Date: 20170828. Publication Type: Article. Journal Subset: Nursing; USA. NLM UID: 9302170. 
KW  - Analgesics, Opioid
KW  - Substance Withdrawal Syndrome -- Drug Therapy
KW  - Emergency Care
KW  - Treatment Outcomes
KW  - Drug Therapy, Combination
KW  - Drug Enforcement Administration
KW  - Buprenorphine -- Therapeutic Use
KW  - Naloxone -- Therapeutic Use
SP  - 10
EP  - 13
JO  - Case Management Advisor
JF  - Case Management Advisor
JA  - CASE MANAGE ADVIS
VL  - 28
IS  - 9
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - The article focuses on initiating medication-assisted treatment for patients presenting with opioid withdrawal. Topics discussed include problems surrounding opioid misuse; statement of Darin Neven, an emergency physician at Providence Sacred Heart Medical Center on the treatment of addictive substances; and role of medicine in treating patients with diseases.
SN  - 1053-5500
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127951395
T1  - Opioid Use Disorder: Challenges During Acute Hospitalization.
AU  - Turner, Carla C.
AU  - Fogger, Susanne A.
AU  - Frazier, Sandra L.
Y1  - 2018/02//
N1  - Accession Number: 127951395. Language: English. Entry Date: 20180228. Revision Date: 20180228. Publication Type: Article. Journal Subset: Blind Peer Reviewed; Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 101264817. 
KW  - Substance Use Disorders
KW  - Emergency Service -- Utilization
KW  - Hospitalization
KW  - Nurse Practitioners
KW  - Inpatients
SP  - 61
EP  - 67
JO  - Journal for Nurse Practitioners
JF  - Journal for Nurse Practitioners
JA  - J NURSE PRACT
VL  - 14
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Opioid use is a major public health concern increasing the volume of need for medical care and the national tragedy of accidental overdose deaths. Patients with opioid use disorders have higher numbers of emergency department visits, acute hospitalizations, and complications secondary to opioid use. Acute care nurse practitioners are challenged to manage increasingly complicated patient encounters related to opioid use. This article addresses effective strategies for inpatient management of opioid use disorder including identification and the use of measurement-based tools, as well as providing supportive care.
SN  - 1555-4155
DO  - 10.1016/j.nurpra.2017.12.009
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124846732
T1  - Three-year retention in buprenorphine treatment for opioid use disorder nationally in the Veterans Health Administration.
AU  - Manhapra, Ajay
AU  - Petrakis, Ismene
AU  - Rosenheck, Robert
Y1  - 2017/09//
N1  - Accession Number: 124846732. Language: English. Entry Date: In Process. Revision Date: 20180413. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Charlson Comorbidity Index (CCI). NLM UID: 9208821. 
KW  - Medication Compliance
KW  - Buprenorphine -- Administration and Dosage
KW  - Substance Use Disorders -- Drug Therapy
KW  - Veterans -- Psychosocial Factors
KW  - United States
KW  - Long Term Care -- Statistics and Numerical Data
KW  - Substance Use Disorders -- Epidemiology
KW  - Socioeconomic Factors
KW  - Substance Use Disorders -- Psychosocial Factors
KW  - Buprenorphine -- Therapeutic Use
KW  - Demography
KW  - Long Term Care -- Psychosocial Factors
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Veterans -- Statistics and Numerical Data
KW  - Cox Proportional Hazards Model
KW  - Male
KW  - Female
KW  - Adult
KW  - United States Department of Veterans Affairs -- Statistics and Numerical Data
SP  - 572
EP  - 580
JO  - American Journal on Addictions
JF  - American Journal on Addictions
JA  - AM J ADDICT
VL  - 26
IS  - 6
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Background: Buprenorphine has become the major treatment for opioid use disorder (OUD) but data on long treatment term retention and its correlates are sparse.Methods: All veterans with OUD treated in Veterans Health Administration (VHA) facilities nationally in fiscal year (FY) 2012, and who began treatment with buprenorphine as indicated by a first prescription after the first 60 days of the year were identified with the date of and their last prescription from FY 2012-2015. Veterans were classified into four groups based on time from first to last prescription: (0-30 days, 31-365 days; 1-3 years; and more than 3 years). These groups were compared on socio-demographic, diagnoses and service, and psychotropic drug use. Kaplan-Meier curves and Cox proportional hazards models were used to identify variables independently associated with retention in buprenorphine treatment.Results: Veterans newly started on buprenorphine (n = 3,151) were retained in treatment for a mean duration of 1.68 years (standard deviation [SD] 1.23), with 61.60% (n = 1,941) retained for more than a year and 31.83% (n = 1,003) for more than 3 years. Cox proportion hazards model showed that only black race (Hazards ratio [HR] 1.26; standard error [SE] .06; p.0003), the Charlson index (HR 1.03; SE .01; p.0132) and emergency room visits during FY 2012 (HR 1.03; SE .01; p < .0001) were the only available variables independently associated higher odds of buprenorphine discontinuation.Conclusions: Buprenorphine retention was substantial among veterans treated in VHA, but few individual characteristics correlated with retention.Scientific Significance: Future research focused on identifying further correlates of treatment retention is required to help devise interventions to improve treatment continuation. (Am J Addict 2017;26:572-580).
SN  - 1055-0496
AD  - VA New England Mental Illness Research and Education Center
AD  - Department of Psychiatry, Yale School of Medicine
AD  - Department of Internal Medicine, Yale Medical School
AD  - VA Hampton Medical Center
U2  - PMID: 28472543.
DO  - 10.1111/ajad.12553
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127357744
T1  - An emergency response to the opioid overdose crisis in Canada: a regulated opioid distribution program.
AU  - Tyndall, Mark
Y1  - 2018/01/15/
N1  - Accession Number: 127357744. Language: English. Entry Date: In Process. Revision Date: 20180221. Publication Type: Article. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 9711805. 
SP  - E35
EP  - E36
JO  - CMAJ: Canadian Medical Association Journal
JF  - CMAJ: Canadian Medical Association Journal
JA  - CMAJ
VL  - 190
IS  - 2
CY  - Ottowa, Ontario
PB  - Joule Inc.
AB  - The author comments on the rapid increase of unintentional drug overdose in Canada. Topics include the estimated number of overdose deaths reported in the first eight months of 2017 in British Columbia and factors contributing directly to the death toll such as the introduction of potent synthetic opioids. Other topics include the effectiveness of regulated naloxone distribution programs and a renewed focus on reducing opioid prescribing by physicians.
SN  - 0820-3946
AD  - BC Centre for Disease Control, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
U2  - PMID: 29335260.
DO  - 10.1503/cmaj.171060
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122008936
T1  - Decreased Opioid Prescribing in a Pediatric Emergency Department After the Rescheduling of Hydrocodone.
AU  - Chumpitazi, Corrie E.
AU  - Rees, Chris A.
AU  - Camp, Elizabeth A.
AU  - Bernhardt, M. Brooke
Y1  - 2017/04//
N1  - Accession Number: 122008936. Language: English. Entry Date: 20171105. Revision Date: 20171208. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8412174. 
KW  - Codeine -- Therapeutic Use
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Male
KW  - Pediatrics -- Methods
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Analgesics, Opioid -- Pharmacodynamics
KW  - Pediatrics -- Manpower
KW  - Cross Sectional Studies
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Administration
KW  - Female
SP  - 547
EP  - 553
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 52
IS  - 4
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: The Drug Enforcement Administration (DEA) changed hydrocodone-containing products (HCPs) from Schedule III to II status on October 6, 2014, making codeine-containing products (CCPs) the only non-Schedule II oral opioid agents.Objectives: We sought to describe prescribing patterns of oral opioid agents in the pediatric emergency department before and after the 2014 DEA rescheduling of HCPs.Methods: We performed a cross-sectional study evaluating prescribing patterns in the pediatric emergency department at an urban, academic, quaternary care children's hospital system for 6 months before and 6 months after the DEA rescheduling of HCPs. Differences in patient demographics, provider type, and diagnoses were assessed during the two time periods using Pearson's chi-squared test. The Breslow-Day statistic was used to assess differences in prescribing patterns by provider type.Results: There were 1256 prescriptions for HCPs and CCPs in our pediatric emergency department during the study period, and only 36 prescriptions for alternate oral opioid medications. Prescriptions of all opioid pain medications decreased by 55% after rescheduling. The odds of prescribing HCPs were reduced by 60% after the DEA rescheduling (odds ratio 0.40 [95% confidence interval {CI} 0.30-0.54]; p < 0.001). There was no difference between monthly ordering frequencies for CCPs before or after the DEA rescheduling (p = 0.75).Conclusions: The period after rescheduling of HCPs was associated with a lower odds of HCP prescriptions in our emergency department without an increase in the prescription of CCPs.
SN  - 0736-4679
AD  - Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas
AD  - Department of Pediatrics, Baylor College of Medicine, Houston, Texas
AD  - Department of Pharmacy, Texas Children's Hospital, Houston, Texas
U2  - PMID: 27727038.
DO  - 10.1016/j.jemermed.2016.08.026
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103956505
T1  - Differences in Healthcare Utilization and Associated Costs Between Patients Prescribed vs. Nonprescribed Opioids During an Inpatient or Emergency Department Visit.
AU  - Xie, Lin
AU  - Joshi, Ashish V.
AU  - Schaaf, David
AU  - Mardekian, Jack
AU  - Harnett, James
AU  - Shah, Nilay D.
AU  - Baser, Onur
Y1  - 2014/06//
N1  - Accession Number: 103956505. Language: English. Entry Date: 20140604. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Pain and Pain Management. Grant Information: This study was sponsored by Pfizer Inc, New York, NY.. NLM UID: 101130835. 
KW  - Health Resource Utilization -- Economics
KW  - Narcotics -- Administration and Dosage
KW  - Hospitalization
KW  - Emergency Service
KW  - Prescribing Patterns
KW  - Inpatients
KW  - Outpatients
KW  - Retrospective Design
KW  - Prospective Studies
KW  - Human
KW  - Male
KW  - Female
KW  - Child
KW  - Adolescence
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Analysis of Covariance
KW  - United States
KW  - Univariate Statistics
KW  - Descriptive Research
KW  - Descriptive Statistics
KW  - T-Tests
KW  - Multivariate Analysis
KW  - Observational Methods
KW  - Odds Ratio
KW  - Substance Abuse -- Epidemiology -- United States
KW  - Funding Source
SP  - 446
EP  - 456
JO  - Pain Practice
JF  - Pain Practice
JA  - PAIN PRACTICE
VL  - 14
IS  - 5
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objectives Compare healthcare resource utilization ( HCRU) and costs between patients prescribed opioids ( Rx OP) and those who were not ( No Rx OP) during an emergency department ( ED) or inpatient visit. Methods Retrospective cohort analysis was performed ( January 2006 to September 2010). Continuously eligible Rx OP patients in ED/inpatient settings ( January 2007 to September 2009) were included if age was ≥ 12 years by initial prescription date (or random date between first ED/inpatient admission and September 30, 2009 [ NoRx OP patients]). Healthcare resource utilization and costs for 12 months after initial prescription were compared. Univariate descriptive analyses were performed for baseline and outcome variables and compared using appropriate tests. Risk adjustment compared HCRU between Rx OP and No Rx OP cohorts for the postindex period. Results Of 27,599 eligible patients, Rx OP patients ( n = 18,819) were younger, less likely to be male, more likely to reside in southern United States and to have Preferred Provider Organization health plans, and had lower comorbidity index scores, compared with No Rx OP patients ( n = 8,780). Rx OP patients were less likely to have nonpain-related comorbidities and more frequently diagnosed with pain-related comorbidities. Unmatched and propensity-matched Rx OP patients experienced higher HCRU and costs in all subcategories (total, inpatient, outpatient ED, physician, pharmacy, other outpatient settings). Opioid abuse frequency was low in patients with common diagnoses/procedures within 3 months before initial prescription (0.48%). Average time to abuse was < 1 year (201 days). Conclusion Most patients were prescribed opioids initially during ED/inpatient visits and incurred higher HCRU than those not prescribed opioids. Among those with diagnosed opioid abuse after initiating opioids, time to diagnosis was rapid (range: 14 to 260 days) for patients with common diseases and procedures.
SN  - 1530-7085
AD  - STATinMED Research
AD  - Shire Pharmaceuticals
AD  - Pfizer Inc
AD  - Mayo Clinic
AD  - STATinMED Research; The University of Michigan
U2  - PMID: 23809064.
DO  - 10.1111/papr.12098
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122980772
T1  - Multiple Fentanyl Overdoses - New Haven, Connecticut, June 23, 2016.
AU  - Tomassoni, Anthony J.
AU  - Hawk, Kathryn F.
AU  - Jubanyik, Karen
AU  - Nogee, Daniel P.
AU  - Durant, Thomas
AU  - Lynch, Kara L.
AU  - Patel, Rushaben
AU  - Dinh, David
AU  - Ulrich, Andrew
AU  - D'Onofrio, Gail
Y1  - 2017/02/03/
N1  - Accession Number: 122980772. Language: English. Entry Date: 20180123. Revision Date: 20180123. Publication Type: journal article; case study. Journal Subset: Biomedical; Public Health; USA. NLM UID: 7802429. 
KW  - Fentanyl -- Poisoning
KW  - Overdose -- Diagnosis
KW  - Middle Age
KW  - Aged
KW  - Connecticut
KW  - Female
KW  - Emergency Service
KW  - Naloxone -- Therapeutic Use
KW  - Male
KW  - Adult
KW  - Overdose -- Therapy
KW  - Fentanyl -- Blood
KW  - Fentanyl -- Urine
KW  - Fatal Outcome
SP  - 107
EP  - 111
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 66
IS  - 4
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
AB  - On the evening of June 23, 2016, a white powder advertised as cocaine was purchased off the streets from multiple sources and used by an unknown number of persons in New Haven, Connecticut. During a period of less than 8 hours, 12 patients were brought to the emergency department (ED) at Yale New Haven Hospital, experiencing signs and symptoms consistent with opioid overdose. The route of intoxication was not known, but presumed to be insufflation ("snorting") in most cases. Some patients required doses of the opioid antidote naloxone exceeding 4 mg (usual initial dose = 0.1-0.2 mg intravenously), and several patients who were alert after receiving naloxone subsequently developed respiratory failure. Nine patients were admitted to the hospital, including four to the intensive care unit (ICU); three required endotracheal intubation, and one required continuous naloxone infusion. Three patients died. The white powder was determined to be fentanyl, a drug 50 times more potent than heroin, and it included trace amounts of cocaine. The episode triggered rapid notification of public health and law enforcement agencies, interviews of patients and their family members to trace and limit further use or distribution of the fentanyl, immediate naloxone resupply and augmentation for emergency medical services (EMS) crews, public health alerts, and plans to accelerate naloxone distribution to opioid users and their friends and families. Effective communication and timely, coordinated, collaborative actions of community partners reduced the harm caused by this event and prevented potential subsequent episodes.
SN  - 0149-2195
AD  - Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
AD  - Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut
AD  - Department of Laboratory Medicine, University of California, San Francisco
U2  - PMID: 28151928.
DO  - 10.15585/mm6604a4
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125071351
T1  - Do more robust prescription drug monitoring programs reduce prescription opioid overdose?
AU  - Pardo, Bryce
Y1  - 2017/10//
N1  - Accession Number: 125071351. Language: English. Entry Date: 20170912. Revision Date: 20170918. Publication Type: Article; equations & formulas; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Overdose -- Prevention and Control -- United States
KW  - Drugs, Prescription
KW  - Analgesics, Opioid
KW  - Drug Monitoring -- Methods -- United States
KW  - Overdose -- Mortality -- United States
KW  - United States
KW  - Medical Marijuana
KW  - Centers for Disease Control and Prevention (U.S.)
KW  - Descriptive Statistics
KW  - Naloxone
KW  - Confidence Intervals
KW  - Overdose -- Legislation and Jurisprudence -- United States
KW  - Pain -- Drug Therapy -- United States
KW  - Public Policy -- United States
KW  - Health Policy -- United States
SP  - 1773
EP  - 1783
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 112
IS  - 10
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Background and Aims In the United States, overdose deaths attributed to opioid pain relievers (OPR) have quadrupled since 1999, prompting many states to adopt Prescription Drug Monitoring Programs (PMP). This study aimed to: (1) estimate the relationship of PMP strength with OPR overdose deaths across states and over time; (2) measure what threshold in PMP strength is associated with the greatest reduction in OPR overdose; and (3) assess the relationship of medical marijuana dispensaries with OPR overdose deaths. Design Panel data from the Centers for Disease Control and Prevention's (CDC's) Wide-ranging Online Data for Epidemiologic Research database (WONDER) were analyzed using fixed effects to regress state-year death rates on an index variable compiled from the Prescription Drug Abuse Policy System (PDAPS) while controlling for PMP administration, demographic factors and laws that might affect OPR overdose. Setting and Participants Age-adjusted opioid overdose death rates for all 50 states and the District of Columbia between 1999 and 2014 for a total of 816 observations. Measurements PMP strength was calculated using legal data compiled by the Prescription Drug Abuse Policy System (PDAPS). In addition to demographic controls, other covariates included laws that regulate pain clinics, access to naloxone, use of emergency services (Good Samaritan Laws) and medical marijuana. Findings PMP strength was associated negatively with OPR overdose deaths. Every 1-point increase in PMP strength was associated with a 1% [95% confidence interval (CI) = 0.2-2%] reduction in overdose deaths. When collapsed into quartiles, PMPs in the third quartile were associated with an approximately 18% (95% CI = 1.6-29%) reduction in OPR overdose death rates compared with states without a PMP. States with medical marijuana dispensaries reported a 16% (95% CI = 1-30%) reduction in OPR overdoses. Conclusions US states that have more robust prescription drug monitoring programs have fewer prescription opioid overdose deaths than states with weaker PMPs. States with medical marijuana dispensaries also report fewer opioid overdose deaths than states without these.
SN  - 0965-2140
AD  - School of Public Policy, University of Maryland
DO  - 10.1111/add.13741
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127944269
T1  - Perception and Practice Among Emergency Medicine Health Care Providers Regarding Discharging Patients After Opioid Administration.
AU  - Surmaitis, Ryan M.
AU  - Amaducci, Alexandra
AU  - Henry, Kathryn
AU  - Jong, Michael
AU  - Kiernan, Emily A.
AU  - Kincaid, Hope
AU  - Houck, Lindsay J.
AU  - Sabbatini, Sandra J.
AU  - Greenberg, Marna Rayl
AU  - Katz, Kenneth D.
Y1  - 2018/02//
N1  - Accession Number: 127944269. Language: English. Entry Date: In Process. Revision Date: 20180213. Publication Type: Article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7706726. 
SP  - 214
EP  - 223.e5
JO  - Clinical Therapeutics
JF  - Clinical Therapeutics
JA  - CLIN THER
VL  - 40
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0149-2918
AD  - Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, Allentown, PA
DO  - 10.1016/j.clinthera.2018.01.001
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104103858
T1  - Take-home emergency naloxone to prevent heroin overdose deaths after prison release: rationale and practicalities for the N-ALIVE randomized trial.
AU  - Strang, John
AU  - Bird, Sheila M
AU  - Parmar, Mahesh K B
Y1  - 2013/10//
N1  - Accession Number: 104103858. Language: English. Entry Date: 20140606. Revision Date: 20170928. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Public Health; USA. Special Interest: Public Health. Grant Information: MC_U105260794//Medical Research Council/United Kingdom. NLM UID: 9809909. 
KW  - Overdose -- Drug Therapy
KW  - Substance Use Disorders -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Narcotic Antagonists -- Adverse Effects
KW  - Correctional Facilities
KW  - Overdose -- Mortality
KW  - Emergencies
KW  - Substance Use Disorders -- Mortality
KW  - Human
KW  - Patient Attitudes
SP  - 983
EP  - 996
JO  - Journal of Urban Health
JF  - Journal of Urban Health
JA  - J URBAN HEALTH
VL  - 90
IS  - 5
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
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.
SN  - 1099-3460
AD  - King's College London, National Addiction Centre (Institute of Psychiatry and The Maudsley), London, SE5 8AF, UK, john.strang@kcl.ac.uk.
U2  - PMID: 23633090.
DO  - 10.1007/s11524-013-9803-1
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127501151
T1  - Opiate Prescribing in Hospitalized Older Adults: Patterns and Outcomes.
AU  - Maiti, Sutapa
AU  - Sinvani, Liron
AU  - Pisano, Michele
AU  - Kozikowski, Andrzej
AU  - Patel, Vidhi
AU  - Akerman, Meredith
AU  - Patel, Karishma
AU  - Smilios, Christopher
AU  - Nouryan, Christian
AU  - Qiu, Guang
AU  - Pekmezaris, Renee
AU  - Wolf‐Klein, Gisele
Y1  - 2018/01//
N1  - Accession Number: 127501151. Language: English. Entry Date: 20180131. Revision Date: 20180131. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 7503062. 
KW  - Narcotics
KW  - Prescriptions, Drug
KW  - Aged, Hospitalized
KW  - Prescribing Patterns
KW  - Human
KW  - Treatment Outcomes
KW  - Retrospective Design
KW  - Prospective Studies
KW  - Tertiary Health Care
KW  - Aged
KW  - Aged, 80 and Over
KW  - Female
KW  - Male
KW  - Ethnic Groups
KW  - Length of Stay
KW  - Readmission
KW  - Patient Discharge
KW  - Hospitalization
KW  - Pain Management
SP  - 70
EP  - 75
JO  - Journal of the American Geriatrics Society
JF  - Journal of the American Geriatrics Society
JA  - J AM GERIATR SOC
VL  - 66
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Background/Objectives: Whereas opiate prescribing patterns have been well described in outpatient and emergency department settings, they have been less defined in hospitalized older adults. The objective was to describe patterns of opiate prescribing and associated outcomes in hospitalized older adults. Design: Retrospective cohort study. Setting: Tertiary care facility. Participants: Hospitalized medical patients aged 65 and older (N = 9,245; mean age 80.3, 55.2% female, 72.3% white, 90.8% non‐Hispanic). Measurements: Opiate exposure and duration of action, concurrent use of potentially inappropriate medications (PIMs), adverse events, discharge disposition, length of stay (LOS), and 30‐day readmissions. Results: There was no difference in sex, race, ethnicity, or Charlson Comorbidity Index between opiate exposure groups. Participants who had never received opiates had a significantly shorter mean LOS than prior and new opiate users (5.2, 6.8, 7.7 days; <italic>P</italic> < .001) and were more likely to be discharged home (88.6%, 82.8%, 82.5%; <italic>P</italic> < .001) and significantly less likely to be readmitted within 30‐days (19.6%, 25.0%, 22.3%; <italic>P</italic> < .001). Participant who had never been exposed to opiates had a significantly shorter mean LOS than those receiving short‐ and long‐acting opiates (5.2, 7.3, 8.6 days; <italic>P</italic> < .001) and were more likely to be discharged home (88.6%, 82.6%, 82.4%; <italic>P</italic> < .001) and significantly less likely to be readmitted within 30‐days (19.6%, 27.7%, 28.9%; <italic>P</italic> < .001). Conclusion: Opiate use is widespread during hospitalization and is associated with significant negative clinical outcomes and quality metrics. There is an urgent need to develop innovative pain management alternatives to opiate use.
SN  - 0002-8614
AD  - Division of Hospital Medicine, Northwell Health, Manhasset, New York
AD  - Department of Medicine, Northwell Health, Manhasset, New York
AD  - Feinstein Institute for Medical Research, Manhasset, New York
AD  - Division of Geriatric and Palliative Medicine, Northwell Health, Manhasset, New York
DO  - 10.1111/jgs.15127
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=127501151&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124008920
T1  - Initiating Medication-assisted Treatment for Patients Presenting With Opioid Withdrawal: Critical to success: partnering with a reliable provider who can take over care of patients after they have been discharged from the ED.
Y1  - 2017/08//
N1  - Accession Number: 124008920. Language: English. Entry Date: 20170712. Revision Date: 20170713. Publication Type: Article. Note: For CE log on to AHCMedia.com. Journal Subset: Nursing; USA. NLM UID: 9425690. 
KW  - Substance Dependence -- Drug Therapy
KW  - Substance Abusers
KW  - Emergency Care
KW  - Substance Withdrawal, Controlled
KW  - Substance Use Rehabilitation Programs
KW  - After Care
KW  - Referral and Consultation
KW  - Hospital Programs
KW  - Emergency Patients
KW  - Narcotics
KW  - Emergency Service
KW  - Buprenorphine -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Drug Combinations
KW  - Patient Compliance
KW  - Health Services Accessibility
KW  - Physicians, Emergency
KW  - Prescriptions, Drug
KW  - Program Development
KW  - Outpatients
KW  - Education, Continuing (Credit)
SP  - 85
EP  - 89
JO  - ED Management
JF  - ED Management
JA  - ED MANAGE
VL  - 29
IS  - 8
CY  - Atlanta, Georgia
PB  - AHC Media LLC
SN  - 1044-9167
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124008920&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120535320
T1  - Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments.
AU  - Mazer-Amirshahi, Maryann
AU  - Mullins, Peter M.
AU  - Sun, Christie
AU  - Pines, Jesse M.
AU  - Nelson, Lewis S.
AU  - Perrone, Jeanmarie
Y1  - 2016/12//
N1  - Accession Number: 120535320. Language: English. Entry Date: 20170105. Revision Date: 20171201. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management. NLM UID: 100894201. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Interns and Residents
KW  - Emergency Care -- Trends -- United States
KW  - Pain -- Drug Therapy
KW  - United States
KW  - Human
KW  - Confidence Intervals
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
SP  - 2389
EP  - 2396
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 17
IS  - 12
PB  - Oxford University Press / USA
AB  - Background. Opioid analgesic use has increased dramatically in emergency departments (EDs), but the relative contribution of physician trainees has not been explored. We assessed trends in opioid utilization focusing on ED encounters where a physician trainee was involved. Methods. We studied ED visits from the National Hospital Ambulatory Medical Care Survey, 2001- 2011. Adult ED visits in which an opioid was administered in the ED or prescribed at discharge were stratified by whether or not there was trainee involvement. Trends in use over time for five common opioids (codeine, hydrocodone, hydromorphone, morphine, oxycodone) were tested using survey-weighted logistic regression. Results. From 2001-02 to 2009-11, the proportion of ED visits where an opioid analgesic was used increased 31.5% from 21.9% (95% CI: 20.3-23.6) of visits to 28.8% (95% CI: 27.5-30.1). Trainee involvement in ED visits was stable, with 9.3% (95% CI: 7.7-11.3) seen by a trainee in 2001-02 vs. 10.2% (95% CI: 8.1-12.7) in 2010-11. Opioid use in visits with trainee involvement did not change significantly over time relative to visits without a trainee (increase of 36.8% compared to 31.2% without trainees, P=0.652). Trends in opioid utilization for trainee visits paralleled non-trainee visits. Hydromorphone had the greatest relative increase in use for all providers. Adjusted for patient- and hospital-level factors, the probability of receiving opioids when a trainee was involved increased to a greater extent than among non-trainee visits (30.9% vs. 24.0%). Conclusion. Opioid utilization patterns for visits involving trainees reflect similar trends in attending practice, and highlights the more liberal opioid prescribing climate over time.
SN  - 1526-2375
AD  - Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC
AD  - Georgetown University School of Medicine, Washington, DC
AD  - Center for Clinical Practice Innovation, The George Washington University, Washington, DC
AD  - Department of Emergency Medicine, The George Washington University, Washington, DC
AD  - Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
AD  - Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
DO  - 10.1093/pm/pnw048
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125626461
T1  - Toxicological Emergencies in the Resuscitation Area of a Pediatric Emergency Department: A 12-Month Review.
AU  - Beauchamp, Gillian A.
AU  - Kerrey, Benjamin T.
AU  - Mittiga, Matthew R.
AU  - Rinderknecht, Andrea S.
AU  - Shan Yin
AU  - Yin, Shan
Y1  - 2017/10//
N1  - Accession Number: 125626461. Language: English. Entry Date: In Process. Revision Date: 20180205. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: UL1 TR001425/TR/NCATS NIH HHS/United States. NLM UID: 8507560. 
SP  - 670
EP  - 674
JO  - Pediatric Emergency Care
JF  - Pediatric Emergency Care
JA  - PEDIATR EMERG CARE
VL  - 33
IS  - 10
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Objective: Few studies of children with toxicological emergencies describe those undergoing acute resuscitation, and most describe exposures to single agents. We describe a 12-month sample of patients evaluated in the resuscitation area of a pediatric emergency department (ED) for a toxicological emergency.Methods: We conducted a retrospective chart review of patients in a high-volume, academic pediatric ED. We identified patients evaluated in the ED resuscitation area for toxicological exposure and conducted structured chart reviews to collect relevant data. For all variables of interest, we calculated standard descriptive statistics.Results: Of 2999 patients evaluated in the resuscitation area through 12 months (March 2009 to April 2010), we identified 80 (2.7%) whose primary ED diagnosis was toxicological. The mean age was 11.4 years. Eighty-six percent of patients were triaged to the resuscitation area for significantly altered mental status. The most frequent single exposures were ethanol (25%), clonidine (10%), and acetaminophen (5%). At least 1 laboratory test was performed for almost all patients (97%). Interventions performed in the resuscitation area included intravenous access placement (97%), activated charcoal (20%), naloxone (19%), and endotracheal intubation (12%). Eighty-two percent of patients were admitted to the hospital; 37% to the intensive care unit. No patients studied in this sample died and most received only supportive care.Conclusions: In a high-volume pediatric ED, toxicological emergencies requiring acute resuscitation were rare. Ethanol and clonidine were the most frequent single exposures. Most patients received diagnostic testing and were admitted. Further studies are needed to describe regional differences in pediatric toxicological emergencies.
SN  - 0749-5161
AD  - Department of Emergency Medicine, University of Cincinnati
AD  - Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
U2  - PMID: 27649040.
DO  - 10.1097/PEC.0000000000000858
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120275126
T1  - Fentanyl and a Novel Synthetic Opioid U-47700 Masquerading as Street "Norco" in Central California: A Case Report.
AU  - Armenian, Patil
AU  - Olson, Alexander
AU  - Anaya, Andres
AU  - Kurtz, Alicia
AU  - Ruegner, Rawnica
AU  - Gerona, Roy R.
Y1  - 2017/01//
N1  - Accession Number: 120275126. Language: English. Entry Date: 20170701. Revision Date: 20171208. Publication Type: journal article; case study. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Instrumentation: California Verbal Learning Test (CVLT). NLM UID: 8002646. 
KW  - Designer Drugs
KW  - Narcotics
KW  - Benzamides
KW  - Fentanyl
KW  - Emergency Service
KW  - Substance Use Disorders -- Diagnosis
KW  - Substance Use Disorders -- Complications
KW  - Adult
KW  - Female
KW  - California
KW  - Drug Interactions
KW  - Clinical Assessment Tools
SP  - 87
EP  - 90
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 69
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
AB  - In 2013 and 2014, more than 700 deaths were attributed to fentanyl and fentanyl analogues in the United States. Of recent concern is the cluster of unintentional fentanyl overdoses because of tablets thought to be "Norco" purchased on the street in Northern California. U-47700 (trans-3,4-dichloro-N-[2-(dimethyl-amino)cyclohexyl]-N-methylbenz-amide) is a nonfentanyl-based synthetic opioid with 7.5 times the binding affinity of morphine to μ-opioid. We report a case of fentanyl and U-47700 intoxication from what was thought to be illicitly purchased Norco. A 41-year-old woman presented to the emergency department (ED) for altered mental status shortly after ingesting 3 beige Norco pills bearing a Watson imprint. She had pinpoint pupils and respiratory depression, which reversed after 0.4 mg naloxone administration intravenously. She had complete recovery and was discharged from the ED after a 4-hour observation period. Serum testing with liquid chromatography-quadrupole time-of-flight mass spectrometry (LC 1260 QTOF/MS 6550; Agilent, Santa Clara, CA) confirmed the presence of the medications the patient reported receiving, and additionally fentanyl (15.2 ng/mL) and U-47700 (7.6 ng/mL). In this case report, street Norco purchased in Central California resulted in altered mental status requiring naloxone reversal because of fentanyl and the novel synthetic opioid U-47700. Because these compounds are not detected by routine urine drug testing and physical examination findings are similar to those of a traditional opioid toxidrome, emergency providers should use the patient's history and other circumstantial details to aid in diagnosis. In cases with suspicion of opioid or opioid analogue cause, we recommend that emergency providers contact their local poison control center, medical toxicologist, or public health department to aid in the investigation.
SN  - 0196-0644
AD  - Department of Emergency Medicine, University of California, San Francisco–Fresno, Fresno, CA
AD  - Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA
U2  - PMID: 27473610.
DO  - 10.1016/j.annemergmed.2016.06.014
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109714374
T1  - Preventing iatrogenic overdose: a review of in-emergency department opioid-related adverse drug events and medication errors.
AU  - Beaudoin, Francesca L
AU  - Merchant, Roland C
AU  - Janicki, Adam
AU  - McKaig, Donald M
AU  - Babu, Kavita M
Y1  - 2015/04//
N1  - Accession Number: 109714374. Language: English. Entry Date: 20150529. Revision Date: 20160507. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
SP  - 423
EP  - 431
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 65
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: We describe characteristics of patients with in-emergency department (ED) opioid-related adverse drug events, medication errors, and harm resulting from medication errors; identify patient-, provider-, and system-based factors associated with in-ED opioid-related medication errors and harm; and create a list of strategies to prevent future events.Methods: This retrospective study was conducted at 2 urban academic EDs. Potential iatrogenic opioid overdoses were identified by querying the ED electronic medical record for cases when naloxone was administered after an opioid was administered in the ED. Cases involving medication errors resulting in harm were reviewed qualitatively for common patient-, provider-, and systems-based factors that might have contributed to the event.Results: Of 73 ED patients with in-ED opioid-related adverse events that required reversal with naloxone, 43 had a medication error resulting in harm. Patient-, provider-, and systems-based factors that might have contributed to the events included chronic health conditions that could predispose an individual to an opioid-related adverse event, failure to adjust opioid dosing in the elderly and for hepatic or renal impairment, multiple doses and routes of administration of opioids, coadministration of opioids with other sedating medications, and systems-based problems with patient handoffs and pharmacy oversight.Conclusion: We identified patient-, provider-, and systems-based factors related to opioid-related adverse drug events and medication errors among ED patients who had received naloxone. The results from our assessment can be used to inform educational and policy initiatives aimed to prevent in-ED opioid-related adverse drug events and medication errors.
SN  - 0196-0644
U2  - PMID: 25534653.
DO  - 10.1016/j.annemergmed.2014.11.016
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119864916
T1  - Naloxone Administration in Suspected Opiate Overdose in a Homeless Health Clinic.
AU  - Fear, Whitney
Y1  - 2017/11//Nov2016-Jan2017
N1  - Accession Number: 119864916. Language: English. Entry Date: 20170729. Revision Date: 20170729. Publication Type: Article; brief item. Supplement Title: Nov2016-Jan2017. 
KW  - Public Health
KW  - Analgesics, Opioid -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Prehospital Care
SP  - 9
EP  - 9
JO  - North Dakota Nurse
JF  - North Dakota Nurse
VL  - 85
IS  - 4
CY  - Birmarck, North Dakota
PB  - North Dakota Nurses' Association
SN  - 0032-6666
AD  - Homeless Health Case Manager and Shelter Outreach Nurse in the Homeless Health division of Family Health Care
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118492646
T1  - FIGHTING THE OPIOID CRISIS FROM THE FRONT LINES.
AU  - Kinsman, Jeremiah M.
AU  - Elder, Jeffrey M.
AU  - Kanter, Joseph M.
Y1  - 2016/10//
N1  - Accession Number: 118492646. Language: English. Entry Date: 20161011. Revision Date: 20161011. Publication Type: Article; pictorial. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Public Health. NLM UID: 101466002. 
KW  - Emergency Medical Services
KW  - Prehospital Care
KW  - Narcotics -- Poisoning
KW  - Overdose -- Epidemiology -- United States
KW  - Disease Surveillance
KW  - Databases, Health
KW  - Public Health
KW  - Health Information Systems
KW  - Overdose -- Epidemiology -- Louisiana
KW  - Overdose -- Mortality
KW  - United States
KW  - Government Agencies
KW  - Data Collection
KW  - Louisiana
KW  - Public Health Administration
KW  - Maps
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Legislation and Jurisprudence -- Louisiana
KW  - Emergency Medical Technicians
KW  - Scope of Practice
KW  - Drug Utilization
KW  - Interinstitutional Relations
KW  - Collaboration
SP  - 25
EP  - 34
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 45
IS  - 10
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
AB  - The article discusses the role of emergency medical service (EMS) in sharing data and partnering with public health to help combat the U.S. opioid crisis. Topics include the link between drug overdoses and injury-related mortality, and the value of the information collected by EMS providers to identifying high-risk population, conducting epidemiologic surveillance, and pinpointing geographic hotspots for drug overdoses.
SN  - 1946-9365
AD  - Association of Schools and Programs of Public Health fellow, NHTSA Office of EMS
AD  - Director and medical director, New Orleans EMS
AD  - Medical director, New Orleans Fire Department
AD  - Chief medical officer, New Orleans Office of Homeland Security and Emergency Preparedness
AD  - Medical director, New Orleans Health Department
AD  - Health Care for the Homeless Clinic
AD  - Emergency physician, University Medical Center
AD  - Clinical assistant professor of medicine, LSU Health Sciences Center
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127282764
T1  - Healthcare utilization and costs associated with treatment for opioid dependence.
AU  - Shah, Ankit
AU  - Duncan, Margaret
AU  - Atreja, Nipun
AU  - Tai, Kei Sing
AU  - Gore, Mugdha
Y1  - 2018/01/10/
N1  - Accession Number: 127282764. Language: English. Entry Date: In Process. Revision Date: 20180318. Publication Type: journal article. Journal Subset: Biomedical; Health Services Administration; USA. NLM UID: 9892255. 
SP  - 1
EP  - 21
JO  - Journal of Medical Economics
JF  - Journal of Medical Economics
JA  - J MED ECON
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Objective: Opioid use disorder (OUD) can be managed with medication assisted therapy (MAT) (methadone [MET], buprenorphine [BUP], or extended-release naltrexone [XR-NTX]) or counseling alone (non-pharmacological therapy [NPT]). The objective of this study was to evaluate healthcare resource utilization and costs associated with XR-NTX compared with alternative treatments for opioid dependence.Methods: Adults with a diagnosis of opioid dependence who initiated treatment with XR-NTX, BUP, MET, or NPT between January 1, 2011 and December 31, 2014 were identified in the Truven Health MarketScan Commercial administrative claims database. Healthcare resource utilization, costs (inpatient [IP], emergency department [ED], outpatient [OP], and pharmacy) and adherence were evaluated for each cohort during 12-month baseline and follow-up periods.Results: A total of 29,235 patients were included in the analysis; 1,041, 20,566, 745, and 6,883 received XR-NTX, BUP, MET, and NPT, respectively. Patients in the XR-NTX cohort were significantly younger and had more comorbidities compared with the other cohorts. Patients in the XR-NTX group had the largest percentage decrease in IP and ED utilization and costs from baseline to follow-up. OP and pharmacy costs increased significantly from baseline to follow-up for all cohorts. Overall, there was no significant change in total healthcare costs for the XR-NTX group, whereas the costs increased significantly for other groups (BUP = +43%, MET = +47.7%, NPT = +38.8%).Conclusions: Healthcare resource utilization and costs increased from baseline to follow-up in BUP, MET, and NPT patients, whereas patients receiving XR-NTX experienced no such increase. This analysis suggests there may be economic value in the use of XR-NTX for OUD.
SN  - 1369-6998
AD  - a Alkermes, Inc. , Waltham , Massachusetts , USA
AD  - b Symlink, LLC , Portage , Michigan , USA
U2  - PMID: 29320915.
DO  - 10.1080/13696998.2018.1427101
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126708485
T1  - Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit.
AU  - Molokie, Robert E.
AU  - Montminy, Chariz
AU  - Dionisio, Corissa
AU  - Farooqui, Muhammad Ahmen
AU  - Gowhari, Michel
AU  - Yao, Yingwei
AU  - Suarez, Marie L.
AU  - Ezenwa, Miriam O.
AU  - Schlaeger, Judith M.
AU  - Wang, Zaijie J.
AU  - Wilkie, Diana J.
Y1  - 2018/01//
N1  - Accession Number: 126708485. Language: English. Entry Date: 20171231. Revision Date: 20171231. Publication Type: journal article; research. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Pain -- Drug Therapy
KW  - Critical Care
KW  - Emergency Service -- Administration
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Anemia, Sickle Cell -- Complications
KW  - Hospitals, Special
KW  - Female
KW  - Human
KW  - Adult
KW  - Young Adult
KW  - Regression
KW  - Retrospective Design
KW  - Pain Measurement
KW  - Middle Age
KW  - Dose-Response Relationship, Drug
KW  - United States
KW  - Male
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
SP  - 88
EP  - 92
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 36
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Background: Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay.Methods: In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay.Findings: Pain on admission to the ED averaged 8.7±1.5 and to the ACU averaged 8.0±1.6. The average pain on discharge from the ED was 6.4±3.0 and for the ACU was 4.5±2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted.Conclusions: Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions.
SN  - 0735-6757
AD  - University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States
AD  - Jesse Brown Veterans Administration Medical Center, 820 S. Damen Avenue, MP 111, Chicago, IL 60612, United States
AD  - University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States
AD  - University of Illinois Hospital and Health Sciences System, Department of Nursing, 1740 W. Taylor, Chicago, IL 60614, United States
AD  - Riley Hospital for Children at Indiana University Health Department of Psychiatry, 705 Riley Hospital Drive, Indianapolis, IN 46202, United States
AD  - Saint George's University, University Centre, Grenada
AD  - University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States
AD  - University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States
AD  - University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States
U2  - PMID: 28802541.
DO  - 10.1016/j.ajem.2017.07.037
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121904919
T1  - Strategies and policies to address the opioid epidemic: A case study of Ohio.
AU  - Penm, Jonathan
AU  - MacKinnon, Neil J.
AU  - Boone, Jill M.
AU  - Ciaccia, Antonio
AU  - McNamee, Cameron
AU  - Winstanley, Erin L.
Y1  - 2017/03/02/2017 Supplement
N1  - Accession Number: 121904919. Language: English. Entry Date: 20170910. Revision Date: 20170910. Publication Type: journal article. Supplement Title: 2017 Supplement. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Pennebaker Inventory of Limbic Languidness (PILL). Grant Information: U54 GM104942/GM/NIGMS NIH HHS/United States. NLM UID: 101176252. 
KW  - Overdose -- Drug Therapy
KW  - Substance Use Disorders -- Complications
KW  - Pharmacists -- Administration
KW  - Naloxone -- Administration and Dosage
KW  - Naloxone -- Supply and Distribution
KW  - Professional Role
KW  - Ohio
KW  - Narcotic Antagonists -- Supply and Distribution
KW  - Public Health
KW  - Substance Use Disorders -- Epidemiology
KW  - Overdose -- Epidemiology
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Pharmacy Service -- Administration
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Health Policy
KW  - Health Services Accessibility
SP  - S148
EP  - S153
JO  - Journal of the American Pharmacists Association: JAPhA
JF  - Journal of the American Pharmacists Association: JAPhA
JA  - J AM PHARM ASSOC
VL  - 57
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Objective: To describe the strategies and policies implemented in Ohio to improve opioid safety and to discuss the role that pharmacists can play in implementing, promoting, and enhancing the effectiveness of these policies.Setting: Ohio has the fifth highest rate of drug overdose deaths (24.6 deaths per 100,000) in the United States. Unintentional drug overdose has become the leading cause of injury-related death in Ohio. In 2015, there were 3050 overdose deaths in Ohio, and in 2014 there were an estimated 12,847 overdose events reversed by emergency medical services with naloxone.Practice Description: Not applicable.Practice Policy Innovation: In 2011, the Governor's Cabinet Opiate Action Team was created to implement a multifaceted strategy, in part (1) to promote the responsible use of opioids, (2) to reduce the supply of opioids, and (3) to support overdose prevention and expand access to naloxone. Innovations to assist these goals include the development of Ohio guidelines on the responsible use of opioids, mandatory use of Ohio's prescription drug monitoring program, closing pill mills, promotion of drug take-back programs and increased access to naloxone and public health campaigns.Evaluation: Not applicable.Results: Since the development of the Governor's Cabinet Opiate Action Team, there were 81 million fewer doses of opioids dispensed to Ohio patients in 2015 compared with 782 million doses dispensed in 2011. As such, the proportion of unintentional drug overdose deaths involving prescription opioids has reduced from 45% in 2011 to 22% in 2015.Conclusion: Strong political support was crucial in Ohio to facilitate the rapid implementation opioid overdose prevention programs and the promotion of public awareness campaigns. However, the misuse and abuse of prescription opioids are complex problems requiring a comprehensive and multifaceted approach. Pharmacists are identified as a crucial component of the state strategy to addressing opioid abuse by promoting responsible prescribing and adopting prevention practices.
SN  - 1544-3191
AD  - Lecturer, Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia; Fellow, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
AD  - Dean and Professor, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
AD  - Clinical Professor, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
AD  - Director of Government and Public Affairs, Ohio Pharmacists Association, Columbus, OH
AD  - Director of Policy and Communications, State of Ohio Board of Pharmacy, Columbus, OH
AD  - Associate Professor, School of Pharmacy, West Virginia University, Morgantown, WV
U2  - PMID: 28189539.
DO  - 10.1016/j.japh.2017.01.001
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103924936
T1  - Just sleeping, or opioid-induced sedation: A review of unintended advancing sedation and respiratory depression after the administration of opioids in the emergency department.
AU  - Drebert, Charlene
Y1  - 2014///Fall2014
N1  - Accession Number: 103924936. Language: English. Entry Date: 20141215. Revision Date: 20150820. Publication Type: Journal Article; pictorial. Journal Subset: Canada; Editorial Board Reviewed; Nursing; Peer Reviewed. Special Interest: Emergency Care; Patient Safety. 
KW  - Sedation -- Evaluation
KW  - Polypharmacy -- Adverse Effects
KW  - Respiration Disorders -- Risk Factors
KW  - Emergency Nursing -- Methods
KW  - Nursing Assessment
KW  - Patient Safety
KW  - Drug Monitoring
SP  - 24
EP  - 26
JO  - Canadian Journal of Emergency Nursing (CJEN)
JF  - Canadian Journal of Emergency Nursing (CJEN)
JA  - CAN J EMERG NURS
VL  - 37
IS  - 2
CY  - Chiliwack, British Columbia
PB  - National Emergency Nurses Association
SN  - 1499-3627
AD  - Emergency department, Victoria General Hospital; Athabasca University
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119398417
T1  - A Call for Better Opioid Prescribing Training and Education.
AU  - Khidir, Hazar
AU  - Weiner, Scott G.
Y1  - 2016/11//
N1  - Accession Number: 119398417. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Student Experiences
KW  - Education -- Standards
KW  - Students, Medical
KW  - Emergency Service
KW  - Schools, Medical
SP  - 686
EP  - 689
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 17
IS  - 6
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - Pain is the most common complaint in the emergency department (ED), and emergency physicians face unique challenges in making opioid-related treatment decisions. Medical students and residents experience significant variation in the quality of education they receive both about opioid prescribing as well as substance-use detection and intervention in the ED. To achieve a better standard of education, clinical educators will need to (a) develop a clearer understanding of the risk for aberrant opioid prescribing in the ED, (b) recognize prescribing bias and promote uptake of evidence-based opioid prescribing guidelines in their EDs, and (c) advocate for integrated opioid management and addiction medicine training formally into medical school curricula.
SN  - 1936-900X
AD  - Harvard Medical School, Boston, Massachusetts
AD  - Harvard Medical School, Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
DO  - 10.5811/westjem.2016.8.31204
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103849887
T1  - Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse-related emergency department visits and drug-related deaths - United States, 2010.
AU  - Jones, Christopher M
AU  - Paulozzi, Leonard J
AU  - Mack, Karin A
Y1  - 2014/10/10/
N1  - Accession Number: 103849887. Corporate Author: Centers for Disease Control and Prevention (CDC). Language: English. Entry Date: 20150123. Revision Date: 20180123. Publication Type: journal article. Journal Subset: Biomedical; Public Health; USA. Special Interest: Public Health. NLM UID: 7802429. 
KW  - Alcohol Drinking -- Epidemiology
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Antianxiety Agents, Benzodiazepine -- Administration and Dosage
KW  - Emergency Service -- Utilization
KW  - Drug Therapy -- Mortality
KW  - Substance Use Disorders -- Epidemiology
KW  - Adolescence
KW  - Adult
KW  - Child
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Substance Use Disorders -- Mortality
KW  - United States
KW  - Young Adult
SP  - 881
EP  - 885
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 63
IS  - 40
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
AB  - The abuse of prescription drugs has led to a significant increase in emergency department (ED) visits and drug-related deaths over the past decade. Opioid pain relievers (OPRs) and benzodiazepines are the prescription drugs most commonly involved in these events. Excessive alcohol consumption also accounts for a significant health burden and is common among groups that report high rates of prescription drug abuse. When taken with OPRs or benzodiazepines, alcohol increases central nervous system depression and the risk for overdose. Data describing alcohol involvement in OPR or benzodiazepine abuse are limited. To quantify alcohol involvement in OPR and benzodiazepine abuse and drug-related deaths and to inform prevention efforts, the Food and Drug Administration (FDA) and CDC analyzed 2010 data for drug abuse-related ED visits in the United States and drug-related deaths that involved OPRs and alcohol or benzodiazepines and alcohol in 13 states. The analyses showed alcohol was involved in 18.5% of OPR and 27.2% of benzodiazepine drug abuse-related ED visits and 22.1% of OPR and 21.4% of benzodiazepine drug-related deaths. These findings indicate that alcohol plays a significant role in OPR and benzodiazepine abuse. Interventions to reduce the abuse of alcohol and these drugs alone and in combination are needed.
SN  - 0149-2195
U2  - PMID: 25299603.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119006925
T1  - Pediatric Emergency Department Visits for Buprenorphine/Naloxone Ingestion -- United States, 2008-2015.
AU  - Budnitz, Daniel S.
AU  - Lovegrove, Maribeth C.
AU  - Sapiano, Mathew R. P.
AU  - Mathew, Justin
AU  - Kegler, Scott R.
AU  - Geller, Andrew I.
AU  - Hampp, Christian
Y1  - 2016/10/21/
N1  - Accession Number: 119006925. Language: English. Entry Date: In Process. Revision Date: 20161103. Publication Type: Article. Journal Subset: Biomedical; Public Health; USA. NLM UID: 7802429. 
SP  - 1148
EP  - 1149
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 65
IS  - 41
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
SN  - 0149-2195
AD  - Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
AD  - Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration
AD  - Division of Research, Analysis, and Practice Integration, National Center for Injury Prevention and Control, CDC
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127282740
T1  - Acute Radiologic Manifestations of America's Opioid Epidemic.
AU  - Bates, David D B
AU  - Gallagher, Katherine
AU  - Yu, HeiShun
AU  - Uyeda, Jennifer
AU  - Murakami, Akira M
AU  - Setty, Bindu N
AU  - Anderson, Stephan W
AU  - Clement, Mariza O
Y1  - 2018/01//2018 Jan-Feb
N1  - Accession Number: 127282740. Language: English. Entry Date: In Process. Revision Date: 20180114. Publication Type: journal article. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8302501. 
SP  - 109
EP  - 123
JO  - RadioGraphics
JF  - RadioGraphics
JA  - RADIOGRAPHICS
VL  - 38
IS  - 1
CY  - Oak Brook, Illinois
PB  - Radiological Society of North America
AB  - The United States is in the midst of an opioid use epidemic, which has severe medical, social, and economic consequences. Addictions to and abuse of prescription and illicit opioids are increasing, and emergency department radiologists are increasingly being faced with the task of examining patients who present with opioid-related complications. These complications may be the result of direct drug toxicity or nonsterile injection of the drugs. Neurologic, musculoskeletal, cardiopulmonary, genitourinary, and gastrointestinal complications may be evident at diagnostic imaging in emergent settings. Heroin-induced leukoencephalopathy, cerebral septic emboli, mycotic arterial aneurysms, soft-tissue infections, and infective endocarditis are some of the conditions that patients may be found to have after they present to the emergency department. In this article, the above topics, including clinical features, pathophysiology, imaging findings, and treatment options, are reviewed. Recognizing the limitations of diagnostic imaging modalities that are available to radiologists is equally important, as some conditions can be successfully diagnosed after the initial triage-for example, transesophageal echocardiography can be performed to diagnose infective endocarditis. The emergency department radiologist may be responsible for identifying acute conditions, which can be life threatening. Some of the more common emergent opioid-related conditions and complications are reviewed, with specific emphasis on cases in which emergency department radiologists encounter conditions for which additional expertise is required. Becoming familiar with the conditions directly related to the current opioid epidemic will enable the diagnosis of these entities in a timely and accurate manner. ©RSNA, 2018.
SN  - 0271-5333
AD  - From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.)
U2  - PMID: 29320313.
DO  - 10.1148/rg.2018170114
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127010139
T1  - Emergency Department Opioid Misuse Diagnoses Increasing in Adolescents and Young Adults.
AU  - Abbasi, Jennifer
Y1  - 2017/12/26/
N1  - Accession Number: 127010139. Language: English. Entry Date: 20180104. Revision Date: 20180125. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Substance Use Disorders -- Epidemiology
KW  - Analgesics, Opioid
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Adolescence
KW  - Emergency Service
KW  - Young Adult
KW  - Drug Therapy -- Trends
KW  - United States
SP  - 2416
EP  - 2417
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 318
IS  - 24
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - The article discusses research which indicates that the number of hospital emergency department (ED) opioid misuse diagnoses involving adolescents and young adults has increased in America since 2008, and it mentions diagnosis codes for opioid dependence or abuse (OD/OA) and information about an opioid use disorder in children public health crisis in the U.S. According to the article, opioid-related inpatient stays and ED visits increased for all age groups between 2005 and 2014.
SN  - 0098-7484
U2  - PMID: 29214309.
DO  - 10.1001/jama.2017.16586
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110659936
T1  - Implementing routine emergency department naloxone rescue kits for patients at risk of opioid overdose.
AU  - Drainoni, Mari-Lynn
AU  - Ellison, Jacqueline
AU  - Koppelman, Elisa
AU  - Mitchell, Patricia
AU  - Feldman, James
AU  - Bernstein, Edward
AU  - Walley, Alexander
Y1  - 2015/11//
N1  - Accession Number: 110659936. Language: English. Entry Date: 20160622. Revision Date: 20160409. Publication Type: Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
SP  - e60
EP  - e60
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 156
PB  - Elsevier B.V.
SN  - 0376-8716
AD  - Medicine, Boston Univ., Boston, MA, United States
AD  - Public Health, Boston Univ., Boston, MA, United States
AD  - Boston Medical Center, Boston, MA, United States
DO  - 10.1016/j.drugalcdep.2015.07.1080
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128072674
T1  - Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use.
AU  - Jeffery, Molly Moore
AU  - Hooten, W. Michael
AU  - Hess, Erik P.
AU  - Meara, Ellen R.
AU  - Ross, Joseph S.
AU  - Henk, Henry J.
AU  - Borgundvaag, Bjug
AU  - Shah, Nilay D.
AU  - Bellolio, M. Fernanda
Y1  - 2018/03//
N1  - Accession Number: 128072674. Language: English. Entry Date: In Process. Revision Date: 20180228. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - 326
EP  - 336.e19
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 71
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: We explore the emergency department (ED) contribution to prescription opioid use for opioid-naive patients by comparing the guideline concordance of ED prescriptions with those attributed to other settings and the risk of patients' continuing long-term opioid use.Methods: We used analysis of administrative claims data (OptumLabs Data Warehouse 2009 to 2015) of opioid-naive privately insured and Medicare Advantage (aged and disabled) beneficiaries to compare characteristics of opioid prescriptions attributed to the ED with those attributed to other settings. Concordance with Centers for Disease Control and Prevention (CDC) guidelines and rate of progression to long-term opioid use are reported.Results: We identified 5.2 million opioid prescription fills that met inclusion criteria. Opioid prescriptions from the ED were more likely to adhere to CDC guidelines for dose, days' supply, and formulation than those attributed to non-ED settings. Disabled Medicare beneficiaries were the most likely to progress to long-term use, with 13.4% of their fills resulting in long-term use compared with 6.2% of aged Medicare and 1.8% of commercial beneficiaries' fills. Compared with patients in non-ED settings, commercial beneficiaries receiving opioid prescriptions in the ED were 46% less likely, aged Medicare patients 56% less likely, and disabled Medicare patients 58% less likely to progress to long-term opioid use.Conclusion: Compared with non-ED settings, opioid prescriptions provided to opioid-naive patients in the ED were more likely to align with CDC recommendations. They were shorter, written for lower daily doses, and less likely to be for long-acting formulations. Prescriptions from the ED are associated with a lower risk of progression to long-term use.
SN  - 0196-0644
AD  - Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
AD  - Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
AD  - Department of Emergency Medicine, Mayo Clinic, Rochester, MN
AD  - Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH
AD  - Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
AD  - OptumLabs, Optum, Eden Prairie, MN
AD  - Schwartz/Reisman Emergency Medicine Institute, Division of Emergency Services, Mount Sinai Hospital, Toronto, Ontario, Canada
U2  - PMID: 28967517.
DO  - 10.1016/j.annemergmed.2017.08.042
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112929262
T1  - Use of diagnosis codes for detection of clinically significant opioid poisoning in the emergency department: A retrospective analysis of a surveillance case definition.
AU  - Reardon, Joseph M.
AU  - Harmon, Katherine J.
AU  - Schult, Genevieve C.
AU  - Staton, Catherine A.
AU  - Waller, Anna E.
Y1  - 2016/02/08/
N1  - Accession Number: 112929262. Language: English. Entry Date: In Process. Revision Date: 20170929. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Instrumentation: Wide Range Achievement Test (WRAT). NLM UID: 100968543. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Coding
KW  - Emergency Service
KW  - International Classification of Diseases
KW  - Adolescence
KW  - Population Surveillance
KW  - Female
KW  - Retrospective Design
KW  - Young Adult
KW  - Adult
KW  - Middle Age
KW  - Male
KW  - Triage
SP  - 1
EP  - 6
JO  - BMC Emergency Medicine
JF  - BMC Emergency Medicine
JA  - BMC EMERG MED
VL  - 16
PB  - BioMed Central
AB  - Background: Although fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time.Methods: We determined the utility of ICD-9-CM diagnosis codes for identifying clinically significant opioid poisonings in a state-wide emergency department (ED) surveillance system. We sampled visits from four hospitals from July 2009 to June 2012 with diagnosis codes of 965.00, 965.01, 965.02 and 965.09 (poisoning by opiates and related narcotics) and/or an external cause of injury code of E850.0-E850.2 (accidental poisoning by opiates and related narcotics), and developed a novel case definition to determine in which cases opioid poisoning prompted the ED visit. We calculated the percentage of visits coded for opioid poisoning that were clinically significant and compared it to the percentage of visits coded for poisoning by non-opioid agents in which there was actually poisoning by an opioid agent. We created a multivariate regression model to determine if other collected triage data can improve the positive predictive value of diagnosis codes alone for detecting clinically significant opioid poisoning.Results: 70.1 % of visits (Standard Error 2.4 %) coded for opioid poisoning were primarily prompted by opioid poisoning. The remainder of visits represented opioid exposure in the setting of other primary diseases. Among non-opioid poisoning codes reviewed, up to 36 % were reclassified as an opioid poisoning. In multivariate analysis, only naloxone use improved the positive predictive value of ICD-9-CM codes for identifying clinically significant opioid poisoning, but was associated with a high false negative rate.Conclusions: This surveillance mechanism identifies many clinically significant opioid overdoses with a high positive predictive value. With further validation, it may help target control measures such as prescriber education and pharmacy monitoring.
SN  - 1471-227X
AD  - Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Box 3935, Durham, NC 27710, USA
AD  - Carolina Center for Health Informatics and the Injury Prevention Research Center, University of North Carolina at Chapel Hill, 100 Market St, Chapel Hill 27516NC, USA
AD  - Department of Emergency Medicine, University of North Carolina at Chapel Hill, Box 7594170 Manning Dr, Chapel Hill 27599NC, USA
AD  - Duke Global Health Institute, Duke University, 310 Trent Dr, Durham 27710NC, USA
U2  - PMID: 26856978.
DO  - 10.1186/s12873-016-0075-4
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120504741
T1  - An Algorithm for Opioid and Barbiturate Reduction in the Acute Management of Headache in the Emergency Department.
AU  - Ahmed, Zubair A.
AU  - Nacopoulos, Dimitrios A.
AU  - John, Seby
AU  - Papesh, Nancy
AU  - Levine, David
AU  - Bamford, Cynthia C.
Y1  - 2017/01//
N1  - Accession Number: 120504741. Language: English. Entry Date: 20170104. Revision Date: 20180101. Publication Type: Article; algorithm; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 2985091R. 
KW  - Migraine -- Drug Therapy
KW  - Migraine -- Diagnosis
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Barbiturates -- Administration and Dosage
KW  - Discharge Planning
KW  - Algorithms -- Utilization
KW  - Quality Improvement
KW  - Pilot Studies
KW  - Hospitals -- Ohio
KW  - Emergency Service
KW  - Ohio
KW  - Outpatients
KW  - Retrospective Design
KW  - Record Review
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - P-Value
KW  - T-Tests
KW  - Fisher's Exact Test
KW  - Pearson's Correlation Coefficient
KW  - Chi Square Test
KW  - Pretest-Posttest Design
KW  - Adolescence
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Treatment Outcomes
KW  - Human
KW  - Female
KW  - Male
SP  - 71
EP  - 79
JO  - Headache: The Journal of Head & Face Pain
JF  - Headache: The Journal of Head & Face Pain
JA  - HEADACHE
VL  - 57
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objective To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. Background Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications. In addition, discharge plans seldom include measures to prevent recurrence or instructions to re-treat if pain persists. At this time, there is no standardized management protocol directed at acute headaches presenting to the ED. Methods An ED headache treatment algorithm with step-wise instructions for diagnosis, treatment, and discharge planning was piloted at Lakewood Hospital, a regional Cleveland Clinic affiliated hospital. This non-randomized interventional study compared outcomes after implementation of the algorithm to historical controls. Patient demographic data including age, gender, and payer mix was collected. Outcomes measured included the frequency of treatment with opioids or barbiturates, imaging, neurology consults, admissions, and a patient reported pain score. Data relevant to patient disposition and follow-up, including prescriptions for opioids or barbiturates given at discharge, and ensuring PCP or neurology follow-up appointments at discharge was also reviewed. Results Demographic data did not differ significantly between the pre- and post-algorithm groups. There was a significant decline in the number of patients treated with opioids and barbiturates from 66.0% pre-algorithm to 6.8% immediately after algorithm implementation ( P <. 001), and to 28% ( P < .001) one year after algorithm implementation, indicating both an immediate effect of the algorithm and a sustained effect. Similarly, pre-algorithm implementation, 37% of patients were discharged with a prescription for opioids or barbiturates as compared to 12% and 6% in the early post-algorithm cohort and at 1 year, respectively. There was also an increase in scheduled follow-up appointments after discharge from the ED from 59% to 98% immediately post algorithm ( P < .001). Other measures including the frequency of imaging, and patient reported pain did not significantly change. There was a significant increase in neurology consults and admissions a year after the algorithm was implemented. Conclusions A quality improvement pilot study aimed at treating headache in an Emergency Department setting was successfully implemented in a regional Cleveland Clinic Hospital. Our results demonstrated significant decrease in acute treatment with opioids or barbiturates and a decrease in prescriptions written for opioids or barbiturates on discharge. This study is limited by small sample size. More data are needed to determine the reason for 1) increased consultation and subsequent admission after algorithm implementation and 2) decreased scheduled follow-up appointments at one-year post algorithm.
SN  - 0017-8748
AD  - Division of Headache, Department of Neurology, University of Utah
AD  - Department of Adult Neurology, Cleveland Clinic, Neurological Institute
AD  - Department of Emergency Medicine, Lakewood Hospital
AD  - Center for Neuro-Restoration, Center for Headache and Pain, Cleveland Clinic, Neurological Institute
DO  - 10.1111/head.12961
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128072681
T1  - Effect of Automated Prescription Drug Monitoring Program Queries on Emergency Department Opioid Prescribing.
AU  - Sun, Benjamin C.
AU  - Charlesworth, Christina J.
AU  - Lupulescu-Mann, Nicoleta
AU  - Young, Jenny I.
AU  - Kim, Hyunjee
AU  - Hartung, Daniel M.
AU  - Deyo, Richard A.
AU  - McConnell, K. John
Y1  - 2018/03//
N1  - Accession Number: 128072681. Language: English. Entry Date: In Process. Revision Date: 20180228. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Grant Information: R01 DA036522/DA/NIDA NIH HHS/United States. NLM UID: 8002646. 
SP  - 337
EP  - 347.e6
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 71
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: We assess whether an automated prescription drug monitoring program intervention in emergency department (ED) settings is associated with reductions in opioid prescribing and quantities.Methods: We performed a retrospective cohort study of ED visits by Medicaid beneficiaries. We assessed the staggered implementation (pre-post) of automated prescription drug monitoring program queries at 86 EDs in Washington State from January 1, 2013, to September 30, 2015. The outcomes included any opioid prescribed within 1 day of the index ED visit and total dispensed morphine milligram equivalents. The exposure was the automated prescription drug monitoring program query intervention. We assessed program effects stratified by previous high-risk opioid use. We performed multiple sensitivity analyses, including restriction to pain-related visits, restriction to visits with a confirmed prescription drug monitoring program query, and assessment of 6 specific opioid high-risk indicators.Results: The study included 1,187,237 qualifying ED visits (898,162 preintervention; 289,075 postintervention). Compared with the preintervention period, automated prescription drug monitoring program queries were not significantly associated with reductions in the proportion of visits with opioid prescribing (5.8 per 1,000 encounters; 95% confidence interval [CI] -0.11 to 11.8) or the amount of prescribed morphine milligram equivalents (difference 2.66; 95% CI -0.15 to 5.48). There was no evidence of selective reduction in patients with previous high-risk opioid use (1.2 per 1,000 encounters, 95% CI -9.5 to 12.0; morphine milligram equivalents 1.22, 95% CI -3.39 to 5.82). The lack of a selective reduction in high-risk patients was robust to all sensitivity analyses.Conclusion: An automated prescription drug monitoring program query intervention was not associated with reductions in ED opioid prescribing or quantities, even in patients with previous high-risk opioid use.
SN  - 0196-0644
AD  - Center for Policy Research–Emergency Medicine, Oregon Health & Science University, Portland, OR
AD  - Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
AD  - College of Pharmacy, Oregon Health & Science University, Portland, OR
AD  - College of Pharmacy, Oregon State University, Portland, OR
AD  - Department of Family Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
AD  - Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR
U2  - PMID: 29248333.
DO  - 10.1016/j.annemergmed.2017.10.023
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128072681&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110323264
T1  - Expanded Access to Naloxone Among Firefighters, Police Officers, and Emergency Medical Technicians in Massachusetts.
AU  - Davis, Corey S.
AU  - Ruiz, Sarah
AU  - Glynn, Patrick
AU  - Picariello, Gerald
AU  - Walley, Alexander Y.
Y1  - 2014/08//
N1  - Accession Number: 110323264. Language: English. Entry Date: 20140808. Revision Date: 20160330. Publication Type: Article. Journal Subset: Biomedical; Core Nursing; Double Blind Peer Reviewed; Nursing; Peer Reviewed; Public Health; USA. Special Interest: Public Health. NLM UID: 1254074. 
KW  - Naloxone -- Therapeutic Use -- Massachusetts
KW  - Firefighters
KW  - Police
KW  - Emergency Medical Technicians
KW  - Massachusetts
KW  - Overdose
KW  - Health Services Accessibility
KW  - Cost Benefit Analysis
SP  - e7
EP  - e9
JO  - American Journal of Public Health
JF  - American Journal of Public Health
JA  - AM J PUBLIC HEALTH
VL  - 104
IS  - 8
CY  - Washington, District of Columbia
PB  - American Public Health Association
AB  - Naloxone is a medication that reverses respiratory depression from opioid overdose if given in time. Paramedics routinely administer naloxone to opioid overdose victims in the prehospital setting, and many states are moving to increase access to the medication. Several jurisdictions have expanded naloxone administration authority to nonparamedic first responders, and others are considering that step. We report here on policy change in Massachusetts, where several communities have equipped emergency medical technicians, law enforcement officers, and firefighters with naloxone.
SN  - 0090-0036
AD  - Network for Public Health Law, Southeastern Region, Carrboro, NC.
AD  - Massachusetts Department of Health, Bureau of Substance Abuse Services, Boston.
AD  - Special Investigations and Narcotics Unit, Quincy, MA, Police Department.
AD  - Revere, MA, Fire Department.
AD  - Clinical Addiction Research and Education Unit, Boston University School of Medicine, Massachusetts Department of Health, Opioid Overdose Prevention Pilot Program, Boston.
U2  - PMID: 24922133.
DO  - 10.2105/AJPH.2014.302062
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110323264&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 116962232
T1  - Emergency Department Prescription Opioids as an Initial Exposure Preceding Addiction.
AU  - Butler, Megan M.
AU  - Ancona, Rachel M.
AU  - Beauchamp, Gillian A.
AU  - Yamin, Cyrus K.
AU  - Winstanley, Erin L.
AU  - Hart, Kimberly W.
AU  - Ruffner, Andrew H.
AU  - Ryan, Shawn W.
AU  - Ryan, Richard J.
AU  - Lindsell, Christopher J.
AU  - Lyons, Michael S.
Y1  - 2016/08//
N1  - Accession Number: 116962232. Language: English. Entry Date: 20170627. Revision Date: 20171208. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Instrumentation: Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer). Grant Information: UL1 TR001425/TR/NCATS NIH HHS/United States. NLM UID: 8002646. 
KW  - Emergency Service
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Substance Use Disorders -- Etiology
KW  - Academic Medical Centers
KW  - Drug Therapy
KW  - Hospitals, Urban
KW  - Cross Sectional Studies
KW  - Female
KW  - Iatrogenic Disease
KW  - Male
KW  - Adult
KW  - Short Portable Mental Status Questionnaire
SP  - 202
EP  - 208
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: Opioid abuse and overdose constitute an ongoing health emergency. Many presume opioids have little potential for iatrogenic addiction when used as directed, particularly in short courses, as is typical of the emergency department (ED) setting. We preliminarily explore the possibility that initial exposure to opioids by EDs could be related to subsequent opioid misuse.Methods: This cross-sectional study surveyed a convenience sample of patients reporting heroin or nonmedical opioid use at an urban, academic ED. We estimated the proportion whose initial exposure to opioids was a legitimate medical prescription and the proportion of those prescriptions that came from an ED. Secondary measurements included the proportion of patients receiving nonopioid substances before initial opioid exposure, the source of opioids between initial exposure and onset of regular nonmedical use, and time from initial prescription to opioid use disorder.Results: Of 59 subjects, 35 (59%; 95% confidence interval [CI] 47% to 71%) reported they were first exposed to opioids by a legitimate medical prescription, and for 10 of 35 (29%; 95% CI 16% to 45%), the prescription came from an ED. Most medically exposed subjects (28/35; 80%; 95% CI 65% to 91%) reported nonopioid substance use or treatment for nonopioid substance use disorders preceding the initial opioid exposure. Emergency providers were a source of opioids between exposure and onset of regular nonmedical use in 11 of 35 cases (31%; 95% CI 18% to 48%). Thirty-one of the 35 medically exposed subjects reported the time of onset of nonmedical use; median time from exposure to onset of nonmedical use was 6 months for use to get high (N=25; interquartile range [IQR] 2 to 36), 12 months for regular use to get high (N=24; IQR 2 to 36), 18 months for use to avoid withdrawal (N=26; IQR 2 to 38), and 24 months for regular use to avoid withdrawal (N=27; IQR 2 to 48). Eleven subjects (36%; 95% CI 21% to 53%) began nonmedical use within 2 months, and 9 of 11 (82%; 95% CI 53% to 96%) reported nonopioid substance use or treatment for alcohol abuse before initial opioid exposure.Conclusion: Although short-term opioid administration by emergency providers is unlikely to cause addiction by itself, ED opioid prescriptions may contribute to the development of addiction in some patients. There is an urgent need for further research to estimate long-term risks of short-course opioid therapy so that the risk of iatrogenic addiction can be appropriately balanced with the benefit of analgesia.
SN  - 0196-0644
AD  - Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
AD  - James L. Winkle College of Pharmacy and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH
U2  - PMID: 26875061.
DO  - 10.1016/j.annemergmed.2015.11.033
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116962232&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103805780
T1  - Opioid Education and Nasal Naloxone Rescue Kits in the Emergency Department.
AU  - Dwyer, Kristin
AU  - Walley, Alexander Y.
AU  - Langlois, Breanne K.
AU  - Mitchell, Patricia M.
AU  - Nelson, Kerrie P.
AU  - Cromwell, John
AU  - Bernstein, Edward
Y1  - 2015/05//
N1  - Accession Number: 103805780. Language: English. Entry Date: 20150529. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Patient Education
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Equipment and Supplies
KW  - Emergency Service
KW  - Human
KW  - Overdose -- Therapy
KW  - Substance Abuse -- Mortality
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Telephone
KW  - Surveys
KW  - Overdose -- Risk Factors
KW  - Overdose -- Prevention and Control
KW  - Retrospective Design
KW  - United States
KW  - Prescribing Patterns
KW  - Government Agencies
KW  - Academic Medical Centers
KW  - Trauma Centers
KW  - Protocols
KW  - Mental Health
KW  - Data Collection
KW  - Data Analysis
KW  - Behavior Modification
KW  - Patient Selection
KW  - Adult
KW  - Race Factors
KW  - Ethnic Groups
KW  - Emergency Medical Services
KW  - Outcomes (Health Care)
KW  - Patient Care
KW  - Airway Management
SP  - 381
EP  - 384
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 16
IS  - 3
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
SN  - 1936-900X
AD  - Boston University School of Medicine, Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
AD  - Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts
AD  - Boston University School of Medicine, Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts; Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
DO  - 10.5811/westjem.2015.2.24909
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103805780&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123688646
T1  - Opioid Addiction in Medicaid Population Calls for New Case Management Strategies: One solution: Limit patients to one pharmacy.
Y1  - 2017/07//
N1  - Accession Number: 123688646. Language: English. Entry Date: 20170624. Revision Date: 20170624. Publication Type: Article; case study. Journal Subset: Biomedical; USA. NLM UID: 9889446. 
KW  - Substance Dependence -- Trends -- United States
KW  - Analgesics, Opioid
KW  - Emergency Service -- Utilization
KW  - Case Management -- Methods
KW  - Telemedicine
KW  - Pharmacy, Retail -- Utilization
KW  - United States
KW  - Medicaid
KW  - Health Services Misuse
KW  - Patient Safety
SP  - 49
EP  - 51
JO  - ED Legal Letter
JF  - ED Legal Letter
JA  - ED LEGAL LETT
VL  - 28
IS  - 7
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - Healthcare organizations saw a disturbing trend of opioid addiction among some Medicaid plan members. The challenge was to address this problem and reduce its resulting increase in ED utilization. • An interrelated trend was of Medicaid patients not seeing their primary care providers and overusing EDs. • A solution was a one-pharmacy rule as part of a safety initiative. • Patients with the highest ED visits in a six-month window were targeted for the program and provided telephonic case management, as well as visits by outreach teams.
SN  - 1087-7341
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123688646&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123992305
T1  - A Retrospective Cohort Study of Obstetric Outcomes in Opioid-Dependent Women Treated with Implant Naltrexone, Oral Methadone or Sublingual Buprenorphine, and Non-Dependent Controls.
AU  - Kelty, Erin
AU  - Hulse, Gary
Y1  - 2017/07/15/
N1  - Accession Number: 123992305. Language: English. Entry Date: 20170712. Revision Date: 20170712. Publication Type: Article; research; tables/charts. Journal Subset: Australia & New Zealand; Biomedical; Peer Reviewed. Grant Information: Funding for this study was provided by the State HealthResearch Advisory Council via a Research Translation Project Grantand a Telethon Institute for Child Health Research Grant.. NLM UID: 7600076. 
KW  - Pregnancy Outcomes -- Evaluation
KW  - Substance Abuse -- Therapy
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Human
KW  - Retrospective Design
KW  - Obstetrics
KW  - Female
KW  - Pregnancy
KW  - Substance Abusers
KW  - Drug Implants
KW  - Naltrexone -- Administration and Dosage
KW  - Methadone -- Administration and Dosage
KW  - Administration, Oral
KW  - Administration, Sublingual
KW  - Control Group
KW  - Buprenorphine -- Administration and Dosage
KW  - Naltrexone -- Adverse Effects
KW  - Narcotic Antagonists
KW  - Data Collection
KW  - Data Analysis Software
KW  - International Classification of Diseases
KW  - Socioeconomic Factors
KW  - Maternal Mortality
KW  - Confidence Intervals
KW  - Labor
KW  - Delivery, Obstetric
KW  - Funding Source
SP  - 1199
EP  - 1210
JO  - Drugs
JF  - Drugs
JA  - DRUGS
VL  - 77
IS  - 11
PB  - Springer Science & Business Media B.V.
AB  - Background: Opioid pharmacotherapies play an important role in the treatment of opioid-dependent women; however, very little is known about the safety of naltrexone in pregnant patients. Objective: This study examined the obstetric health of opioid-dependent women who were treated with implant naltrexone during pregnancy, and compared them with women treated with methadone and/or buprenorphine and a cohort of non-opioid-dependent controls. Methods: Women treated with implant naltrexone, oral methadone or sublingual buprenorphine between 2001 and 2010, along with a cohort of age-matched controls, were linked with records from midwives, hospital and emergency departments (EDs) and the death registry to identify pregnancy and health events that occurred during pregnancy and in the post-partum period. Results: Overall rates of pregnancy loss (requiring hospital or ED attendance) were significantly elevated in naltrexone-treated women compared with buprenorphine-treated women ( p = 0.018) and controls ( p < 0.001); however, they were not statistically different to methadone-treated women ( p = 0.210). Birth rates in women on naltrexone implant treatment were significantly higher than in all three comparison groups ( p < 0.001). Rates of hospital and ED attendance during pregnancy in the naltrexone-treated women were not statistically different to those of either the methadone or buprenorphine groups, and neither were overall complications during pregnancy and labour. Overall rates of complications during pregnancy were significantly higher in the naltrexone-treated women than in the controls. Conclusion: Opioid-dependent women treated with naltrexone implant had higher rates of birth than the other three groups (methadone- or buprenorphine-treated women, or age-matched controls). Overall rates of complications during pregnancy were elevated in naltrexone-treated women when compared with the control group, but were generally not significantly different to rates in methadone- or buprenorphine-treated women.
SN  - 0012-6667
AD  - School of Psychiatry and Clinical Neuroscience , University of Western Australia , Sir Charles Gairdner Hospital Nedlands 6009 Australia
DO  - 10.1007/s40265-017-0762-9
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123992305&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109700366
T1  - Impact of age, sex and route of administration on adverse events after opioid treatment in the emergency department: a retrospective study.
AU  - Daoust, Raoul
AU  - Paquet, Jean
AU  - Lavigne, Gilles
AU  - Piette, Éric
AU  - Chauny, Jean-Marc
Y1  - 2015/01//Jan/Feb2015
N1  - Accession Number: 109700366. Language: English. Entry Date: 20150923. Revision Date: 20160522. Publication Type: journal article. Journal Subset: Biomedical; Canada. Special Interest: Pain and Pain Management. NLM UID: 9612504. 
SP  - 23
EP  - 28
JO  - Pain Research & Management
JF  - Pain Research & Management
JA  - PAIN RES MANAGE
VL  - 20
IS  - 1
CY  - London, <Blank>
PB  - Hindawi Limited
AB  - Background: The efficacy of opioids for acute pain relief in the emergency department (ED) is well recognized, but treatment with opioids is associated with adverse events ranging from minor discomforts to life-threatening events.Objective: To assess the impact of age, sex and route of administration on the incidence of adverse events due to opioid administration in the ED.Methods: Real-time archived data were analyzed retrospectively in a tertiary care urban hospital. All consecutive patients (≥16 years of age) who were assigned to an ED bed and received an opioid between March 2008 and December 2012 were included. Adverse events were defined as: nausea⁄vomiting (minor); systolic blood pressure (SBP) <90 mmHg, oxygen saturation (Sat) <92% and respiration rate <10 breaths⁄min (major) within 2 h of the first opioid doses.Results: In the study period, 31,742 patients were treated with opioids. The mean (± SD) age was 55.8±20.5 years, and 53% were female. The overall incidence of adverse events was 12.0% (95% CI 11.6% to 12.4%): 5.9% (95% CI 5.6% to 6.2%) experienced nausea⁄vomiting, 2.4% (95% CI 2.2% to 2.6%) SBP <90 mmHg, 4.7% (95% CI 4.5% to 4.9%) Sat that dropped to <92% and 0.09% respiration rate <10 breaths⁄min. After controlling for confounding factors, these adverse events were associated with: female sex (more nausea⁄vomiting, more SBP <90 mmHg, less Sat <92%); age ≥65 years (less nausea⁄vomiting, more SBP <90 mmHg, more Sat <92%); and route of administration (intravenous > subcutaneous > oral).Conclusions: The incidence of adverse events associated with opioid administration in the ED is generally low and is associated with age, sex and route of administration.
SN  - 1203-6765
U2  - PMID: 25664538.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109700366&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119398435
T1  - Opioid Dependent Malingerer with Self-Induced Sepsis.
AU  - Kesler, Kelly A.
AU  - Langdorf, Mark I.
AU  - Burns, Michael J.
Y1  - 2016/11//
N1  - Accession Number: 119398435. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; case study. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Candida
KW  - Sepsis
KW  - Emergency Service
KW  - Ego
KW  - Infection
KW  - Women
KW  - Female
SP  - 798
EP  - 800
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 17
IS  - 6
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - A 21-year-old woman was admitted to the emergency department (ED) with severe sepsis. Both the mechanism of infection and organisms discovered were unusual.
SN  - 1936-900X
AD  - University of California, Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California
DO  - 10.5811/westjem.2016.9.31515
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119398435&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128620619
T1  - Advocacy in Practice. Opioids: A public health emergency.
AU  - Kaplan, Louise
Y1  - 2018/04//
N1  - Accession Number: 128620619. Language: English. Entry Date: 20180330. Revision Date: 20180410. Publication Type: Article. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 7603663. 
KW  - Narcotics
KW  - Substance Abuse -- Epidemiology -- United States
KW  - Substance Abuse -- Prevention and Control
KW  - Public Health
KW  - Overdose
KW  - Nurse Practitioners
KW  - Nursing Role
KW  - Health Services Accessibility
KW  - Health Policy
KW  - United States
SP  - 12
EP  - 13
JO  - Nurse Practitioner
JF  - Nurse Practitioner
JA  - NURSE PRACT
VL  - 43
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - The article offers information on initiatives that are taken for prevention of opioid misuse and prevent opioid deaths in the U.S. Topics discussed include declaration of the opioid crisis as a public health emergency by Eric Hargan, Secretary of the U.S. Department of Health and Human Services; information on the Drug Addiction Treatment Act (DATA); and need for nurse practitioners (NP) for being informed about changes in laws, rules, and policies.
SN  - 0361-1817
AD  - Associate professor at Washington State University College of Nursing in Vancouver, Wash.
DO  - 10.1097/01.NPR.0000531073.34429.81
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128620619&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117665523
T1  - Small state takes big steps in opioid-overdose reversal.
AU  - Traynor, Kate
Y1  - 2016/06//6/1/2016
N1  - Accession Number: 117665523. Language: English. Entry Date: 20170413. Revision Date: 20170413. Publication Type: Article; pictorial. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. 
KW  - Overdose -- Prevention and Control -- Vermont
KW  - Analgesics, Opioid -- Vermont
KW  - Naloxone -- Administration and Dosage
KW  - Vermont
KW  - Emergency Service
KW  - Administration, Intranasal
KW  - Administration, Transcutaneous
SP  - 734
EP  - 738
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 73
IS  - 11
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - The article focuses on a public health campaign in Vermont regarding the use of naloxone. A pilot program operated by the Vermont Department of Health in 2014 and 2015 distributed naloxone rescue kits or kit refills from a network that includes 10 sites operated by drug treatment centers in the state. According to Mark DiParlo, manager of University of Vermont Medical Center's outpatient pharmacies, naloxone could be distributed in outpatient pharmacies through a collaborative care agreement.
SN  - 1079-2082
DO  - 10.2146/news160033
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117665523&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126757098
T1  - Macroeconomic conditions and opioid abuse.
AU  - Hollingsworth, Alex
AU  - Ruhm, Christopher J.
AU  - Simon, Kosali
Y1  - 2017/12//
N1  - Accession Number: 126757098. Language: English. Entry Date: In Process. Revision Date: 20180102. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Europe; Health Services Administration; Peer Reviewed. NLM UID: 8410622. 
SP  - 222
EP  - 233
JO  - Journal of Health Economics
JF  - Journal of Health Economics
JA  - J HEALTH ECON
VL  - 56
PB  - Elsevier B.V.
AB  - We examine how deaths and emergency department (ED) visits related to use of opioid analgesics (opioids) and other drugs vary with macroeconomic conditions. As the county unemployment rate increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose ED visit rate per 100,000 increases by 0.95 (7.0%). Macroeconomic shocks also increase the overall drug death rate, but this increase is driven by rising opioid deaths. Our findings hold when performing a state-level analysis, rather than county-level; are primarily driven by adverse events among whites; and are stable across time periods.
SN  - 0167-6296
AD  - School of Public and Environmental Affairs, Indiana University, United States
AD  - Public Policy and Economics, Frank Batten School of Leadership and Public Policy, University of Virginia, United States
AD  - NBER, United States
U2  - PMID: 29128677.
DO  - 10.1016/j.jhealeco.2017.07.009
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125916718
T1  - Reframing the Opioid Epidemic as a National Emergency.
AU  - Gostin, Lawrence O.
AU  - Hodge Jr., James G.
AU  - Noe, Sarah A.
AU  - Hodge, James G Jr
Y1  - 2017/10/24/
N1  - Accession Number: 125916718. Language: English. Entry Date: 20171104. Revision Date: 20171208. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Analgesics, Opioid
KW  - Public Health
KW  - Disease Outbreaks
KW  - Substance Use Disorders -- Epidemiology
KW  - Emergencies
KW  - United States
SP  - 1539
EP  - 1540
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 318
IS  - 16
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - The article discusses what the authors refer to as the reframing of America's opioid abuse epidemic as a national emergency as of 2017, and it mentions U.S. President Donald Trump's intentions and a recommendation from the President's Commission on Combating Drug Addiction and the Opioid Crisis. Preventable public health threats in America are addressed, along with the deaths that are associated with opioid abuse, prescription pain relievers, and substance use disorders.
SN  - 0098-7484
AD  - O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC.
AD  - Center for Public Health Law and Policy, Sandra Day O’Connor College of Law, Arizona State University, Phoenix.
AD  - University of Pennsylvania Law School, Philadelphia.
AD  - Center for Public Health Law and Policy, Sandra Day O'Connor College of Law, Arizona State University, Phoenix
U2  - PMID: 28832871.
DO  - 10.1001/jama.2017.13358
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125916718&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123427496
T1  - Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study.
AU  - Chai, Peter R.
AU  - Carreiro, Stephanie
AU  - Innes, Brendan J.
AU  - Rosen, Rochelle K.
AU  - O'Cleirigh, Conall
AU  - Mayer, Kenneth H.
AU  - Boyer, Edward W.
Y1  - 2017/01//
N1  - Accession Number: 123427496. Language: English. Entry Date: In Process. Revision Date: 20180311. Publication Type: journal article; clinical trial; research. Journal Subset: Biomedical; Canada; Computer/Information Science; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Evidence-Based Practice. Instrumentation: Wide Range Achievement Test (WRAT); Home Observation for Measurement of the Environment (HOME) (Bradley and Caldwell); Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer); Attitudes to Treatment Questionnaire (ATQ); Pennebaker Inventory of Limbic Languidness (PILL); Behavior Rating Inventory of Executive Function (BRIEF). Grant Information: U01 HD068040/HD/NICHD NIH HHS/United States. NLM UID: 100959882. 
KW  - Fractures -- Physiopathology
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Fractures -- Drug Therapy
KW  - Pain -- Drug Therapy
KW  - Pain -- Etiology
KW  - Oxycodone -- Administration and Dosage
KW  - Biosensing Techniques
KW  - Female
KW  - Emergency Service
KW  - Middle Age
KW  - Radio Waves
KW  - Medication Compliance
KW  - Male
KW  - Pilot Studies
KW  - Human
KW  - Adult
KW  - Clinical Trials
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Clinical Assessment Tools
KW  - Questionnaires
KW  - Short Portable Mental Status Questionnaire
SP  - 1
EP  - 10
JO  - Journal of Medical Internet Research
JF  - Journal of Medical Internet Research
JA  - J MED INTERNET RES
VL  - 19
IS  - 1
CY  - Toronto, Ontario
PB  - JMIR Publications Inc.
AB  - Background: Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy.Objective: The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture.Methods: We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis.Results: We recruited 10 study participants and recorded 96 ingestion events (87.3%, 96/110 accuracy). Study participants reported being able to operate all aspects of the digital pill system after their training. Two participants stopped using the digital pill, reporting they were in too much pain to focus on the novel technology. The digital pill system detected multiple simultaneous ingestion events by the digital pill system. Participants ingested a mean 8 (SD 5) digital pills during the study period and four participants continued on opioids at the end of the study period. After interacting with the digital pill system in the real world, participants found the system highly acceptable (80%, 8/10) and reported a willingness to continue to use a digital pill to improve medication adherence monitoring (90%, 9/10).Conclusions: The digital pill is a feasible method to measure real-time opioid ingestion patterns in individuals with acute pain and to develop real-time interventions if opioid abuse is detected. Deploying digital pills is possible through the ED with a short instructional course. Patients who used the digital pill accepted the technology.
SN  - 1438-8871
AD  - Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.
AD  - Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
AD  - University of Massachusetts Medical School, Worcester, MA, United States.
AD  - Behavioral and Preventative Medicine, The Miriam Hospital, Brown School of Public Health, Providence, RI, United States.
AD  - Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
AD  - Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
U2  - PMID: 28087496.
DO  - 10.2196/jmir.7050
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123427496&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121451570
T1  - Something for pain: Responsible opioid use in emergency medicine.
AU  - Strayer, Reuben J.
AU  - Motov, Sergey M.
AU  - Nelson, Lewis S.
Y1  - 2017/02//
N1  - Accession Number: 121451570. Language: English. Entry Date: 20170417. Revision Date: 20170817. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Pain -- Drug Therapy
KW  - Drug Tolerance
KW  - Emergency Medicine -- Standards
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Substance Use Disorders -- Prevention and Control
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Chronic Pain -- Drug Therapy
KW  - Risk Assessment
KW  - Substance Use Disorders -- Etiology
KW  - Drug Therapy -- Trends
KW  - Substance Use Disorders -- Mortality
KW  - Analgesics, Opioid -- Standards
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - United States
KW  - Emergency Medicine -- Methods
SP  - 337
EP  - 341
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 35
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - The United States is currently experiencing a public health crisis of opioid addiction, which has its genesis in an industry marketing effort that successfully encouraged clinicians to prescribe opioids liberally, and asserted the safety of prescribing opioids for chronic non-cancer pain, despite a preponderance of evidence demonstrating the risks of dependence and misuse. The resulting rise in opioid use has pushed drug overdose deaths in front of motor vehicle collisions to become the leading cause of accidental death in the country. Emergency providers frequently treat patients for complications of opioid abuse, and also manage patients with acute and chronic pain, for which opioids are routinely prescribed. Emergency providers are therefore well positioned to both prevent new cases of opioid misuse and initiate appropriate treatment of existing opioid addicts. In opioid-naive patients, this is accomplished by a careful consideration of the likelihood of benefit and harm of an opioid prescription for acute pain. If opioids are prescribed, the chance of harm is reduced by matching the number of pills prescribed to the expected duration of pain and selecting an opioid preparation with low abuse liability. Patients who present to acute care with exacerbations of chronic pain or painful conditions associated with opioid misuse are best managed by treating symptoms with opioid alternatives and encouraging treatment for opioid addiction.
SN  - 0735-6757
AD  - 79-01 Broadway, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, NY 11373, United States
AD  - 4802 Tenth Ave, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY 11219, United States
AD  - 185 South Orange Avenue, Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
U2  - PMID: 27802876.
DO  - 10.1016/j.ajem.2016.10.043
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121451570&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123531822
T1  - Alarming Rates of Mortality in Patients with Opioid Use Disorder Should Spur Action.
Y1  - 2017/07//
N1  - Accession Number: 123531822. Language: English. Entry Date: 20170613. Revision Date: 20170615. Publication Type: Article. Journal Subset: Nursing; USA. Special Interest: Patient Safety. NLM UID: 9425690. 
KW  - Substance Use Disorders -- Prevention and Control
KW  - Substance Use Disorders -- Rehabilitation
KW  - Emergency Care
KW  - Health Care Delivery, Integrated
KW  - Narcotics -- Poisoning
KW  - Substance Abusers
KW  - Emergency Patients
KW  - Referral and Consultation
KW  - Primary Health Care
KW  - Substance Use Rehabilitation Programs
KW  - Medicaid
KW  - Emergency Service
KW  - Telemedicine
KW  - Comorbidity
KW  - Substance Use Disorders -- Mortality
KW  - Washington
SP  - 1
EP  - 5
JO  - ED Management
JF  - ED Management
JA  - ED MANAGE
VL  - 29
IS  - 7
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - With a new study showing alarming rates of mortality among patients with opioid use disorder (OUD) who are seen in general medical settings, experts stress that healthcare organizations and policymakers must create innovative solutions to ensure that OUD is diagnosed at an early stage, and that all care settings are equipped with the training and mechanisms to link these patients with effective treatment. • In a population of 2,576 adults with OUD in a large healthcare system, researchers found that 476 patients died after four years of follow-up for a mortality rate of 18.1%, 10 times that of the general population. • The average age of patients when first diagnosed with OUD was 41 years, and the patients exhibited high rates of other mental and physical illnesses. • One model used in some emergency settings to link patients with OUD to care is Screening, Brief Intervention, and Referral to Treatment, but the approach requires partners who can take over the care of the patients following initial treatment with an FDA-approved medication in the ED. • The Medicaid program in Washington has made steady progress trimming both the number of prescription opioid deaths and the number of prescriptions for opioids written in EDs through clinical leadership, an electronic information exchange that connects all EDs in the state, and a system of feedback on opioid prescribing. • The state is working to facilitate access for patients with OUD to addiction specialists and medication-assisted treatment, and it is pursuing behavioral integration.
SN  - 1044-9167
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119652186
T1  - Is There a Role for Intravenous Subdissociative-Dose Ketamine Administered as an Adjunct to Opioids or as a Single Agent for Acute Pain Management in the Emergency Department?
AU  - Motov, Sergey
AU  - Rosenbaum, Steven
AU  - Vilke, Gary M.
AU  - Nakajima, Yuko
Y1  - 2016/12//
N1  - Accession Number: 119652186. Language: English. Entry Date: 20171021. Revision Date: 20171021. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 8412174. 
KW  - Pain -- Drug Therapy
KW  - Ketamine -- Administration and Dosage
KW  - Anesthetics, Dissociative -- Administration and Dosage
KW  - Ketamine -- Therapeutic Use
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Anesthetics, Dissociative -- Therapeutic Use
KW  - Pain -- Therapy
KW  - Clinical Trials
KW  - Drug Therapy, Combination
KW  - Human
KW  - Administration, Intravenous
KW  - Emergency Service
KW  - Scales
SP  - 752
EP  - 757
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 51
IS  - 6
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Whether acute or chronic, emergency physicians frequently encounter patients reporting pain. It is the responsibility of the emergency physician to assess and evaluate, and if appropriate, safely and effectively reduce pain. Recently, analgesics other than opioids are being considered in an effort to provide safe alternatives for pain management in the emergency department (ED). Opioids have significant adverse effects such as respiratory depression, hypotension, and sedation, to say nothing of their potential for abuse. Although ketamine has long been used in the ED for procedural sedation and rapid sequence intubation, it is used infrequently for analgesia. Recent evidence suggests that ketamine use in subdissociative doses proves to be effective for pain control and serves as a feasible alternative to traditional opioids. This paper evaluates ketamine's analgesic effectiveness and safety in the ED.Methods: This is a literature review of randomized controlled trials, systematic reviews, meta-analyses, and observational studies evaluating ketamine for pain control in the ED setting. Based on these search parameters, eight studies were included in the final analysis and graded based on the American Academy of Emergency Medicine Clinical Practice Committee manuscript review process.Results: A total of eight papers were reviewed in detail and graded. Recommendations were given based upon this review process.Conclusions: Subdissociative-dose ketamine (low-dose ketamine) is effective and safe to use alone or in combination with opioid analgesics for the treatment of acute pain in the ED. Its use is associated with higher rates of minor, but well-tolerated adverse side effects.
SN  - 0736-4679
AD  - Maimonides Medical Center, Brooklyn, New York
AD  - American Academy of Emergency Medicine, Milwaukee, Wisconsin
AD  - University of California at San Diego Medical Center, San Diego, California
U2  - PMID: 27693070.
DO  - 10.1016/j.jemermed.2016.07.087
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119652186&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112629459
T1  - A comparison of an opioid abuse screening tool and prescription drug monitoring data in the emergency department.
AU  - Weiner, Scott G.
AU  - Horton, Laura C.
AU  - Green, Traci C.
AU  - Butler, Stephen F.
Y1  - 2016/02//
N1  - Accession Number: 112629459. Language: English. Entry Date: 20160906. Revision Date: 20170203. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
KW  - Substance Use Disorders -- Diagnosis
KW  - Emergency Service
KW  - Risk Taking Behavior
KW  - Drug Utilization -- Statistics and Numerical Data
KW  - Middle Age
KW  - Young Adult
KW  - Human
KW  - Substance Use Disorders -- Psychosocial Factors
KW  - Psychometrics
KW  - Resource Databases
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Adolescence
KW  - Risk Assessment
KW  - Adult
KW  - Female
KW  - Male
KW  - Aged
KW  - Pain -- Drug Therapy
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
SP  - 152
EP  - 157
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 159
PB  - Elsevier B.V.
AB  - Objectives: This study aimed to: (a) determine the percentage of ED patients receiving prescriptions for opioid pain medications that meet the criteria for "high-risk for abuse potential" on the Screener and Opioid Assessment for Patients with Pain (SOAPP(®)-R), (b) determine the percentage of patients with high-risk behavior on the state prescription drug monitoring program (PDMP) database, (c) compare the SOAPP-R with data from the PDMP, and (d) determine psychometric properties of SOAPP-R for ED patientsMethods: Convenience sample of ED patients who were being considered for discharge with a prescription for an opioid pain medication. Subjects completed SOAPP-R on an electronic tablet and PDMP data was obtained. Scores on SOAPP-R ≥ 18 were defined as "at-risk", and PDMP data showing both ≥ 4 opioid prescriptions and ≥ 4 providers in 12 months was considered the criterion standard for high-risk behavior.Results: 82 patients (88.2%) provided consent. 32.9% (n=27) were determined to be "at-risk" (score ≥ 18) by SOAPP-R. 15.9% (n=13) subjects met PDMP criteria and 53.9% (n=7) of those had SOAPP-R scores ≥ 18 (sensitivity 54%, specificity 71%, positive predictive value 26%, negative predictive value 89%). The association of an at-risk SOAPP-R score and PDMP high-risk criteria was an adjusted odds ratio of 1.39 (95% confidence interval 0.73-3.68).Conclusions: In our population, about one-third of patients being considered for discharge with an opioid prescription scored "at-risk" on SOAPP-R and 15.9% met the PDMP high-risk criteria. The high negative predictive value of SOAPP-R indicates it may be a useful screening tool for the ED patient population.
SN  - 0376-8716
AD  - Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States
AD  - Tufts University School of Medicine, Boston, MA, United States
AD  - Boston Medical Center and Boston University Department of Emergency Medicine Providence, RI Inflexxion, Inc., Newton, MA, United States
AD  - Inflexxion, Inc., Newton, MA, United States
U2  - PMID: 26743334.
DO  - 10.1016/j.drugalcdep.2015.12.007
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118293174
T1  - New Initiative Slashes Opioid Prescriptions, Boosts Community Response.
Y1  - 2016/10//
N1  - Accession Number: 118293174. Language: English. Entry Date: 20170607. Revision Date: 20171010. Publication Type: Article. Journal Subset: Nursing; USA. Special Interest: Emergency Care; Pain and Pain Management; Psychiatry/Psychology. NLM UID: 9302170. 
KW  - Narcotics -- Therapeutic Use
KW  - Pain -- Drug Therapy
KW  - Emergency Care
KW  - Emergency Service
KW  - Prescriptions, Drug
KW  - Practice Guidelines
KW  - Substance Use Rehabilitation Programs
KW  - California
KW  - Hospitals, Community
KW  - Substance Abusers
KW  - Guideline Adherence
KW  - Drug Utilization
KW  - Primary Health Care
SP  - 115
EP  - 118
JO  - Case Management Advisor
JF  - Case Management Advisor
JA  - CASE MANAGE ADVIS
VL  - 27
IS  - 10
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - The article discusses the development of Monterey County Prescribe Safe Initiative (MCPSI) by Community Hospital of Monterey Peninsula which focuses to provide solution to problem of prescription opioid misuse in Monterey County, California. Topics include the role of emergency providers in leading multiple interventions addressing the aspects of opioid crisis, and the effectiveness of MCPSI in reducing the emergency department visits.
SN  - 1053-5500
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118293174&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104057985
T1  - Epidemiology of emergency department visits for opioid overdose: a population-based study.
AU  - Hasegawa, Kohei
AU  - Brown, David F M
AU  - Tsugawa, Yusuke
AU  - Camargo Jr, Carlos A
Y1  - 2014/04//
N1  - Accession Number: 104057985. Language: English. Entry Date: 20140606. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0405543. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Cause of Death
KW  - Emergency Service -- Utilization
KW  - Substance Use Disorders -- Diagnosis
KW  - Substance Use Disorders -- Epidemiology
KW  - Adolescence
KW  - Adult
KW  - Demography
KW  - Aged
KW  - Analgesics, Opioid -- Poisoning
KW  - California
KW  - Prospective Studies
KW  - Confidence Intervals
KW  - Resource Databases
KW  - Overdose -- Diagnosis
KW  - Overdose -- Epidemiology
KW  - Overdose -- Therapy
KW  - Female
KW  - Florida
KW  - Human
KW  - Kaplan-Meier Estimator
KW  - Male
KW  - Middle Age
KW  - Multivariate Analysis
KW  - Substance Use Disorders -- Therapy
KW  - Population Surveillance
KW  - Prevalence
KW  - Risk Assessment
KW  - Survival Analysis
KW  - Young Adult
SP  - 462
EP  - 471
JO  - Mayo Clinic Proceedings
JF  - Mayo Clinic Proceedings
JA  - MAYO CLIN PROC
VL  - 89
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - OBJECTIVES: To evaluate the rate of emergency department (ED) visits for opioid overdose and to examine whether frequent ED visits for opioid overdose are associated with more hospitalizations, near-fatal events, and health care spending. PATIENTS AND METHODS: Retrospective cohort study of adults with at least 1 ED visit for opioid overdose between January 1, 2010, and December 31, 2011, derived from population-based data of State Emergency Department Databases and State Inpatient Databases for 2 large and diverse states: California and Florida. Main outcome measures were hospitalizations for opioid overdose, near-fatal events (overdose involving mechanical ventilation), and hospital charges during the year after the first ED visit. RESULTS: The analytic cohort comprised 19,831 unique patients with 21,609 ED visits for opioid overdose. During a 1-year period, 7% (95% CI, 7%-7%; n=1389 patients) of the patients had frequent (2 or more) ED visits, accounting for 15% (95% CI, 14%-15%; n=3167) of all opioid overdose ED visits. Middle age, male sex, public insurance, lower household income, and comorbidities (such as chronic pulmonary disease and neurological diseases) were associated with frequent ED visits (all P<.01). Overall, 53% (95% CI, 52%-54%; n=11,412) of the ED visits for opioid overdose resulted in hospitalizations; patients with frequent ED visits for opioid overdose had a higher likelihood of hospitalization (adjusted odds ratio, 3.98; 95% CI, 3.38-4.69). In addition, 10.0% (95% CI, 10%-10%; n=2161) of the ED visits led to near-fatal events; patients with frequent ED visits had a higher likelihood of a near-fatal event (adjusted odds ratio, 2.27; 95% CI, 1.96-2.66). Total charges in Florida were $208 million (95% CI, $200-$219 million). CONCLUSION: In this population-based cohort, we found that frequent ED visits for opioid overdose were associated with a higher likelihood of future hospitalizations and near-fatal events.
SN  - 0025-6196
AD  - Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: khasegawa1@partners.org.
AD  - Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
AD  - Harvard Interfaculty Initiative in Health Policy, Cambridge, MA.
U2  - PMID: 24629443.
DO  - 10.1016/j.mayocp.2013.12.008
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117877364
T1  - Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.
AU  - Levine, Michael
AU  - Sanko, Stephen
AU  - Eckstein, Marc
Y1  - 2016/09//Sep/Oct2016
N1  - Accession Number: 117877364. Language: English. Entry Date: 20160915. Revision Date: 20180223. Publication Type: Article; research. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Treatment Refusal
KW  - Emergency Care
KW  - Prehospital Care
KW  - Human
KW  - Patient Care -- Methods
KW  - Emergency Medical Technicians
KW  - Retrospective Design
KW  - Substance Abuse -- Diagnosis
KW  - Analgesics, Opioid
KW  - Patient Safety
KW  - Firefighters
KW  - Professional Organizations
KW  - Documentation
KW  - Respiratory Rate -- Evaluation
KW  - Electronic Health Records
KW  - Record Review
KW  - Death
KW  - Coroners and Medical Examiners
SP  - 566
EP  - 569
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 20
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background:EMS providers frequently encounter opioid-toxic patients who receive naloxone and then refuse further medical care. Older studies revealed this practice to be safe. In light of the evolving patterns of opioid abuse, this study attempted to determine the safety of this practice.Methods:This is a retrospective review of all patient encounters by the Los Angeles Fire Department (LAFD) between July 1, 2011–December 31, 2013. All LAFD patient encounters are stored electronically. These electronic records were reviewed for subjects who received naloxone had a documented respiratory rate (RR) less than 12, and subsequently refused transport. Data abstracted included name, social security number (SSN), date of birth (DOB), date of EMS encounter, age, and treatment rendered. The names, SSN, and DOB, as available, were supplied to the coroner's office. The Coroner's records were reviewed to determine if a patient with the same or similar name (e.g., Jon vs. Jonathan) had died within 24 hours, 30 days, or 6 months of the initial EMS encounter. The abstractor was blinded to the study hypothesis.Results: 205 subjects were identified; the median (IQR) age was 41 (29-53) years. 27 (13%) were female. One subject (0.49%) died within 24 hours of the initial EMS encounter. The cause of death (COD) was coronary artery disease and heroin use. Two additional subjects (1. %) died within 30 days. One of these subjects died 6 days later; the COD is unknown. The other subject died 20 days after the EMS encounter; the COD was cardiovascular disease and liver cirrhosis. No additional subjects were identified at the 6 month follow up. A third subject died of a heroin overdose 16 months after the initial EMS encounter, but was beyond the pre-defined follow up period.Conclusions:The practice of receiving pre-hospital naloxone by paramedics and subsequently refusing care is associated with an extremely low short- and intermediate-term mortality. Despite an evolving pattern of opioid abuse, the results of this study are consistent with previously reported studies.
SN  - 1090-3127
DO  - 10.3109/10903127.2016.1142626
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104247833
T1  - Use and efficacy of nebulized naloxone in patients with suspected opioid intoxication.
AU  - Baumann, Brigitte M
AU  - Patterson, Rachel A
AU  - Parone, Dominic A
AU  - Jones, Molly K
AU  - Glaspey, Lindsey J
AU  - Thompson, Nicole M
AU  - Stauss, Mary P
AU  - Haroz, Rachel
Y1  - 2013/03//
N1  - Accession Number: 104247833. Language: English. Entry Date: 20130510. Revision Date: 20170802. Publication Type: Journal Article; clinical trial; research. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. Instrumentation: Glasgow Coma Scale (GCS); Richmond Agitation Sedation Scale (RASS). NLM UID: 8309942. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Naloxone
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Administration, Inhalation
KW  - Adolescence
KW  - Adult
KW  - Clinical Assessment Tools
KW  - Clinical Trials
KW  - Glasgow Coma Scale
KW  - Human
KW  - Middle Age
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Pilot Studies
KW  - Prospective Studies
KW  - Scales
KW  - Treatment Outcomes
KW  - Young Adult
SP  - 585
EP  - 588
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 31
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - OBJECTIVE: To describe the use and efficacy of nebulized naloxone in patients with suspected opioid intoxication. METHODS: This was an observational study conducted at an inner city emergency department. Patients were eligible if they had self-reported or suspected opioid intoxication and a spontaneous respiratory rate >=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 < .0001. Need for supplemental oxygen decreased from 81% to 50%, P = .03. Vital signs did not differ pre/post therapy. There were few adverse effects from nebulized naloxone administration: 12% experienced moderate-severe agitation, 8% were diaphoretic and none vomited. Eleven required subsequent administrations of naloxone, nine of whom self-reported using either heroin, methadone or both. Of these, 5 underwent urine drug screening and all 5 tested positive for either opiates or methadone. CONCLUSIONS: Nebulized naloxone was well-tolerated and led to a reduction in the need for supplemental oxygen as well as improved median GCS and RASS scores in patients with suspected opioid intoxication.
SN  - 0735-6757
AD  - Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ 08103, USA. Electronic address: baumann-b@cooperhealth.edu.
U2  - PMID: 23347721.
DO  - 10.1016/j.ajem.2012.10.004
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104247833&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126574788
T1  - Emergency Department Visits Involving Opioid Overdoses, U.S., 2010-2014.
AU  - Guy, Gery P.
AU  - Pasalic, Emilia
AU  - Zhang, Kun
AU  - Guy, Gery P Jr
Y1  - 2018/01//
N1  - Accession Number: 126574788. Language: English. Entry Date: In Process. Revision Date: 20171222. Publication Type: journal article. Journal Subset: Biomedical; Health Promotion/Education; USA. NLM UID: 8704773. 
SP  - e37
EP  - e39
JO  - American Journal of Preventive Medicine
JF  - American Journal of Preventive Medicine
JA  - AM J PREV MED
VL  - 54
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0749-3797
AD  - Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
U2  - PMID: 29132953.
DO  - 10.1016/j.amepre.2017.09.003
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126574788&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104218819
T1  - Estimates of Charges Associated With Emergency Department and Hospital Inpatient Care for Opioid Abuse-Related Events.
AU  - Chandwani, Hitesh S.
AU  - Strassels, Scott A.
AU  - Rascati, Karen L.
AU  - Lawson, Kenneth A.
AU  - Wilson, James P.
Y1  - 2013/08//
N1  - Accession Number: 104218819. Language: English. Entry Date: 20130909. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management; Palliative Care/Hospice. NLM UID: 101125608. 
KW  - Substance Abuse
KW  - Analgesics, Opioid
KW  - Drugs, Prescription
KW  - Emergency Service -- Economics -- United States
KW  - Hospitalization -- Economics
KW  - Insurance, Health
KW  - Human
KW  - Male
KW  - Female
KW  - Descriptive Statistics
KW  - Confidence Intervals
KW  - Regression
KW  - Adult
KW  - Medicare
KW  - Medicaid
KW  - United States
KW  - Data Analysis Software
KW  - Comorbidity
SP  - 206
EP  - 213
JO  - Journal of Pain & Palliative Care Pharmacotherapy
JF  - Journal of Pain & Palliative Care Pharmacotherapy
JA  - J PAIN PALLIAT CARE PHARMACOTHER
VL  - 27
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - The economic burden of prescription opioid abuse is substantial; however, no study has estimated the monetary burden of hospital services (emergency department [ED] and inpatient) using a single, nationally representative database. We sought to estimate total and average (adjusted for demographic and clinical factors) charges billed for opioid abuse-related events, and magnitude of difference in charges between ED visits resulting in inpatient admission to the same hospital and treat-and-release ED visits in the United States. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). Using methods to account for the complex sampling design of the NEDS and a log-linked gamma regression model, we estimated national total and mean charges (in 2010 USD). Total charges were $9.8, $9.6, and $9.5 billion for 2006, 2007, and 2008, respectively. Medicaid-covered events had the highest total charges ($3 billion), followed by events covered by Medicare ($2 billion) for each year. The national estimate of adjusted, mean, per-event charges, was $18,891 (95% confidence interval [CI] = $18,167-$19,616). Compared with events covered by private insurance, mean charges for Medicare- and Medicaid-covered events were higher ( t = 28.14, P < .001; t = 6.42, P < .001, respectively), whereas self-paid events had significantly lower charges ( t = −11.14, P < .001). ED visits resulting in subsequent inpatient admission had approximately 6 times higher charges than treat-and-release visits. This study provides estimates of differences in hospital costs of opioid abuse by insurance status, resulting in a better understanding of the economic burden of opioid abuse on the health care system.
SN  - 1536-0288
AD  - Hitesh S. Chandwani, MBBS, MS, was a doctoral student in Health Outcomes at the time of this study. Scott A. Strassels, PharmD, PhD, is Assistant Professor, Karen L. Rascati, PhD, is Centennial Endowed Professor, Kenneth A. Lawson, PhD, is Associate Professor, and James P. Wilson, PhD, is Associate Professor, Health Outcomes & Pharmacy Practice, University of Texas at Austin College of Pharmacy, Austin, Texas, USA.
U2  - PMID: 23879214.
DO  - 10.3109/15360288.2013.803511
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104218819&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124665782
T1  - Declaring U.S. opioid emergency opens up resources for providers.
AU  - Johnson, Steven Ross
Y1  - 2017/08/14/
N1  - Accession Number: 124665782. Language: English. Entry Date: 20170822. Revision Date: 20170822. Publication Type: Article; brief item. Journal Subset: Health Services Administration; USA. NLM UID: 7801798. 
KW  - Analgesics, Opioid
KW  - Disease Outbreaks
KW  - Politics -- United States
KW  - Emergencies
KW  - United States
KW  - Government Regulations -- United States
KW  - Naloxone -- Therapeutic Use
KW  - Insurance, Health, Reimbursement
KW  - Emergency Care
KW  - Buprenorphine -- Therapeutic Use
KW  - Methadone -- Therapeutic Use
SP  - 0002
EP  - 0002
JO  - Modern Healthcare
JF  - Modern Healthcare
JA  - MOD HEALTHC
VL  - 47
IS  - 33
CY  - Detroit, Michigan
PB  - Crain Communications Inc. (MI)
AB  - The article reports on U.S. President Donald Trump's plan to declare the opioid crisis a national emergency, and assesses its implications for health care providers. Topics discussed include the distribution of emergency funds and resources to states that have been hardest hit by the crisis, the ability of the government to negotiate drug prices for medication-assisted treatments, and the expected decrease in the cost of the overdose-reversal drug naloxone.
SN  - 0160-7480
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124665782&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113935833
T1  - Development and initial testing of a tailored telephone intervention delivered by peers to prevent recurring opioid-overdoses (TTIP-PRO).
AU  - Winhusen, T.
AU  - Theobald, J.
AU  - Lewis, D.
AU  - Wilder, C. M.
AU  - Lyons, M. S.
Y1  - 2016/04//
N1  - Accession Number: 113935833. Language: English. Entry Date: 20160331. Revision Date: 20170403. Publication Type: Article; research; tables/charts. Journal Subset: Europe; Health Promotion/Education; Peer Reviewed; UK & Ireland. Instrumentation: Opioid Overdose and Treatment Awareness Survey (OOTAS); Personal Opioid-Overdose Risk Survey (PORS). Grant Information: This work was supported by the University ofCincinnati Department of Psychiatry andBehavioral Neuroscience.. NLM UID: 8608459. 
KW  - Telephone
KW  - Overdose -- Prevention and Control
KW  - Analgesics, Opioid -- Poisoning
KW  - Human
KW  - Pretest-Posttest Design
KW  - Heroin -- Poisoning
KW  - Software
KW  - Methadone
KW  - Buprenorphine
KW  - Data Analysis Software
KW  - Wilcoxon Rank Sum Test
KW  - Whites
KW  - Female
KW  - Male
KW  - Adult
KW  - Middle Age
KW  - Funding Source
KW  - Questionnaires
SP  - 146
EP  - 160
JO  - Health Education Research
JF  - Health Education Research
JA  - HEALTH EDUC RES
VL  - 31
IS  - 2
PB  - Oxford University Press / USA
AB  - Individuals with opioid use disorder experiencing a non-fatal opioid-overdose (OOD) are at heightened risk for future OODs; there are no interventions to facilitate treatment enrollment for these patients. Our goal was to develop and initially test the 'tailored telephone intervention delivered by peers to prevent recurring opioid-overdoses' (TTIP-PRO), a computer-facilitated, peer-delivered, individually tailored secondary prevention intervention designed to: (i) encourage patients to initiate medication-assisted treatment (MAT) and (ii) increase OOD knowledge. A pre-post-study assessed TTIP-PRO-content acceptability and software performance. Two Peer Interventionists, who were abstinent from illicit opioids, enrolled in MAT and had experience with OOD, were recruited from a MAT clinic. Recruitment letters were sent to patients treated for OOD in a hospital emergency department within the prior 8 months. Eight patients received TTIP-PRO and completed pre-/post-assessment. Peer Interventionists completed training within 4 h and reported high satisfaction with TTIP-PRO. There were no performance issues with the software. All participants rated TTIP-PRO as 'very helpful'. Participants' OOD knowledge increased significantly, with 69.9% correct responses pre-TTIP-PRO and 93.6% post-TTIP-PRO. Interest in receiving MAT, measured on a 10-point scale, increased from 8.1 to 9.5, but this change was not statistically significant. Further development and testing of TTIP-PRO appears warranted.
SN  - 0268-1153
AD  - Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA
AD  - Cincinnati Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA
AD  - Department of Emergency Medicine, University of Cincinnati College of Medicine 231 Albert Sabin Way, Cincinnati, OH 45267, USA
DO  - 10.1093/her/cyw010
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113935833&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

ID  - 126196954
T1  - The opioid crisis in the USA: a public health emergency.
AU  - The Lancet
Y1  - 2017/11/04/
N1  - Accession Number: 126196954. Language: English. Entry Date: 20180403. Revision Date: 20180111. Publication Type: editorial. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 2985213R. 
SP  - 2016
EP  - 2016
JO  - Lancet
JF  - Lancet
JA  - LANCET
VL  - 390 North American Edition
IS  - 10107
CY  - Philadelphia, Pennsylvania
PB  - Lancet
SN  - 0099-5355
U2  - PMID: 29115231.
DO  - 10.1016/S0140-6736(17)32808-8
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126196954&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126138174
T1  - The opioid crisis in the USA: a public health emergency.
Y1  - 2017/11/04/
N1  - Accession Number: 126138174. Language: English. Entry Date: 20180403. Revision Date: 20180111. Publication Type: Article. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 2985213R. 
SP  - 2016
EP  - 2016
JO  - Lancet
JF  - Lancet
JA  - LANCET
VL  - 390 North American Edition
IS  - 10107
CY  - Philadelphia, Pennsylvania
PB  - Lancet
SN  - 0099-5355
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126138174&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103922961
T1  - Intranasal naloxone administration for treatment of opioid overdose.
AU  - Robinson, Amanda
AU  - Wermeling, Daniel P.
Y1  - 2014/12/15/
N1  - Accession Number: 103922961. Language: English. Entry Date: 20141205. Revision Date: 20150710. Publication Type: Journal Article; pictorial; review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. 
KW  - Administration, Intranasal
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Narcotics -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Pharmacokinetics
KW  - Naloxone -- Pharmacodynamics
KW  - Prehospital Care
KW  - Respiration Disorders -- Chemically Induced
KW  - Injections, Intramuscular
KW  - Administration, Intravenous
KW  - Naloxone -- Adverse Effects
SP  - 2129
EP  - 2135
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 71
IS  - 24
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - Purpose. The pharmacology, pharmacokinetic properties, and clinical efficacy of naloxone injection administered intranasally for the reversal of opioid overdose are reviewed. Summary. Naloxone is an opioid-receptor antagonist that is used in the treatment of opioid overdose to reverse the respiratory and central nervous system–depressant effects of the opioid. Naloxone injection is traditionally given by intravenous, intramuscular, and subcutaneous routes. Paramedics also administer naloxone injection intranasally in the prehospital setting to treat suspected opioid overdose. The nasal mucosa has a rich blood supply that allows for efficient drug absorption and the avoidance of first-pass hepatic metabolism that would be seen with oral administration. Obtaining vascular access can be difficult in known drug users, prolonging the time required to administer the antidote. Patients awakening from an overdose may be agitated, confused, and even combative, thus increasing the risk of needle-stick injury to first responders. The intranasal route avoids the need for establishing vascular access and can be associated with speedier patient recovery. In two randomized controlled trials, intranasal naloxone alone was shown to be sufficient for reversing opioid-induced respiratory depression in 74% and 72% of the respective study populations of patients experiencing opioid overdose. In addition, the safety profile of intranasal naloxone appears to be no different than that of naloxone injection in the treatment of opioid overdose in the prehospital setting. Conclusion. Intranasal administration of naloxone appears to be effective in treatment of opioid overdose when i.v. administration is impossible or undesirable.
SN  - 1079-2082
AD  - Professor of Pharmacy, University of Kentucky College of Pharmacy, Lexington
U2  - PMID: 25465584.
DO  - 10.2146/ajhp130798
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126065818
T1  - An Opioid-Free ED: St. Joseph's Regional Medical Center is first in country to implement an opiate-free protocol.
AU  - Neff Newitt, Valerie
Y1  - 2016/11//
N1  - Accession Number: 126065818. Language: English. Entry Date: 20171117. Revision Date: 20171117. Publication Type: Article; pictorial. Journal Subset: Biomedical; USA. 
KW  - Emergency Service -- New Jersey
KW  - Pain Management -- Methods
KW  - Analgesics, Nonnarcotic -- Therapeutic Use
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - New Jersey
KW  - Drug Monitoring
KW  - Prescribing Patterns
KW  - Substance Abuse -- Diagnosis
KW  - Mental Disorders -- Diagnosis
KW  - Medical Practice, Evidence-Based
KW  - Collaboration
KW  - Trigger Point
KW  - Injections
KW  - Nerve Block
SP  - 12
EP  - 15
JO  - Advance for Respiratory Care & Sleep Medicine
JF  - Advance for Respiratory Care & Sleep Medicine
JA  - ADV RESPIR CARE SLEEP MED
CY  - King of Prussia, Pa 19406-0956, Pennsylvania
PB  - Merion Publications
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128289271
T1  - Rhode Island Quality Institute: Rhode Island Quality Institute's care management dashboard connects opioid treatment teams.
AU  - RATHS, DAVID
Y1  - 2018///2018 1st Quarter
N1  - Accession Number: 128289271. Language: English. Entry Date: 20180312. Revision Date: 20180321. Publication Type: Article; pictorial. Supplement Title: 2018 1st Quarter. Journal Subset: Computer/Information Science; Health Services Administration; USA. NLM UID: 9004557. 
KW  - Case Management
KW  - Analgesics, Opioid
KW  - Nurse Managers -- Rhode Island
KW  - Rhode Island
KW  - Awards and Honors
KW  - Data Analytics
KW  - Substance Use Rehabilitation Programs -- Rhode Island
SP  - 18
EP  - 19
JO  - Healthcare Informatics
JF  - Healthcare Informatics
JA  - HEALTHC INFORM
CY  - New York, New York
PB  - Vendome Group LLC
AB  - The article offers information on the care management dashboard connecting opioid treatment teams by Rhode Island Quality Institute. It mentions views of Elaine Fontaine, director of data quality and analytics at Rhode Island Quality Institute, on the efficiency and reducing patients' likelihood of being readmitted or return to the emergency department.
SN  - 1050-9135
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128289271&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127264654
T1  - BEYOND NALOXONE: Providing comprehensive prehospital care to overdose patients.
AU  - Taxel, Simon
AU  - Hagahmed, Mohamed
Y1  - 2018/01//
N1  - Accession Number: 127264654. Language: English. Entry Date: 20180129. Revision Date: 20180129. Publication Type: Article; case study; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Emergency Medical Services
KW  - Prehospital Care
KW  - Emergency Medical Technicians
KW  - Professional Practice
KW  - Overdose -- Therapy
KW  - Emergency Patients
KW  - Narcotics -- Poisoning
KW  - Narcotics -- Pharmacodynamics
KW  - Narcotics -- Pharmacokinetics
KW  - Naloxone -- Administration and Dosage
SP  - 35
EP  - 45
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 43
IS  - 1
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Crew chief and public safety diver for the Pittsburgh Bureau of EMS
AD  - Senior emergency medicine resident physician at the University of Pittsburgh Medical Center
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127811364
T1  - EDs not a major source of opioids.
Y1  - 2018/02//
N1  - Accession Number: 127811364. Language: English. Entry Date: 20180212. Revision Date: 20180212. Publication Type: Article; brief item. Journal Subset: Health Services Administration; USA. NLM UID: 9890033. 
KW  - Emergency Service
KW  - Analgesics, Opioid
KW  - Prescriptions, Drug
SP  - 17
EP  - 17
JO  - Healthcare Leadership Review
JF  - Healthcare Leadership Review
JA  - HEALTHC LEADERSHIP REV
VL  - 37
IS  - 2
CY  - Danvers, Massachusetts
PB  - HCPro
SN  - 1082-6718
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127811357
T1  - EMR 'nudges' decrease opioid tablets prescribed.
Y1  - 2018/02//
N1  - Accession Number: 127811357. Language: English. Entry Date: 20180212. Revision Date: 20180212. Publication Type: Article; brief item. Journal Subset: Health Services Administration; USA. NLM UID: 9890033. 
KW  - Electronic Health Records
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Prescriptions, Drug
KW  - Patient Discharge
KW  - Emergency Service
SP  - 14
EP  - 14
JO  - Healthcare Leadership Review
JF  - Healthcare Leadership Review
JA  - HEALTHC LEADERSHIP REV
VL  - 37
IS  - 2
CY  - Danvers, Massachusetts
PB  - HCPro
SN  - 1082-6718
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112063647
T1  - Prehospital Opioid Administration in the Emergency Care of Injured Children.
AU  - Browne, Lorin R.
AU  - Studnek, Jonathan R.
AU  - Shah, Manish I.
AU  - Brousseau, David C.
AU  - Guse, Clare E.
AU  - Lerner, E. Brooke
Y1  - 2016/01//Jan/Feb2016
N1  - Accession Number: 112063647. Language: English. Entry Date: 20160115. Revision Date: 20170626. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Prehospital Care
KW  - Accidents
KW  - Emergency Care
KW  - Trauma
KW  - Human
KW  - Child
KW  - Cross Sectional Studies
KW  - Emergency Medical Services
KW  - Pain -- Therapy
KW  - Adolescence
KW  - Wisconsin
KW  - Glasgow Coma Scale -- Evaluation
KW  - Blood Pressure Determination
KW  - Oxygen Saturation
KW  - Systolic Pressure -- Evaluation
KW  - Ethics
KW  - Outcomes (Health Care)
KW  - Documentation
KW  - Vascular Access Devices
KW  - Administration, Intravenous
KW  - Injections, Intramuscular
KW  - Data Analysis
KW  - Confidence Intervals
KW  - Transportation of Patients
SP  - 59
EP  - 65
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 20
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Objective:Prior studies have identified provider and system characteristics that impede pain management in children, but no studies have investigated the effect of changing these characteristics on prehospital opioid analgesia. Our objectives were to determine: 1) the frequency of opioid analgesia and pain score documentation among prehospital pediatric patients after system wide changes to improve pain treatment, and 2) if older age, longer transport times, the presence of vascular access and pain score documentation were associated with increased prehospital administration of opioid analgesia in children.Methods:This was a retrospective cross-sectional study of pediatric patients aged 3–18 years assessed by a single EMS system between October 1, 2011 and September 30, 2013. Prior to October 2011, the EMS system had implemented 3 changes to improve pain treatment: (1) training on age appropriate pain scales, (2) protocol changes to allow opioid analgesia without contacting medical control, and (3) the introduction of intranasal fentanyl. All patients with working assessments of blunt, penetrating, lacerating, and/or burn trauma were included. We used descriptive statistics to determine the frequency of pain score documentation and opioid analgesia administration and logistic regression to determine the association of age, transport time, and the presence of intravenous access with opioid analgesia administration.Results:Of the 1,368 eligible children, 336 (25%) had a documented pain score. Eleven percent (130/1204) of children without documented contraindications to opioid administration received opioids. Of the children with no documented pain score and no protocol exclusions, 9% (81/929) received opioid analgesia, whereas 18% (49/275) with a documented pain score ≥4 and no protocol exclusions received opioids. Multivariate analysis revealed that vascular access (OR = 11.89; 95% CI: 7.33–19.29), longer patient transport time (OR = 1.07; 95% CI: 1.04–1.11), age (OR 0.93; 95% CI: 0.88–0.98) and pain score documentation (OR 2.23; 95% CI: 1.40–3.55) were associated with opioid analgesia.Conclusions:Despite implementation of several best practice recommendations to improve prehospital pain treatment, few children have a documented pain score and even fewer receive opioid analgesia. Children with longer transport times, successful IV placement, and/or documentation of pain score(s) were more likely to receive prehospital analgesia.
SN  - 1090-3127
DO  - 10.3109/10903127.2015.1056897
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128687780
T1  - Opiate Crisis and Healthcare Reform in America: A Review for Nurses.
AU  - Painter, Susan G.
Y1  - 2017/05//
N1  - Accession Number: 128687780. Language: English. Entry Date: 20180329. Revision Date: 20180329. Publication Type: Article. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Psychiatry/Psychology; Public Health. NLM UID: 9806525. 
KW  - Narcotics -- Poisoning
KW  - Overdose
KW  - Health Policy
KW  - Health Care Reform
KW  - Street Drugs
KW  - Nursing Practice
KW  - Patient Protection and Affordable Care Act
KW  - Substance Abuse
KW  - Substance Dependence
KW  - United States
KW  - Naloxone
KW  - Education, Nursing
SP  - 11
EP  - 11
JO  - Online Journal of Issues in Nursing
JF  - Online Journal of Issues in Nursing
JA  - ONLINE J ISSUES NURS
VL  - 22
IS  - 2
CY  - Silver Spring, Maryland
PB  - American Nurses Association
AB  - On a daily basis in the United States, patients overdosing on opioids fill our emergency rooms, intensive care units, and, sadly, our cemeteries. Overdose and subsequent death from opioid addiction has reached astonishing numbers and death rates by opioid overdoses continue to rise annually. Nurses are in front line positions to provide assessment for patients with opioid use histories and subsequently connect them to resources that save lives. All nurses face the challenges of caring for patients with addiction issues and have the opportunity to change the stigma regarding addiction. Nurse engagement can influence positive outcomes when addicted individuals are reaching out for resources and treatment. This article reviews changes in opiate usage over time; related information in the Affordable Care Act; and other changes in federal, state and local policy that affect current opiate treatment. Also discussed are considerations for nurses to effect change and potential future policy. In conclusion, with the ever increasing numbers of individuals with opioid addiction, and insufficient availability of opiate treatment programs, our nation is in a race against time to positively impact and reverse this crisis.
SN  - 1091-3734
AD  - Faculty in the Family Systems Psychiatric Nurse Practitioner program in the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, OH
DO  - 10.3912/OJIN.Vol22No02Man03
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123202965
T1  - Capsule Commentary on D'Onofrio et al., Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention.
AU  - Murimi, Irene
AU  - Murimi, Irene Berita
Y1  - 2017/06//
N1  - Accession Number: 123202965. Language: English. Entry Date: In Process. Revision Date: 20170614. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Europe. NLM UID: 8605834. 
SP  - 683
EP  - 683
JO  - JGIM: Journal of General Internal Medicine
JF  - JGIM: Journal of General Internal Medicine
JA  - J GEN INTERN MED
VL  - 32
IS  - 6
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
AB  - The author comments on a study that examined the benefits of emergency department (ED)-initiated buprenorphine-naloxone with continued primary care in treating opioid addiction compared to treatment referral only or a brief intervention with referral to treatment. She describes the benefits of the ED-initiated method, including better treatment engagement and reduced illicit opioid use. She also explores the implications of the results at the 2-, 6-and 12-month assessment points.
SN  - 0884-8734
AD  - Center for Drug Safety and Effectiveness, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore USA
AD  - Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
U2  - PMID: 28243878.
DO  - 10.1007/s11606-017-4015-0
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123202965&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113707570
T1  - Patient-reported Outcomes from A National, Prospective, Observational Study of Emergency Department Acute Pain Management With an Intranasal Nonsteroidal Anti-inflammatory Drug, Opioids, or Both.
AU  - Pollack, Charles V.
AU  - Diercks, Deborah B.
AU  - Thomas, Stephen H.
AU  - Shapiro, Nathan I.
AU  - Fanikos, John
AU  - Mace, Sharon E.
AU  - Rafique, Zubaid
AU  - Todd, Knox H.
Y1  - 2016/03//
N1  - Accession Number: 113707570. Language: English. Entry Date: 20160321. Revision Date: 20170301. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: The registry, termed AMPED, for “Acute Management ofPain from the Emergency Department” (NCT01626235 onClinicalTrials.gov), was an investigator-initiated studysupported by a research grant from Luitpold Pharmaceuticals.. NLM UID: 9418450. 
KW  - Pain -- Therapy
KW  - Acute Care
KW  - Antiinflammatory Agents, Non-Steroidal -- Administration and Dosage
KW  - Narcotics -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Human
KW  - Nonexperimental Studies
KW  - Prospective Studies
KW  - Emergency Service
KW  - Telephone
KW  - Adult
KW  - Male
KW  - Female
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Protocols
KW  - Time Factors
KW  - Data Collection
KW  - Analysis of Variance
KW  - Chi Square Test
KW  - Paired T-Tests
KW  - Logistic Regression
KW  - Interviews
KW  - Questionnaires
KW  - Funding Source
SP  - 331
EP  - 341
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 23
IS  - 3
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objectives Patient compliance and satisfaction with analgesics prescribed after emergency department ( ED) care for acute pain are poorly understood, largely because of the lack of direct patient follow-up with the ED provider. Our objective was to compare patient satisfaction with three analgesia regimens prescribed for post- ED care-a nasally administered nonsteroidal anti-inflammatory drug ( NSAID), an opioid, or combination therapy-by collecting granular follow-up on analgesic use, pain scores, side effects, work activity levels, and overall satisfaction directly from patients. Methods We designed a prospective registry linking ED assessment and analgesic management for acute pain of specific musculoskeletal or visceral etiologies with self-reported automated telephonic follow-up daily for the 4 days post- ED discharge. Patients were prescribed a specific NSAID ( SPRIX, ketorolac tromethamine for nasal instillation) only, an oral opioid only, or both with the opioid clearly defined as rescue therapy, at the ED provider's discretion. Results There were 824 evaluable subjects. Maximum pain scores improved day to day more effectively with a ketorolac-based approach. Self-reported rates of return to work and work effectiveness were higher with SPRIX than with opioids or combination therapy. Adverse effects of nausea, constipation, drowsiness, and abdominal pain were higher each day among patients taking an opioid; nasal irritation was more common with SPRIX. Overall satisfaction at the end of the follow-up period was higher with SPRIX-based treatment than with opioid monotherapy. Conclusions Automated telephonic follow-up of ED patients prescribed short-term analgesia is feasible. Ketorolac-based analgesia after an ED visit for many acute pain syndromes was associated with favorable patient outcomes and higher satisfaction than opioid-based therapy. SPRIX, an NSAID that is not available over the counter and has a novel delivery approach, may be useful for short-term post- ED outpatient analgesia.
SN  - 1069-6563
AD  - Department of Emergency Medicine, Thomas Jefferson University
AD  - Department of Emergency Medicine, University of California Davis Medical Center
AD  - Department of Emergency Medicine, University of Oklahoma College of Medicine
AD  - Department of Emergency Medicine, Beth Israel Deaconess Medical Center
AD  - Department of Pharmacy, Brigham and Women's Hospital
AD  - Department of Emergency Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
AD  - Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine
AD  - Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center
DO  - 10.1111/acem.12902
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112834991
T1  - Risk for Opioid Misuse Among Emergency Department Cancer Patients.
AU  - Reyes-Gibby, Cielito C.
AU  - Anderson, Karen O.
AU  - Todd, Knox H.
Y1  - 2016/02//
N1  - Accession Number: 112834991. Language: English. Entry Date: 20160212. Revision Date: 20170131. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Screener and Opioid Assessment for Patients in Pain (SOAPP) tool; Center for Epidemiologic Studies Depression Scale (CES-D). NLM UID: 9418450. 
KW  - Substance Abuse -- Risk Factors
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Cancer Patients -- Evaluation
KW  - Emergency Service
KW  - Emergency Medicine
KW  - Human
KW  - Medical Practice
KW  - Pain -- Therapy
KW  - United States
KW  - Patient Care
KW  - Depression -- Diagnosis
KW  - Odds Ratio
KW  - Confidence Intervals
KW  - Oncology
KW  - Behavior
KW  - Chronic Pain -- Therapy
KW  - Cross Sectional Studies
KW  - Center for Epidemiological Studies Depression Scale
KW  - Scales
KW  - Coping
KW  - Alcohol Drinking
KW  - Epidemiology
KW  - Demography
KW  - Comorbidity
KW  - Drug Evaluation
KW  - Data Analysis
KW  - Practice Guidelines
KW  - Logistic Regression
KW  - Pearson's Correlation Coefficient
KW  - Chi Square Test
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Prescribing Patterns
KW  - Middle Age
KW  - Male
KW  - Female
KW  - Education
KW  - Marriage
KW  - Work
KW  - Race Factors
KW  - Ethnic Groups
KW  - Smoking -- Evaluation
SP  - 151
EP  - 158
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 23
IS  - 2
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objectives One of the most challenging areas of emergency medicine practice is the management and treatment of severe and persistent pain, including cancer-related pain. Emergency departments ( EDs) in the United States frequently provide care for patients with cancer and an increasing concern is the potential for opioid misuse in this patient group. The authors determined the risk for opioid misuse among ED cancer patients with pain and assessed demographic and clinical factors associated with increased misuse risk. The Texas state prescription monitoring program was also queried for evidence of multiple opioid prescriptions for comparing low- and high-risk groups. Methods The Screener and Opioid Assessment for Patients with Pain-Revised ( SOAPP-R) was administered to assess risk for opioid misuse among cancer patients presenting to the ED of a comprehensive cancer center in the United States. Eligibility criteria included: 1) presentation for treatment of chronic cancer-related pain while taking a prescribed schedule II opioid for analgesia, 2) age of 18 years or older, 3) ability to speak English, and 4) ability to understand the study and give written informed consent. Results Of 934 ED patients screened for the study, 290 were eligible and 209 participated (72% response rate). On the basis of the recommended SOAPP-R cutoff score of 18, a total of 71 of the 209 patients (34%) were categorized as having a high risk of misuse. Of note, 15% and 4% of all patients reported past or current use of illicit substances, respectively. The total number of annual opioid prescriptions (17.8 vs. 12.6; p = 0.023) differed between the high- versus low-risk groups. Multivariable analyses showed that depression (odds ratio [ OR] = 3.06, 95% confidence interval [ CI] = 1.45 to 6.48; p = 0.003), poor coping ( OR = 1.08, 95% CI = 1.03 to 1.13; p = 0.001), and illicit substance use ( OR = 28.30, 95% CI = 2.97 to 269.24; p = 0.029) were significantly associated with high risk of opioid misuse. Conclusions The risk of opioid misuse among cancer patients is substantial. Screening for opioid misuse in the ED is feasible.
SN  - 1069-6563
AD  - Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center
AD  - Department of Symptom Research, The University of Texas MD Anderson Cancer Center
DO  - 10.1111/acem.12861
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112834990
T1  - Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010.
AU  - Kea, Bory
AU  - Fu, Rochelle
AU  - Lowe, Robert A.
AU  - Sun, Benjamin C.
Y1  - 2016/02//
N1  - Accession Number: 112834990. Language: English. Entry Date: 20160212. Revision Date: 20170131. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Surveys
KW  - Hospitals
KW  - Ambulatory Care
KW  - Emergency Service
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Prescribing Patterns
KW  - Emergency Medicine
KW  - Human
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Overdose
KW  - Documentation
KW  - Pain -- Therapy
KW  - Back Pain -- Therapy
KW  - Race Factors
KW  - Ethnic Groups
KW  - Substance Abuse -- Economics
KW  - Pharmacy and Pharmacology
KW  - Professional Organizations
KW  - Data Analysis
KW  - Odds Ratio
KW  - Confidence Intervals
SP  - 159
EP  - 165
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 23
IS  - 2
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objectives Prescription opioid overdoses are a leading cause of death in the United States. Emergency departments ( EDs) are potentially high-risk environments for doctor shopping and diversion. The hypothesis was that opioid prescribing rates from the ED have increased over time. Methods The authors analyzed data on ED discharges from the 2006 through 2010 NHAMCS, a probability sample of all U.S. EDs. The outcome was documentation of an opioid prescription on discharge. The primary independent predictor was time. Covariates included severity of pain, a pain-related discharge diagnosis, age, sex, race, payer, hospital ownership, and geographic location of hospital. Up to three discharge diagnoses were available in NHAMCS to identify 'pain-related' (e.g., back pain, fracture, dental/jaw pain, nephrolithiasis) ED visits. Multivariate logistic regression was performed to assess the independent associations between opioid prescribing and predictors. All analyses incorporated NHAMCS survey weights, and all results are presented as national estimates. Results Opioids were prescribed for 18.7% (95% confidence interval = 17.7% to 19.7%) of all ED discharges, representing 18.8 million prescriptions per year. There were no significant temporal trends in opioid prescribing overall (adjusted p = 0.93). Pain-related discharge diagnoses that received the top three highest proportion of opioids prescriptions included nephrolithiasis (62.1%), neck pain (51.6%), and dental/jaw pain (49.7%). A pain-related discharge diagnosis, non-Hispanic white race, older age, male sex, uninsured status, and Western region were positively associated with opioid prescribing (p < 0.05). Conclusions No temporal trend toward increased prescribing from 2006 to 2012 was found. These results suggest that problems with opioid overprescribing are multifactorial and not solely rooted in the ED.
SN  - 1069-6563
AD  - Center for Policy and Research in Emergency Medicine, Oregon Health & Science University
AD  - Department of Emergency Medicine, Oregon Health & Science University
AD  - Department of Public Health and Preventive Medicine, Oregon Health & Science University
AD  - Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University
DO  - 10.1111/acem.12862
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127961643
T1  - ECMO used successfully in a near fatal case of opioid-induced acute respiratory distress syndrome.
AU  - Greenberg, Karen
AU  - Kohl, Benjamin
Y1  - 2018/02//
N1  - Accession Number: 127961643. Language: English. Entry Date: In Process. Revision Date: 20180220. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
SP  - 343.e5
EP  - 343.e6
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 36
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Acute Respiratory Distress Syndrome (ARDS) was first recognized during the 1960s. It is a distinct type of hypoxemic respiratory failure characterized by acute abnormality of both lungs. Extracorporeal membrane oxygenation (ECMO) is being increasingly used for patients with severe ARDS refractory to otherwise conventional management. A 29year old male arrived with Emergency Medical Services (EMS) status post presumed heroin overdose. He was administered Naloxone 2mg intravenously prior to arrival in the emergency department. The patient arrived in severe respiratory distress with a pulse oximetry level of 50% and was immediately intubated. The patient's pulse oximetry level remained in the seventies despite intubation and aggressive ventilator management. The Intensive Care Unit team in conjunction with cardiothoracic surgery initiated venovenous ECMO therapy in the emergency department itself. The patient was transferred to a tertiary center for venoarterial ECMO that was continued for 6 more days. After an extensive hospitalization, the patient was ultimately transferred to an acute medical rehabilitation center. With the current opioid crisis, emergency physicians and providers need to be aware that opioids can induce severe ARDS refractory to mechanical ventilation. ECMO as a treatment option can be used safely and successfully as described in this unique patient case report.
SN  - 0735-6757
AD  - Drexel Neurosciences Institute, Drexel University College of Medicine, 219 North Broad St 7th Floor, Philadelphia, PA 19107, USA
AD  - Aria Jefferson Health System, Torresdale campus, 10800 Knights Road, Philadephia, PA 19114, USA
U2  - PMID: 29146420.
DO  - 10.1016/j.ajem.2017.11.020
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119150274
T1  - Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children.
AU  - Browne, Lorin R.
AU  - Shah, Manish I.
AU  - Studnek, Jonathan R.
AU  - Ostermayer, Daniel G.
AU  - Reynolds, Stacy
AU  - Guse, Clare E.
AU  - Brousseau, David C.
AU  - Lerner, E. Brooke
Y1  - 2016/11//Nov/Dec2016
N1  - Accession Number: 119150274. Language: English. Entry Date: 20161111. Revision Date: 20161111. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Prehospital Care
KW  - Pain -- Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Care
KW  - Human
KW  - Child
KW  - Pediatrics
KW  - Medical Organizations
KW  - Retrospective Design
KW  - Emergency Medical Services
KW  - Protocols
KW  - Record Review
KW  - Outcomes (Health Care)
KW  - Patient Assessment
KW  - Analgesia -- Methods
SP  - 759
EP  - 767
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 20
IS  - 6
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background:The National Association of Emergency Medical Services Physicians’ (NAEMSP) Position Statement on Prehospital Pain Management and the joint National Highway Traffic Safety Administration (NHTSA) and Emergency Medical Services for Children (EMSC) Evidence-based Guideline for Prehospital Analgesia in Trauma aim to improve the recognition, assessment, and treatment of prehospital pain. The impact of implementation of these guidelines on pain management in children by emergency medical services (EMS) agencies has not been assessed.Objective:Determine the change in frequency of documented pain severity assessment and opiate administration among injured pediatric patients in three EMS agencies after adoption of best practice recommendations.Methods:This is a retrospective study of children <18 years of age with a prehospital injury-related primary impression from three EMS agencies. Each agency independently implemented pain protocol changes which included adding the use of age-appropriate pain scales, decreasing the minimum age for opiate administration, and updating fentanyl dosing. We abstracted data from prehospital electronic patient records before and after changes to the pain management protocols. The primary outcomes were the frequency of administration of opioid analgesia and documentation of pain severity assessment as recorded in the prehospital patient care record.Results:A total of 3,597 injured children were transported prior to pain protocol changes and 3,743 children after changes. Opiate administration to eligible patients across study sites regardless of documentation of pain severity was 156/3,089 (5%) before protocol changes and 175/3,509 (5%) after (p = 0.97). Prior to protocol changes, 580 (18%) children had documented pain assessments and 430 (74%) had moderate-to-severe pain. After protocol changes, 644 (18%) patients had pain severity documented with 464 (72%) in moderate-to-severe pain. For all study agencies, pain severity was documented in 13%, 19%, and 22% of patient records both before and after protocol changes. There was a difference in intranasal fentanyl administration rates before (27%) and after (17%) protocol changes (p = 0.02).Conclusion:The proportion of injured children who receive prehospital opioid analgesia remains suboptimal despite implementation of best practice recommendations. Frequency of pain severity assessment of injured children is low. Intranasal fentanyl administration may be an underutilized modality of prehospital opiate administration.
SN  - 1090-3127
DO  - 10.1080/10903127.2016.1194931
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121669187
T1  - Who Overdoses on Opioids at a VA Emergency Department?
AU  - Clement, Cassandra
AU  - Stock, Christopher
Y1  - 2017/03//
N1  - Accession Number: 121669187. Language: English. Entry Date: 20170321. Revision Date: 20170321. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. 
KW  - Narcotics
KW  - Overdose -- Mortality -- United States
KW  - Overdose -- Therapy
KW  - Overdose -- Diagnosis
KW  - Veterans
KW  - Emergency Service
KW  - United States
KW  - Human
KW  - Retrospective Design
KW  - Record Review
KW  - Descriptive Statistics
KW  - Pearson's Correlation Coefficient
KW  - Chi Square Test
KW  - T-Tests
SP  - 116
EP  - 124
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 49
IS  - 3
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
AD  - Clinical pharmacy specialist at the Orlando Veterans Affairs Medical Center, Florida
AD  - Pharmacist at the George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
DO  - 10.12788/emed.2017.0018
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121669185
T1  - Emergency Physicians' Rates of Opioid Prescribing Vary Widely, Even Within the Same ED.
AU  - BAUER, JEFF
Y1  - 2017/03//
N1  - Accession Number: 121669185. Language: English. Entry Date: 20170321. Revision Date: 20170321. Publication Type: Article; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. 
KW  - Prescribing Patterns -- Evaluation
KW  - Narcotics
KW  - Physicians, Emergency
KW  - Emergency Service
SP  - 101
EP  - 104
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 49
IS  - 3
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122008915
T1  - Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy.
AU  - Osborn, Scott R.
AU  - Yu, Julianna
AU  - Williams, Barbara
AU  - Vasilyadis, Maria
AU  - Blackmore, C. Craig
Y1  - 2017/04//
N1  - Accession Number: 122008915. Language: English. Entry Date: 20171105. Revision Date: 20171208. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8412174. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Organizational Policies
KW  - Aged
KW  - United States
KW  - Codeine -- Therapeutic Use
KW  - Adult
KW  - Dihydromorphinone -- Therapeutic Use
KW  - Middle Age
KW  - Adolescence
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Quality Improvement
KW  - Emergency Service -- Administration
KW  - Aged, 80 and Over
KW  - Male
KW  - Prescriptions, Drug -- Standards
KW  - Female
SP  - 538
EP  - 546
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 52
IS  - 4
PB  - Pergamon Press - An Imprint of Elsevier Science
SN  - 0736-4679
AD  - Virginia Mason Medical Center, Seattle, Washington
U2  - PMID: 28111065.
DO  - 10.1016/j.jemermed.2016.07.120
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122008915&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104098947
T1  - Associations between pain clinic density and distributions of opioid pain relievers, drug-related deaths, hospitalizations, emergency department visits, and neonatal abstinence syndrome in Florida.
AU  - Sauber-Schatz, Erin K
AU  - Mack, Karin A
AU  - Diekman, Shane T
AU  - Paulozzi, Leonard J
Y1  - 2013/11//
N1  - Accession Number: 104098947. Language: English. Entry Date: 20140509. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Psychiatry/Psychology. NLM UID: 7513587. 
KW  - Analgesics, Opioid
KW  - Overdose -- Mortality
KW  - Drug Utilization -- Statistics and Numerical Data
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Models, Statistical
KW  - Neonatal Abstinence Syndrome -- Epidemiology
KW  - Pain Clinics -- Statistics and Numerical Data
KW  - Demography
KW  - Cause of Death
KW  - Female
KW  - Florida
KW  - Male
SP  - 161
EP  - 166
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 133
IS  - 1
PB  - Elsevier B.V.
AB  - BACKGROUND: Community-level associations between pain clinics and drug-related outcomes have not been empirically demonstrated. METHODS: To explore these associations we correlated overdose death rates, hospital-discharge rates for drug-related hospitalizations including neonatal abstinence syndrome, and emergency department rates for drug-related visits with registered pain clinic density and rate of opioid pills dispensed per person at the county-level Florida in 2009. Negative binomial regression was used to model the crude associations and associations adjusted for exposure measures and county demographic characteristics. RESULTS: An estimated 732 pain clinics operated in Florida in 2009, a rate of 3.9/100,000 people. Among the 67 counties in Florida, 23 (34.3%) had no pain clinics, and three had 90 or more. Adjusted negative binomial regression determined no significant association between pain clinic rate and drug-related outcomes. However, rates of drug-caused, opioid-caused, and oxycodone-caused death correlated significantly with rates of opioid and oxycodone pills dispensed per person in adjusted analyses. For every increase of one pill in the rate of oxycodone pills per person, there was a 6% increase in the rate of oxycodone-related overdose death. CONCLUSIONS: Although pain clinics, some of which are 'pill mills,' are clearly a source of drugs used nonmedically, their impact on health outcomes might be difficult to quantify because the pills they prescribe might be consumed in other counties or states. The impact of 'pill mill' laws might be better measured by more proximal measures such as the number of such facilities.
SN  - 0376-8716
AD  - Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., Mailstop F62, Atlanta, GA 30341, United States. Electronic address: ige7@cdc.gov.
U2  - PMID: 23769424.
DO  - 10.1016/j.drugalcdep.2013.05.017
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107914667
T1  - Association Between Opioid Use and Health Care Utilization as Measured by Emergency Room Visits and Hospitalizations Among Persons Living With HIV.
AU  - Koeppe, John
AU  - Lyda, Karen
AU  - Armon, Carl
Y1  - 2013/11//2013 Nov
N1  - Accession Number: 107914667. Language: English. Entry Date: 20140530. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 8507389. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Health Care Delivery -- Utilization
KW  - Emergency Service -- Statistics and Numerical Data
KW  - HIV Infections -- Therapy
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Pain -- Drug Therapy
KW  - Adult
KW  - Resource Databases
KW  - Female
KW  - Human
KW  - Logistic Regression
KW  - Male
KW  - Middle Age
KW  - Multivariate Analysis
SP  - 957
EP  - 961
JO  - Clinical Journal of Pain
JF  - Clinical Journal of Pain
JA  - CLIN J PAIN
VL  - 29
IS  - 11
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - BACKGROUND: Epidemiologic studies in the non-human immunodeficiency virus (HIV) positive population have shown greater health care utilization among persons with chronic non-cancer pain on opioid therapy. However, we are not aware of any similar data in the HIV positive population. METHODS: We evaluated health care utilization, as measured by emergency room (ER) visits and hospitalizations, among persons with HIV and chronic pain seen at an academic medical center, during the calendar year 2005. We compared these outcomes between patients on chronic opioid therapy with those not on opioids. RESULTS: In univariate models chronic opioid therapy was associated with both ER visits and hospitalization: ER visits odds ratio (OR)=2.18 (95% confidence interval [CI], 1.30-3.66), hospitalization OR=1.90 (95% CI, 1.03-3.51). After multivariate analyses only nonsignificant trends remain: ER visits OR=1.71 (95% CI, 0.95-3.08); hospitalization OR=1.28 (95% CI, 0.66-2.49). CONCLUSIONS: In our study HIV positive individuals with chronic pain were more likely to be seen in the ER and be hospitalized if they were on opioids. However, after controlling for other variables, the association with opioids no longer remained significant.
SN  - 0749-8047
AD  - Divisions of *General Internal Medicine tInfectious Diseases, Department of Medicine, School of Medicine, University of Colorado, CO tDepartment of Epidemiology, Children's Hospital Colorado, Aurora.
U2  - PMID: 23370078.
DO  - 10.1097/AJP.0b013e31827c7b05
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104186427
T1  - Prescription Opioid Guidelines and the Emergency Department...Lewis Nelson... Knox Todd
AU  - Wattana, Monica K.
AU  - Nelson, Lewis S.
AU  - Todd, Knox H.
Y1  - 2013/06//
N1  - Accession Number: 104186427. Language: English. Entry Date: 20130627. Revision Date: 20150711. Publication Type: Journal Article; interview; practice guidelines; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management; Palliative Care/Hospice. NLM UID: 101125608. 
KW  - Emergency Service -- New York
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - New York
KW  - Substance Abuse -- Prevention and Control
KW  - Prescribing Patterns
KW  - Nelson L
KW  - Todd K
SP  - 155
EP  - 162
JO  - Journal of Pain & Palliative Care Pharmacotherapy
JF  - Journal of Pain & Palliative Care Pharmacotherapy
JA  - J PAIN PALLIAT CARE PHARMACOTHER
VL  - 27
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - On January 10, 2013, Mayor Michael Bloomberg announced a set of recommendations intended to guide opioid analgesic prescribing in New York City emergency departments. The intent and scope of these guidelines are discussed through an interview bu an emergency medicine fellow with an expert in emergency medicine pain management and one of the authors of the guidelines. The guidelines are appended to the commentary.
SN  - 1536-0288
AD  - Monica K. Wattana, MD, is a Fellow in Oncologic Emergency Medicine at The University of Texas MD Anderson Cancer Center, Houston Texas. Lewis S. Nelson, MD, is Professor and Vice Chair for Academic Affairs, Department of Emergency Medicine, New York University School of Medicine. Knox H. Todd, MD, MPH is Professor and Chair, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas
U2  - PMID: 23713906.
DO  - 10.3109/15360288.2013.788602
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123568913
T1  - Cost-effectiveness of subdermal implantable buprenorphine versus sublingual buprenorphine to treat opioid use disorder.
AU  - Carter, John A
AU  - Dammerman, Ryan
AU  - Frost, Michael
Y1  - 2017/06/10/
N1  - Accession Number: 123568913. Language: English. Entry Date: In Process. Revision Date: 20170727. Publication Type: journal article. Journal Subset: Biomedical; Health Services Administration; USA. NLM UID: 9892255. 
SP  - 1
EP  - 20
JO  - Journal of Medical Economics
JF  - Journal of Medical Economics
JA  - J MED ECON
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Aims: Subdermal implantable buprenorphine (BSI) was recently approved to treat opioid use disorder (OUD) in clinically-stable adults. In the pivotal clinical trial, BSI was associated with a higher proportion of completely-abstinent patients (85.7% vs 71.9%; p = .03) vs sublingual buprenorphine (SL-BPN). Elsewhere, relapse to illicit drug use is associated with diminished treatment outcomes and increased costs. This study evaluated the cost-effectiveness of BSI vs SL-BPN from a US societal perspective.Methods: A Markov model simulated BSI and SL-BPN cohorts (clinically-stable adults) transiting through four mutually-exclusive health states for 12 months. Cohorts accumulated direct medical costs from drug acquisition/administration; treatment-diversion/abuse; newly-acquired hepatitis-C; emergency room, hospital, and rehabilitation services; and pediatric poisonings. Non-medical costs of criminality, lost wages/work-productivity, and out-of-pocket expenses were also included. Transition probabilities to a relapsed state were derived from the aforementioned trial. Other transition probabilities, costs, and health-state utilities were derived from observational studies and adjusted for trial characteristics. Outcomes included incremental cost per quality-adjusted-life-year (QALY) gained and incremental net-monetary-benefit (INMB). Uncertainty was assessed by univariate and probabilistic sensitivity analysis (PSA).Results: BSI was associated with lower total costs (-$4,386), more QALYs (+0.031), and favorable INMB at all willingness-to-pay (WTP) thresholds considered. Higher drug acquisition costs for BSI (+$6,492) were outpaced, primarily by reductions in emergency room/hospital utilization (-$8,040) and criminality (-$1,212). BSI was cost-effective in 89% of PSA model replicates, and had a significantly higher NMB at $50,000/QALY ($20,783 vs $15,007; p < .05).Conclusions: BSI was preferred over SL-BPN from a health-economic perspective for treatment of OUD in clinically-stable adults. These findings should be interpreted carefully, due to some relationships having been modeled from inputs derived from multiple sources, and would benefit from comparison with outcomes from studies that employ administrative claims data or a naturalistic comparative design.
SN  - 1369-6998
AD  - a EPI-Q Inc. , Oak Brook , IL , USA
AD  - b Braeburn Pharmaceuticals , Princeton , NJ , USA
AD  - c Eagleville Hospital , Eagleville , PA , USA
U2  - PMID: 28604141.
DO  - 10.1080/13696998.2017.1341416
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112808765
T1  - Correlates of Opioid Use in Adults With Self-Reported Drug Use Recruited From Public Safety-Net Primary Care Clinics.
AU  - Ries, Richard
AU  - Krupski, Antoinette
AU  - West, Imara I.
AU  - Maynard, Charles
AU  - Bumgardner, Kristin
AU  - Donovan, Dennis
AU  - Dunn, Chris
AU  - Roy-Byrne, Peter
Y1  - 2015/09//Sep/Oct2015
N1  - Accession Number: 112808765. Language: English. Entry Date: 20160310. Revision Date: 20160310. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 101306759. 
KW  - Self Report
KW  - Narcotics
KW  - Substance Abuse
KW  - Safety-Net Providers
KW  - Primary Health Care
KW  - Treatment Outcomes
KW  - Human
KW  - Health Services -- Utilization
KW  - Health Care Costs
KW  - Confidence Intervals
KW  - Narcotics -- Adverse Effects
KW  - Multidisciplinary Care Team
KW  - Overdose -- Prevention and Control
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Physicians, Family
KW  - Substance Abusers
SP  - 417
EP  - 426
JO  - Journal of Addiction Medicine
JF  - Journal of Addiction Medicine
JA  - J ADDICT MED
VL  - 9
IS  - 5
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Objectives: The purpose of this study was to compare demographic, clinical, and survival characteristics of drug-using safety-net primary care patients who used or did not use opioids, and to examine treatment implications of our findings. Methods: The sample consisted of 868 adults who reported illicit drug use in the 90 days before study enrollment, 396 (45.6%) of whom were opioid users. Results: Multiple measures indicated that, as a group, opioid users were less physically and psychiatrically healthy than drug users who did not endorse using opioids, and were heavy users of medical services (eg, emergency departments, inpatient hospitals, and outpatient medical) at considerable public expense. After adjusting for age, they were 2.61 (confidence interval, 1.48-4.61) times more likely to die in the 1 to 5 years after study enrollment and more likely to die from accidental poisoning than nonopioid users. Subgroup analyses suggested patients using any nonprescribed opioids had more serious drug problems including more intravenous drug use and greater HIV risk than patients using opioids only as prescribed. Conclusions: Use of opioids adds a dimension of severity over and above illicit drug use as it presents in the primary care setting. Opioid users may benefit from psychiatric and addiction care integrated into their primary care setting, naloxone overdose prevention kits, and prevention efforts such as clean needle exchanges. Addiction or primary care providers are in a key position to facilitate change among such patients, especially the third or more opioid users having a goal of abstinence from drugs.
SN  - 1932-0620
AD  - Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA
AD  - Department of Health Services, University of Washington School of Public Health, Seattle, WA
AD  - Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA
DO  - 10.1097/ADM.0000000000000151
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109352737
T1  - The Economics of Opioids: Abuse, REMS, and Treatment Benefits.
AU  - Fudin, Jeffrey
Y1  - 2015/08/03/Aug2015 Supplement Use of Opioid Analgesics
N1  - Accession Number: 109352737. Language: English. Entry Date: 20151021. Revision Date: 20151021. Publication Type: Article; tables/charts. Supplement Title: Aug2015 Supplement Use of Opioid Analgesics. Note: For CE pages see website.. Journal Subset: Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. NLM UID: 9613960. 
KW  - Analgesics, Opioid -- Economics -- United States
KW  - Substance Use Disorders -- Prevention and Control -- United States
KW  - Health Care Costs
KW  - United States Food and Drug Administration
KW  - Analgesics, Opioid -- Legislation and Jurisprudence -- United States
KW  - United States
KW  - Pain -- Drug Therapy
KW  - Health Screening
KW  - Insurance, Health, Reimbursement
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Education, Continuing (Credit)
SP  - S188
EP  - S194
JO  - American Journal of Managed Care
JF  - American Journal of Managed Care
JA  - AM J MANAGE CARE
CY  - Plainsboro, New Jersey
PB  - Intellisphere, LLC
AB  - Since the 1990s, there has been a 10-fold increase in the use of opioid analgesics, which has placed a significant financial burden on the healthcare system. Extra costs include time lost from work, multiple emergency department (ED) and ambulatory clinic visits, frequent office visits, doctor-shopping, prescriptions, and rehabilitation facilities. In an attempt to ensure the safe use of extended-release (ER) and long-acting (LA) opioids, including methadone, the FDA has enacted a classwide Risk Evaluation and Mitigation Strategy (REMS) program mandating prescriber and patient education to encourage proper patient screening and appropriate monitoring. The REMS components require a time and financial commitment for both healthcare providers and payers. Although physicians have said they are willing to comply with REMS mandates, many have said they would be reluctant to prescribe opioids covered under REMS. The FDA does not have adequate data on the effectiveness of the current opioid REMS, so evidence is lacking to confirm its utility in diminishing opioid abuse. Payers could play an important role by reimbursing healthcare providers for the time spent issuing opioid risk tools, implementing patient and caregiver education risk stratification, providing naloxone reversal prescriptions with appropriate education, and monitoring overall. Furthermore, payment for abuse-deterrent formulations might also help to mitigate risk, but at a significant cost to society.
SN  - 1088-0224
AD  - Western New England University, College of Pharmacy, Springfield, MA
AD  - University of Connecticut School of Pharmacy, Storrs
AD  - PGY2 Pharmacy Pain & Palliative Care Residency, Stratton VA Medical Center, Albany, NY
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109352737&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 115008426
T1  - Emergency Department Patient Perspectives on the Risk of Addiction to Prescription Opioids.
AU  - Conrardy, Michael
AU  - Lank, Patrick
AU  - Cameron, Kenzie A.
AU  - McConnell, Ryan
AU  - Chevrier, Alison
AU  - Sears, Jill
AU  - Ahlstrom, Eric
AU  - Wolf, Michael S.
AU  - Courtney, D. Mark
AU  - McCarthy, Danielle M.
Y1  - 2016/01//
N1  - Accession Number: 115008426. Language: English. Entry Date: 20160505. Revision Date: 20170203. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: Data collection for this project was funded by a research grant from The Emergency Medicine Foundation in conjunction with Purdue Pharma.. NLM UID: 100894201. 
KW  - Drugs, Prescription
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Substance Dependence -- Risk Factors
KW  - Emergency Service
KW  - Patient Attitudes
KW  - Human
KW  - Descriptive Statistics
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Thematic Analysis
KW  - Health Knowledge
KW  - Audiorecording
KW  - Interviews
KW  - Content Analysis
KW  - Codeine -- Therapeutic Use
KW  - Acetaminophen -- Therapeutic Use
KW  - Kappa Statistic
KW  - Multimethod Studies
KW  - Urban Areas
KW  - Pain -- Drug Therapy
KW  - Data Analysis Software
KW  - Chi Square Test
KW  - Fisher's Exact Test
KW  - T-Tests
KW  - Funding Source
KW  - United States
SP  - 114
EP  - 121
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 17
IS  - 1
PB  - Oxford University Press / USA
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.
SN  - 1526-2375
AD  - Feinberg School of Medicine, Northwestern University, Chicago, Illinois
AD  - Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
AD  - Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
AD  - Division of General Internal Medicine and Geriatrics, Health Literacy and Learning Program, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
DO  - 10.1111/pme.12862
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125150721
T1  - Adverse cardiac events associated with incident opioid drug use among older adults with COPD.
AU  - Vozoris, Nicholas
AU  - Wang, Xuesong
AU  - Austin, Peter
AU  - Lee, Douglas
AU  - Stephenson, Anne
AU  - O'Donnell, Denis
AU  - Gill, Sudeep
AU  - Rochon, Paula
Y1  - 2017/10//
N1  - Accession Number: 125150721. Language: English. Entry Date: 20170921. Revision Date: 20171004. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 1256165. 
KW  - Pulmonary Disease, Chronic Obstructive -- Diagnosis
KW  - Narcotics -- Adverse Effects
KW  - Cardiovascular Diseases -- Etiology
KW  - Pulmonary Disease, Chronic Obstructive -- Drug Therapy
KW  - Human
KW  - Aged
KW  - Exploratory Research
KW  - Retrospective Design
KW  - Prospective Studies
KW  - Drug Therapy -- Evaluation
SP  - 1287
EP  - 1295
JO  - European Journal of Clinical Pharmacology
JF  - European Journal of Clinical Pharmacology
JA  - EUR J CLIN PHARMACOL
VL  - 73
IS  - 10
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
AB  - Purpose: We evaluated whether incident opioid drug use was associated with adverse cardiac events among older adults with chronic obstructive pulmonary disease (COPD). Methods: This was an exploratory, retrospective cohort study using health administrative data from Ontario, Canada, from 2008 to 2013. Using a validated algorithm, we identified adults aged 66 years and older with non-palliative COPD. Hazard ratios (HR) were estimated for adverse cardiac events within 30 days of incident opioid receipt compared to controls using inverse probability of treatment weighting using the propensity score. Results: There were 134,408 community-dwelling individuals and 14,685 long-term care residents with COPD identified, 67.0 and 60.6% of whom received an incident opioid. Incident use of any opioid was associated with significantly decreased rates of emergency room (ER) visits and hospitalizations for congestive heart failure (CHF) among community-dwelling older adults (HR 0.84; 95% CI 0.73-0.97), but significantly increased rates of ischemic heart disease (IHD)-related mortality among long-term care residents (HR 2.15; 95% CI 1.50-3.09). In the community-dwelling group, users of more potent opioid-only agents without aspirin or acetaminophen combined had significantly increased rates of ER visits and hospitalizations for IHD (HR 1.38; 95% CI 1.08-1.77) and IHD-related mortality (HR 1.83; 95% CI 1.32-2.53). Conclusions: New opioid use was associated with elevated rates of IHD-related morbidity and mortality among older adults with COPD. Adverse cardiac events may need to be considered when administering new opioids to older adults with COPD, but further studies are required to establish if the observed associations are causal or related to residual confounding.
SN  - 0031-6970
AD  - Institute for Clinical Evaluative Sciences , Toronto Canada
AD  - Department of Medicine , Queen's University , Kingston Canada
DO  - 10.1007/s00228-017-2278-3
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120444271
T1  - Is a Prehospital Treat and Release Protocol for Opioid Overdose Safe?
AU  - Kolinsky, Daniel
AU  - Keim, Samuel M.
AU  - Cohn, Brian G.
AU  - Schwarz, Evan S.
AU  - Yealy, Donald M.
Y1  - 2017/01//
N1  - Accession Number: 120444271. Language: English. Entry Date: 20171105. Revision Date: 20171105. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 8412174. 
KW  - Patient Safety -- Standards
KW  - Overdose -- Therapy
KW  - Practice Guidelines -- Standards
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Naloxone -- Administration and Dosage
KW  - Analgesics -- Adverse Effects
KW  - Naloxone -- Therapeutic Use
KW  - Analgesics, Opioid
KW  - Emergency Service -- Administration
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Heroin -- Therapeutic Use
KW  - Analgesics -- Therapeutic Use
KW  - Heroin -- Adverse Effects
KW  - Human
KW  - Scales
SP  - 52
EP  - 58
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 52
IS  - 1
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: The current standards for domestic emergency medical services suggest that all patients suspected of opioid overdose be transported to the emergency department for evaluation and treatment. This includes patients who improve after naloxone administration in the field because of concerns for rebound toxicity. However, various emergency medical services systems release such patients at the scene after a 15- to 20-min observation period as long as they return to their baseline.Objectives: We sought to determine if a "treat and release" clinical pathway is safe in prehospital patients with suspected opioid overdose.Results: Five studies were identified and critically appraised. From a pooled total of 3875 patients who refused transport to the emergency department after an opioid overdose, three patient deaths were attributed to rebound toxicity. These results imply that a "treat and release" policy might be safe with rare complications. A close review of these studies reveals several confounding factors that make extrapolation to our population limited.Conclusion: The existing literature suggests a "treat and release" policy for suspected prehospital opioid overdose might be safe, but additional research should be conducted in a prospective design.
SN  - 0736-4679
AD  - Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
AD  - Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona
AD  - Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
U2  - PMID: 27769615.
DO  - 10.1016/j.jemermed.2016.09.015
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120444271&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126592016
T1  - Multicenter prevalence of opioid medication use as abortive therapy in the ED treatment of migraine headaches.
AU  - Young, Neil
AU  - Silverman, Daniel
AU  - Bradford, Heather
AU  - Finkelstein, Jeffrey
Y1  - 2017/12//
N1  - Accession Number: 126592016. Language: English. Entry Date: 20180108. Revision Date: 20180108. Publication Type: journal article; research. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Dopamine Antagonists -- Therapeutic Use
KW  - Migraine -- Drug Therapy
KW  - Antiinflammatory Agents, Non-Steroidal -- Therapeutic Use
KW  - Emergency Medical Services
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Prevalence
KW  - Cross Sectional Studies
KW  - United States
KW  - Protocols
KW  - Female
KW  - Migraine -- Epidemiology
KW  - Male
KW  - Patient Discharge
KW  - Adult
KW  - Human
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
SP  - 1845
EP  - 1849
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 35
IS  - 12
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Despite a range of therapeutic options for treating acute migraine headaches, the use of opioids is still reported to be common practice. This study describes treatment practices in regards to migraines in the ED. It characterizes the prevalence of opioid orders during visits in three different settings, an academic medical center, a non-academic urban ED, and a community ED. Fourteen months of consecutive migraine visits were identified. All medications ordered were separated into first-line and rescue medications. Number of visits, length of stay, door to provider time, and total provider time were compared. A total of 1222 visits were identified. Opioids were ordered in 35.8% of these visits. By facility, opioids were ordered in 12.3% of academic medical center visits, 40.9% of urban ED visits, and 68.6% of community ED visits. This ranged from 6.9% of first-line therapies in the academic center to 69.9% of rescue therapies in the community ED. Of those who received opioids, 36.0% versus 25.1% required rescue medications. Patients who received opioids had more repeat visits, 1.79 versus 1.30. The academic center and urban ED both found greater than 30% decrease in length of stay in visits where opioids were not given. In the face of evidence against opioids for migraines, over one third of patients received them. There was a higher prevalence in the community setting. There were no significant benefits in overall throughput time, however, opioid visits required more rescue medications, increased length of stay, and resulted in more repeat visits.
SN  - 0735-6757
AD  - UCONN Integrated Residency in Emergency Medicine, Hartford, CT, United States
AD  - Hartford HealthCare, Hartford CT, United States
U2  - PMID: 28645559.
DO  - 10.1016/j.ajem.2017.06.015
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126592016&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 126708499
T1  - Addressing the high rate of opioid prescriptions for dental pain in the emergency department.
AU  - Patel, Nisarg A.
AU  - Afshar, Salim
Y1  - 2018/01//
N1  - Accession Number: 126708499. Language: English. Entry Date: 20171231. Revision Date: 20171222. Publication Type: letter. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
SP  - 138
EP  - 139
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 36
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0735-6757
AD  - Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA
AD  - Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
U2  - PMID: 28709712.
DO  - 10.1016/j.ajem.2017.07.003
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126708499&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124252884
T1  - First, do no harm: Advocating for opioid prescribing guidelines in Canadian emergency departments.
AU  - Moore, Kieran
AU  - Lew, Julia
AU  - Buttemer, Samantha
AU  - Kielstra, Lauren
Y1  - 2017/07//
N1  - Accession Number: 124252884. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; editorial. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 100893237. 
KW  - Emergency Service
KW  - Centers for Disease Control and Prevention (U.S.)
KW  - Mental Health
KW  - Chronic Pain
KW  - Physicians, Emergency
KW  - Canada
SP  - 324
EP  - 326
JO  - CJEM: Canadian Journal of Emergency Medicine
JF  - CJEM: Canadian Journal of Emergency Medicine
JA  - CAN J EMERG MED
VL  - 19
IS  - 4
PB  - Cambridge University Press
SN  - 1481-8035
AD  - Department of Medicine, Public Health and Preventive Medicine, Queen’s University, Kingston, ON
AD  - School of Medicine, Public Health and Preventive Medicine, Queen’s University, Kingston, ON
AD  - Department of Family Medicine, Public Health and Preventive Medicine, Queen’s University, Kingston, ON.
DO  - 10.1017/cem.2017.8
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124252884&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128954569
T1  - Employees Face Opioid Overflow in EDs.
AU  - AHC MEDIA
Y1  - 2018/05//
N1  - Accession Number: 128954569. Language: English. Entry Date: 20180411. Revision Date: 20180414. Publication Type: Article. Journal Subset: Nursing; USA. Special Interest: Emergency Care. NLM UID: 8510434. 
KW  - Emergency Service
KW  - Narcotics -- Poisoning
KW  - Overdose -- Epidemiology -- United States
KW  - Environmental Exposure
KW  - Occupational Safety
KW  - Workplace Violence
KW  - Patient Assault
KW  - Personnel, Health Facility
KW  - Emergency Patients
KW  - Substance Abusers
KW  - United States
SP  - N.PAG
EP  - N.PAG
JO  - Hospital Employee Health
JF  - Hospital Employee Health
JA  - HOSP EMPLOYEE HEALTH
VL  - 37
IS  - 5
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - In data reported from July 2016 through September 2017, the CDC found that ED visits in 45 states showed that opioid overdoses are increasing across all regions.
SN  - 0744-6470
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128954569&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

ID  - 116962204
T1  - Opioids and the Emergency Physician: Ducking Between Pendulum Swings.
AU  - Yealy, Donald M.
AU  - Green, Steven M.
Y1  - 2016/08//
N1  - Accession Number: 116962204. Language: English. Entry Date: 20170627. Revision Date: 20171209. Publication Type: editorial; commentary. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Analgesics, Opioid
KW  - Physicians
SP  - 209
EP  - 212
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Department of Emergency Medicine, University of Pittsburgh/UPMC
AD  - Department of Emergency Medicine, Loma Linda University
U2  - PMID: 26973177.
DO  - 10.1016/j.annemergmed.2016.01.026
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116962204&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127581153
T1  - Silence greets calls to extend opioid emergency.
AU  - Johnson, Steven Ross
Y1  - 2018/01/22/
N1  - Accession Number: 127581153. Language: English. Entry Date: 20180131. Revision Date: 20180131. Publication Type: Article; brief item. Journal Subset: Health Services Administration; USA. NLM UID: 7801798. 
KW  - Public Health
KW  - Health Resource Allocation
KW  - Substance Use Disorders -- Prevention and Control
KW  - Public Figures
SP  - 0003
EP  - 0003
JO  - Modern Healthcare
JF  - Modern Healthcare
JA  - MOD HEALTHC
VL  - 48
IS  - 4
CY  - Detroit, Michigan
PB  - Crain Communications Inc. (MI)
AB  - The article reports on calls for U.S. President Donald Trump to extend the opioid public health emergency beyond its 90-day limit. Topics mentioned include a large-scale media campaign promoting drug prevention among children, Trump's plan to release his annual fiscal budget request, and an increase in drug overdose deaths in 2016 according to the U.S. Centers for Disease Control and Prevention.
SN  - 0160-7480
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=127581153&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106372856
T1  - Naloxone in opioid poisoning: walking the tightrope.
AU  - Clarke SFJ
AU  - Dargan PI
AU  - Jones AL
Y1  - 2005/09//
N1  - Accession Number: 106372856. Language: English. Entry Date: 20060106. Revision Date: 20150820. Publication Type: Journal Article; algorithm; research; systematic review. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 100963089. 
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Administration, Intravenous
KW  - Embase
KW  - Injections, Subcutaneous
KW  - Medline
KW  - Naloxone -- Adverse Effects
KW  - Substance Withdrawal Syndrome
KW  - Treatment Outcomes
KW  - Human
SP  - 612
EP  - 616
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
PB  - BMJ Publishing Group
AB  - Acute opioid intoxication and overdose are common causes of presentation to emergency departments. Although naloxone, a pure opioid antagonist, has been available for many years, there is still confusion over the appropriate dose and route of administration. This article looks at the reasons for this uncertainty and undertakes a literature review from which a treatment algorithm is presented.
SN  - 1472-0205
AD  - Acting Consultant in Emergency Medicine, South Manchester University Hospital Trust, Manchester, UK; sfjclarke@doctors.org.uk
U2  - PMID: 16113176.
DO  - 10.1136/emj.2003.009613
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106372856&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128715796
T1  - Opioid-Related Harms in Canada.
AU  - Grywacheski, Vera
AU  - O'Connor, Shannon
AU  - Louie, Krista
Y1  - 2018/01//
N1  - Accession Number: 128715796. Language: English. Entry Date: 20180329. Revision Date: 20180329. Publication Type: Article. Journal Subset: Canada; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed. NLM UID: 101208192. 
KW  - Analgesics, Opioid -- Poisoning -- Canada
KW  - Overdose -- Trends -- Canada
KW  - Canada
KW  - Hospitalization -- Trends -- Canada
KW  - Fentanyl
KW  - Mortality -- Trends -- Canada
KW  - Emergency Service -- Utilization -- Canada
KW  - Human
KW  - Descriptive Statistics
KW  - Middle Age
KW  - Aged
KW  - Adolescence
KW  - Young Adult
KW  - Geographic Factors
KW  - Heroin
SP  - 10
EP  - 12
JO  - Healthcare Quarterly
JF  - Healthcare Quarterly
JA  - HEALTHC Q
VL  - 20
IS  - 4
CY  - Toronto, Ontario
PB  - Longwoods Publishing
AB  - The rise in harms associated with opioids is an issue of increasing public health importance in Canada. The Government of Canada recently reported 2,816 apparent opioid-related deaths across the country in 2016. Recent 2017 data show that deaths involving fentanyl-related opioids have doubled from January to March as compared to the same time period in 2016 (Government of Canada 2017). Additional measures that provide a better understanding of opioid-related harms, such as hospitalizations and emergency department (ED) visits, are a high priority. The objective of this study is to present pan-Canadian data on hospitalizations and ED visits because of opioid poisoning.
SN  - 1710-2774
AD  - Senior analyst with the PDA team at CIHI, Ottawa, Ontario
AD  - Program lead with the PDA team at CIHI, Ottawa, Ontario
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128715796&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109463462
T1  - Chronic Pain Patients' Impressions of an Emergency Department Opioid Prescribing Guideline Poster.
AU  - Weiner, Scott G.
AU  - Yannopoulos, Paul F.
AU  - Lu, Chao
Y1  - 2015/09//
N1  - Accession Number: 109463462. Language: English. Entry Date: 20150918. Revision Date: 20160831. Publication Type: Article; pictorial; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 100894201. 
KW  - Health Information
KW  - Chronic Pain
KW  - Patient Attitudes
KW  - Practice Guidelines
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Posters
KW  - Cross Sectional Studies
KW  - Pain Clinics
KW  - Hospitals -- Massachusetts
KW  - Inpatients
KW  - Human
KW  - Female
KW  - Male
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - P-Value
KW  - Confidence Intervals
KW  - Odds Ratio
KW  - Massachusetts
KW  - Waiting Rooms
KW  - Emergency Service
SP  - 1759
EP  - 1763
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 16
IS  - 9
PB  - Oxford University Press / USA
AB  - Objective To determine if an opioid prescribing guideline poster, meant to be posted in an emergency department (ED) triage area, would deter patients with chronic pain from seeking care. Methods We prospectively enrolled patients presenting to a chronic craniofacial pain clinic affiliated with an urban academic Level I trauma center. Patients were surveyed with a close-ended, structured questionnaire. Included patients were aged 18 and older with pain lasting 12 weeks or longer. Patients were shown a sample pain poster. The primary outcome was determination if such a poster would prevent the patient from staying to receive care in the ED. Results One hundred patients were surveyed. Most patients (77%) reported having been a patient in the ED in the past, and of these, 23% reported visiting the ED for worsening of chronic pain. After being shown the poster, 97% believed the recommendations in the poster were reasonable and 97% thought that the poster should be displayed in the ED. Seven patients (7%) reported that seeing the poster in the ED waiting room or triage area would intimidate them, and two patients within this group (2% of total sample) reported that it would prevent them from staying to get care. Conclusions The vast majority of patients with chronic pain in this cohort believes that a pain guideline poster is reasonable and should be posted in the ED. However, a small percentage of patients reported that they would feel intimidated by such a poster and that it would prevent them from staying to get care, a result meant to inform hospitals and policy-makers deciding if such posters should be displayed.
SN  - 1526-2375
AD  - Division of Health Policy Translation, Department of Emergency Medicine, Brigham and Women's Hospital
AD  - Tufts University School of Medicine
AD  - Craniofacial Pain Center, Tufts University School of Dental Medicine
U2  - PMID: 25929837.
DO  - 10.1111/pme.12776
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109463462&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111056703
T1  - Emergency Visits for Prescription Opioid Poisonings.
AU  - Tadros, Allison
AU  - Layman, Shelley M.
AU  - Davis, Stephen M.
AU  - Davidov, Danielle M.
AU  - Cimino, Scott
Y1  - 2015/12//
N1  - Accession Number: 111056703. Language: English. Entry Date: 20160228. Revision Date: 20161202. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: U54 GM104942/GM/NIGMS NIH HHS/United States. NLM UID: 8412174. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Overdose -- Diagnosis
KW  - Emergency Service -- Utilization
KW  - Substance Use Disorders -- Epidemiology
KW  - Patient Admission -- Statistics and Numerical Data
KW  - Adolescence
KW  - Retrospective Design
KW  - Middle Age
KW  - Suicide, Attempted
KW  - Aged, 80 and Over
KW  - Adult
KW  - Aged
KW  - United States
KW  - Risk Factors
KW  - Male
KW  - Female
KW  - Scales
SP  - 871
EP  - 877
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 49
IS  - 6
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Prescription opioid abuse and overdose has steadily increased in the United States (US) over the past two decades, and current research has shown a dramatic increase in hospitalizations resulting from opioid poisonings. Still, much is unknown about the clinical and demographic features of patients presenting to emergency departments (EDs) for poisoning from prescription drugs.Objective: We sought to evaluate ED visits by adults for prescription opioids.Methods: This was a retrospective cohort study utilizing 2006-2011 data from the Nationwide Emergency Department Sample. Total number of admissions (weighted), disposition, gender, age, expected payer, income, geographic region, charges, and procedures performed were examined.Results: From 2006 through 2010, there were 259,093 ED visits by adults for poisoning by opioids, and 53.50% of these were unintentional. The overall mean age of patients was 45.5 years, with more visits made by females (52.37%). Patients who unintentionally overdosed were more likely to have Medicare (36.54%), whereas those who intentionally overdosed had private insurance (29.41%). The majority of patients resided in the South (40.93%) and came from lower-income neighborhoods. Approximately 108,504 patients were discharged, and 140,395 were admitted.Conclusions: There were over 250,000 visits to US EDs from 2006 through 2011 with a primary diagnosis of poisoning by a prescription opioid. Females made the majority of visits, and over half were admitted to the hospital, resulting in over $4 billion in charges. Future studies should examine preventative measures, optimal screening, and intervention programs for these patients.
SN  - 0736-4679
AD  - Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
U2  - PMID: 26409674.
DO  - 10.1016/j.jemermed.2015.06.035
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111056703&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105833427
T1  - Naloxone use in a tiered-response emergency medical services system.
AU  - Belz D
AU  - Lieb J
AU  - Rea T
AU  - Eisenberg MS
Y1  - 2006/10//Oct-Dec2006
N1  - Accession Number: 105833427. Language: English. Entry Date: 20090102. Revision Date: 20150820. Publication Type: Journal Article; research. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Emergency Medical Services -- Statistics and Numerical Data
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Substance Use Disorders -- Drug Therapy
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Aged, 80 and Over
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Overdose
KW  - Severity of Illness Indices
KW  - Substance Use Disorders -- Diagnosis
KW  - Substance Use Disorders -- Mortality
KW  - Time Factors
KW  - Washington
KW  - Human
SP  - 468
EP  - 471
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 10
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Objective. To examine the delivery and effect of naloxone for opioid overdose in a tiered-response emergency medical services (EMS) system and to ascertain how much time could be saved if the first arriving emergency medical technicians (EMTs) could have administered intranasal naloxone. Methods. This was case series of all EMS-treated overdose patients who received naloxone by paramedics in a two-tiered EMS system during 2004. The system dispatches basic life support-trained fire fighter-EMTs and/or advanced life support-trained paramedics depending on the severity of cases. Main outcomes were geographic distribution of naloxone-treated overdose, severity of cases, response to naloxone, and time interval between arrival of EMTs and arrival of paramedics at the scene. Results. There were 164 patients who received naloxone for suspected overdose. There were 75 patients (46%) initially unresponsive to painful stimulus. Respiratory rate was <10 breaths/min in 79 (48%). Death occurred in 36 (22%) at the scene or during transport. A full or partial response to naloxone occurred in 119 (73%). Recognized adverse reactions were limited to agitation/combativeness in 25 (15%) and emesis in six (4%). Average EMT arrival time was 5.9 minutes. Average paramedic arrival time was 11.6 minutes in most cases and 16.1 minutes in 46 cases (28%) in which paramedics were requested by EMTs at the scene. Conclusions. There is potential for significantly earlier delivery of naloxone to patients in opioid overdose if EMTs could deliver intranasal naloxone. A pilot study training and authorizing EMTs to administer intranasal naloxone in suspected opioid overdose is warranted.
SN  - 1090-3127
AD  - Department of Medicine, School of Medicine, University of Washington, Seattle, WA.
U2  - PMID: 16997776.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105833427&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103924441
T1  - Intranasal Naloxone for Opioid Overdose Reversal.
AU  - Davis, Corey S.
AU  - Banta-Green, Caleb J.
AU  - Coffin, Phillip
AU  - Dailey, Michael W.
AU  - Walley, Alexander Y.
Y1  - 2015/01//
N1  - Accession Number: 103924441. Language: English. Entry Date: 20141217. Revision Date: 20160624. Publication Type: Journal Article; letter. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Overdose -- Therapy
KW  - Analgesics, Opioid
KW  - Prehospital Care
KW  - Emergency Care
KW  - National Institutes of Health (U.S.)
KW  - Emergencies
KW  - Emergency Medical Technicians
SP  - 135
EP  - 137
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 19
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
SN  - 1090-3127
DO  - 10.3109/10903127.2014.942484
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103924441&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104377668
T1  - Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence.
AU  - Schwarz R
AU  - Zelenev A
AU  - Bruce RD
AU  - Altice FL
AU  - Schwarz, Ryan
AU  - Zelenev, Alexei
AU  - Bruce, R Douglas
AU  - Altice, Frederick L
Y1  - 2012/12//
N1  - Accession Number: 104377668. Language: English. Entry Date: 20130517. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Grant Information: K24 DA017072-08/DA/NIDA NIH HHS/United States. NLM UID: 8500909. 
KW  - Buprenorphine -- Administration and Dosage
KW  - Emergency Service -- Utilization
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Substance Use Disorders -- Rehabilitation
KW  - Adult
KW  - Prospective Studies
KW  - Female
KW  - Human
KW  - Length of Stay
KW  - Male
KW  - Middle Age
KW  - Regression
KW  - Time Factors
KW  - Young Adult
SP  - 451
EP  - 457
JO  - Journal of Substance Abuse Treatment
JF  - Journal of Substance Abuse Treatment
JA  - J SUBST ABUSE TREAT
VL  - 43
IS  - 4
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Drug users are marginalized from typical primary care, often resulting in emergency department (ED) usage and hospitalization due to late-stage disease. Though data suggest methadone decreases such fragmented healthcare utilization (HCU), the impact of buprenorphine maintenance treatment (BMT) on HCU is unknown. Chart review was conducted on opioid dependent patients seeking BMT, comparing individuals (n=59) who left BMT≤7days with those retained on BMT (n=150), for ED use and hospitalization. Using negative binomial regressions, including comparison of time before BMT induction, ED utilization and hospitalization were assessed. Overall, ED utilization was 0.93 events per person year and was significantly reduced by BMT, with increasing time (retention) on BMT. BMT had no significant effect on hospitalizations or average length of stay.
SN  - 0740-5472
AD  - Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
AD  - Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Children's Hospital of Boston, Boston, MA, USA; Yale University School of Medicine, New Haven, CT, USA.
U2  - PMID: 22534003.
DO  - 10.1016/j.jsat.2012.03.008
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104377668&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104554636
T1  - More educated emergency department patients are less likely to receive opioids for acute pain.
AU  - Platts-Mills TF
AU  - Hunold KM
AU  - Bortsov AV
AU  - Soward AC
AU  - Peak DA
AU  - Jones JS
AU  - Swor RA
AU  - Lee DC
AU  - Domeier RM
AU  - Hendry PL
AU  - Rathlev NK
AU  - McLean SA
AU  - Platts-Mills, Timothy F
AU  - Hunold, Katie M
AU  - Bortsov, Andrey V
AU  - Soward, April C
AU  - Peak, David A
AU  - Jones, Jeffrey S
AU  - Swor, Robert A
AU  - Lee, David C
Y1  - 2012/05//
N1  - Accession Number: 104554636. Language: English. Entry Date: 20120824. Revision Date: 20161117. Publication Type: journal article; research. Commentary: Fanciullo GJ. Who receives opioids for acute pain in emergency departments? Considering evidence, patient and provider preferences. (PAIN) May2012; 153 (5): 941-942. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. Grant Information: KL2 RR025746/RR/NCRR NIH HHS/United States. NLM UID: 7508686. 
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Utilization
KW  - Practice Patterns
KW  - Accidents, Traffic
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Cross Sectional Studies
KW  - Educational Status
KW  - Emergency Service
KW  - Female
KW  - Human
KW  - Prospective Studies
KW  - Male
KW  - Middle Age
KW  - Pain Measurement
KW  - Socioeconomic Factors
KW  - United States
SP  - 967
EP  - 973
JO  - Pain (03043959)
JF  - Pain (03043959)
JA  - PAIN
VL  - 153
IS  - 5
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Inadequate treatment of pain in United States emergency departments (EDs) is common, in part because of the limited and idiosyncratic use of opioids by emergency providers. This study sought to determine the relationship between patient socioeconomic characteristics and the likelihood that they would receive opioids during a pain-related ED visit. We conducted a cross-sectional analysis of ED data obtained as part of a multicenter study of outcomes after minor motor vehicle collision (MVC). Study patients were non-Hispanic white patients between the ages of 18 and 65 years who were evaluated and discharged home from 1 of 8 EDs in 4 states. Socioeconomic characteristics include educational attainment and income. Of 690 enrolled patients, the majority had moderate or severe pain (80%). Patients with higher education attainment had lower levels of pain, pain catastrophizing, perceived life threat, and distress. More educated patients were also less likely to receive opioids during their ED visit. Opioids were given to 54% of patients who did not complete high school vs 10% of patients with post-college education (χ(2) test P<.001). Differences in the frequency of opioid administration between patients with the lowest educational attainment (39%, 95% confidence interval 22% to 60%) and highest educational attainment (13%, 95% confidence interval 7% to 23%) remained after adjustment for age, sex, income, and pain severity (P=.01). In this sample of post-MVC ED patients, more educated patients were less likely to receive opioids. Further study is needed to assess the generalizability of these findings and to determine the reason for the difference.
SN  - 0304-3959
AD  - Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599-7010, USA
U2  - PMID: 22386895.
DO  - 10.1016/j.pain.2012.01.013
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104554636&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 111894439
T1  - Opioid Considerations for Emergency Practice.
AU  - Terndrup, Thomas
Y1  - 2015/12//
N1  - Accession Number: 111894439. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Opinion. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101476450. 
KW  - Emergency Service
KW  - Patient Selection
KW  - Emergencies
KW  - Adverse Drug Event
KW  - Analgesia
SP  - 1084
EP  - 1085
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 16
IS  - 7
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - The article discusses the research on the use of opioid as an analgesia agent in emergency departments and recommends that patient selection and safe monitoring could decrease the harmful effects of opioids in patients.
SN  - 1936-900X
AD  - Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
DO  - 10.5811/westjem.2015.12.29447
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111894439&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109879746
T1  - Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study.
AU  - Lindstrom, Heather A
AU  - Clemency, Brian M
AU  - Snyder, Ryan
AU  - Consiglio, Joseph D
AU  - May, Paul R
AU  - Moscati, Ronald M
Y1  - 2015/08//2015 Aug
N1  - Accession Number: 109879746. Language: English. Entry Date: 20150923. Revision Date: 20151101. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health; USA. Special Interest: Emergency Care. NLM UID: 8918173. 
SP  - 385
EP  - 389
JO  - Prehospital & Disaster Medicine
JF  - Prehospital & Disaster Medicine
JA  - PREHOSPITAL DISASTER MED
VL  - 30
IS  - 4
PB  - Cambridge University Press
AB  - Background: Abuse or unintended overdose (OD) of opiates and heroin may result in prehospital and emergency department (ED) care. Prehospital naloxone use has been suggested as a surrogate marker of community opiate ODs. The study objective was to verify externally whether prehospital naloxone use is a surrogate marker of community opiate ODs by comparing Emergency Medical Services (EMS) naloxone administration records to an independent database of ED visits for opiate and heroin ODs in the same community.Methods: A retrospective chart review of prehospital and ED data from July 2009 through June 2013 was conducted. Prehospital naloxone administration data obtained from the electronic medical records (EMRs) of a large private EMS provider serving a metropolitan area were considered a surrogate marker for suspected opiate OD. Comparison data were obtained from the regional trauma/psychiatric ED that receives the majority of the OD patients. The ED maintains a de-identified database of narcotic-related visits for surveillance of narcotic use in the metropolitan area. The ED database was queried for ODs associated with opiates or heroin. Cross-correlation analysis was used to test if prehospital naloxone administration was independent of ED visits for opiate/heroin ODs.Results: Naloxone was administered during 1,812 prehospital patient encounters, and 1,294 ED visits for opiate/heroin ODs were identified. The distribution of patients in the prehospital and ED datasets did not differ by gender, but it did differ by race and age. The frequency of naloxone administration by prehospital providers varied directly with the frequency of ED visits for opiate/heroin ODs. A monthly increase of two ED visits for opiate-related ODs was associated with an increase in one prehospital naloxone administration (cross-correlation coefficient [CCF]=0.44; P=.0021). A monthly increase of 100 ED visits for heroin-related ODs was associated with an increase in 94 prehospital naloxone administrations (CCF=0.46; P=.0012).Conclusions: Frequency of naloxone administration by EMS providers in the prehospital setting varied directly with frequency of opiate/heroin OD-related ED visits. The data correlated both for short-term frequency and longer term trends of use. However, there was a marked difference in demographic data suggesting neither data source alone should be relied upon to determine which populations are at risk within the community.
SN  - 1049-023X
U2  - PMID: 26061280.
DO  - 10.1017/S1049023X15004793
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109879746&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128083286
T1  - Ibuprofen + acetaminophen did not differ from opioids + acetaminophen for reducing acute extremity pain at 2 h.
AU  - Varner, Catherine
AU  - Carpenter, Christopher R.
Y1  - 2018/02/20/
N1  - Accession Number: 128083286. Language: English. Entry Date: In Process. Revision Date: 20180306. Publication Type: journal article. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0372351. 
SP  - JC21
EP  - JC21
JO  - Annals of Internal Medicine
JF  - Annals of Internal Medicine
JA  - ANN INTERN MED
VL  - 168
IS  - 4f
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
AB  - The article discusses research which compared effectiveness of oral opioids to nonopioid analgesics in reducing acute extremity pain in emergency department patients, conducted by A. K. Chang and colleagues, published in a 2017 issue of "JAMA: The Journal of the American Medical Association." Topics explored include the drug dosage administered to patients, the change in pain recorded following treatment, and the lack of difference between the drug combinations used for pain treatment.
SN  - 0003-4819
AD  - Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
AD  - Washington University in St. Louis, St. Louis, Missouri, USA.
U2  - PMID: 29459958.
DO  - 10.7326/ACPJC-2018-168-4-021
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128083286&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127269833
T1  - Pennsylvania Governor Declares Heroin, Opioid Emergency.
Y1  - 2018/01/11/
N1  - Accession Number: 127269833. Language: English. Entry Date: 20180121. Revision Date: 20180121. Publication Type: Article. Journal Subset: Consumer Health; USA. NLM UID: 8704590. 
KW  - Substance Use Disorders -- Prevention and Control -- Pennsylvania
KW  - Public Health
KW  - Health Policy
KW  - Government Programs
KW  - Pennsylvania
KW  - Heroin
KW  - Narcotics
KW  - Substance Use Disorders -- Mortality
SP  - 1
EP  - 2
JO  - Occupational Health & Safety News
JF  - Occupational Health & Safety News
JA  - OCCUP HEALTH SAF NEWS
CY  - Chatsworth, California
PB  - 1105 Media, Inc.
SN  - 0896-3835
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=127269833&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117640272
T1  - Health Care Costs and Utilization in Patients Receiving Prescriptions for Long-acting Opioids for Acute Postsurgical Pain.
AU  - Gold, Laura S.
AU  - Strassels, Scott A.
AU  - Hansen, Ryan N.
Y1  - 2016/09//
N1  - Accession Number: 117640272. Language: English. Entry Date: In Process. Revision Date: 20180209. Publication Type: journal article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer). NLM UID: 8507389. 
KW  - Patient Attitudes
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Analgesics, Opioid -- Economics
KW  - Postoperative Pain -- Drug Therapy
KW  - Health Care Costs
KW  - Postoperative Pain -- Economics
KW  - Pain -- Therapy
KW  - Male
KW  - Postoperative Pain -- Epidemiology
KW  - Arthroplasty, Replacement, Hip
KW  - Age Factors
KW  - Middle Age
KW  - Arthroplasty, Replacement, Knee
KW  - Female
KW  - Short Portable Mental Status Questionnaire
SP  - 747
EP  - 754
JO  - Clinical Journal of Pain
JF  - Clinical Journal of Pain
JA  - CLIN J PAIN
VL  - 32
IS  - 9
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Objectives: Severe pain after joint replacement surgeries is common and is usually managed by opioid analgesics. We described joint replacement surgery patients who received prescriptions for long-acting opioids (LAOs) and compared their health care utilization and costs with postsurgical patients who did not receive LAO prescriptions.Materials and Methods: Patients undergoing hip, knee, or shoulder replacement surgery between January 1, 2008 and December 31, 2011were included in the study and were classified by their exposure to LAOs. We estimated multivariate models to compare the groups' health care utilization and costs in the first 7 days and in the 1, 3, 6, and 12 months after surgery.Results: Of 118,816 patients who met our inclusion criteria, 15,094 (13%) received LAO prescriptions in 30 days following surgery. LAO recipients were slightly younger and more likely than nonrecipients to have taken antibiotics, antidepressants, benzodiazepines, antihypertensives, sedatives, muscle relaxants, and short-acting opioids in the 60 days before surgery. LAO recipients were more likely to have had a hospitalization and an emergency department visit in the subsequent 1 week and in the next 1, 3, 6, and 12 months. Patients receiving LAO prescriptions incurred greater costs in the 1 week and in the 1, 3, 6, and 12 months following their surgeries compared with patients who did not receive LAO prescriptions.Discussion: We found associations between patients who received prescriptions for LAOs and increased costs and utilization. Future studies should elucidate causal relationships between LAOs and increased resource use. Providers should consider alternative pain management strategies.
SN  - 0749-8047
AD  - Department of Radiology, University of Washington, Seattle, WA
AD  - Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
AD  - Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Hazelwood, MO
U2  - PMID: 26626298.
DO  - 10.1097/AJP.0000000000000322
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117640272&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117972021
T1  - Effect of opioid prescribing guidelines in primary care.
AU  - Chen, Jonathan H.
AU  - Jason Hom
AU  - Richman, Ilana
AU  - Asch, Steven M.
AU  - Podchiyska, Tanya
AU  - Johansen, Nawal Atwan
AU  - Hom, Jason
Y1  - 2016/08/30/
N1  - Accession Number: 117972021. Language: English. Entry Date: 20170210. Revision Date: 20170615. Publication Type: journal article; practice guidelines. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: K01 ES026837/ES/NIEHS NIH HHS/United States. NLM UID: 2985248R. 
KW  - Chronic Pain -- Drug Therapy
KW  - Prescriptions, Drug -- Standards
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Primary Health Care -- Standards
KW  - Male
KW  - Female
KW  - Middle Age
KW  - Scales
SP  - 1
EP  - 6
JO  - Medicine
JF  - Medicine
JA  - MEDICINE
VL  - 95
IS  - 35
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice.
SN  - 0025-7974
AD  - Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, CA
AD  - Center for Innovation to Implementation (Ci2i), Veteran Affairs Palo Alto Health Care System, Palo Alto, Stanford, CA
AD  - Center for Primary Care and Outcomes Research (PCOR), Stanford University, Stanford, CA
AD  - Department of Health Research and Policy-- Epidemiology, Stanford University, Stanford, CA
U2  - PMID: 27583928.
DO  - 10.1097/MD.0000000000004760
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117972021&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117662875
T1  - Medical encounters for opioid-related intoxications in Southern Nevada: sociodemographic and clinical correlates.
AU  - Jing Feng
AU  - Iser, Joseph P.
AU  - Wei Yang
AU  - Feng, Jing
AU  - Yang, Wei
Y1  - 2016/08/24/
N1  - Accession Number: 117662875. Language: English. Entry Date: In Process. Revision Date: 20180121. Publication Type: journal article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 101088677. 
KW  - Substance Use Disorders -- Rehabilitation
KW  - Emergency Service -- Utilization
KW  - Comorbidity
KW  - Chronic Disease
KW  - Suicide, Attempted
KW  - Analgesics, Opioid -- Poisoning
KW  - Urban Health
KW  - Logistic Regression
KW  - Whites
KW  - Antianxiety Agents, Benzodiazepine -- Adverse Effects
KW  - Overdose -- Rehabilitation
KW  - Prevalence
KW  - Female
KW  - Male
KW  - Nevada
KW  - Adult
KW  - Overdose -- Epidemiology
KW  - Blacks
KW  - Substance Use Disorders -- Epidemiology
KW  - Poverty
KW  - Adolescence
KW  - Middle Age
KW  - Young Adult
KW  - Hispanics -- Statistics and Numerical Data
KW  - Scales
SP  - 1
EP  - 10
JO  - BMC Health Services Research
JF  - BMC Health Services Research
JA  - BMC HEALTH SERV RES
VL  - 16
PB  - BioMed Central
AB  - Background: Despite today's heightened concern over opioid overdose, the lack of population-based data examining clinical and contextual factors associated with opioid use represents a knowledge gap with relevance to prevention and treatment interventions. We sought to quantify rates of emergency department (ED) visits and inpatient hospitalizations for harmful opioid effects and their sociodemographic differentials as well as clinical correlates in Southern Nevada, using ED visit and hospital inpatient discharge records from 2011 to 2013.Methods: Cases were identified by ICD-9-CM diagnosis codes for opioid poisoning and opioid-type drug dependence and abuse as well as poisoning and adverse effect E-codes. Comorbid conditions, including pain-related diagnoses, major chronic diseases, affective disorders, sleep disorders, sexually transmitted infections and viral hepatitis were assessed from all available diagnosis fields. Counts by age-race per zip code were modeled by negative binomial regression. Opioid injuries were further examined as a function both of neighborhood income and individual characteristics, with mixed-effects logistic regression to estimate the likelihood for an adverse outcome.Results: Opioid intoxications and comorbidities were more common in low-income communities. The multivariable-adjusted rate for opioid-related healthcare utilization was 42 % higher in the poorest vs. richest quartile during the study period. The inter-quartile (quartile 1 vs. 4) rate increases for chronic bodily pains (44 %), hypertension (89 %), renal failure/diabetes (2.6 times), chronic lower respiratory disease (2.2 times), and affective disorders (57 %) were statistically significant. Chronic disease comorbidity was greater among non-Hispanic blacks, whereas abuse/dependence related disorders, alcohol or benzodiazepine co-use, chronic bodily pains, and affective disorders were more prevalent among non-Hispanic whites than nonwhites.Conclusions: There were consistent patterns of disparities in healthcare utilization across sociodemographic groups for opioid-associated disorders. Further initiatives to evaluate the determinants of overdose and abuse and to implement targeted response efforts are needed.
SN  - 1472-6963
AD  - Southern Nevada Health District, PO Box 3902, Las Vegas, NV 89032, USA
AD  - School of Community Health Sciences/MS274, University of Nevada, Reno, Reno, NV 89557, USA
AD  - Southern Nevada Health District, PO Box 3902, Las Vegas, NV, 89032, USA
AD  - School of Community Health Sciences/MS274, University of Nevada, Reno, Reno, NV, 89557, USA
U2  - PMID: 27557947.
DO  - 10.1186/s12913-016-1692-z
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117662875&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 116088750
T1  - Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont.
AU  - Mohlman, Mary Kate
AU  - Tanzman, Beth
AU  - Finison, Karl
AU  - Pinette, Melanie
AU  - Jones, Craig
Y1  - 2016/08//
N1  - Accession Number: 116088750. Language: English. Entry Date: In Process. Revision Date: 20180220. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Instrumentation: General Health Questionnaire (GHQ). NLM UID: 8500909. 
KW  - Substance Use Disorders -- Drug Therapy
KW  - Medicaid -- Economics
KW  - Health Care Costs -- Statistics and Numerical Data
KW  - Adult
KW  - Cross Sectional Studies
KW  - Young Adult
KW  - United States
KW  - Emergency Service -- Standards
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Hospitalization -- Economics
KW  - Substance Use Disorders -- Rehabilitation
KW  - Male
KW  - Substance Use Disorders -- Economics
KW  - Emergency Service -- Economics
KW  - Vermont
KW  - Health Services -- Utilization
KW  - Middle Age
KW  - Adolescence
KW  - Human
KW  - Female
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Questionnaires
SP  - 9
EP  - 14
JO  - Journal of Substance Abuse Treatment
JF  - Journal of Substance Abuse Treatment
JA  - J SUBST ABUSE TREAT
VL  - 67
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - In the face of increasing rates of overdose deaths, escalating health care costs, and the tremendous social costs of opioid addiction, policy makers are asked to address the questions of whether and how to expand access to treatment services. In response to an upward trend in opioid abuse and adverse outcomes, Vermont is investing in statewide expansion of a medication-assisted therapy program delivered in a network of community practices and specialized treatment centers (Hub & Spoke Program). This study was conducted to test the rationale for these investments and to establish a pre-Hub & Spoke baseline for evaluating the additive impact of the program. Using a serial cross-sectional design from 2008 to 2013 to evaluate medical claims for Vermont Medicaid beneficiaries with opioid dependence or addiction (6158 in the intervention group, 2494 in the control group), this study assesses the treatment and medical service expenditures for those receiving medication-assisted treatment compared to those receiving substance abuse treatment without medication. Results suggest that medication-assisted therapy is associated with reduced general health care expenditures and utilization, such as inpatient hospital admissions and outpatient emergency department visits, for Medicaid beneficiaries with opioid addiction. For state Medicaid leaders facing similar decisions on approaches to opioid addiction, these results provide early support for expanding medication-assisted treatment services rather than relying only on psychosocial, abstinence, or detoxification interventions.
SN  - 0740-5472
AD  - Vermont Blueprint for Health, NOB 1 South, 280 State Drive, Waterbury, VT 05671, USA
AD  - Onpoint Health Data, 254 Commercial Street, Suite 257, Portland, ME 04101, USA
U2  - PMID: 27296656.
DO  - 10.1016/j.jsat.2016.05.002
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116088750&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104177394
T1  - EMS Runs for Suspected Opioid Overdose: Implications for Surveillance and Prevention.
AU  - Knowlton, Amy
AU  - Weir, Brian W.
AU  - Hazzard, Frank
AU  - Olsen, Yngvild
AU  - McWilliams, Junette
AU  - Fields, Julie
AU  - Gaasch, Wade
Y1  - 2013/07//Jul-Sep2013
N1  - Accession Number: 104177394. Language: English. Entry Date: 20130607. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Emergency Medical Services
KW  - Overdose -- Therapy
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Overdose -- Prevention and Control
KW  - Prehospital Care
KW  - United States
KW  - Patient Care
KW  - Data Analysis
KW  - Human
KW  - Firefighters
KW  - Record Review
KW  - Heroin -- Administration and Dosage
KW  - Substance Abuse
KW  - Naloxone -- Therapeutic Use
KW  - Overdose -- Epidemiology
KW  - Maryland
KW  - Urban Areas
KW  - Crime
KW  - Data Analysis Software
KW  - Chi Square Test
KW  - Naloxone -- Administration and Dosage
KW  - Demography
KW  - Confidence Intervals
KW  - Race Factors
KW  - Middle Age
KW  - Male
KW  - Female
KW  - Ethnic Groups
SP  - 317
EP  - 329
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 17
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background. Opioid (including prescription opiate) abuse and overdose rates in the United States have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. Objective. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. Methods. We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a 13-month time period (2008-2009) based on 2008 Census data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared with the demographic distributions of the EMS patient and city populations and with prior study findings. Results. Of 116,910 EMS incidents during the study period for patients aged 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. The overall incidence was 1.87 administrations per 1,000 residents per year. Findings indicated that naloxone administration peaked in the summer months (31% of administrations), on weekends (32%), and in the late afternoon (4:00-5:00 pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among male patients, white patients, and those in the 45-54-year age group. Findings on temporal patterns were comparable with findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug- or alcohol-related overdoses in Baltimore in 2008-2009 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of opioid overdose. Conclusions. While our findings suggest limitations of EMS naloxone administration data as a proxy indicator of opioid overdose, the results provide partial support for using these data for estimating opioid overdose incidence and suggest ways to improve such data. The study findings have implications for an EMS role in conducting real-time surveillance and treatment and prevention of opioid abuse and overdose.
SN  - 1090-3127
AD  - From Johns Hopkins University Bloomberg School of Public Health (AK, BW, JM, JF), Baltimore, Maryland; Baltimore City Fire Department (FH, WG), Baltimore, Maryland; Baltimore Substance Abuse Systems, Inc. (YO), Baltimore, Maryland; the Institute for Behavior Resources, Inc. (YO, JF), Baltimore, Maryland; Johns Hopkins School of Medicine (YO), Baltimore, Maryland; and the University of Maryland School of Medicine (WG), Baltimore, Maryland.
U2  - PMID: 23734988.
DO  - 10.3109/10903127.2013.792888
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104177394&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 115897978
T1  - Opioid Prescribing Laws and Emergency Department Guidelines for Chronic Non-Cancer Pain in Washington State.
AU  - Skaer, Tracy L.
AU  - Nwude, Azuka C.
Y1  - 2016/06//
N1  - Accession Number: 115897978. Language: English. Entry Date: 20160617. Revision Date: 20170601. Publication Type: Article; review; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101130835. 
KW  - Chronic Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Legislation, Medical -- Washington
KW  - Drug and Narcotic Control -- Washington
KW  - Emergency Service
KW  - Practice Guidelines -- Legislation and Jurisprudence -- Washington
KW  - Washington
KW  - Prescribing Patterns
KW  - Guideline Adherence
KW  - Risk Assessment
SP  - 642
EP  - 647
JO  - Pain Practice
JF  - Pain Practice
JA  - PAIN PRACTICE
VL  - 16
IS  - 5
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Rising mortality rates, increased opioid prescription abuse, and a perceived need to provide practitioners with structured guidance in opioid prescribing have prompted the Washington State Legislature to establish new legal standards of practice regarding chronic non-cancer pain management. Clinicians are required to conduct a detailed physical examination and health history prior to treatment. Risk assessments for abuse and detailed periodic reviews of treatment are required at least every 6 months. Those considered 'high risk' or who have significant psychiatric comorbidities will be required to sign and follow a written agreement or pain contract, obtain their pain prescriptions from a single provider, and submit to biological drug screening. Unless an exemption exists, patients prescribed > 120 mg of morphine-equivalents daily, considered severe pain nonresponders, necessitating dosage escalation, diagnosed with multifaceted mental health-related comorbidities, demonstrating diagnostic ambiguity, and/or requiring significant treatment individualization are referred to a pain specialist. Episodic care settings should refrain from supplying opioids to chronic pain patients whenever possible. The ER is for Emergencies coalition instituted the Seven Best Practices program throughout the state to reduce unnecessary visits, coordinate prescribing practice, reduce Medicaid expenditures, and improve overall patient care. The state reported approximately $33.65 million in savings in 2013 through the use of these practices and converting Medicaid participants from fee-for-service to managed care plans. Similar legislation to complement clinical practice guidelines is expected to be enacted in other states. It is vital that practitioners comprehend the new guidelines and make appropriate adjustments in their opioid prescribing habits.
SN  - 1530-7085
AD  - Department of Pharmacotherapy, College of Pharmacy, Washington State University
DO  - 10.1111/papr.12359
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115897978&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103925772
T1  - Prescription Opioid Abuse: A Literature Review of the Clinical and Economic Burden in the United States.
AU  - Meyer, Roxanne
AU  - Patel, Anisha M.
AU  - Rattana, Stacy K.
AU  - Quock, Tiffany P.
AU  - Mody, Samir H.
Y1  - 2014/12//
N1  - Accession Number: 103925772. Language: English. Entry Date: 20141216. Revision Date: 20151201. Publication Type: Journal Article; research; systematic review; tables/charts. Journal Subset: Health Services Administration; Peer Reviewed; USA. Special Interest: Case Management; Evidence-Based Practice. Grant Information: Funding for this study was provided by Janssen Scientific Affairs.. NLM UID: 101481266. 
KW  - Drugs, Prescription
KW  - Substance Abuse -- Economics
KW  - Human
KW  - Systematic Review
KW  - Health Care Costs
KW  - Descriptive Statistics
KW  - Medline
KW  - Overdose
KW  - Substance Abuse -- Mortality
KW  - Substance Abuse -- Epidemiology -- United States
KW  - United States
KW  - Prevalence
KW  - Comorbidity
KW  - Substance Use Disorders -- Drug Therapy
KW  - Ambulatory Care -- Economics
KW  - Funding Source
SP  - 372
EP  - 387
JO  - Population Health Management
JF  - Population Health Management
JA  - POPUL HEALTH MANAGE
VL  - 17
IS  - 6
CY  - New Rochelle, New York
PB  - Mary Ann Liebert, Inc.
AB  - Between 2002 and 2007, the nonmedical use of prescription pain relievers grew from 11.0 million to 12.5 million people in the United States. Societal costs attributable to prescription opioid abuse were estimated at $55.7 billion in 2007. The purpose of this study was to comprehensively review the recent clinical and economic evaluations of prescription opioid abuse. A comprehensive literature search was conducted for studies published from 2002 to 2012. Articles were included if they were original research studies in English that reported the clinical and economic burden associated with prescription opioid abuse. A total of 23 studies (183 unique citations identified, 54 articles subjected to full text review) were included in this review and analysis. Findings from the review demonstrated that rates of opioid overdose-related deaths ranged from 5528 deaths in 2002 to 14,800 in 2008. Furthermore, overdose reportedly results in 830,652 years of potential life lost before age 65. Opioid abusers were generally more likely to utilize medical services, such as emergency department, physician outpatient visits, and inpatient hospital stays, relative to non-abusers. When compared to a matched control group (non-abusers), mean annual excess health care costs for opioid abusers with private insurance ranged from $14,054 to $20,546. Similarly, the mean annual excess health care costs for opioid abusers with Medicaid ranged from $5874 to $15,183. The issue of opioid abuse has significant clinical and economic consequences for patients, health care providers, commercial and government payers, and society as a whole. ( Population Health Management 2014;17:372-387)
SN  - 1942-7891
AD  - Janssen Scientific Affairs, Raritan, New Jersey.
AD  - InVentiv Health Clinical, Deerfield, Illinois.
AD  - Covance Market Access Services Inc., San Diego, California.
U2  - PMID: 25075734.
DO  - 10.1089/pop.2013.0098
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103925772&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106647856
T1  - Suspected opioid-related emergency medical services encounters in a rural state, 1997-2002.
AU  - Alexander JL
AU  - Burton JH
AU  - Bradshaw JR
AU  - Colin F
Y1  - 2004/10//2004 Oct-Dec
N1  - Accession Number: 106647856. Language: English. Entry Date: 20050617. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Emergency Medical Services -- Utilization
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Adult
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Female
KW  - Maine
KW  - Male
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists
KW  - Prehospital Care
KW  - Record Review
KW  - Retrospective Design
KW  - Human
SP  - 427
EP  - 430
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 8
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - INTRODUCTION: News organizations and governmental agencies have reported substantial increases in the number of opioid-related overdose cases in recent years. OBJECTIVE: To describe the utilization of emergency medical services (EMS) for suspected opioid-related overdose cases in a rural state during the period 1997 through 2002. METHODS: Statewide EMS records were reviewed for 1997 through 2002. Data reviewed included prehospital diagnosis and medications given to all patients by prehospital providers. For cases with a prehospital diagnosis of poisoning or overdose, data reviewed included medications given to patients by prehospital providers, pupil size, and respiratory rate. All records were reviewed in a defined sequence. RESULTS: The study period encompassed 1,175,781 patient encounters. Poisoning or overdose patients accounted for 19,808 (1.7%) encounters. Naloxone was administered by the EMS provider to 2,668 (0.2%) patients. For all poisoning or overdose patients, 1,308 (6.6%) had miotic pupils, 450 (2.2%) had a respiratory rate of <12 breaths/min, and 1,569 (7.9%) received naloxone. During the investigation period, total EMS patient encounters increased 25%, while patients with a complaint of poisoning or overdose increased 47%. The incidences of EMS overdose patients with miotic pupils, respiratory rate <10 breaths/min, and naloxone administration increased 167%, 295%, and 154%, respectively. CONCLUSION: In this rural state, prehospital patients with findings suspicious for opioid overdose disproportionately outpaced the growth of all EMS encounters as well as general overdose encounters during the defined investigation period.
SN  - 1090-3127
AD  - Dept of Emergency Medicine, Maine Medical Center, 47 Bramhall St, Portland, ME 04102; alexajo@mmc.org
U2  - PMID: 15626007.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106647856&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118138830
T1  - New Initiative Slashes Opioid Prescriptions, Boosts Community Response.
Y1  - 2016/10//
N1  - Accession Number: 118138830. Language: English. Entry Date: 20160921. Revision Date: 20160922. Publication Type: Article. Journal Subset: Nursing; USA. NLM UID: 9425690. 
KW  - Pain -- Drug Therapy
KW  - Substance Abuse -- Prevention and Control
KW  - Emergency Service -- Utilization
KW  - Practice Guidelines
KW  - Collaboration
KW  - Health Facilities -- California
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - California
KW  - Patient Care Plans
KW  - Patient Assessment
KW  - Staff Development
KW  - Education, Medical, Continuing
KW  - Referral and Consultation
KW  - Networking, Professional
KW  - Patient Safety
KW  - Overdose
KW  - Documentation
KW  - Hospital Programs -- California
SP  - 109
EP  - 112
JO  - ED Management
JF  - ED Management
JA  - ED MANAGE
VL  - 28
IS  - 10
CY  - Atlanta, Georgia
PB  - AHC Media LLC
SN  - 1044-9167
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118138830&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109574664
T1  - Budgetary impact of the utilization of buprenorphine/naloxone sublingual film and tablet for Medicaid in the United States.
AU  - Asche, Carl V.
AU  - Clay, Emilie
AU  - Kharitonova, Elizaveta
AU  - Zah, Vladimir
AU  - Ruby, Jane
AU  - Aballéa, Samuel
AU  - Aballéa, Samuel
Y1  - 2015/08//
N1  - Accession Number: 109574664. Language: English. Entry Date: 20161223. Revision Date: 20170104. Publication Type: journal article. Journal Subset: Biomedical; Health Services Administration; USA. Instrumentation: Impact of Events Scale (IES). NLM UID: 9892255. 
KW  - Analgesics, Opioid -- Economics
KW  - Narcotic Antagonists -- Economics
KW  - Substance Use Disorders -- Drug Therapy
KW  - Medicaid -- Economics
KW  - Reproducibility of Results
KW  - Administration, Sublingual
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Tablets
KW  - Probability
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Health Services -- Economics
KW  - Time Factors
KW  - Health Care Costs -- Statistics and Numerical Data
KW  - Human
KW  - Health Services -- Utilization
KW  - Retrospective Design
KW  - United States
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Impact of Events Scale
SP  - 600
EP  - 611
JO  - Journal of Medical Economics
JF  - Journal of Medical Economics
JA  - J MED ECON
VL  - 18
IS  - 8
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Objectives: The buprenorphine/naloxone combination for the treatment of opioid dependence is available in a film or tablet formulation. Recent retrospective studies demonstrated that treatment with the sublingual film formulation is associated with improved treatment retention and lower healthcare costs. In March 2013, generic buprenorphine/naloxone tablets were approved in the US. A budget impact model was built to compare healthcare expenditures for different market shares of sublingual film and tablet.Methods: A Markov model was developed to track a cohort of opioid dependent patients treated with sublingual film or tablet through the following treatment phases: initiation, maintenance, discontinuation, off-treatment and reinitiation. Transition probabilities and costs for each phase were estimated from the MarketScan Medicaid database for the period between 1 March 2010 and 30 June 2012. The total expenditure for the plan and expenditure per plan member per month were predicted over 5 years. Two market share scenarios were considered: 1) sublingual film is progressively replaced by generic tablet (current situation) and 2) the sublingual film holds a market share of 100%.Results: Predicted total costs over 5 years were $6400 million when the sublingual film holds a market share of 100% (as per Scenario 2) which is lower than when sublingual film is progressively replaced by generic tablet (current situation as per Scenario 1) by $64 million. These savings were mostly driven by inpatient care ($56 million saved over 5 years), followed by emergency room care ($27 million) and pharmaceutical costs ($24 million). Costs of outpatient care attenuated the difference as they were predicted to be higher by $44 million in Scenario 2. The reduction in total cost per member per month reached $0.027 in the fifth year. Results were most sensitive to price rebates and to the probability of non-psychiatric hospitalization.Conclusions: While using the sublingual film formulation for more patients treated with buprenorphine/naloxone is predicted to increase outpatient care costs, it would generate savings in emergency care and hospitalizations. In the treatment of opioid dependence, total direct medical costs for Medicaid would be lower for sublingual film treated patients, at current drug prices.
SN  - 1369-6998
AD  - University of Illinois College of Medicine at Peoria/University of Illinois at Chicago College of Pharmacy, Peoria, IL, USA
AD  - Creativ-Ceutical, Paris, France
AD  - Creativ-Ceutical, Chicago, IL, USA
AD  - ZRx Outcomes Research Inc., Mississauga, ON, Canada
AD  - Reckitt Benckiser Pharmaceuticals Inc., Richmond, VA, USA
AD  - b b Creativ-Ceutical , Paris , France
U2  - PMID: 25851505.
DO  - 10.3111/13696998.2015.1036760
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118160471
T1  - Identifying Patients for Overdose Prevention With ICD-9 Classification in the Emergency Department, Massachusetts, 2013-2014.
AU  - Ellison, Jacqueline
AU  - Walley, Alexander Y.
AU  - Feldman, James A.
AU  - Bernstein, Edward
AU  - Mitchell, Patricia M.
Y1  - 2016/09//Sep/Oct2016
N1  - Accession Number: 118160471. Language: English. Entry Date: 20160922. Revision Date: 20160922. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; Public Health; USA. Grant Information: Thisstudy was supported by the Boston University School of PublicHealth Established Investigator Innovation Award.. NLM UID: 9716844. 
KW  - International Classification of Diseases
KW  - Patient Assessment
KW  - Overdose -- Prevention and Control -- Massachusetts
KW  - Emergency Service
KW  - Massachusetts
KW  - Risk Assessment
KW  - Record Review
KW  - Data Analysis Software
KW  - Human
KW  - Male
KW  - Female
KW  - Adolescence
KW  - Young Adult
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Funding Source
KW  - Naloxone -- Supply and Distribution
SP  - 671
EP  - 675
JO  - Public Health Reports
JF  - Public Health Reports
JA  - PUBLIC HEALTH REP
VL  - 131
IS  - 5
PB  - Sage Publications Inc.
AB  - The national rise in opioid overdose deaths signifies a need to integrate overdose prevention within healthcare delivery settings. The emergency department (ED) is an opportune location for such interventions. To effectively integrate prevention services, the target population must be clearly defined. We used ICD-9 discharge codes to establish and apply overdose risk categories to ED patients seen from January 1, 2013 to December 31, 2014 at an urban safety-net hospital in Massachusetts with the goal of informing ED-based naloxone rescue kit distribution programs. Of 96,419 patients, 4,468 (4.6%) were at increased risk of opioid overdose, defined by prior opioid overdose, misuse, or polysubstance misuse. A small proportion of those at risk were prescribed opioids on a separate occasion. Use of risk categories defined by ICD-9 codes identified a notable proportion of ED patients at risk for overdose, and provides a systematic means to prioritize and direct clinical overdose prevention efforts.
SN  - 0033-3549
AD  - Boston University School of Public Health, Boston, MA, USA
AD  - Boston University School of Medicine, Boston, MA, USA
AD  - Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MA, USA
AD  - Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
DO  - 10.1177/0033354916661981
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121488803
T1  - Pharmacist involvement on a rapid response team.
AU  - Feih, Joel
AU  - Peppard, William J.
AU  - Katz, Michael
Y1  - 2017/03/02/2017 Supplement
N1  - Accession Number: 121488803. Language: English. Entry Date: 20170302. Revision Date: 20170303. Publication Type: Article; research; tables/charts. Supplement Title: 2017 Supplement. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. 
KW  - Pharmacist Attitudes -- Evaluation
KW  - Early Intervention
KW  - Emergency Service
KW  - Documentation
KW  - Hospitalization
KW  - Intensive Care Units
KW  - Length of Stay
KW  - Metoprolol
KW  - Naloxone
KW  - Patient Discharge
KW  - Pharmacy and Pharmacology
KW  - Pharmacy, Retail
KW  - Human
KW  - Retrospective Design
KW  - Quasi-Experimental Studies
KW  - Chi Square Test
KW  - T-Tests
KW  - Wilcoxon Rank Sum Test
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
SP  - S10
EP  - S16
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 74
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - Purpose. The effect of a pharmacist on a rapid response team (RRT) was investigated. Methods. This study evaluated 234 patients before and 157 patients after pharmacist involvement on an RRT. The primary outcome was time to medication administration, with a goal turnaround time of less than 30 minutes. Secondary outcomes included most frequently used medications, readmissions to the intensive care unit (ICU) within 48 hours, number of rapid responses that resulted in ICU admission, length of hospital stay, and survival to hospital discharge. Additionally, pharmacist interventions were tracked in the postinterventional group. Results. The preinterventional group screened 326 rapid response events, of which 234 were included for analysis; during the postinterventional phase, 256 rapid response events were evaluated, of which 157 were included. The primary outcome, median time to medication administration from central pharmacy, was lower in the postinterventional group compared with the preinterventional group (32.0 minutes versus 64.5 minutes, p = 0.004). ICU admission rates following rapid response were not significantly different between the two groups. Additionally, there were no significant differences between rates of medical emergency and survival to hospital discharge. The most common medications administered were metoprolol and naloxone. Pharmacists provided documentation for 90 of 157 (57%) patient cases. In the 90 cases with documentation, 18 (20% of patients) had documented pharmacist interventions, including dosing assistance for 8 cases (44% of interventions). Conclusion. The addition of a pharmacist to an RRT reduced time to medication administration, helped improve medication accessibility, and helped optimize medication selection and dosing.
SN  - 1079-2082
AD  - Cardiovascular Intensive Care Unit, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
AD  - Surgical Intensive Care Unit, Froedtert &the Medical College of Wisconsin, Milwaukee, WI
AD  - Medical Intensive Care Unit, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
DO  - 10.2146/ajhp160076
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105156589
T1  - Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses.
AU  - Merlin MA
AU  - Saybolt M
AU  - Kapitanyan R
AU  - Alter SM
AU  - Jeges J
AU  - Liu J
AU  - Calabrese S
AU  - Rynn KO
AU  - Perritt R
AU  - Pryor PW II
Y1  - 2010/03//
N1  - Accession Number: 105156589. Language: English. Entry Date: 20100514. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Administration, Intranasal
KW  - Administration, Intravenous
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Therapy
KW  - Academic Medical Centers
KW  - Adult
KW  - Advanced Cardiac Life Support
KW  - Data Analysis -- Methods
KW  - Descriptive Statistics
KW  - Emergency Medicine
KW  - Government Agencies
KW  - Human
KW  - Middle Age
KW  - Outcomes (Health Care)
KW  - Patient Selection -- Methods
KW  - Record Review -- Methods
SP  - 296
EP  - 303
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 28
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - INTRODUCTION: This study proposes that intranasal (IN) naloxone administration is preferable to intravenous (IV) naloxone by emergency medical services for opioid overdoses. Our study attempts to establish that IN naloxone is as effective as IV naloxone but without the risk of needle exposure. We also attempt to validate the use of the Glasgow Coma Scale (GCS) in opioid intoxication. METHODS: A retrospective chart review of prehospital advanced life support patients was performed on confirmed opioid overdose patients. Initial and final unassisted respiratory rates (RR) and GCS, recorded by paramedics, were used as indicators of naloxone effectiveness. The median changes in RR and GCS were determined. RESULTS: Three hundred forty-four patients who received naloxone by paramedics from January 1, 2005, until December 31, 2007, were evaluated. Of confirmed opioid overdoses, change in RR was 6 for the IV group and 4 for the IN group (P = .08). Change in GCS was 4 for the IV group and 3 for the IN group (P = .19). Correlations between RR and GCS for initial, final, and change were significant at the 0.01 level (rho = 0.577, 0.462, 0.568, respectively). CONCLUSION: Intranasal naloxone is statistically as effective as IV naloxone at reversing the effects of opioid overdose. The IV and IN groups had similar average increases in RR and GCS. Based on our results, IN naloxone is a viable alternative to IV naloxone while posing less risk of needle stick injury. Additionally, we demonstrated that GCS is correlated with RR in opioid intoxication. © 2010 Elsevier Inc. All rights reserved.
SN  - 0735-6757
AD  - Department of Emergency Medicine and Pediatrics, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA. merlinma@umdnj.edu
U2  - PMID: 20223386.
DO  - 10.1016/j.ajem.2008.12.009
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128022402
T1  - Colorado ERs work together to lower opioid prescribing by 36%.
AU  - Castellucci, Maria
Y1  - 2018/02/12/
N1  - Accession Number: 128022402. Language: English. Entry Date: 20180223. Revision Date: 20180223. Publication Type: Article. Journal Subset: Health Services Administration; USA. NLM UID: 7801798. 
KW  - Prescribing Patterns -- Evaluation
KW  - Organizational Change
KW  - Substance Abuse -- Prevention and Control
KW  - Emergency Service -- Trends -- Colorado
KW  - Colorado
KW  - Decision Making, Clinical
KW  - Physician-Patient Relations
SP  - 0030
EP  - 0030
JO  - Modern Healthcare
JF  - Modern Healthcare
JA  - MOD HEALTHC
VL  - 48
IS  - 7
CY  - Detroit, Michigan
PB  - Crain Communications Inc. (MI)
AB  - The article discusses initiatives launched by emergency room (ER) clinicians in Colorado to help address opioid addiction in the U.S. Topics explored include the use of other pain treatment options instead of prescribing opioids, the reduction in opioid usage recorded by participating ER from June to November 2017, and the training of ER personnel on available alternative pain medications such as lidocaine and ibuprofen.
SN  - 0160-7480
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128022402&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126114313
T1  - In Response: The Contribution of the Emergency Department to Opioid Pain Reliever Misuse and Diversion: A Critical Review...Lyapustina T, Castillo R, Omaki E. The contribution of the emergency department to opioid pain reliever misuse and diversion: a critical review. Pain Pract. 2017;17:1097–1104.
AU  - Mazer-Amirshahi, Maryann
AU  - Motov, Sergey
AU  - Nelson, Lewis
Y1  - 2017/11//
N1  - Accession Number: 126114313. Language: English. Entry Date: 20171113. Revision Date: 20171113. Publication Type: Article; commentary; letter. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101130835. 
KW  - Analgesics, Opioid
KW  - Prescriptions, Drug
KW  - Substance Abuse -- Complications
KW  - Inappropriate Prescribing
KW  - Emergency Service
KW  - Public Health
KW  - United States
KW  - Mortality
KW  - Morbidity
KW  - Substance Abuse -- Prevention and Control
SP  - 1122
EP  - 1122
JO  - Pain Practice
JF  - Pain Practice
JA  - PAIN PRACTICE
VL  - 17
IS  - 8
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1530-7085
AD  - Department of Emergency Medicine, MedStar Washington Hospital Center
AD  - Georgetown University School of Medicine
AD  - Department of Emergency Medicine, Maimonides Medical Center
AD  - Department of Emergency Medicine, Rutgers New Jersey School of Medicine
DO  - 10.1111/papr.12590
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126114313&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126114312
T1  - Response to Letter to the Editor The Contribution of the Emergency Department to Opioid Pain Reliever Misuse and Diversion: A Critical Review...Mazer-Amirshahi M, Motov Sergey, Nelson L. In Response: The Contribution of the Emergency Department to Opioid Pain Reliever Misuse and Diversion: A Critical Review. PAIN PRACTICE. 2017;17(8):1122-1122.
AU  - Lyapustina, Tatyana
AU  - Castillo, Renan
AU  - Omaki, Elise
AU  - Shields, Wendy
AU  - McDonald, Eileen
AU  - Rothman, Richard
AU  - Gielen, Andrea
Y1  - 2017/11//
N1  - Accession Number: 126114312. Language: English. Entry Date: 20171113. Revision Date: 20171113. Publication Type: Article; letter; response. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101130835. 
KW  - Analgesics, Opioid
KW  - Prescriptions, Drug
KW  - Substance Abuse -- Complications
KW  - Emergency Service
KW  - Inappropriate Prescribing
KW  - Public Health
KW  - United States
KW  - Mortality
KW  - Morbidity
KW  - Substance Abuse -- Prevention and Control
SP  - 1123
EP  - 1123
JO  - Pain Practice
JF  - Pain Practice
JA  - PAIN PRACTICE
VL  - 17
IS  - 8
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1530-7085
AD  - University of Connecticut Health Center
AD  - Johns Hopkins School of Medicine
AD  - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
AD  - Division of Emergency Medicine, Johns Hopkins Medicine
DO  - 10.1111/papr.12598
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126114312&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113951972
T1  - Risk Factors of Prescription Opioid Overdose Among Colorado Medicaid Beneficiaries.
AU  - Dilokthornsakul, Piyameth
AU  - Moore, Gina
AU  - Campbell, Jonathan D.
AU  - Lodge, Robert
AU  - Traugott, Cathy
AU  - Zerzan, Judy
AU  - Allen, Richard
AU  - IIPage, Robert L.
AU  - Page, Robert L 2nd
Y1  - 2016/04//
N1  - Accession Number: 113951972. Language: English. Entry Date: In Process. Revision Date: 20170104. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Arthritis Impact Measurement Scale (AIMS) (Meenan); Home Observation for Measurement of the Environment (HOME) (Bradley and Caldwell). NLM UID: 100898657. 
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Medicaid -- Statistics and Numerical Data
KW  - Overdose -- Epidemiology
KW  - Substance Use Disorders -- Epidemiology
KW  - Substance Use Disorders -- Etiology
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Chronic Pain -- Epidemiology
KW  - Chronic Pain -- Etiology
KW  - Demography
KW  - Human
KW  - Female
KW  - Dose-Response Relationship, Drug
KW  - Risk Factors
KW  - Adult
KW  - United States
KW  - Sex Factors
KW  - Colorado
KW  - Aged, 80 and Over
KW  - Adolescence
KW  - Case Control Studies
KW  - Chronic Pain -- Drug Therapy
KW  - Middle Age
KW  - Male
KW  - Child
KW  - Retrospective Design
KW  - Young Adult
KW  - Aged
KW  - Validation Studies
KW  - Comparative Studies
KW  - Evaluation Research
KW  - Multicenter Studies
KW  - Arthritis Impact Measurement Scales
SP  - 436
EP  - 443
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 17
IS  - 4
PB  - Churchill Livingstone, Inc.
AB  - Unlabelled: This study aims to determine risk factors of opioid overdose among the Colorado Medicaid population. A retrospective nested case-control study was undertaken. Medicaid beneficiaries who had ≥1 medical claim for an emergency department visit or a hospitalization associated with an opioid overdose from July 2009 to June 2014 were defined as cases. Controls were selected using a nearest neighbor matching without replacement. The matched controls were selected on the basis of age, sex, and opioid prescription. One case was matched with three controls. Multivariate conditional logistic regression was used to compare risk factors. A total of 816 cases with 2,448 controls were included. Six factors were associated with opioid overdose: mean morphine dose equivalent (>50 mg/d; odds ratio [OR] = 1.986 [95% confidence interval [CI], 1.509-2.614]), methadone use (switching opioid to methadone vs. no methadone use; OR = 7.230 [95% CI, 2.346-22.286]), drug/alcohol abuse (OR = 3.104 [95% CI, 2.195-4.388]), other psychiatric illness (OR = 1.730 [95% CI, 1.307-2.291]), benzodiazepine use (OR = 2.005 [95% CI, 1.516-2.652]), and the number of pharmacies used by the beneficiary (≥4 pharmacies vs. 1 pharmacy; OR = 1.514 [95% CI, 1.003-2.286]). In conclusion, several factors are associated with opioid overdose. States and communities should ensure the availability of at-home intranasal naloxone for overdose rescue on the basis of the presence of risk factors.Perspective: This article presents the risk factors of opioid overdose among the Colorado Medicaid population. On the basis of study findings, Colorado Medicaid is currently working with physicians, hospitals, and other health system stakeholders to continue to develop policies to identify and assist this subset of our population. One such policy will be to provide at-home intranasal naloxone for overdose rescue.
SN  - 1526-5900
AD  - Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
AD  - Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
AD  - Department of Health Care Policy and Financing, State of Colorado, Denver, Colorado
AD  - Peak Statistical Services, Evergreen, Colorado
U2  - PMID: 26721613.
DO  - 10.1016/j.jpain.2015.12.006
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113951972&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109319144
T1  - Emergency Department Visits and Overdose Deaths From Combined Use of Opioids and Benzodiazepines.
AU  - Jones, Christopher M.
AU  - McAninch, Jana K.
Y1  - 2015/10//
N1  - Accession Number: 109319144. Language: English. Entry Date: 20160703. Revision Date: 20160703. Publication Type: journal article. Journal Subset: Biomedical; Health Promotion/Education; USA. NLM UID: 8704773. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Antianxiety Agents, Benzodiazepine -- Poisoning
KW  - Overdose -- Mortality
KW  - Middle Age
KW  - Child
KW  - Young Adult
KW  - Adolescence
KW  - Drug Interactions
KW  - Adult
KW  - United States
KW  - Female
KW  - Male
KW  - Aged
SP  - 493
EP  - 501
JO  - American Journal of Preventive Medicine
JF  - American Journal of Preventive Medicine
JA  - AM J PREV MED
VL  - 49
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Introduction: Opioid analgesics and benzodiazepines are the prescription drugs most commonly associated with drug overdose deaths. This study was conducted to assess trends in nonmedical use-related emergency department (ED) visits and drug overdose deaths that involved both opioid analgesics and benzodiazepines in the U.S. from 2004 to 2011.Methods: Opioid analgesic and benzodiazepine nonmedical use-related ED visits from the Drug Abuse Warning Network and drug overdose deaths from the National Vital Statistics System were analyzed for 2004-2011 to determine trends and demographic-specific rates. Data were analyzed from March 2014 to June 2014.Results: From 2004 to 2011, the rate of nonmedical use-related ED visits involving both opioid analgesics and benzodiazepines increased from 11.0 to 34.2 per 100,000 population (p-trend<0.0001). During the same period, drug overdose deaths involving both drugs increased from 0.6 to 1.7 per 100,000 (p-trend<0.0001). Statistically significant increases in ED visits occurred among males and females, non-Hispanic whites, non-Hispanic blacks, and Hispanics, and all age groups except 12- to 17-year-olds. For overdose deaths, statistically significant increases were seen in males and females, all three race/ethnicity groups, and all age groups except 12- to 17-year-olds. Benzodiazepine involvement in opioid analgesic overdose deaths increased each year, increasing from 18% of opioid analgesic overdose deaths in 2004 to 31% in 2011 (p-trend<0.0001).Conclusions: ED visits and drug overdose deaths involving both opioid analgesics and benzodiazepines increased significantly between 2004 and 2011. Interventions to improve the appropriate prescribing and use of these medications are needed.
SN  - 0749-3797
AD  - Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland
AD  - Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
U2  - PMID: 26143953.
DO  - 10.1016/j.amepre.2015.03.040
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110271624
T1  - Variation Between Physicians and Mid-level Providers in Opioid Treatment for Musculoskeletal Pain in the Emergency Department.
AU  - Thomas, Stephen H.
AU  - Mumma, Shannon
AU  - Satterwhite, Amanda
AU  - Haas, Tyler
AU  - Arthur, Annette O.
AU  - Todd, Knox H.
AU  - Mace, Sharon
AU  - Diercks, Deborah B.
AU  - Pollack, Charles V.
Y1  - 2015/10//
N1  - Accession Number: 110271624. Language: English. Entry Date: 20160109. Revision Date: 20160710. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8412174. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Prospective Studies
KW  - Adult
KW  - Aged
KW  - United States
KW  - Female
KW  - Logistic Regression
KW  - Pain -- Therapy
KW  - Middle Age
KW  - Male
SP  - 415
EP  - 423
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 49
IS  - 4
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Effective, appropriate, and safe opioid analgesia administration in the Emergency Department (ED) is a complex issue, with risks of both over- and underutilization of medications.Objective: To assess for possible association between practitioner status (physician [MD] vs. mid-level provider [MLP]) and use of opioids for in-ED treatment of musculoskeletal pain (MSP).Methods: This was a secondary, hypothesis-generating analysis of a subset of subjects who had ED analgesia noted as part of entry into a prospective registry trial of outpatient analgesia. The study was conducted at 12 U.S. academic EDs, 10 of which utilized MLPs. Patients were enrolled as a convenience sample from September 2012 through February 2014. Study patients were adults (>17 years of age) with acute MSP and eligibility for both nonsteroidal antiinflammatory drugs and opioids at ED discharge. The intervention of interest was whether patients received opioid therapy in the ED prior to discharge.Results: MDs were significantly more likely to order opioids than MLPs for ED patients with MSP. The association between MD/MLP status and likelihood of treatment with opioids was similar in both classical logistic regression (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-4.5, p = 0.019) and in propensity-adjusted modeling (OR 2.1, 95% CI 1.0-4.5, p = 0.049).Conclusions: In preliminary analysis, MD/MLP status was significantly associated with likelihood of provider treatment of MSP with opioids. A follow-up study is warranted to confirm the results of this hypothesis-testing analysis and to inform efforts toward consistency in opioid therapy in the ED.
SN  - 0736-4679
AD  - Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma
AD  - Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
AD  - Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
AD  - Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
AD  - Department of Emergency Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania
U2  - PMID: 26238183.
DO  - 10.1016/j.jemermed.2015.05.036
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127028022
T1  - Opioid Emergency Declared.
AU  - Kuehn, Bridget
Y1  - 2017/12/26/
N1  - Accession Number: 127028022. Language: English. Entry Date: 20180104. Revision Date: 20180315. Publication Type: Article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
SP  - 2418
EP  - 2418
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 318
IS  - 24
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - The article announces that U.S. President Donald Trump has designated an opioid epidemic as a public health emergency in America as of October 26, 2017, and it mentions crisis response-related flexibility for the U.S. Department of Health and Human Services and federal and state health agencies.
SN  - 0098-7484
U2  - PMID: 29279911.
DO  - 10.1001/jama.2017.19014
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=127028022&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126428216
T1  - The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio.
AU  - Weiner, Scott G
AU  - Baker, Olesya
AU  - Poon, Sabrina J
AU  - Rodgers, Ann F
AU  - Garner, Chad
AU  - Nelson, Lewis S
AU  - Schuur, Jeremiah D
Y1  - 2017/12//
N1  - Accession Number: 126428216. Language: English. Entry Date: 20171129. Revision Date: 20171208. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Practice Guidelines
KW  - Male
KW  - Codeine -- Therapeutic Use
KW  - Dihydromorphinone -- Therapeutic Use
KW  - Guideline Adherence -- Statistics and Numerical Data
KW  - Oxycodone -- Therapeutic Use
KW  - Adult
KW  - Tramadol -- Therapeutic Use
KW  - Female
KW  - Ohio
KW  - Middle Age
SP  - 799
EP  - 799
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
IS  - 6
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: The objective of our study is to evaluate the association between Ohio's April 2012 emergency physician guidelines aimed at reducing inappropriate opioid prescribing and the number and type of opioid prescriptions dispensed by emergency physicians.Methods: We used Ohio's prescription drug monitoring program data from January 1, 2010, to December 31, 2014, and included the 5 most commonly prescribed opioids (hydrocodone, oxycodone, tramadol, codeine, and hydromorphone). The primary outcome was the monthly statewide prescription total of opioids written by emergency physicians in Ohio. We used an interrupted time series analysis to compare pre- and postguideline level and trend in number of opioid prescriptions dispensed by emergency physicians per month, number of prescriptions stratified by 5 commonly prescribed opioids, and number of prescriptions for greater than 3 days' supply of opioids.Results: Beginning in January 2010, the number of prescriptions dispensed by all emergency physicians in Ohio decreased by 0.3% per month (95% confidence interval [CI] -0.49% to -0.15%). The implementation of the guidelines in April 2012 was associated with a 12% reduction (95% CI -17.7% to -6.3%) in the level of statewide total prescriptions per month and an additional decline of 0.9% (95% CI -1.1% to -0.7%) in trend relative to the preguideline trend. The estimated effect of the guidelines on total monthly prescriptions greater than a 3-day supply was an 11.2% reduction in level (95% CI -18.8% to -3.6%) and an additional 0.9% (95% CI -1.3% to -0.5%) decline in trend per month after the guidelines. Guidelines were also associated with a reduction in prescribing for each of the 5 individual opioids, with various effect.Conclusion: In Ohio, emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians. Although introduction of the guidelines occurred in parallel with other opioid-related interventions, our findings suggest an additional effect of the guidelines on prescribing behavior. Similar guidelines may have the potential to reduce opioid prescribing in other geographic areas and for other specialties as well.
SN  - 0196-0644
AD  - Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
AD  - Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
AD  - Department of Emergency Medicine, Swedish Medical Center, Seattle, WA
AD  - State of Ohio Board of Pharmacy, Columbus, OH
AD  - Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
U2  - PMID: 28549620.
DO  - 10.1016/j.annemergmed.2017.03.057
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103891585
T1  - Pitfalls of Intranasal Naloxone.
AU  - Zuckerman, Matthew
AU  - Weisberg, Stacy N.
AU  - Boyer, Edward W.
Y1  - 2014/10/02/
N1  - Accession Number: 103891585. Language: English. Entry Date: 20140925. Revision Date: 20160325. Publication Type: Journal Article; abstract; case study; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Administration, Intranasal
KW  - Naloxone -- Administration and Dosage
KW  - Prehospital Care
KW  - Emergency Care
KW  - Naloxone -- Therapeutic Use
KW  - Emergency Medical Services
KW  - Protocols
KW  - Overdose
KW  - Heroin -- Adverse Effects
KW  - Adult
KW  - United States
KW  - Public Health
KW  - Policy Making
KW  - Patient Care -- Methods
KW  - Male
KW  - Analgesics, Opioid
KW  - Substance Abuse
KW  - Substance Dependence -- Diagnosis
KW  - Fentanyl -- Administration and Dosage
KW  - Drug Toxicity
KW  - Patient Assessment
KW  - Outcomes (Health Care)
SP  - 550
EP  - 554
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 18
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - We present a case of failed prehospital treatment of fentanyl induced apnea with intranasal (IN) naloxone. While IN administration of naloxone is becoming more common in both lay and pre-hospital settings, older EMS protocols utilized intravenous (IV) administration. Longer-acting, higher potency opioids, such as fentanyl, may not be as easily reversed as heroin, and studies evaluating IN administration in this population are lacking. In order to contribute to our understanding of the strengths and limitations of IN administration of naloxone, we present a case where it failed to restore ventilation. We also describe peer reviewed literature that supports the use of IV naloxone following heroin overdose and explore possible limitations of generalizing this literature to opioids other than heroin and to IN routes of administration.
SN  - 1090-3127
U2  - PMID: 24830404.
DO  - 10.3109/10903127.2014.896961
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125387782
T1  - Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study.
AU  - Maragh-Bass, Allysha C
AU  - Fields, Julie C
AU  - McWilliams, Junette
AU  - Knowlton, Amy R
Y1  - 2017/04//
N1  - Accession Number: 125387782. Language: English. Entry Date: 20170929. Revision Date: 20170929. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health; USA. Instrumentation: Screen for Caregiver Burden (SCB); Social Readjustment Rating Scale (SRRS) (Holmes and Rahe); Constant and Murley Score; Behavior Rating Inventory of Executive Function (BRIEF); Work Environment Scale (WES) (Moos et al); Longitudinal Interval Follow-Up Evaluation (LIFE). NLM UID: 8918173. 
KW  - Overdose -- Prevention and Control
KW  - Substance Abuse, Intravenous -- Prevention and Control
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Emergency Medical Technicians
KW  - Adult
KW  - Male
KW  - Interviews
KW  - Study Design
KW  - Pilot Studies
KW  - Female
KW  - Clinical Assessment Tools
KW  - Scales
KW  - Social Readjustment Rating Scale
SP  - 148
EP  - 155
JO  - Prehospital & Disaster Medicine
JF  - Prehospital & Disaster Medicine
JA  - PREHOSPITAL DISASTER MED
VL  - 32
IS  - 2
PB  - Cambridge University Press
AB  - Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment.Methods: Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison.Results: Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the "frequent flyer problem" (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called "hitting their bottom." Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers' current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited knowledge of substance abuse treatment modalities, and fearing negative repercussions from supervisors and/or patients. Despite reservations, several EMS providers expressed inclination to deliver brief motivational messages to encourage substance-using patients to consider treatment, given adequate training and skill-building.Conclusions: Emergency Medical Service providers may have many demands, including difficult case time/resource limitations. Even so, participants recognized their unique position as first responders to deliver motivational, harm-reduction messages to substance-using patients during transport. With incentivized training, implementing this program could be life- and cost-saving, improving emergency and behavioral health services. Findings will inform future efforts to connect substance users with drug treatment, potentially reducing EMS over-use in Baltimore. Maragh-Bass AC , Fields JC , McWilliams J , Knowlton AR . Challenges and opportunities to engaging Emergency Medical Service providers in substance use research: a qualitative study. Prehosp Disaster Med. 2017;32(2):148-155.
SN  - 1049-023X
AD  - 1Center for Surgery and Public Health,Brigham and Women's Hospital,Harvard Schools of Medicine and Public Health,Boston,MassachusettsUSA
AD  - 2Johns Hopkins Bloomberg School of Public Health,Department of Health,Behavior and Society,Baltimore,MarylandUSA
U2  - PMID: 28122657.
DO  - 10.1017/S1049023X16001424
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126498924
T1  - Boston Medical Center's Project ASSERT provides alcohol and substance use disorder services.
AU  - BERNSTEIN, EDWARD
AU  - YOUNG, LUDY
AU  - ERIKSEN LEARY, JENNY
Y1  - 2017/12//
N1  - Accession Number: 126498924. Language: English. Entry Date: 20171204. Revision Date: 20171205. Publication Type: Article; pictorial; statistics; tables/charts. Journal Subset: Health Services Administration; USA. NLM UID: 9312077. 
KW  - Alcohol Abuse -- Therapy -- Massachusetts
KW  - Substance Abuse -- Therapy -- Massachusetts
KW  - Substance Use Rehabilitation Programs -- Massachusetts
KW  - Mental Health Services -- Methods -- Massachusetts
KW  - Substance Abuse -- Prevention and Control -- Massachusetts
KW  - Massachusetts
KW  - Collaboration
KW  - Counseling
KW  - Emergency Service
KW  - Patient Education
KW  - Referral and Consultation
KW  - Naloxone
KW  - Overdose -- Prevention and Control
KW  - Patient Advocacy
KW  - Patient Navigation
KW  - Grants
KW  - Program Evaluation
KW  - Stigma
KW  - Substance Abuse -- Psychosocial Factors
KW  - Narcotics
SP  - 32
EP  - 35
JO  - H&HN: Hospitals & Health Networks
JF  - H&HN: Hospitals & Health Networks
JA  - H&HN HOSP HEALTH NETW
VL  - 91
IS  - 12
CY  - Chicago, Illinois
PB  - Health Forum
AB  - The article discusses Boston Medical Center's (BMC) Project ASSERT that provides services to alcohol and substance abuse disorder patients in the emergency department. Topics discussed include the complex social and medical issues affecting substance abuse disorder patients and how BMC created a more informed options for patients at discharge from the emergency department. Also mentioned are BMC partnerships with other organizations to improve overdose recognition and appropriate response.
SN  - 1068-8838
AD  - Founder and medical director of Project ASSERT
AD  - Supervisor of Project ASSERT
AD  - Associate communications director of media relations at Boston Medical Center
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 115373488
T1  - Innovative Program Targets Five Common Pain Syndromes With Non-opioid Alternatives.
Y1  - 2016/06//
N1  - Accession Number: 115373488. Language: English. Entry Date: 20160518. Revision Date: 20160525. Publication Type: Article. Journal Subset: Nursing; USA. NLM UID: 9425690. 
KW  - Pain -- Prevention and Control
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Substance Abuse -- Prevention and Control
KW  - Hospital Programs -- New Jersey
KW  - New Jersey
KW  - Emergency Service
KW  - Support, Psychosocial
KW  - Patient Education
SP  - 61
EP  - 66
JO  - ED Management
JF  - ED Management
JA  - ED MANAGE
VL  - 28
IS  - 6
CY  - Atlanta, Georgia
PB  - AHC Media LLC
SN  - 1044-9167
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 114603473
T1  - Age as a predictor of rescue opioid administration immediately after the emergence of general anesthesia.
AU  - Ladha, Karim S
AU  - Wanderer, Jonathan P
AU  - Nanji, Karen C
Y1  - 2015/11//
N1  - Accession Number: 114603473. Language: English. Entry Date: 20160702. Revision Date: 20160713. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: General Health Questionnaire (GHQ). NLM UID: 8812166. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Arthroplasty, Replacement, Knee -- Methods
KW  - Postoperative Pain -- Drug Therapy
KW  - Arthroplasty, Replacement, Hip -- Methods
KW  - Age Factors
KW  - Retrospective Design
KW  - Aged, 80 and Over
KW  - Female
KW  - Male
KW  - Dose-Response Relationship, Drug
KW  - Anesthesia, General -- Methods
KW  - Postoperative Pain -- Epidemiology
KW  - Middle Age
KW  - Prospective Studies
KW  - Aged
KW  - Questionnaires
SP  - 537
EP  - 542
JO  - Journal of Clinical Anesthesia
JF  - Journal of Clinical Anesthesia
JA  - J CLIN ANESTH
VL  - 27
IS  - 7
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Background and Objectives: While previous studies have shown that elderly patients require lower dosages of opioids, the literature suggests that pain is undertreated in the geriatric population, which may lead to postoperative pain and high rescue analgesia requirements. The purpose of this study is to determine whether elderly patients undergoing hip and knee arthroplasty require higher levels of postoperative rescue opioids than their younger counterparts early after emergence from anesthesia.Methods: Using a nonconcurrent retrospective cohort study design, patients who underwent hip or knee arthroplasty under general anesthesia at a tertiary academic hospital from 2007 to 2012 were identified. Demographic information and data regarding patients' anesthetic care were obtained from the institution's anesthesia information management system. To assess the presence of pain after the emergence of anesthesia, we used, as a proxy, opioid administration by the anesthesia provider after leaving the operating room and before the end of anesthesia care.Results: A total of 2731 patients met inclusion criteria, of which 487 (17.8%) received rescue opioids. Patients older than 80 years were less likely to receive opioids after leaving the operating room (odds ratio, 0.57; 95% confidence interval, 0.37-0.88; P = .01) and received 1.37 mg less of hydromorphone equivalent opioid compared to patients younger than the age of 50 years (95% confidence interval, 1.18-1.55; P < .001). The proportion of patients who received rescue opioids varied significantly between anesthesia providers from 0% to 38% (P < .001).Conclusions: While elderly patients received lower doses of opioids intraoperatively, they were less likely to require rescue analgesia. The variability among providers in rescue opioid administration after emergence presents an opportunity for further research.
SN  - 0952-8180
AD  - Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
AD  - Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University, Nashville, TN
AD  - Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston MA
U2  - PMID: 26342632.
DO  - 10.1016/j.jclinane.2015.07.026
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113536316
T1  - Take-home naloxone programs and calls to emergency services.
AU  - Kirwan, Amy
AU  - Curtis, Michael
AU  - van Beek, Ingrid A.
AU  - Cantwell, Kate
AU  - Dietze, Paul M.
Y1  - 2016/03/07/
N1  - Accession Number: 113536316. Language: English. Entry Date: 20160715. Revision Date: 20160715. Publication Type: journal article. Journal Subset: Australia & New Zealand; Biomedical; Double Blind Peer Reviewed; Peer Reviewed. Instrumentation: Home Observation for Measurement of the Environment (HOME) (Bradley and Caldwell). NLM UID: 0400714. 
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Emergency Medical Services -- Statistics and Numerical Data
KW  - Overdose -- Prevention and Control
KW  - Naloxone -- Therapeutic Use
KW  - Home Health Care
SP  - 143
EP  - 143
JO  - Medical Journal of Australia
JF  - Medical Journal of Australia
JA  - MED J AUST
VL  - 204
IS  - 4
PB  - Australasian Medical Publishing Company
AB  - The article explores the process of decision-making for calling emergency services and administration of naloxone to reverse opioid overdose. It reviews current, as of March 2016, naloxone guidelines in emergency call taking, the use of assessment scripts for overdose, implementation of cardio-pulmonary resuscitation, and administration of naloxone. It also recommends appropriate actions in a generalized overdose scenario.
SN  - 0025-729X
AD  - Burnet Institute, Melbourne, VIC
AD  - Kirketon Road Centre, Sydney, NSW
AD  - Ambulance Victoria, Melbourne, VIC
AD  - Monash University, Melbourne, VIC
U2  - PMID: 26937662.
DO  - 10.5694/mja15.00783
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122979979
T1  - An interventionist adherence scale for a specialized brief negotiation interview focused on treatment engagement for opioid use disorders.
AU  - Pantalon, Michael V.
AU  - Dziura, James
AU  - Li, Fang-Yong
AU  - Owens, Patricia H.
AU  - O'Connor, Patrick G.
AU  - D'Onofrio, Gail
Y1  - 2017/04//Apr-Jun2017
N1  - Accession Number: 122979979. Language: English. Entry Date: 20170523. Revision Date: 20170523. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Brief Negotiation Interview (BNI) Adherence Scale for Opioid Use Disorders (BAS-O). NLM UID: 8808537. 
KW  - Substance Abuse -- Therapy
KW  - Narcotics
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Human
KW  - Scales
SP  - 191
EP  - 199
JO  - Substance Abuse
JF  - Substance Abuse
JA  - SUBST ABUSE
VL  - 38
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background: No psychometrically validated instrument for evaluating the extent to which interventionists correctly implement brief interventions designed to motivate treatment engagement for opioid use disorders has been reported in the literature. The objective of this study was to develop and examine the psychometric properties of the Brief Negotiation Interview (BNI) Adherence Scale for Opioid Use Disorders (BAS-O).Methods: In the context of a randomized controlled trial evaluating the efficacy of 3 models of emergency department care for opioid use disorders, the authors developed and subsequently examined the psychometric properties of the BAS-O, a 38-item scale that required raters to answer whether or not (“Yes” or “No”) each of the critical actions of the BNI was correctly implemented by the research interventionist. BAS-O items pertained to the BNI's 4 steps: (1) Raise the Subject, (2) Provide Feedback, (3) Enhance Motivation, and (4) Negotiate and Advise. A total of 215 audio-recorded BNI and 88 control encounters were rated by 3 trained raters who were independent of the study team and blind to study hypotheses, treatment, and assignment.Results: The results indicated the BAS-O has fair to excellent psychometric properties, in terms of good internal consistency, excellent interrater reliability, discriminant validity, and construct validity, and fair predictive validity. A 13-item, 2-factor solution accounted for nearly 80% of the variance, where factor 1 addressed “Autonomy and Planning” (7 items) and factor 2 addressed “Motivation and Problems” (6 items). However, predictive validity was found for only one of the BAS-O factor items (i.e., Telling patients that treatment will address a range of issues related to their opioid use disorder).Conclusions: This study suggests that the BAS-O is a psychometrically valid measure of adherence to the specialized BNI for motivating treatment engagement in patients with opioid use disorders, thus providing a brief (13-item), objective method of evaluating BNI skill performance.
SN  - 0889-7077
AD  - Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
AD  - Yale University School of Public Health, New Haven, Connecticut, USA
AD  - Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
DO  - 10.1080/08897077.2017.1294548
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122979977
T1  - Implementation of a pharmacy consult to reduce co-prescribing of opioids and benzodiazepines in a Veteran population.
AU  - Pardo, Deborah
AU  - Miller, Lacey
AU  - Chiulli, Dana
Y1  - 2017/04//Apr-Jun2017
N1  - Accession Number: 122979977. Language: English. Entry Date: 20170523. Revision Date: 20170523. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8808537. 
KW  - Analgesics, Opioid
KW  - Antianxiety Agents, Benzodiazepine
KW  - Veterans
KW  - Prescribing Patterns
KW  - Human
KW  - Drugs, Prescription
SP  - 157
EP  - 160
JO  - Substance Abuse
JF  - Substance Abuse
JA  - SUBST ABUSE
VL  - 38
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background: The dangers of co-administration of opioid pain relievers (OPRs) and benzodiazepines (BZDs) are well documented. The combination of OPRs and BZDs make up the majority of medications involved in prescription drug–related overdose and are often used concomitantly. This pattern is consistent among the veteran population where mental health illness and substance abuse are prominent. The Veterans Health Administration implemented the Opioid Safety Initiative (OSI) aimed at improving patient safety surrounding OPRs. In alignment with OSI, the study facility implemented a prior authorization pharmacy consult in an effort to reduce OPR and BZD co-prescribing and optimize patient safety. The purpose of this article is to report the frequency of co-prescribing before and after implementation of the consult. Secondary aims include reporting the emergency room visits and hospitalizations, prescribers' actions in the setting of disapproved consults, patient characteristics associated with co-prescribing, and frequency of co-prescribing without a consult.Methods: This was a single-center, retrospective chart review study. Microsoft Structured Query Language server database and Veterans Health Information Systems and Technology Architecture were used to extract data and identify study patients. The Computerized Patient Record System was used to collect patient data. Microsoft Access and Excel were utilized to organize, query, and analyze the extracted data.Results: There was a 34.6% reduction in patients on chronic OPR therapy co-prescribed a BZD, and the total number of overdose-related events decreased after implementation of the consult. In the event of disapproved consults, pharmacists' evidence-based recommendations were implemented 63% of the time. Patients for whom co-prescribing consults were placed were more likely to have mental health diagnoses.Conclusions: Following implementation of a pharmacy consult, there was a reduction in co-prescribing and overdose-related events at the study facility.
SN  - 0889-7077
AD  - Veterans Affairs Palo Alto Health Care System (VAPAHCS), Palo Alto, California, USA
DO  - 10.1080/08897077.2017.1290011
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113846530
T1  - Association Between Opioid Abuse/Dependence and Outcomes in Hospitalized Heart Failure Patients.
AU  - Gupta, Tanush
AU  - Mujib, Marjan
AU  - Agarwal, Pallak
AU  - Prakash, Priya
AU  - Garg, Anjali
AU  - Sharma, Nisha
AU  - Aronow, Wilbert S.
AU  - Nabors, Christopher
Y1  - 2016/03//Mar/Apr2016
N1  - Accession Number: 113846530. Language: English. Entry Date: 20161223. Revision Date: 20170104. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 9441347. 
KW  - Heart Failure -- Mortality
KW  - Substance Use Disorders -- Complications
KW  - Aged
KW  - Hospital Mortality
KW  - Middle Age
KW  - Aged, 80 and Over
KW  - Female
KW  - Adult
KW  - Logistic Regression
KW  - Heart Failure -- Etiology
KW  - Hospitalization
KW  - Male
SP  - e350
EP  - e356
JO  - American Journal of Therapeutics
JF  - American Journal of Therapeutics
JA  - AM J THER
VL  - 23
IS  - 2
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Opioid use is associated with unintentional and intentional overdose and is one of the leading causes of emergency room visits and accidental deaths. However, the association between opioid abuse/dependence and outcomes in hospitalized patients has not been well studied. Congestive heart failure (HF) is the fourth most common cause of hospitalization in the United States. The purpose of this study was to examine the effect of opioid abuse/dependence on outcomes in patients hospitalized with HF. We queried the 2002-2010 Nationwide Inpatient Sample databases to identify all patients aged 18 years and older admitted with the primary diagnosis of HF. Multivariate logistic regression analysis was used to compare the frequency of hospital-acquired conditions (HACs) and in-hospital mortality between patients with and without a history of opioid abuse/dependence. Of 9,993,240 patients with HF, 29,014 had a history of opioid abuse or dependence. Opioid abusers/dependents were likely to be younger men of poor socioeconomic background with self pay or Medicaid as their primary payer. They had a lower prevalence of dyslipidemia, diabetes mellitus, coronary artery disease, prior myocardial infarction, and peripheral vascular disease (P < 0.001 for all). They were more likely to be smokers and have chronic pulmonary disease, depression, liver disease, and obesity (P < 0.001 for all). Patients with a history of opioid abuse/dependence had lower incidence of HACs (14.8% vs. 16.5%, adjusted odds ratio: 0.71, P < 0.001) and lower in-hospital mortality (1.3% vs. 3.6%, adjusted odds ratio: 0.64, P < 0.001) as compared with patients without prior opioid abuse/dependence. In conclusion, among adult patients aged 18 years and older hospitalized with HF, opioid abuse/dependence was associated with lower frequency of HACs and lower in-hospital mortality.
SN  - 1075-2765
AD  - Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
U2  - PMID: 25611362.
DO  - 10.1097/MJT.0000000000000190
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109689187
T1  - Prescription of opioid and nonopioid analgesics for dental care in emergency departments: Findings from the National Hospital Ambulatory Medical Care Survey.
AU  - Okunseri, Christopher
AU  - Okunseri, Elaye
AU  - Xiang, Qun
AU  - Thorpe, Joshua M
AU  - Szabo, Aniko
Y1  - 2014/09//2014 Sep
N1  - Accession Number: 109689187. Language: English. Entry Date: 20150923. Revision Date: 20161117. Publication Type: journal article. Journal Subset: Biomedical; Public Health; USA. Special Interest: Dental Care; Public Health. Grant Information: 1R15DE021196-01/DE/NIDCR NIH HHS/United States. NLM UID: 0014207. 
SP  - 283
EP  - 292
JO  - Journal of Public Health Dentistry
JF  - Journal of Public Health Dentistry
JA  - J PUBLIC HEALTH DENT
VL  - 74
IS  - 4
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objectives: The aim of this study was to examine trends and associated factors in the prescription of opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic combinations, and no analgesics by emergency physicians for nontraumatic dental condition (NTDC)-related visits. Our secondary aim was to investigate whether race/ethnicity is a possible predictor of receiving a prescription for either type of medication for NTDC visits in emergency departments (EDs) after adjustment for potential covariates.Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997-2000 and 2003-2007, and used multinomial multivariate logistic regression to estimate the probability of receiving a prescription for opioid analgesics, nonopioid analgesics, or a combination of both, compared with receiving no analgesics for NTDC-related visits.Results: During 1997-2000 and 2003-2007, prescription of opioid analgesics and combinations of opioid and nonopioid analgesics increased, and that of no analgesics decreased over time. The prescription rates for opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic combinations, and no analgesics for NTDC-related visits in EDs were 43 percent, 20 percent, 12 percent, and 25 percent, respectively. Majority of patients categorized as having severe pain received prescriptions for opioids for NTDC-related visits in EDs. After adjusting for covariates, patients with self-reported dental reasons for visit and severe pain had a significantly higher probability of receiving prescriptions for opioid analgesics and opioid and nonopioid analgesic combinations.Conclusions: Prescription of opioid analgesics increased over time. ED physicians were more likely to prescribe opioid analgesics and opioid and nonopioid analgesic combinations for NTDC-related visits with reported severe pain.
SN  - 0022-4006
U2  - PMID: 24863407.
DO  - 10.1111/jphd.12055
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103844787
T1  - Trends in opioid analgesic use for headaches in US emergency departments.
AU  - Mazer-Amirshahi, Maryann
AU  - Dewey, Kayla
AU  - Mullins, Peter M
AU  - van den Anker, John
AU  - Pines, Jesse M
AU  - Perrone, Jeanmarie
AU  - Nelson, Lewis
Y1  - 2014/09//
N1  - Accession Number: 103844787. Language: English. Entry Date: 20150123. Revision Date: 20170802. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Trends
KW  - Headache -- Drug Therapy
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Analgesics -- Therapeutic Use
KW  - Female
KW  - Surveys
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Retrospective Design
KW  - United States
KW  - Young Adult
SP  - 1068
EP  - 1073
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 32
IS  - 9
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - OBJECTIVE: Although not recommended as first line therapy by consensus guidelines, opioid analgesics are commonly used to treat headaches. This study evaluates trends in opioid use for headaches in US emergency departments (EDs). METHODS: We performed a retrospective review of the National Hospital Ambulatory Medical Care Survey, 2001 through 2010. Adult headache-related visits were identified. Medications (opioid and nonopioid) used for the treatment of headache were categorized based on medication class. Trends in ED use of the most common opioids (codeine, hydrocodone, hydromorphone, morphine, and oxycodone) were explored. The proportion of visits for which each medication was used was tabulated, and trends were analyzed using survey-weighted logistic regression. RESULTS: Headache visits during which any opioid was used increased between 2001 (20.6%; 95% confidence interval [CI], 18.1-23.4) and 2010 (35.0%; 95% CI, 31.8-38.4; P < .001). Prescribing of hydromorphone, morphine, and oxycodone increased, with the largest relative increase (461.1%) in hydromorphone (2001, 1.8% [95% CI, 1.2-2.6]; 2010, 10.1% [95% CI, 8.2-12.4]). Codeine use declined, and hydrocodone use remained stable. Use of opioid alternatives, including acetaminophen, butalbital, and triptans did not change over the study period, whereas use of nonsteroidal anti-inflammatory drugs increased from 26.2% (95% CI, 23.0-29.7) to 31.4% (95% CI, 28.6-34.3). Prescribing of antiemetic agents decreased from 24.1% (95% CI, 19.6-29.2) to 23.5% (95% CI, 21.1-26.0). Intravenous fluid use increased from 20.0% (95% CI, 17.0-23.4) to 34.5% (95% CI, 31.0-38.2) of visits. CONCLUSIONS: Despite limited endorsement by consensus guidelines, there was increased use of opioid analgesics to treat headaches in US EDs over the past decade.
SN  - 0735-6757
AD  - Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC. Electronic address: maryannmazer@gmail.com.
AD  - Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.
AD  - The George Washington University, School of Medicine and Health Sciences, Washington, DC.
AD  - Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University, Washington, DC; Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pediatric Pharmacology, University Children's Hospital Basel, Switzerland.
AD  - The George Washington University, School of Medicine and Health Sciences, Washington, DC; Department of Emergency Medicine, the George Washington University, Washington, DC.
AD  - Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
AD  - Department of Emergency Medicine, New York University, New York, NY.
U2  - PMID: 25091873.
DO  - 10.1016/j.ajem.2014.07.001
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107791506
T1  - Trends in prescription opioid use in pediatric emergency department patients.
AU  - Mazer-Amirshahi, Maryann
AU  - Mullins, Peter M
AU  - Rasooly, Irit R
AU  - van den Anker, John
AU  - Pines, Jesse M
Y1  - 2014/04//2014 Apr
N1  - Accession Number: 107791506. Language: English. Entry Date: 20150116. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 8507560. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Pain -- Drug Therapy
KW  - Pain -- Trends
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Adolescence
KW  - Female
KW  - Human
KW  - Male
KW  - Pediatrics
KW  - Surveys
KW  - Young Adult
SP  - 230
EP  - 235
JO  - Pediatric Emergency Care
JF  - Pediatric Emergency Care
JA  - PEDIATR EMERG CARE
VL  - 30
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - OBJECTIVE: In recent years, there has been increased emphasis on treating pain in emergency departments (EDs), coinciding with mounting concerns regarding the abuse potential of prescription opioids. In this study, we describe trends in opioid prescribing in pediatric patients in the US EDs over the past decade. METHODS: Data from the 2001-2010 National Hospital Ambulatory Medical Care Survey were analyzed and pain-related visits were identified. Pain-related ED visits by pediatric patients (<=19 y) where an opioid analgesic was administered or prescribed were tabulated by age category and year. Specific opioids analyzed included codeine, hydrocodone, hydromorphone, morphine, and oxycodone. The use patterns of nonopioid pain relievers were also investigated. Results were further stratified by Drug Enforcement Agency schedule and pain-related diagnosis. RESULTS: The overall use of opioid analgesics in pain-related pediatric ED visits increased from 11.2% to 14.5% between 2001 and 2010 (P = 0.015). The use of Drug Enforcement Agency schedule II agents doubled from 3.6% in 2001 to 7.0% in 2010 (P < 0.001), whereas there was no significant increase in the use of schedule III, IV, and V agents (P = 0.34). Hydrocodone was the most frequently prescribed opioid analgesic. Increased opioid use was most dramatic in ED visits that involved adolescents. There was no significant increase in the use of nonopioid analgesics in pediatric ED patients (P = 0.086). CONCLUSIONS: Opioid use for pain-related pediatric ED visits has increased significantly from 2001 to 2010, particularly among adolescents. Emergency department providers must be vigilant in balancing pain relief with minimizing the adverse effects of opioid analgesics.
SN  - 0749-5161
AD  - From the *Department of Emergency Medicine, The George Washington University; tThe George Washington University School of Medicine and Health Sciences; tDepartment of Pediatrics, The George Washington University; and §Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC.
U2  - PMID: 24651218.
DO  - 10.1097/PEC.0000000000000102
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119354111
T1  - Choosing Opioid Policies Our Patients Can Live With.
AU  - Stolbach, Andrew I.
AU  - Nelson, Lewis S.
Y1  - 2016/11//
N1  - Accession Number: 119354111. Language: English. Entry Date: 20161115. Revision Date: 20171101. Publication Type: Article; commentary. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Policy Making
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Patient Care
KW  - Emergency Medicine
KW  - Pain -- Therapy
KW  - Medical Organizations
KW  - Prescribing Patterns
SP  - 1290
EP  - 1292
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 23
IS  - 11
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - The authors discusses the research "Opioid-related policies in New England emergency departments" by S.G. Weiner and colleagues. Topics discussed include use of opioids for the treatment of chronic pain; notification of the primary prescriber when prescribing opioids, use of a screening tool, and prescription of naloxone to at-risk patients; and role of promoting safe opioid prescribing for controlling the opioid epidemic.
SN  - 1069-6563
AD  - Department of Emergency Medicine, Johns Hopkins University
AD  - Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City Poison Control Center
DO  - 10.1111/acem.13040
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119354111&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104088612
T1  - Prescription opioid mortality trends in New York City, 1990-2006: examining the emergence of an epidemic.
AU  - Cerdá, Magdalena
AU  - Ransome, Yusuf
AU  - Keyes, Katherine M
AU  - Koenen, Karestan C
AU  - Tracy, Melissa
AU  - Tardiff, Kenneth J
AU  - Vlahov, David
AU  - Galea, Sandro
Y1  - 2013/09//
N1  - Accession Number: 104088612. Language: English. Entry Date: 20140328. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Psychiatry/Psychology. Grant Information: T32 DA007233/DA/NIDA NIH HHS/United States. NLM UID: 7513587. 
KW  - Overdose -- Mortality
KW  - Drugs, Prescription -- Poisoning
KW  - Adolescence
KW  - Adult
KW  - Age Factors
KW  - Analgesics, Opioid -- Poisoning
KW  - Data Analysis, Statistical
KW  - Disease Outbreaks
KW  - Ethnic Groups
KW  - Female
KW  - Substance Use Disorders -- Mortality
KW  - Human
KW  - Hypnotics and Sedatives -- Poisoning
KW  - Male
KW  - Methadone -- Poisoning
KW  - Middle Age
KW  - Narcotics -- Poisoning
KW  - New York
KW  - Psychotropic Drugs -- Poisoning
KW  - Sex Factors
KW  - Socioeconomic Factors
KW  - Young Adult
SP  - 53
EP  - 62
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 132
IS  - 1/2
PB  - Elsevier B.V.
AB  - Background: The drug overdose mortality rate tripled between 1990 and 2006; prescription opioids have driven this epidemic. We examined the period 1990-2006 to inform our understanding of how the current prescription opioid overdose epidemic emerged in urban areas.Methods: We used data from the Office of the Chief Medical Examiner to examine changes in demographic and spatial patterns in overdose fatalities induced by prescription opioids (i.e., analgesics and methadone) in New York City (NYC) in 1990-2006, and what factors were associated with death from prescription opioids vs. heroin, historically the most prevalent form of opioid overdose in urban areas.Results: Analgesic-induced overdose fatalities were the only types of overdose fatalities to increase in 1990-2006 in NYC; the fatality rate increased sevenfold from 0.39 in 1990 to 2.7 per 100,000 persons in 2006. Whites and Latinos were the only racial/ethnic groups to exhibit an increase in overdose-related mortality. Relative to heroin overdose decedents, analgesic and methadone overdose decedents were more likely to be female and to concurrently use psychotherapeutic drugs, but less likely to concurrently use alcohol or cocaine. Analgesic overdose decedents were less likely to be Black or Hispanic, while methadone overdose decedents were more likely to be Black or Hispanic in contrast to heroin overdose decedents.Conclusions: The distinct epidemiologic profiles exhibited by analgesic and methadone overdose fatalities highlight the need to define drug-specific public health prevention efforts.
SN  - 0376-8716
AD  - Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA. Electronic address: mc3226@columbia.edu.
U2  - PMID: 23357743.
DO  - 10.1016/j.drugalcdep.2012.12.027
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104088612&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104223010
T1  - Opioid overuse a 'public health emergency'.
Y1  - 2013/09//
N1  - Accession Number: 104223010. Language: English. Entry Date: 20130918. Revision Date: 20170802. Publication Type: Journal Article. Journal Subset: Nursing; USA. NLM UID: 8510434. 
KW  - Narcotics -- Adverse Effects
KW  - Public Health
KW  - Overdose -- Trends
KW  - Pain -- Drug Therapy
KW  - Practice Guidelines
KW  - Narcotics -- Administration and Dosage
KW  - Worker's Compensation
KW  - Liability, Legal
KW  - Low Back Pain -- Drug Therapy
KW  - Substance Abuse
KW  - Substance Abuse Detection
SP  - 101
EP  - 103
JO  - Hospital Employee Health
JF  - Hospital Employee Health
JA  - HOSP EMPLOYEE HEALTH
VL  - 32
IS  - 9
CY  - Atlanta, Georgia
PB  - AHC Media LLC
SN  - 0744-6470
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104223010&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120888618
T1  - Prescribing opioids safely in the emergency department study: Predictors of emergency department discharge with high morphine milligram equivalent prescription.
AU  - Hawk, Kathryn
AU  - Weiner, Scott
AU  - Dziura, Jim
AU  - Fiellin, David A.
AU  - DaEun, Dana
AU  - Nelson, Lewis
AU  - Hoppe, Jason
AU  - Perrone, Jeanmarie
AU  - D’Onofrio, Gail
Y1  - 2017/02//
N1  - Accession Number: 120888618. Language: English. Entry Date: In Process. Revision Date: 20170126. Publication Type: Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
SP  - e86
EP  - e86
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 171
PB  - Elsevier B.V.
SN  - 0376-8716
AD  - Emergency Medicine, Yale University, New Haven, CT, United States
AD  - Emergency Medicine, Brigham & Women's Hospital, Boston, MA, United States
AD  - Internal Medicine, Yale University, New Haven, CT, United States
AD  - Harvard Medical School, Boston, MA, United States
AD  - Emergency Medicine, NYU, New York, NY, United States
AD  - Emergency Medicine, University of Colorado, Denver, CO, United States
AD  - Emergency Medicine, University of Pennsylvania, Phiadelphia, PA, United States
DO  - 10.1016/j.drugalcdep.2016.08.242
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120888618&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120888988
T1  - Association between prescription opioid use and frequent emergency department use.
AU  - Milani, Sadaf Arefi
AU  - Crooke, Hannah Renee
AU  - Cottler, Linda
AU  - Striley, Catherine Woodstock
Y1  - 2017/02//
N1  - Accession Number: 120888988. Language: English. Entry Date: In Process. Revision Date: 20170126. Publication Type: Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
SP  - e145
EP  - e145
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 171
PB  - Elsevier B.V.
SN  - 0376-8716
AD  - Epidemiology, University of Florida, Gainesville, FL, United States
DO  - 10.1016/j.drugalcdep.2016.08.401
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120888988&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120888897
T1  - Integrating opioid overdose prevention in the emergency department.
AU  - McCormack, Ryan
AU  - Koziatek, Christian
AU  - Rubin, Ada
AU  - O’Donnell, Lauren
AU  - Nelson, Lewis
Y1  - 2017/02//
N1  - Accession Number: 120888897. Language: English. Entry Date: In Process. Revision Date: 20170126. Publication Type: Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
SP  - e136
EP  - e137
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 171
PB  - Elsevier B.V.
SN  - 0376-8716
AD  - Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, United States
AD  - NYU School of Medicine, New York, NY, United States
DO  - 10.1016/j.drugalcdep.2016.08.378
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120888897&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120888718
T1  - State-level opioid antagonist access laws: The emergence of three distinct strategies, 2001–2015.
AU  - Burris, Scott
AU  - Johnson, Sterling K.
AU  - Ibrahim, Jennifer
AU  - Platt, Elizabeth
AU  - Allen, Leslie
Y1  - 2017/02//
N1  - Accession Number: 120888718. Language: English. Entry Date: In Process. Revision Date: 20170126. Publication Type: Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
SP  - e29
EP  - e29
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 171
PB  - Elsevier B.V.
SN  - 0376-8716
AD  - Temple University Beasley School of Law, Philadelphia, PA, United States
AD  - Legal Science, LLC, Philadelphia, PA, United States
AD  - College of Public Health, Temple University, Philadelphia, PA, United States
DO  - 10.1016/j.drugalcdep.2016.08.094
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120888718&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120798057
T1  - Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients with Acute Pain (TH341D).
AU  - Patel, Pina
AU  - Goodman, Lauren
AU  - Knepel, Sheri
AU  - Miller, Charles
AU  - Azimi, Asma
AU  - Gustin, Jillian
AU  - Hartman, Amber
Y1  - 2017/02//
N1  - Accession Number: 120798057. Language: English. Entry Date: 20180328. Revision Date: 20170123. Publication Type: Article. Journal Subset: Biomedical; Core Nursing; Nursing; Peer Reviewed; USA. NLM UID: 8605836. 
SP  - 338
EP  - 338
JO  - Journal of Pain & Symptom Management
JF  - Journal of Pain & Symptom Management
JA  - J PAIN SYMPTOM MANAGE
VL  - 53
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0885-3924
AD  - The Ohio State University Wexner Medical Center, Columbus, OH
AD  - Ohio State University, Columbus, OH
AD  - Zusman Hospice, New Albany, OH
AD  - Alta Bates Summit Hospital, Columbus, OH
DO  - 10.1016/j.jpainsymman.2016.12.071
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120798057&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104075530
T1  - Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit.
AU  - Mercadante, Sebastiano
AU  - Prestia, Giovanna
AU  - Ranieri, Maurizio
AU  - Giarratano, Antonello
AU  - Casuccio, Alessandra
Y1  - 2013/07//
N1  - Accession Number: 104075530. Language: English. Entry Date: 20140606. Revision Date: 20171020. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. NLM UID: 9302957. 
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Neoplasms -- Complications
KW  - Palliative Care -- Methods
KW  - Pain -- Etiology
KW  - Adult
KW  - Aged
KW  - Breakthrough Pain -- Drug Therapy
KW  - Breakthrough Pain -- Etiology
KW  - Continuity of Patient Care
KW  - Prescriptions, Drug
KW  - Female
KW  - Human
KW  - Male
KW  - Morphine -- Administration and Dosage
KW  - Pain Measurement
KW  - Patient Discharge
SP  - 1853
EP  - 1859
JO  - Supportive Care in Cancer
JF  - Supportive Care in Cancer
JA  - SUPPORT CARE CANCER
VL  - 21
IS  - 7
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
AB  - The aim of this study was to present how opioids are used in an acute pain relief and palliative care unit (APRPCU), where many patients with difficult pain conditions are admitted from GPs, home palliative care programs, oncology departments, other hospitals or emergency units, and other regional places. From a consecutive sample of cancer patients admitted to an APRPCU for a period of 6 months, patients who had been administered opioids were included in this survey. Basic information was collected as well as opioid therapy prescribed at admission and, subsequently, during admission and at time of discharge. Patients were discharged once stabilization of pain and symptoms were obtained and the treatment was considered to be optimized. One week after being discharged, patients or relatives were contacted by phone to gather information about the availability of opioids at dosages prescribed at time of discharge. One hundred eighty six of 231 patients were specifically admitted for uncontrolled pain, with a mean pain intensity of 6.8 (SD 2.5). The mean dose of oral morphine equivalents in patients receiving opioids before admission was 45 mg/day (range 10-500 mg). One hundred seventy five patients (75.7 %) were prescribed around the clock opioids at admission. About one third of patients changed treatment (opioid or route). Forty two of 175 (24 %), 27/58 (46.5 %), 10/22 (45.4 %), and 2/4 (50 %) patients were receiving more than 200 mg of oral morphine equivalents, as maximum dose of the first, second, third, and fourth opioid prescriptions, respectively. The pattern of opioids changed, with the highest doses administered with subsequent line options. The mean final dose of opioids, expressed as oral morphine equivalents, for all patients was 318 mg/day (SD 798), that is more than six times the doses of pre-admission opioid doses. One hundred eighty six patients (80.5 %) were prescribed a breakthrough cancer pain (BTcP) medication at admission. Sixty five patients changed their BTcP prescription, and further 27 patients changed again. Finally, eight patients were prescribed a fourth BTcP medication. Of 46 patients available for interview, the majority of them (n = 39, 84 %) did not have problems with their GPs, who facilitated prescription and availability of opioids at the dosages prescribed at discharge. For patients with severe distress, APRPCUs may guarantee a high-level support to optimize pain and symptom intensities providing intensive approach and resolving highly distressing situations in a short time by optimizing the use of opioids.
SN  - 0941-4355
AD  - Pain relief and palliative care unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy, terapiadeldolore@lamaddalenanet.it.
U2  - PMID: 23400316.
DO  - 10.1007/s00520-013-1740-8
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104075530&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 123029547
T1  - Opioid Prescribing by Emergency Physicians and Risk of Long-Term Use.
AU  - Menchine, Michael
AU  - Kea, Bory
AU  - Beaudoin, Francesca L.
AU  - Rich, Josiah D.
AU  - Barnett, Michael L.
AU  - Olenksi, Andrew R.
AU  - Jena, Anupam B.
Y1  - 2017/05/11/
N1  - Accession Number: 123029547. Language: English. Entry Date: 20170516. Revision Date: 20170601. Publication Type: letter; commentary. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0255562. 
KW  - Prescriptions, Drug
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Relative Risk
SP  - 1895
EP  - 1896
JO  - New England Journal of Medicine
JF  - New England Journal of Medicine
JA  - N ENGL J MED
VL  - 376
IS  - 19
CY  - Waltham, Massachusetts
PB  - New England Journal of Medicine
SN  - 0028-4793
AD  - Keck School of Medicine of the University of Southern California Los Angeles, CA
AD  - Oregon Health and Science University Portland, OR
AD  - Warren Alpert Medical School of Brown University Providence, RI
AD  - Harvard T.H. Chan School of Public Health Boston, MA
AD  - Harvard Medical School Boston, MA
U2  - PMID: 28489998.
DO  - 10.1056/NEJMc1703338
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123029547&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 
TY  - JOUR
ID  - 103951970
T1  - Opioid Requirements in Mechanically Ventilated Trauma Patients Receiving Dexmedetomidine Versus Propofol.
AU  - Aljuhani, Ohoud A.
AU  - McKinney, Courtney B.
AU  - Erstad, Brian L.
Y1  - 2014/05//May/Jun2014
N1  - Accession Number: 103951970. Language: English. Entry Date: 20140602. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Blind Peer Reviewed; Core Nursing; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Critical Care; Emergency Care. Instrumentation: Glasgow Coma Scale (GCS); Richmond Agitation Sedation Scale (RASS); Acute Physiology and Chronic Health Evaluation II (APACHE II); Faces, Legs, Activity, Cry, and Consolability Pain Scale (FLACC). NLM UID: 9512997. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Analgesics, Nonnarcotic -- Administration and Dosage
KW  - Propofol -- Administration and Dosage
KW  - Emergency Care
KW  - Sedation
KW  - Ventilator Weaning
KW  - Prospective Studies
KW  - Retrospective Design
KW  - Human
KW  - Comparative Studies
KW  - Ventilator Patients
KW  - Drug Therapy, Combination
KW  - Treatment Outcomes
KW  - Pain Measurement
KW  - Extubation
KW  - Repeat Procedures
KW  - Adverse Drug Event
KW  - Record Review
KW  - Academic Medical Centers
KW  - Intensive Care Units
KW  - Physical Examination
KW  - Severity of Illness
KW  - Glasgow Coma Scale
KW  - Apache
KW  - Scales
KW  - Severity of Illness Indices
KW  - Summated Rating Scaling
KW  - Length of Stay
KW  - Data Analysis Software
KW  - Paired T-Tests
KW  - P-Value
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Inpatients
KW  - Antianxiety Agents, Benzodiazepine -- Administration and Dosage
KW  - Dose-Response Relationship, Drug
KW  - Drug Monitoring
KW  - Descriptive Statistics
SP  - 111
EP  - 114
JO  - Journal of Trauma Nursing
JF  - Journal of Trauma Nursing
JA  - J TRAUMA NURS
VL  - 21
IS  - 3
CY  - Lexington, Kentucky
PB  - Society of Trauma Nurses
AB  - Proponents of dexmedetomidine often cite the agent’s analgesic properties as one of its main advantages over propofol and benzodiazepines. However, there are very limited studies utilizing endpoints such as analgesic requirements to provide supporting evidence for these claims. The primary purpose of this retrospective study was to compare opioid analgesic requirements in trauma patients receiving nonconcurrent dexmedetomidine and propofol for sedation while being weaned from mechanical ventilation. Total analgesic requirements were similar between dexmedetomidine and propofol within 48 hours of sedative initiation in adult trauma patients ( P > .05).
SN  - 1078-7496
AD  - Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson.; University of Arizona Medical Center, University Campus, Tucson.; Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
AD  - Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson.; University of Arizona Medical Center, University Campus, Tucson.; Intermountain Medical Center, Murray, Utah.
AD  - Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson.
DO  - 10.1097/JTN.0000000000000041
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103951970&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109839628
T1  - Constipation Prophylaxis Is Rare for Adults Prescribed Outpatient Opioid Therapy From U.S. Emergency Departments.
AU  - Hunold, Katherine M.
AU  - Smith, Samantha A.
AU  - Platts-Mills, Timothy F.
Y1  - 2015/09//
N1  - Accession Number: 109839628. Language: English. Entry Date: 20150910. Revision Date: 20160831. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9418450. 
KW  - Constipation -- Prevention and Control
KW  - Prescribing Patterns
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service
KW  - Emergency Medicine
KW  - Human
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Ambulatory Care
KW  - Adult
KW  - Cathartics
KW  - Retrospective Design
KW  - United States
KW  - Hospitals
KW  - Data Analysis
KW  - Protocols
KW  - Data Analysis Software
KW  - Confidence Intervals
SP  - 1118
EP  - 1121
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 22
IS  - 9
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - University of Virginia School of Medicine
AD  - Department of Emergency Medicine, University of North Carolina
AD  - Department of Emergency Medicine, University of North Carolina; Department of Anesthesiology, University of North Carolina
U2  - PMID: 26291177.
DO  - 10.1111/acem.12745
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109839628&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112217144
T1  - Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study.
AU  - Larochelle, Marc R.
AU  - Liebschutz, Jane M.
AU  - Fang Zhang
AU  - Ross-Degnan, Dennis
AU  - Wharam, J. Frank
AU  - Zhang, Fang
Y1  - 2016/01/05/
N1  - Accession Number: 112217144. Language: English. Entry Date: 20160507. Revision Date: 20171209. Publication Type: journal article; research. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: T32 HP12706//PHS HHS/United States. NLM UID: 0372351. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Overdose -- Etiology
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Middle Age
KW  - Substance Use Disorders -- Diagnosis
KW  - Recurrence
KW  - Buprenorphine -- Therapeutic Use
KW  - Retrospective Design
KW  - Time Factors
KW  - Overdose -- Drug Therapy
KW  - Overdose -- Diagnosis
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Young Adult
KW  - Male
KW  - Adolescence
KW  - Female
KW  - Adult
KW  - Scales
SP  - 1
EP  - 9
JO  - Annals of Internal Medicine
JF  - Annals of Internal Medicine
JA  - ANN INTERN MED
VL  - 164
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
AB  - Background: Nonfatal opioid overdose is an opportunity to identify and treat substance use disorders, but treatment patterns after the overdose are unknown.Objective: To determine prescribed opioid dosage after an opioid overdose and its association with repeated overdose.Design: Retrospective cohort study.Setting: A large U.S. health insurer.Participants: 2848 commercially insured patients aged 18 to 64 years who had a nonfatal opioid overdose during long-term opioid therapy for noncancer pain between May 2000 and December 2012.Measurements: Nonfatal opioid overdose was identified using International Classification of Diseases, Ninth Revision, Clinical Modification, codes from emergency department or inpatient claims. The primary outcome was daily morphine-equivalent dosage (MED) of opioids dispensed from 60 days before to up to 730 days after the index overdose. We categorized dosages as large (≥100 mg MED), moderate (50 to <100 mg MED), low (<50 mg MED), or none (0 mg MED). Secondary outcomes included time to repeated overdose stratified by daily dosage as a time-varying covariate.Results: Over a median follow-up of 299 days, opioids were dispensed to 91% of patients after an overdose. Seven percent of patients (n = 212) had a repeated opioid overdose. At 2 years, the cumulative incidence of repeated overdose was 17% (95% CI, 14% to 20%) for patients receiving high dosages of opioids after the index overdose, 15% (CI, 10% to 21%) for those receiving moderate dosages, 9% (CI, 6% to 14%) for those receiving low dosages, and 8% (CI, 6% to 11%) for those receiving no opioids.Limitation: The cohort was limited to commercially insured adults.Conclusion: Almost all patients continue to receive prescription opioids after an overdose. Opioid discontinuation after overdose is associated with lower risk for repeated overdose.Primary Funding Source: Health Resources and Services Administration.
SN  - 0003-4819
AD  - Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118.
U2  - PMID: 26720742.
DO  - 10.7326/M15-0038
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193067
T1  - 254 Rates of Naloxone Prescriptions Following Implementation of a Take-Home Naloxone Program from the Emergency Department.
AU  - Lebin, J.A.
AU  - Chen, B.C.
AU  - Korab, G.
AU  - Jablonowski, K.
AU  - Whiteside, L.K.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193067. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S101
EP  - S101
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of Washington, Seattle, WA
DO  - 10.1016/j.annemergmed.2017.07.232
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109771129
T1  - Impact of armed conflicts and warfare on opioid substitution treatment in Ukraine: Responding to emergency needs.
AU  - Filippovych, Sergii
Y1  - 2015/01//
N1  - Accession Number: 109771129. Language: English. Entry Date: 20150918. Revision Date: 20150923. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9014759. 
KW  - Substance Abuse, Intravenous -- Drug Therapy
KW  - Substance Abuse, Intravenous -- Rehabilitation
KW  - War
KW  - Emergency Treatment
KW  - Health Services Needs and Demand
KW  - HIV Infections -- Epidemiology
KW  - HIV Infections -- Prevention and Control
KW  - Ukraine
SP  - 3
EP  - 5
JO  - International Journal of Drug Policy
JF  - International Journal of Drug Policy
JA  - INT J DRUG POLICY
VL  - 26
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0955-3959
U2  - PMID: 25483411.
DO  - 10.1016/j.drugpo.2014.11.005
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113551961
T1  - Low-back pain at the emergency department: still not being managed?
AU  - Rizzardo, Alessandro
AU  - Miceli, Luca
AU  - Bednarova, Rym
AU  - Guadagnin, Giovanni Maria
AU  - Sbrojavacca, Rodolfo
AU  - Rocca, Giorgio Della
AU  - Della Rocca, Giorgio
Y1  - 2016/02//
N1  - Accession Number: 113551961. Language: English. Entry Date: In Process. Revision Date: 20170705. Publication Type: journal article. Journal Subset: Europe; Health Services Administration; UK & Ireland. NLM UID: 101253281. 
SP  - 183
EP  - 187
JO  - Therapeutics & Clinical Risk Management
JF  - Therapeutics & Clinical Risk Management
JA  - THER CLIN RISK MANAGE
VL  - 12
CY  - Auckland, <Blank>
PB  - Dove Medical Press Ltd
AB  - Background: Low-back pain (LBP) affects about 40% of people at some point in their lives. In the presence of "red flags", further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs). Patients and Methods: This retrospective observational study enrolled 1,298 patients admitted to the ED, including all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago. We collected patients' demographic data, medical history, lab workup and imaging performed at the ED, drugs administered at the ED, ED length of stay (LOS), numeric rating scale pain score, admission to ward, and ward LOS data. Thereafter, we performed a cost analysis. Results: Mean numeric rating scale scores were higher than 7/10. Home medication consisted of no drug consumption in up to 90% of patients. Oxycodone-naloxone was the strong opioid most frequently prescribed for the home. Once at the ED, nonsteroidal anti-inflammatory drugs and opiates were administered to up to 72% and 42% of patients, respectively. Imaging was performed in up to 56% of patients. Mean ED LOS was 4 hours, 14 minutes. A total of 43 patients were admitted to a ward. The expense for each non-ward-admitted patient was approximately €200 in the ED, while the mean expense for ward-admitted patients was €9,500, with a mean LOS of 15 days. Conclusion: There is not yet a defined therapeutic care process for the patient with LBP with clear criteria for an ED visit. It is to this end that we need a clinical pathway for the prehospital management of LBP syndrome and consequently for an in-hospital time-saving therapeutic approach to the patient.
SN  - 1176-6336
AD  - Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine
AD  - Pain Medicine and Palliative Care, Health Company Number 2, Gorizia
AD  - Emergency Department, Academic Hospital of Udine, Udine, Italy
AD  - Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy
U2  - PMID: 26929631.
DO  - 10.2147/TCRM.S91898
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193350
T1  - 431 Facilitating an Emergency Department Take-Home Naloxone Program Through Involvement of Community-Based Harm Reductionists.
AU  - Barbour, K.
AU  - McQuade, M.
AU  - Somasundaram, S.
AU  - Chakravarthy, B.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193350. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S168
EP  - S168
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - UC Irvine School of Medicine, Irvine, CA
AD  - UC Irvine, Irvine, CA
DO  - 10.1016/j.annemergmed.2017.07.310
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193053
T1  - 230 The Willingness of Adolescents to Commit to Safe Use, Storage, and Disposal of Prescription Opiates in the Emergency Department.
AU  - Arora, S.
AU  - Grewal, S.
AU  - Escamilla, D.
AU  - Menchine, M.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193053. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S92
EP  - S92
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - USC Keck School of Medicine, Los Angeles, CA
DO  - 10.1016/j.annemergmed.2017.07.452
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111378180
T1  - Opioid use among same-day surgery patients: Prevalence, management and outcomes.
AU  - Wilson, Jennifer L. C.
AU  - Poulin, Patricia A.
AU  - Sikorski, Robert
AU  - Nathan, Howard J.
AU  - Taljaard, Monica
AU  - Smyth, Catherine
AU  - Wilson, Jennifer Lc
Y1  - 2015/11//Nov/Dec2015
N1  - Accession Number: 111378180. Language: English. Entry Date: 20160320. Revision Date: 20160922. Publication Type: journal article. Journal Subset: Biomedical; Canada. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); General Health Questionnaire (GHQ). NLM UID: 9612504. 
KW  - Pain -- Therapy
KW  - Postoperative Pain -- Drug Therapy
KW  - Substance Use Disorders -- Epidemiology
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Readmission -- Statistics and Numerical Data
KW  - Adult
KW  - Length of Stay
KW  - Pain Measurement
KW  - Patient Compliance
KW  - Young Adult
KW  - Aged
KW  - Female
KW  - Middle Age
KW  - Male
KW  - Retrospective Design
KW  - Nonparametric Statistics
KW  - Questionnaires
KW  - Scales
SP  - 300
EP  - 304
JO  - Pain Research & Management
JF  - Pain Research & Management
JA  - PAIN RES MANAGE
VL  - 20
IS  - 6
CY  - London, <Blank>
PB  - Hindawi Limited
AB  - Objectives: To determine whether the prevalence of opioid use among patients requiring elective same-day admission (SDA) surgery is greater than the 2.5% prevalence found in the general population. Secondary objectives were to assess compliance with expert recommendations on acute pain management in opioid-tolerant patients and to examine clinical outcomes.Methods: A retrospective review of 812 systematically sampled adult SDA surgical cases between April 1, 2008 and March 31, 2009 was conducted.Results: Among 798 eligible patients, 148 (18.5% [95% CI 15.9% to 21.2%]) were prescribed opioids, with 4.4% prescribed long-acting opioids (95% CI 3.0% to 5.8%). Use of opioids was most prevalent among orthopedic and neurosurgery patients. Among the 35 patients on long-acting opioids who had a high likelihood of being tolerant, anesthesiologists correctly identified 33, but only 13 (37%) took their usual opioid preoperatively while 22 (63%) had opioids continued postoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered preoperatively in 18 (51%), 15 (43%) and 18 (51%) cases, respectively, while ketamine was used in 15 (43%) patients intraoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered postoperatively in 31 (89%), 15 (43%) and 17 (49%) of the cases, respectively. No differences in length of stay, readmissions and emergency room visits were found between opioid-tolerant and opioid-naive patients.Conclusion: Opioid use is more common in SDA surgical patients than in the general population and is most prevalent within orthopedic and neurosurgery patients. Uptake of expert opinion on the management of acute pain in the opioid tolerant patient population is lacking.
SN  - 1203-6765
AD  - Department of Anesthesiology, University of Ottawa, Ottawa, Ontario
AD  - Department of Psychology, Ottawa Hospital, Ottawa, Ontario
AD  - Ottawa Hospital Research Institute, Ottawa, Ontario
AD  - School of Psychology, University of Ottawa, Ottawa, Ontario
AD  - Department of Anesthesiology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ottawa, Ontario
AD  - Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario
U2  - PMID: 26357683.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125516990
T1  - inbox. Recovery specialists steer opioid users toward treatment.
AU  - STEMPNIAK, MARTY
Y1  - 2017/10//
N1  - Accession Number: 125516990. Language: English. Entry Date: 20171010. Revision Date: 20171013. Publication Type: Article; pictorial. Journal Subset: Health Services Administration; USA. NLM UID: 9312077. 
KW  - Substance Use Rehabilitation Programs -- Trends -- Florida
KW  - Substance Dependence
KW  - Fentanyl -- Adverse Effects
KW  - Florida
KW  - Overdose
KW  - Treatment Outcomes
SP  - 12
EP  - 14
JO  - H&HN: Hospitals & Health Networks
JF  - H&HN: Hospitals & Health Networks
JA  - H&HN HOSP HEALTH NETW
VL  - 91
IS  - 10
CY  - Chicago, Illinois
PB  - Health Forum
AB  - The article discusses the approach used by St. Vincent's Medical Center Riverside in Jacksonville, Florida in treating opioid patients, in which peer-recovery specialists are placed in the emergency department (ED) to help intervene in substance use disorders. Topics covered include the harmful effects of the synthetic opioid known as fentanyl, the noted increase in number of patients being treated with opioid-use disorders, and St. Vincent's pilot peer-recovery specialist program
SN  - 1068-8838
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125114858
T1  - THE OPIOID CRISIS -- A BCEHS EXPERIENCE.
AU  - Harrington, Graham
Y1  - 2017/08//Aug/Sep2017
N1  - Accession Number: 125114858. Language: English. Entry Date: 20171228. Revision Date: 20171228. Publication Type: Article; pictorial; tables/charts. Journal Subset: Allied Health; Canada. Special Interest: Public Health. NLM UID: 101581998. 
KW  - Narcotics -- Adverse Effects
KW  - Emergency Medical Services -- Administration
KW  - Substance Abuse -- Epidemiology -- British Columbia
KW  - Overdose
KW  - Prehospital Care
KW  - British Columbia
KW  - Fentanyl -- Adverse Effects
KW  - Management
KW  - Personnel Staffing and Scheduling
KW  - Emergency Care -- Equipment and Supplies
KW  - Overdose -- Mortality -- British Columbia
KW  - Mobile Health Units -- Utilization
KW  - Death -- Trends -- British Columbia
KW  - Critical Incident Stress
SP  - 28
EP  - 31
JO  - Canadian Paramedicine
JF  - Canadian Paramedicine
JA  - CAN PARAMED
VL  - 40
IS  - 5
CY  - Calgary, Alberta
PB  - Pendragon Publishing Ltd.
SN  - 1927-6710
AD  - Paramedic program at the Justice Institute of BC
AD  - ACLS for private industry
AD  - University of British Columbia in Political Science
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123059429
T1  - A Proper Place for Opioids...Walker, G. Managing Pain without Opiates or the Pain Scale. EMERG MED NEWS. 2017; 39(1):24-25.
AU  - Grant, Todd
Y1  - 2017/04//4/1/2017
N1  - Accession Number: 123059429. Language: English. Entry Date: 20170608. Revision Date: 20170608. Publication Type: Article; commentary; letter. Journal Subset: Biomedical; USA. NLM UID: 9000866. 
KW  - Pain -- Drug Therapy
KW  - Narcotics -- Adverse Effects
KW  - Substance Dependence -- Prevention and Control
KW  - Emergency Service
KW  - Prescribing Patterns
KW  - Narcotics -- Analysis
SP  - 36
EP  - 37
JO  - Emergency Medicine News
JF  - Emergency Medicine News
JA  - EMERG MED NEWS
VL  - 39
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 1054-0725
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123059429&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 114022582
T1  - The Opioid Epidemic.
AU  - STEMPNIAK, MARTY
Y1  - 2016/03//
N1  - Accession Number: 114022582. Language: English. Entry Date: 20160401. Revision Date: 20160401. Publication Type: Article; pictorial; statistics. Journal Subset: Health Services Administration; USA. NLM UID: 9312077. 
KW  - Analgesics, Opioid
KW  - Substance Abuse -- Trends -- United States
KW  - Substance Dependence -- Trends -- United States
KW  - Overdose -- Mortality -- United States
KW  - United States
KW  - Drugs, Prescription
KW  - Heroin
KW  - Substance Abuse -- Economics -- United States
KW  - Substance Abuse -- Prevention and Control -- United States
KW  - Health Facilities
SP  - 22
EP  - 28
JO  - H&HN: Hospitals & Health Networks
JF  - H&HN: Hospitals & Health Networks
JA  - H&HN HOSP HEALTH NETW
VL  - 90
IS  - 3
CY  - Chicago, Illinois
PB  - Health Forum
AB  - The article discusses the opioid epidemic affecting hospitals in the U.S. Topics covered include the guidelines for managing opioids in the emergency department (ED), the health systems that are taking a concentrated approach to ensuring opioids are prescribed properly and the need for hospitals to facilitate easy communication between ED physicians, primary care doctors and clinicians at outpatient facilities.
SN  - 1068-8838
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104089571
T1  - A performance improvement prescribing guideline reduces opioid prescriptions for emergency department dental pain patients.
AU  - Fox, Timothy R
AU  - Li, James
AU  - Stevens, Sandra
AU  - Tippie, Tracy
Y1  - 2013/09//
N1  - Accession Number: 104089571. Language: English. Entry Date: 20150501. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Practice Guidelines
KW  - Toothache -- Drug Therapy
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Aged, 80 and Over
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Female
KW  - Health Services Misuse
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Substance Use Disorders -- Prevention and Control
KW  - Young Adult
SP  - 237
EP  - 240
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 62
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - STUDY OBJECTIVE: In an effort to reduce prescription opioid abuse originating from our institution, we implement and measure the effect of a prescribing guideline on the rate of emergency department (ED) opioid prescriptions written for patients presenting with dental pain, a complaint previously associated with drug-seeking behavior. METHODS: After implementing a departmental guideline on controlled substance prescriptions, we performed a structured before-and-after chart review of dental pain patients aged 16 and older. RESULTS: Before the guideline, the rate of opioid prescription was 59% (302/515). After implementation, the rate was 42% (65/153). The absolute decrease in rates was 17% (95% confidence interval 7% to 25%). Additionally, in comparing the 12-month period before and after implementation, the dental pain visit rate decreased from 26 to 21 per 1,000 ED visits (95% confidence interval of decrease 2 to 9 visits/1,000). CONCLUSION: A performance improvement program involving a departmental prescribing guideline was associated with a reduction in the rate of opioid prescriptions and visits for ED patients presenting with dental pain.
SN  - 0196-0644
AD  - Miles Memorial Hospital, Department of Emergency Medicine, Damariscotta, ME.
U2  - PMID: 23374416.
DO  - 10.1016/j.annemergmed.2012.11.020
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107956906
T1  - Opioid prescribing in emergency departments: the prevalence of potentially inappropriate prescribing and misuse.
AU  - Logan, Joseph
AU  - Liu, Ying
AU  - Paulozzi, Leonard
AU  - Zhang, Kun
AU  - Jones, Christopher
Y1  - 2013/08//2013 Aug
N1  - Accession Number: 107956906. Language: English. Entry Date: 20131004. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0230027. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Inappropriate Prescribing -- Statistics and Numerical Data
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Adolescence
KW  - Adult
KW  - Antianxiety Agents, Benzodiazepine -- Administration and Dosage
KW  - Delayed-Action Preparations
KW  - Drug Combinations
KW  - Female
KW  - Human
KW  - Insurance -- Statistics and Numerical Data
KW  - Male
KW  - Middle Age
KW  - United States
KW  - Young Adult
SP  - 646
EP  - 653
JO  - Medical Care
JF  - Medical Care
JA  - MED CARE
VL  - 51
IS  - 8
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - OBJECTIVE: Emergency departments (EDs) routinely provide care for patients seeking treatment for painful conditions; however, they are also targeted by people seeking opioid analgesics for nonmedical use. This study determined the prevalence of indicators of potential ED opioid misuse and inappropriate prescription practices by ED providers in a large, commercially insured, adult population. RESEARCH DESIGN AND INDICATORS: We analyzed the 2009 Truven Health MarketScan Research Databases to examine the ED visits of enrollees aged 18-64 years. Indicators used to mark potential inappropriate use included opioid prescriptions overlapping by one week or more; overlapping opioid and benzodiazepine prescriptions; high daily doses (>=100 morphine milligram equivalents); long-acting/extended-release (LA/ER) opioids for acute pain, and overlapping LA/ER opioids. Analyses were stratified by sex. RESULTS: We identified 400,288 enrollees who received at least one ED opioid prescription. At least one indicator applied to 10.3% of enrollees: 7.7% had high daily doses; 2.0% had opioid overlap; 1.0% had opioid-benzodiazepine overlap. Among LA/ER opioid prescriptions, 21.7% were for acute pain, and 14.6% were overlapping. Females were more likely to have at least one indicator. CONCLUSIONS: In some instances, the prescribing of opioid analgesics in EDs might not be optimal in terms of minimizing the risk of their misuse. Guidelines for the cautious use of opioid analgesics in EDs and timely data from prescription drug monitoring programs could help EDs treat patients with pain while reducing the risk of nonmedical use.
SN  - 0025-7079
AD  - Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, GA.
U2  - PMID: 23632597.
DO  - 10.1097/MLR.0b013e318293c2c0
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104127400
T1  - The Implementation and Evaluation of an Evidence-based Statewide Prehospital Pain Management Protocol Developed using the National Prehospital Evidence-based Guideline Model Process for Emergency Medical Services.
AU  - Brown, Kathleen M.
AU  - Hirshon, Jon Mark
AU  - Alcorta, Richard
AU  - Weik, Tasmeen S.
AU  - Lawner, Ben
AU  - Ho, Shiu
AU  - Wright, Joseph L.
Y1  - 2014/01/02/Jan2014 Supplement
N1  - Accession Number: 104127400. Language: English. Entry Date: 20131224. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Supplement Title: Jan2014 Supplement. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Evidence-Based Practice. NLM UID: 9703530. 
KW  - Medical Practice, Evidence-Based
KW  - Pain -- Therapy
KW  - Protocols
KW  - Practice Guidelines -- Methods
KW  - Government Agencies
KW  - Emergency Medical Services
KW  - Emergency Care
KW  - Prehospital Care
KW  - United States
KW  - Patient Care -- Methods
KW  - Life Support Care
KW  - Data Analysis
KW  - Emergency Medical Technicians -- Education
KW  - Transportation of Patients
KW  - Advanced Cardiac Life Support -- Methods
KW  - Morphine -- Administration and Dosage
KW  - Dosage Forms
KW  - Male
KW  - Female
KW  - Age Factors
KW  - Pain -- Classification
KW  - Human
SP  - 45
EP  - 51
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 18
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background. In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. Methods. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. Results. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. Conclusions. We demonstrated that the implementation of a revised statewide prehospital pain management protocol based on an EBG developed using the National Prehospital Evidence-based Guideline Model Process was associated with an increase in dosing of narcotic pain medication consistent with that recommended by the EBG. No differences were seen in the percentage of patients receiving opiate analgesia or in the documentation of pain scores.
SN  - 1090-3127
AD  - from the Department of Pediatrics and Emergency Medicine, George Washington School of Medicine, Washington, DC (KMB); Emergency Department, Children's National Medical Center, Washington, DC (KMB); Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland (RA); Health Resources and Services Administration/Maternal and Child Health Bureau, Rockville, Maryland (TSW); Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland (BL); Baltimore City Fire Department, Baltimore Maryland (BL); Shock Trauma and Anesthesiology Research-Organized Research Center, University of Maryland School of Medicine, Baltimore Maryland (SH); Department of Pediatrics, Emergency Medicine, and Health Policy, George Washington University School of Medicine and Public Health, Washington, DC (JLW); Child Health Advocacy Institute, Children's National Medical Center, Washington, DC (JLW); and Department of Emergency Medicine, Department of Epidemiology and Public Health,
DO  - 10.3109/10903127.2013.831510
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123579739
T1  - Retrospective case series analysis of characteristics and trends in unintentional pharmaceutical drug poisoning by methadone, opioid analgesics, antidepressants and benzodiazepines in Clark County, NV 2009-13.
AU  - Bruno, Tamara
AU  - Pharr, Jennifer R.
Y1  - 2017/06//
N1  - Accession Number: 123579739. Language: English. Entry Date: 20170705. Revision Date: 20170705. Publication Type: Article; research; tables/charts. Journal Subset: Europe; Peer Reviewed; Public Health; UK & Ireland. Grant Information: This study was supported by a grant from the National Institute of General Medical Sciences (5 U54 GM104944).. NLM UID: 101188638. 
KW  - Overdose -- Trends -- Nevada
KW  - Prescriptions, Drug -- Utilization -- Nevada
KW  - Methadone -- Poisoning -- Nevada
KW  - Antianxiety Agents, Benzodiazepine -- Poisoning
KW  - Analgesics, Opioid -- Poisoning -- Nevada
KW  - Antidepressive Agents -- Poisoning -- Nevada
KW  - Human
KW  - Funding Source
KW  - Nevada
KW  - Adverse Drug Event
KW  - Overdose -- Epidemiology
KW  - Overdose -- Mortality
KW  - Retrospective Design
KW  - Male
KW  - Female
KW  - Adolescence
KW  - Young Adult
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Chi Square Test
KW  - Hospitalization
KW  - Emergency Care
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Secondary Analysis
KW  - Overdose -- Prevention and Control
KW  - Risk Taking Behavior
KW  - Health Education
KW  - Health Promotion
KW  - Public Health
SP  - 304
EP  - 311
JO  - Journal of Public Health
JF  - Journal of Public Health
JA  - J PUBLIC HEALTH
VL  - 39
IS  - 2
PB  - Oxford University Press / USA
AB  - Background Poisoning has become the leading cause of injury death in the USA--with opioid analgesic involved in more fatal poisonings than any other drug, including cocaine and heroin. The epidemic of prescription drug poisonings is a public health concern. This study aimed to define potential high-risk groups for unintentional prescription drug poisoning by methadone, opioid analgesics, antidepressants or benzodiazepines. Methods A hospital-based retrospective case series analysis of admissions related to prescription drug poisonings associated with methadone, opioid analgesics, antidepressants or benzodiazepines for hospitals in Clark County, Nevada between 2009 and 2013 was employed. Results There were 7414 admissions with a primary diagnosis of an unintentional poisoning due to methadone, opioid analgesics, antidepressants or benzodiazepines. Women had the highest rate of admissions particularly in the 45-54 age group. Higher rates of admissions were also found among non-Hispanic whites, single and uninsured populations. There were concerning increases in admissions among 65+ and Native American/Alaskan Native subgroups in 2013. Benzodiazepines and opioid analgesics were the most prevalent drug categories for prescription drug poisoning admissions. Conclusion Public health professionals can utilize hospital data to identify populations at risk and in need of targeted interventions.
SN  - 1741-3842
AD  - Department of Global and Environmental Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV 89154, USA
DO  - 10.1093/pubmed/fdw052
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193411
T1  - 271 Implementation of an Opioid Detoxification Management Pathway Reduces Emergency Department Length of Stay.
AU  - Bellew, S.D.
AU  - Collins, S.P.
AU  - Barrett, T.W.
AU  - Russ, S.
AU  - Jones, I.
AU  - Self, W.H.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193411. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S107
EP  - S107
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Vanderbilt University, Nashville, TN
DO  - 10.1016/j.annemergmed.2017.07.249
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193234
T1  - 205 Opioid Prescriptions Given in the Emergency Department Have Decreased from 2015 to 2017.
AU  - Jean-Noel, N.
AU  - Calichman, M.
AU  - Eskin, B.
AU  - Allegra, J.R.
AU  - Calello, D.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193234. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S83
EP  - S83
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Morristown Medical Center, Morristown, NJ
AD  - Emergency Medical Associates, Parsippany, NJ
AD  - NJ Poison Information and Education System, NJ Medical School, Rutgers Biomedical Health Sciences, Newark, NJ
DO  - 10.1016/j.annemergmed.2017.07.427
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193206
T1  - 5EMF A Qualitative Investigation of Emergency Department Provider Perspectives on Benzodiazepine-Opioid Co-Prescribing.
AU  - Kim, H.S.
AU  - McCarthy, D.M.
AU  - Hoppe, J.A.
AU  - Courtney, D.M.
AU  - Lambert, B.L.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193206. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S171
EP  - S171
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Northwestern University, Chicago, IL
AD  - University of Colorado, Aurora, CO
DO  - 10.1016/j.annemergmed.2017.07.319
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125193206&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193154
T1  - 170 Opioid Prescribing Varies Markedly Between Pediatric and General Emergency Departments for Children, Adolescents, and Young Adults With and Without Fracture.
AU  - Menchine, M.
AU  - Lam, C.N.
AU  - Arora, S.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193154. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S68
EP  - S69
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - USC Keck School of Medicine, Los Angeles, CA
DO  - 10.1016/j.annemergmed.2017.07.197
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193094
T1  - 252 Geospatial Analysis of Opioid Overdose- Related Emergency Medical Service Calls for Targeting Public Health Interventions.
AU  - Dworkis, D.A.
AU  - Weiner, S.G.
AU  - Rabickow, D.
AU  - Liao, V.T.
AU  - Goldberg, S.A.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193094. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S100
EP  - S100
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Harvard Medical School, Boston, MA
AD  - Brigham Health, Boston, MA
AD  - Professional EMS, Cambridge, MA
DO  - 10.1016/j.annemergmed.2017.07.230
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193091
T1  - 418 Emergency Medicine Clinicians' Views and Practices for Identifying Opioid Misuse in the Era of Prescription Drug Monitoring Programs.
AU  - McKay, M.E.
AU  - McCourt, J.D.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193091. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S164
EP  - S164
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of Nevada School of Medicine, Las Vegas, NV
DO  - 10.1016/j.annemergmed.2017.07.297
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125193000
T1  - 226 Adverse Childhood Events Scores in Opioid Misusing Patients Presenting to the Emergency Department.
AU  - Brucker, K.
Y1  - 2017/10/02/Oct2017 Supplement
N1  - Accession Number: 125193000. Language: English. Entry Date: In Process. Revision Date: 20170922. Publication Type: Article. Supplement Title: Oct2017 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S90
EP  - S91
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Indiana University School of Medicine, Indianapolis, IN
DO  - 10.1016/j.annemergmed.2017.07.448
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123688332
T1  - Opioid Addiction in Medicaid Population Calls for New Case Management Strategies: One solution: Limit patients to one pharmacy.
Y1  - 2017/07//
N1  - Accession Number: 123688332. Language: English. Entry Date: 20170628. Revision Date: 20170629. Publication Type: Article. Journal Subset: Nursing; USA. NLM UID: 9302170. 
KW  - Substance Dependence
KW  - Case Management
KW  - Medicaid
KW  - Narcotics
KW  - Primary Health Care
KW  - Emergency Service -- Utilization
KW  - Health Services Accessibility
KW  - Drug Utilization
KW  - Patient Education
SP  - 76
EP  - 77
JO  - Case Management Advisor
JF  - Case Management Advisor
JA  - CASE MANAGE ADVIS
VL  - 28
IS  - 7
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - Healthcare organizations saw a disturbing trend of opioid addiction among some Medicaid plan members. The challenge was to address this problem and reduce its resulting increase in ED utilization. • An interrelated trend was of Medicaid patients not seeing their primary care providers and overusing EDs. • A solution was a one-pharmacy rule as part of a safety initiative. • Patients with the highest ED visits in a six-month window were targeted for the program and provided telephonic case management, as well as visits by outreach teams.
SN  - 1053-5500
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106187738
T1  - Prescription opioid abuse in the emergency department.
AU  - Wilsey BL
AU  - Fishman SM
AU  - Ogden C
Y1  - 2005///Winter2005
N1  - Accession Number: 106187738. Language: English. Entry Date: 20071109. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9315583. 
KW  - Emergency Service
KW  - Pain -- Diagnosis
KW  - Substance Use Disorders -- Diagnosis
KW  - Chronic Disease
KW  - Comorbidity
KW  - Diagnosis, Differential
KW  - Documentation
KW  - Drug and Narcotic Control -- Legislation and Jurisprudence -- United States
KW  - Pain -- Drug Therapy
KW  - Pain -- Epidemiology
KW  - Patient Compliance
KW  - Substance Use Disorders -- Drug Therapy
KW  - Substance Use Disorders -- Epidemiology
KW  - United States
SP  - 770
EP  - 782
JO  - Journal of Law, Medicine & Ethics
JF  - Journal of Law, Medicine & Ethics
JA  - J LAW MED ETHICS
VL  - 33
IS  - 4
CY  - Thousand Oaks, California
PB  - Sage Publications Inc.
SN  - 1073-1105
AD  - University of California, Davis, VANCHCS/UCD Analgesic Research Center, USA.
U2  - PMID: 16686246.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128187814
T1  - 2017 - Ibuprofen + acetaminophen did not differ from opioids + acetaminophen for reducing acute extremity pain at 2 h.
AU  - Varner, Catherine
AU  - Carpenter, Christopher R.
Y1  - 2018/02/20/
N1  - Accession Number: 128187814. Language: English. Entry Date: 20180323. Revision Date: 20180323. Publication Type: Article; abstract; commentary; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9104824. 
KW  - Ibuprofen -- Administration and Dosage
KW  - Acetaminophen -- Administration and Dosage
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Drug Therapy, Combination
KW  - Pain -- Drug Therapy
KW  - Extremities
KW  - Oxycodone -- Administration and Dosage
KW  - Codeine -- Administration and Dosage
KW  - Emergency Care
KW  - Treatment Outcomes
SP  - 8
EP  - 8
JO  - ACP Journal Club
JF  - ACP Journal Club
JA  - ACP J CLUB
VL  - 168
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
AB  - Question In patients who present to the emergency department (ED), how do different oral analgesics, combined with acetaminophen, compare for reducing acute extremity pain? Methods Design Randomized controlled trial (RCT). ClinicalTrials.gov NCT02455518. Allocation Concealed.* Blinding Blinded* (patients and clinicians). Follow-up period 2 hours. Setting 2 EDs in New York, USA. Patients 416 adults 21 to 64 years of age (mean age 37 y, 52% men, mean pain score 8.7 on an 11-point numerical rating scale [NRS]) who presented to the ED for management of acute extremity pain and required radiologic imaging. Exclusion criteria were presence of a chronic condition that required frequent pain management or that could affect metabolism of a study drug, pregnancy or breastfeeding, history of peptic ulcer disease or adverse reaction to any study medication, current use of a drug that could interact with a study drug, use of ibuprofen or acetaminophen in the past 8 hours or opioids in the past 24 hours, or any past use of methadone or illicit narcotics. Intervention 3 identical capsules containing a total of ibuprofen, 400 mg, plus acetaminophen, 1000 mg (n = 104); oxycodone, 5 mg, plus acetaminophen, 325 mg (n = 104); hydrocodone, 5 mg, plus acetaminophen, 300 mg (n = 104); or codeine, 30 mg, plus acetaminophen, 300 mg (n = 104). Outcomes Change in pain (NRS) at 2 hours. Secondary outcomes included change in pain at 1 hour and use of rescue analgesics. 400 patients provided 80% power to detect a 1.3-point difference (minimum clinically important difference) in change in the NRS score (2-sided a = 0.05). Patient follow-up 98% (intention-to-treat analysis). Main results 62% of patients had sprains or strains, 21% had extremity fractures, 9% had muscle pain, 4% had contusions, and 3% had other diagnoses. Analysis of variance showed no difference across all groups in change in pain at 2 hours (P = 0.053) or at 1 hour (P = 0.13). Comparisons of pairs of treatments showed that no treatment differed from another at 2 hours (Table) or at 1 hour. Groups did not differ for the proportion of patients who received rescue analgesics (P = 0.42). Conclusion In patients who present to the emergency department with acute extremity pain, ibuprofen plus acetaminophen did not differ from opioid-plus-acetaminophen combinations for reducing pain at 2 hours.
SN  - 1056-8751
AD  - Mount Sinai Hospital, University of Toronto Toronto, Ontario, Canada
AD  - Washington University n St. Louis St. Louis, Missouri, USA
DO  - 10.7326/ACPJC-2018-168-4-021
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 124247022
T1  - When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications.
AU  - Rech, Megan A.
AU  - Barbas, Brian
AU  - Chaney, Whitney
AU  - Greenhalgh, Elizabeth
AU  - Turck, Charles
Y1  - 2017/08//
N1  - Accession Number: 124247022. Language: English. Entry Date: 20171023. Revision Date: 20171209. Publication Type: journal article; review. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Instrumentation: Frenchay Aphasia Screening Test (FAST). NLM UID: 8002646. 
KW  - Wounds and Injuries -- Therapy
KW  - Overdose -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service
KW  - Hypnotics and Sedatives -- Administration and Dosage
KW  - Midazolam -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Fentanyl -- Administration and Dosage
KW  - Ketamine -- Administration and Dosage
KW  - Treatment Outcomes
KW  - Imidazoles -- Administration and Dosage
KW  - Clinical Trials
KW  - Conscious Sedation -- Methods
KW  - Naloxone -- Administration and Dosage
KW  - Practice Guidelines
KW  - Patient Safety
KW  - Clinical Assessment Tools
SP  - 203
EP  - 211
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 70
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - The intranasal route for medication administration is increasingly popular in the emergency department and out-of-hospital setting because such administration is simple and fast, and can be used for patients without intravenous access and in situations in which obtaining an intravenous line is difficult or time intensive (eg, for patients who are seizing or combative). Several small studies (mostly pediatric) have shown midazolam to be effective for procedural sedation, anxiolysis, and seizures. Intranasal fentanyl demonstrates both safety and efficacy for the management of acute pain. The intranasal route appears to be an effective alternative for naloxone in opioid overdose. The literature is less clear on roles for intranasal ketamine and dexmedetomidine.
SN  - 0196-0644
AD  - Department of Pharmacy, Loyola University Medical Center, Maywood, IL
AD  - Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL
AD  - ScientiaCME, LLC, Highland Park, IL
U2  - PMID: 28366351.
DO  - 10.1016/j.annemergmed.2017.02.015
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110038175
T1  - Overprescribing opioids leads to more than $718,000 jury verdict.
AU  - Capozzola, Damian D.
AU  - Terrence, Jamie
AU  - Vassalli, David
Y1  - 2015/10/02/Oct2015 Supplement Legal Review & Commentary
N1  - Accession Number: 110038175. Language: English. Entry Date: 20151012. Revision Date: 20170928. Publication Type: Article; legal case. Supplement Title: Oct2015 Supplement Legal Review & Commentary. Journal Subset: Health Services Administration; USA. Legal Case: Superior Court of Cobb County, GA. Case No. A13A1417 (Dec. 11, 2012).. NLM UID: 9889160. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Wrongful Death -- Legislation and Jurisprudence -- United States
KW  - Overdose
KW  - United States
KW  - Damages, Legal
KW  - Pulmonary Disease, Chronic Obstructive
KW  - Emergency Care
KW  - Negligence
KW  - Brain Injuries
KW  - Analgesics, Opioid -- Administration and Dosage
SP  - 1
EP  - 3
JO  - Healthcare Risk Management
JF  - Healthcare Risk Management
JA  - HEALTHC RISK MANAGE
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - The article discusses the overscription of opioids in the U.S. and the associated jury verdict. It mentions the case of a 64-year-old man who went to seek treatment for his broken foot and chronic obstructive pulmonary disease (COPD). It cites the need for the careful administration of opioids and other dangerous medications.
SN  - 1081-6534
AD  - Law Offices of Damian D. Capozzola, Los Angeles
AD  - President and Founder, Healthcare Risk Services
AD  - Pepperdine University School of Law, Malibu, CA
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110038175&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109545142
T1  - Safety and efficacy of intranasally administered medications in the emergency department and prehospital settings.
AU  - CORRIGAN, MEGAN
AU  - WILSON, SUPRAT SAELY
AU  - HAMPTON, JEREMY
Y1  - 2015/09/15/
N1  - Accession Number: 109545142. Language: English. Entry Date: 20150922. Revision Date: 20160115. Publication Type: Article; review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. 
KW  - Drug Therapy
KW  - Administration, Intranasal -- Methods
KW  - Patient Safety
KW  - Emergency Service
KW  - Prehospital Care
KW  - Drugs -- Metabolism
KW  - Respiratory System -- Anatomy and Histology
KW  - Respiratory System -- Physiopathology
KW  - Biological Availability
KW  - Nasal Cavity -- Anatomy and Histology
KW  - Fentanyl -- Therapeutic Use
KW  - Sufentanil -- Therapeutic Use
KW  - Drug Delivery Systems
KW  - Dihydromorphinone -- Therapeutic Use
KW  - Ketamine -- Therapeutic Use
KW  - Haloperidol -- Therapeutic Use
KW  - Naloxone -- Therapeutic Use
KW  - Flumazenil -- Therapeutic Use
KW  - Glucagon -- Therapeutic Use
SP  - 1544
EP  - 1554
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 72
IS  - 18
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - Purpose. The safety and efficacy of medications that may be administered via the intranasal route in adult patients in the prehospital and emergency department (ED) settings are reviewed. Summary. When medications of appropriate molecular character and concentration are delivered intranasally, they are quickly transported across this capillary network and delivered to the systemic circulation, thereby avoiding the absorption-limiting effects of first-pass metabolism. Therapeutic drug concentrations are rapidly attained in the cerebrospinal fluid, making intranasal administration a very effective mode of delivery. To optimize the bioavailability of intranasally administered drugs, providers must minimize the barriers to absorption, minimize the volume by maximizing the concentration, maximize the absorptive surface of the nasal mucosa, and use a delivery system that maximizes drug dispersion and minimizes drug runoff. Medications can be instilled into the nasal cavity with syringes or droppers by applying a few drops at a time or via atomization. The intranasal route of administration may be advantageous for patients who require analgesia, sedation, anxiolysis, termination of seizures, hypoglycemia management, narcotic reversal, and benzodiazepine reversal in the ED or prehospital settings. Medications that have been studied in the adult population include fentanyl, sufen-tanil, hydromorphone, ketamine, midazolam, haloperidol, naloxone, flumazenil, and glucagon. The available data do indicate, however, that intranasal administration may be a safe, effective, and well tolerated route of administration. Conclusion. Based on the published literature, intranasal administration of fentanyl, sufentanil, ketamine, hydromorphone, midazolam, haloperidol, naloxone, glucagon, and, in limited cases, flumazenil may be a safe, effective, and well-tolerated alternative to intramuscular or intravenous administration in the prehospital and ED settings.
SN  - 1079-2082
AD  - Emergency Medicine Clinical Pharmacist, Department of Pharmacy, Advocate Illinois Masonic Medical Center, Chicago
AD  - Emergency Medicine Clinical Pharmacist Specialist, Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, MI
AD  - Is Clinical Specialist Emergency Medicine, Truman Medical Center, Kansas City, MO
AD  - Clinical Assistant Professor, School of Pharmacy, University of Missouri--Kansas City, Kansas City
U2  - PMID: 26346210.
DO  - 10.2146/ajhp140630
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109545142&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121787072
T1  - Benzodiazepine-opioid co-prescribing in a national probability sample of ED encounters.
AU  - Kim, Howard S.
AU  - McCarthy, Danielle M.
AU  - Mark Courtney, D.
AU  - Lank, Patrick M.
AU  - Lambert, Bruce L.
Y1  - 2017/03//
N1  - Accession Number: 121787072. Language: English. Entry Date: 20170506. Revision Date: 20170506. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Antianxiety Agents, Benzodiazepine -- Adverse Effects
KW  - Overdose -- Mortality
KW  - Drug Interactions
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Respiratory Failure -- Chemically Induced
KW  - Overdose -- Epidemiology
KW  - Female
KW  - Aged
KW  - Surveys
KW  - Adult
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Male
KW  - Demography
KW  - Aged, 80 and Over
KW  - Odds Ratio
KW  - Adolescence
KW  - Young Adult
KW  - Middle Age
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Therapy, Combination -- Adverse Effects
SP  - 458
EP  - 464
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 35
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Background: Benzodiazepine-opioid combination therapy is potentially harmful due to the risk of synergistic respiratory depression, and the rate of death due to benzodiazepine-opioid overdose is increasing. Little is known about the prevalence and characteristics of benzodiazepine-opioid co-prescribing from the ED setting.Methods: Secondary analysis of data from the National Hospital Ambulatory Medical Care Survey, using sample weights to generate population estimates. The primary objective was to describe the annual prevalence of benzodiazepine-opioid co-prescribing from 2006 to 2012, using 95% confidence intervals (95% CI) to compare adjacent years. The secondary objective was to compare characteristics of ED encounters receiving a benzodiazepine-opioid co-prescription versus those receiving an opioid prescription alone, using a multivariable logistic regression.Results: The prevalence of benzodiazepine-opioid co-prescribing did not significantly change from 2006 to 2012. During this period, 2.7% (95% CI: 2.5-2.8%) of ED encounters prescribed an opioid were also prescribed a benzodiazepine. Relative to encounters receiving an opioid prescription alone, encounters receiving a co-prescription were more likely to represent a follow-up rather than initial visit (Odds Ratio [OR] 1.52), receive more medications (OR 1.41) and fewer procedures (OR 0.48) while in the ED, and more likely to have a diagnosis related to mental disorder (OR 20.60) or musculoskeletal problem (OR 3.71).Conclusions: From 2006 to 2012, almost 3% of all ED encounters receiving an opioid prescription also received a benzodiazepine co-prescription. The odds of benzodiazepine-opioid co-prescribing were significantly higher in ED encounters representing a follow-up visit and in diagnoses relating to a mental disorder or musculoskeletal problem.
SN  - 0735-6757
AD  - Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
AD  - Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
AD  - Department of Communication Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
U2  - PMID: 27923527.
DO  - 10.1016/j.ajem.2016.11.054
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121787072&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104189577
T1  - Vital signs: overdoses of prescription opioid pain relievers and other drugs among women--United States, 1999-2010.
Y1  - 2013/07/05/
N1  - Accession Number: 104189577. Corporate Author: Centers for Disease Control and Prevention (CDC). Language: English. Entry Date: 20130913. Revision Date: 20180123. Publication Type: journal article. Journal Subset: Biomedical; Public Health; USA. Special Interest: Public Health. NLM UID: 7802429. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Emergency Service
KW  - Drugs, Prescription
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Female
KW  - Middle Age
KW  - United States
KW  - Young Adult
SP  - 537
EP  - 542
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 62
IS  - 26
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
AB  - Background: Overdose deaths have increased steadily over the past decade. This report describes drug-related deaths and emergency department (ED) visits among women.Methods: CDC analyzed rates of fatal drug overdoses and drug misuse- or abuse-related ED visits among women using data from the National Vital Statistics System (1999-2010) and the Drug Abuse Warning Network (2004-2010).Results: In 2010, a total of 15,323 deaths among women were attributed to drug overdose, a rate of 9.8 per 100,000 population. Deaths from opioid pain relievers (OPRs) increased fivefold between 1999 and 2010 for women; OPR deaths among men increased 3.6 times. In 2010, there were 943,365 ED visits by women for drug misuse or abuse. The highest ED visit rates were for cocaine or heroin (147.2 per 100,000 population), benzodiazepines (134.6), and OPR (129.6). ED visits related to misuse or abuse of OPR among women more than doubled between 2004 and 2010.Conclusions: Although more men die from drug overdoses than women, the percentage increase in deaths since 1999 is greater among women. More women have died each year from drug overdoses than from motor vehicle-related injuries since 2007. Deaths and ED visits related to OPR continue to increase among women. The prominent involvement of psychotherapeutic drugs, such as benzodiazepines, among overdoses provides insight for prevention opportunities.Implications For Public Health Practice: Health-care providers should follow guidelines for responsible prescribing, including screening and monitoring for substance abuse and mental health problems, when prescribing OPR. Health-care providers who treat women for pain should use their state's prescription drug monitoring program and regularly screen patients for psychological disorders and use of psychotherapeutic drugs, with or without a prescription.
SN  - 0149-2195
U2  - PMID: 23820967.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104189577&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123615640
T1  - Arizona Under Statewide Opioid Health Emergency.
Y1  - 2017/06/13/
N1  - Accession Number: 123615640. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article. Journal Subset: Consumer Health; USA. NLM UID: 8704590. 
KW  - Health
KW  - Emergencies
KW  - Public Health
KW  - Occupational Health
KW  - Neonatal Abstinence Syndrome
KW  - Arizona
SP  - 1
EP  - 2
JO  - Occupational Health & Safety News
JF  - Occupational Health & Safety News
JA  - OCCUP HEALTH SAF NEWS
CY  - Chatsworth, California
PB  - 1105 Media, Inc.
SN  - 0896-3835
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123615640&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105473527
T1  - Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3. Training and prescription of naloxone for personal use in overdose for opiate addicts.
AU  - Barrie J
Y1  - 2008/10//
N1  - Accession Number: 105473527. Language: English. Entry Date: 20090320. Revision Date: 20150820. Publication Type: Journal Article. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Emergency Care. NLM UID: 100963089. 
KW  - Heroin -- Poisoning
KW  - Naloxone -- Administration and Dosage
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Substance Use Disorders -- Drug Therapy
KW  - Male
KW  - Overdose -- Drug Therapy
KW  - Self Administration
SP  - 688
EP  - 689
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
VL  - 25
IS  - 10
PB  - BMJ Publishing Group
SN  - 1472-0205
U2  - PMID: 18843073.
DO  - 10.1136/emj.2008.065714
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105473527&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118579439
T1  - Magnitude of rib fracture displacement predicts opioid requirements.
AU  - Bugaev, Nikolay
AU  - Breeze, Janis L.
AU  - Alhazmi, Majid
AU  - Anbari, Hassan S.
AU  - Arabian, Sandra S.
AU  - Holewinski, Sharon
AU  - Rabinovici, Reuven
Y1  - 2016/10//
N1  - Accession Number: 118579439. Language: English. Entry Date: 20170703. Revision Date: 20180127. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Injury Severity Score (ISS). Grant Information: UL1 TR001064/TR/NCATS NIH HHS/United States. NLM UID: 101570622. 
KW  - Wounds, Nonpenetrating -- Pathology
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Pain -- Therapy
KW  - Rib Fractures -- Pathology
KW  - Adolescence
KW  - Wounds, Nonpenetrating
KW  - Retrospective Design
KW  - Trauma Severity Indices
KW  - Female
KW  - Tomography, X-Ray Computed
KW  - Male
KW  - Patient-Controlled Analgesia
KW  - Middle Age
KW  - Massachusetts
KW  - Adult
KW  - Trauma Centers
KW  - Rib Fractures
KW  - Aged
SP  - 699
EP  - 704
JO  - Journal of Trauma & Acute Care Surgery
JF  - Journal of Trauma & Acute Care Surgery
JA  - J TRAUMA ACUTE CARE SURG
VL  - 81
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Introduction: It is unknown whether the magnitude of rib fracture (RF) displacement predicts pain medication requirements in blunt chest trauma patients.Methods: Adult blunt RF patients undergoing computed tomography (CT) of the chest admitted to an urban Level 1 trauma center (2007-2012) were retrospectively reviewed. Pain management in those with displaced RF (DRF), nondisplaced RF (NDRF), or combined DRF and NDRF (CRF) was compared by univariate analysis. Linear regression models were developed to determine whether total opioid requirements [expressed as log morphine equianalgesic dose (MED)] could be predicted by the magnitude of RF displacement (expressed as the sum of the Euclidean distance of all displaced RF) or number of RF, after adjusting for patient and injury characteristics.Results: There were 245 patients, of whom 39 (16%) had DRF only, 77 (31%) had NDRF only, and 129 (53%) had CRF. Opioids were given to 224 patients (91%). Compared to DRF (mean, 1.7 RF per patient) and NDRF patients (2.4 RF per patient), those with CRF (6.8 RF per patient) were older and had more RF per patient and a higher Injury Severity Score (ISS) and MED (251 vs 53 and 105 mg, respectively, p < 0.0001 and p = 0.0045). They also more frequently received patient-controlled analgesia. Patients with displaced RF had a lower mean ISS and MED and received more epidural analgesia compared with patients with NDRF. Total MED was associated with both the magnitude of RF displacement (p < 0.0001) and the number of RF (p < 0.0001). Every 5-mm increase in total displacement predicted a 6.3% increase in mean MED (p = 0.0035), while every additional RF predicted an 11.2% increase in MED (p = 0.0001). These associations included adjustment for age, ISS, and presence of chest tubes.Conclusion: The magnitude of RF displacement and the number of RF predicted opioid requirements. This information may assist in anticipating patients with blunt RF who might have higher analgesic requirements.Level Of Evidence: Therapeutic study, level IV.
SN  - 2163-0755
AD  - Division of Trauma and Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
AD  - Tufts Clinical and Translational Science Institute, Tufts University
AD  - Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
U2  - PMID: 27389132.
DO  - 10.1097/TA.0000000000001169
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118579439&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120985800
T1  - The Opiate Epidemic.
AU  - Ludwig, Gary
Y1  - 2017/02//
N1  - Accession Number: 120985800. Language: English. Entry Date: 20170131. Revision Date: 20170207. Publication Type: Article. Journal Subset: Allied Health; USA. 
KW  - Social Problems -- United States
KW  - Overdose
KW  - Substance Abusers
KW  - Analgesics, Opioid -- Adverse Effects
KW  - United States
KW  - Substance Dependence -- Risk Factors
KW  - Heroin
KW  - Naloxone
SP  - 32
EP  - 32
JO  - Firehouse
JF  - Firehouse
JA  - FIREHOUSE
VL  - 42
IS  - 2
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
AB  - The article discusses the problem associated with inappropriate administration of nasal naloxone to individuals affected with opioid addiction in the U.S. The prevalence of opiate addiction is traced to unnecessary prescription of pain medicine and the use of heroin as an alternative to costly painkillers. The role of emergency medical services (EMS) system in addressing opiate addiction and epidemic is emphasized.
SN  - 0145-4064
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 116166741
T1  - ED-based Counseling Sessions Reduce Risky Opioid Use Among Certain Patients.
Y1  - 2016/07//
N1  - Accession Number: 116166741. Language: English. Entry Date: 20160617. Revision Date: 20160622. Publication Type: Article. Journal Subset: Nursing; USA. NLM UID: 9425690. 
KW  - Analgesics, Opioid
KW  - Substance Abuse -- Prevention and Control
KW  - Emergency Service
KW  - Counseling -- Methods
KW  - Harm Reduction
KW  - Motivational Interviewing -- Utilization
KW  - Randomized Controlled Trials
KW  - Education, Continuing (Credit)
SP  - 81
EP  - 83
JO  - ED Management
JF  - ED Management
JA  - ED MANAGE
VL  - 28
IS  - 7
CY  - Atlanta, Georgia
PB  - AHC Media LLC
SN  - 1044-9167
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116166741&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 116691712
T1  - Trends in the Concomitant Prescribing of Opioids and Benzodiazepines, 2002-2014.
AU  - Hwang, Catherine S.
AU  - Kang, Elizabeth M.
AU  - Kornegay, Cynthia J.
AU  - Staffa, Judy A.
AU  - Jones, Christopher M.
AU  - McAninch, Jana K.
Y1  - 2016/08//
N1  - Accession Number: 116691712. Language: English. Entry Date: In Process. Revision Date: 20180127. Publication Type: journal article. Journal Subset: Biomedical; Health Promotion/Education; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 8704773. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Adverse Drug Event
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Overdose -- Drug Therapy
KW  - Female
KW  - Aged
KW  - Adult
KW  - Male
KW  - Middle Age
KW  - Scales
SP  - 151
EP  - 160
JO  - American Journal of Preventive Medicine
JF  - American Journal of Preventive Medicine
JA  - AM J PREV MED
VL  - 51
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Introduction: Although many clinical guidelines caution against the combined use of opioids and benzodiazepines, overdose deaths and emergency department visits involving the co-ingestion of these drugs are increasing.Methods: In this ecologic time series study, the IMS Health Total Patient Tracker was used to describe nationally projected trends of patients receiving opioids and benzodiazepines in the U.S. outpatient retail setting between January 2002 and December 2014. The IMS Health Data Extract Tool was used to examine trends in the concomitant prescribing of these two medication classes among 177 million individuals receiving opioids during this period. The annual proportion of opioid recipients who were prescribed benzodiazepines concomitantly was calculated and stratified by gender, age, duration of opioid use, immediate-release versus extended-release/long-acting opioids, and benzodiazepine molecule. The proportion of patients with concomitancy receiving opioids and benzodiazepines from the same prescriber was also analyzed. Analyses were conducted from April to June 2015.Results: The nationally projected number of patients receiving opioids and benzodiazepines increased by 8% and 31%, respectively, from 2002 to 2014. During this period, the annual proportion of opioid recipients dispensed a benzodiazepine concomitantly increased from 6.8% to 9.6%, which corresponded to a relative increase of 41%. Approximately half of these patients received both prescriptions from the same prescriber on the same day. Concomitancy was more common in patients receiving opioids for ≥90 days, women, and the elderly.Conclusions: Concomitant prescribing of opioids and benzodiazepines is increasing and may play a growing role in adverse patient outcomes related to these medications.
SN  - 0749-3797
AD  - Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
AD  - Division of Science Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C.
U2  - PMID: 27079639.
DO  - 10.1016/j.amepre.2016.02.014
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 113491441
T1  - Case Study: Therapeutic Interchange in Patients Being Treated for Opioid Dependence--Rationale and Real-World Experience.
Y1  - 2016/02/05/Feb2016 Supplement Case Study
N1  - Accession Number: 113491441. Language: English. Entry Date: 20160307. Revision Date: 20160309. Publication Type: Interview; case study; questions and answers; tables/charts. Supplement Title: Feb2016 Supplement Case Study. Journal Subset: Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. NLM UID: 9613960. 
KW  - Substance Abuse -- Diagnosis
KW  - Patient Care
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Managed Care Programs
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service
KW  - Death
KW  - Heroin
KW  - Substance Abusers
KW  - Substance Abuse -- Economics
KW  - Substance Abuse -- Therapy
KW  - United States Food and Drug Administration
KW  - Naloxone -- Administration and Dosage
KW  - Buprenorphine -- Administration and Dosage
KW  - Drug Therapy, Combination
SP  - 1
EP  - 7
JO  - American Journal of Managed Care
JF  - American Journal of Managed Care
JA  - AM J MANAGE CARE
CY  - Plainsboro, New Jersey
PB  - Intellisphere, LLC
AB  - An interview with Sheila Arquette, director of pharmacy at Independent Health is presented where she talked about Independent Health's experience with therapeutic interchange from Suboxone Film To ZUBSOLV Tablet. Topics covered include the expectations in terms of benefits of the interchange, how the process of implementing the therapeutic interchange started and the steps taken by Independent Health to make the therapeutic interchange happen.
SN  - 1088-0224
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103859885
T1  - Gender and Prescription Opioid Misuse in the Emergency Department Relanción entre el Género y el Mal uso de la Prescripción de Opiáceos en el Servicio de Urgencias.
AU  - Choo, Esther K.
AU  - Douriez, Carole
AU  - Green, Traci
Y1  - 2014/12//
N1  - Accession Number: 103859885. Language: English. Entry Date: 20141211. Revision Date: 20151201. Publication Type: Journal Article; proceedings; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9418450. 
KW  - Prescribing Patterns
KW  - Substance Abuse -- Diagnosis
KW  - Emergency Service
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Medicine
KW  - Serial Publications
KW  - Human
KW  - Male
KW  - Female
KW  - Mental Health
KW  - Government Agencies
KW  - Comorbidity
KW  - Retrospective Design
KW  - Databases
KW  - Data Analysis
KW  - Confidence Intervals
SP  - 1493
EP  - 1498
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 21
IS  - 12
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - Department of Emergency Medicine, Warren Alpert Medical School; School of Public Health, Brown University
AD  - Department of Emergency Medicine, Boston University
U2  - PMID: 25491712.
DO  - 10.1111/acem.12547
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103912807
T1  - 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 La Ketamina a Dosis Bajas Mejora el Alivio del Dolor en Pacientes que...
AU  - Beaudoin, Francesca L.
AU  - Lin, Charlie
AU  - Guan, Wentao
AU  - Merchant, Roland C.
Y1  - 2014/11//
N1  - Accession Number: 103912807. Language: English. Entry Date: 20141110. Revision Date: 20151102. Publication Type: Journal Article; clinical trial; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care; Evidence-Based Practice. NLM UID: 9418450. 
KW  - Education, Medical, Continuing
KW  - Ketamine -- Administration and Dosage
KW  - Pain -- Therapy
KW  - Administration, Intravenous
KW  - Acute Disease
KW  - Emergency Service
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Medicine
KW  - Human
KW  - Clinical Trials
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Patient Assessment
KW  - Dosage Calculation
KW  - Morphine -- Administration and Dosage
KW  - Drug Therapy, Combination
KW  - Consent
KW  - Outcomes (Health Care)
KW  - Data Analysis
KW  - Patient Selection
KW  - Adult
KW  - Ethnic Groups
KW  - Patient Discharge
KW  - Pain -- Etiology
KW  - Adverse Drug Event
SP  - 1193
EP  - 1202
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 21
IS  - 11
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - The Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University
U2  - PMID: 25377395.
DO  - 10.1111/acem.12510
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103856204
T1  - The opioid prescription epidemic and the role of emergency medicine.
AU  - Poon, Sabrina J
AU  - Greenwood-Ericksen, Margaret B
Y1  - 2014/11//
N1  - Accession Number: 103856204. Language: English. Entry Date: 20150508. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Emergency Medicine
KW  - Disease Outbreaks -- Prevention and Control
KW  - Substance Use Disorders -- Epidemiology
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Standards
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Substance Use Disorders -- Prevention and Control
KW  - Practice Patterns
KW  - Practice Guidelines
KW  - United States
SP  - 490
EP  - 495
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 64
IS  - 5
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Harvard Affiliated Emergency Medicine Residency-Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA. Electronic address: sjpoon@partners.org.
AD  - Harvard Affiliated Emergency Medicine Residency-Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA.
U2  - PMID: 25017821.
DO  - 10.1016/j.annemergmed.2014.06.016
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103856204&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103904836
T1  - Emergency Medical Services Naloxone Access: A National Systematic Legal Review Acceso a la Naloxona en los Servicios Médicos de Emergencias: Una Revisión Sistemática de los Aspectos Legales a Nivel Nacional.
AU  - Davis, Corey S.
AU  - Southwell, Jessica K.
AU  - Niehaus, Virginia Radford
AU  - Walley, Alexander Y.
AU  - Dailey, Michael W.
Y1  - 2014/10//
N1  - Accession Number: 103904836. Language: English. Entry Date: 20141014. Revision Date: 20151001. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9418450. 
KW  - Emergency Medical Services
KW  - Naloxone -- Administration and Dosage
KW  - Legal Procedure
KW  - Emergency Medicine
KW  - Human
KW  - United States
KW  - Overdose -- Mortality
KW  - Prehospital Care
KW  - Emergency Medical Technicians -- Evaluation
KW  - Data Analysis
KW  - Drug Evaluation
KW  - Naloxone -- Therapeutic Use
KW  - Analgesics, Opioid -- Adverse Effects
SP  - 1173
EP  - 1177
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 21
IS  - 10
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - The Network for Public Health Law-Southeastern Region
AD  - The North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
AD  - The Clinical Addiction Research and Education Unit, Boston University School of Medicine
AD  - The Department of Emergency Medicine, Albany Medical Center
DO  - 10.1111/acem.12485
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103904836&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109737028
T1  - Communication about opioid versus nonopioid analgesics in the emergency department.
AU  - McCarthy, Danielle M
AU  - Cameron, Kenzie A
AU  - Courtney, D Mark
AU  - Adams, James G
AU  - Engel, Kirsten G
Y1  - 2015/05//2015 May-Jun
N1  - Accession Number: 109737028. Language: English. Entry Date: 20150923. Revision Date: 20150923. Publication Type: Journal Article. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101234523. 
SP  - 229
EP  - 236
JO  - Journal of Opioid Management
JF  - Journal of Opioid Management
JA  - J OPIOID MANAGE
VL  - 11
IS  - 3
CY  - Weston, Massachusetts
PB  - Weston Medical Publishing, LLC
SN  - 1551-7489
U2  - PMID: 25985807.
DO  - 10.5055/jom.2015.0271
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109737028&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122626228
T1  - Eradicating the Overuse of Opioids on the Front Line.
AU  - Gillon, Jennifer
AU  - Muller, Lynn S.
Y1  - 2017/03//Mar/Apr2017
N1  - Accession Number: 122626228. Language: English. Entry Date: 20170629. Revision Date: 20170629. Publication Type: Article. Journal Subset: Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 101291585. 
KW  - Analgesics, Opioid
KW  - Substance Abuse -- Prevention and Control
KW  - Case Managers
KW  - Professional Role
KW  - Narcotics -- Legislation and Jurisprudence -- United States
KW  - United States
KW  - Emergency Service
KW  - Pain Measurement -- Methods
KW  - Patient Satisfaction
KW  - Pain Management -- Methods
KW  - Electronic Health Records
KW  - Drug Monitoring -- Methods
KW  - Alternative Therapies
KW  - Analgesics, Nonnarcotic
SP  - 81
EP  - 85
JO  - Professional Case Management
JF  - Professional Case Management
JA  - PROF CASE MANAGE
VL  - 22
IS  - 2
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 1932-8087
AD  - Emergency department nurse, Englewood Hospital and Medical Center in Englewood, NJ
AD  - Nurse attorney, independent case manager, and managing partner of Muller & Muller
DO  - 10.1097/NCM.0000000000000212
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122626228&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107935554
T1  - Nonmedical Prescription Opioid and Sedative Use Among Adolescents in the Emergency Department.
AU  - Whiteside, Lauren K.
AU  - Walton, Maureen A.
AU  - Bohnert, Amy S. B.
AU  - Blow, Frederic C.
AU  - Bonar, Erin E.
AU  - Ehrlich, Peter
AU  - Cunningham, Rebecca M.
Y1  - 2013/11//
N1  - Accession Number: 107935554. Language: English. Entry Date: 20131105. Revision Date: 20150712. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pediatric Care. Instrumentation: Youth Risk Behavior Survey (YRBS); Alcohol Use Disorders Identification Test (AUDIT); Conflict in Adolescent Dating Relationship Inventory; National Institute on Drug Abuse Alcohol, Smoking and Substance Involvement Screening Tests. Grant Information: National Institute of alcohol abuse and alcoholism grant 5 RO1 AA018122 04 FUNDED BY NIH. NLM UID: 0376422. 
KW  - Narcotics -- Administration and Dosage -- In Adolescence
KW  - Hypnotics and Sedatives -- Administration and Dosage -- In Adolescence
KW  - Emergency Service
KW  - Dating Violence -- In Adolescence
KW  - Substance Abuse
KW  - Human
KW  - Adolescence
KW  - Young Adult
KW  - Michigan
KW  - Retrospective Design
KW  - Random Sample
KW  - Questionnaires
KW  - Scales
KW  - Kappa Statistic
KW  - Data Analysis Software
KW  - Chi Square Test
KW  - Analysis of Variance
KW  - Bivariate Statistics
KW  - Multivariate Analysis
KW  - Logistic Regression
KW  - Male
KW  - Female
KW  - Funding Source
SP  - 825
EP  - 832
JO  - Pediatrics
JF  - Pediatrics
JA  - PEDIATRICS
VL  - 132
IS  - 5
CY  - Chicago, Illinois
PB  - American Academy of Pediatrics
AB  - OBJECTIVES: Nonmedical prescription opiate use (NPOLJ) 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. 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. Pediatrics
SN  - 0031-4005
AD  - Division of Emergency Medicine, University of Washington, Seattle, Washington
AD  - Injury Center, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
AD  - Injury Center, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Health Services Research and Development, Ann Arbor, Michigan
AD  - Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
AD  - Injury Center, University of Michigan, Ann Arbor, Michigan; Department of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan
AD  - Injury Center, University of Michigan, Ann Arbor, Michigan; Department of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan; 'Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
U2  - PMID: 24167166.
DO  - 10.1542/peds.2013-0721
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107935554&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121357484
T1  - An Unusual Case of Alternating Ventricular Morphology on the 12-Lead Electrocardiogram.
AU  - Sammon, Maura
AU  - Dawood, Alveena
AU  - Beaudoin, Scott
AU  - Harrigan, Richard A.
Y1  - 2017/03//
N1  - Accession Number: 121357484. Language: English. Entry Date: 20171113. Revision Date: 20171113. Publication Type: journal article; case study. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Longitudinal Interval Follow-Up Evaluation (LIFE). NLM UID: 8412174. 
KW  - Heart Conduction System -- Abnormalities
KW  - Wolff-Parkinson-White Syndrome -- Diagnosis
KW  - Electrocardiography -- Classification
KW  - Naloxone -- Therapeutic Use
KW  - Substance Use Disorders -- Complications
KW  - Wolff-Parkinson-White Syndrome -- Physiopathology
KW  - Narcotic Antagonists -- Pharmacodynamics
KW  - Male
KW  - Naloxone -- Pharmacodynamics
KW  - Heart Conduction System -- Physiopathology
KW  - Adult
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Emergency Service -- Administration
SP  - 348
EP  - 353
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 52
IS  - 3
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions.Case Report: We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose. A systematic approach to the electrocardiogram led to the rare diagnosis of Wolff-Parkinson-White (WPW) alternans. We review the differential diagnosis of this dysrhythmia and the initial evaluation of a patient with the WPW pattern present on their electrocardiogram. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be prepared to use a systematic approach to an undifferentiated dysrhythmia to identify potentially life-threatening conditions.
SN  - 0736-4679
AD  - Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania
U2  - PMID: 27727036.
DO  - 10.1016/j.jemermed.2016.08.027
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121357484&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103791209
T1  - Trends in U.S. Emergency Department Visits for Opioid Overdose, 1993-2010.
AU  - Hasegawa, Kohei
AU  - Espinola, Janice A.
AU  - Brown, David F. M.
AU  - Camargo, Jr., Carlos A.
Y1  - 2014/10//
N1  - Accession Number: 103791209. Language: English. Entry Date: 20150424. Revision Date: 20151001. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management. Grant Information: Supported, in part, by Eleanor and Miles Shore Fellowship Program (Boston, MA).. NLM UID: 100894201. 
KW  - Overdose -- Trends -- United States
KW  - Emergency Service
KW  - Analgesics, Opioid -- Adverse Effects -- United States
KW  - Human
KW  - United States
KW  - Descriptive Statistics
KW  - Confidence Intervals
KW  - Time Factors
KW  - Adult
KW  - Middle Age
KW  - Male
KW  - Female
KW  - Sex Factors
KW  - Age Factors
KW  - Geographic Factors
KW  - Race Factors
KW  - Whites
KW  - Regression
KW  - Data Analysis Software
KW  - Funding Source
SP  - 1765
EP  - 1770
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 15
IS  - 10
PB  - Oxford University Press / USA
SN  - 1526-2375
AD  - Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
U2  - PMID: 25139712.
DO  - 10.1111/pme.12461
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103791209&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128669621
T1  - Hospitals Besieged by Opioid OD Patients.
Y1  - 2018/04//
N1  - Accession Number: 128669621. Language: English. Entry Date: 20180328. Revision Date: 20180330. Publication Type: Article. Journal Subset: Nursing; USA. 
KW  - Emergency Service
KW  - Overdose
KW  - Analgesics, Opioid
KW  - Disease Outbreaks
KW  - Street Drugs
SP  - 14
EP  - 15
JO  - Hospital Infection Control & Prevention
JF  - Hospital Infection Control & Prevention
JA  - HOSP INFECT CONTROL PREV
VL  - 45
IS  - 4
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - The article reports on infection risk of opioid-addicted patients admitted to hospitals in the U.S. It is said that the national opioid epidemic is putting pressure on myriad aspects of healthcare delivery. Also, opioid-addicted patients have seeded their own infections by spiking their intravenou lines with drugs.
SN  - 1945-9653
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128669621&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128352812
T1  - Opioid Overdoses Up 30 Percent Last Year: CDC.
Y1  - 2018/03/07/
N1  - Accession Number: 128352812. Language: English. Entry Date: 20180321. Revision Date: 20180321. Publication Type: Article. Journal Subset: Consumer Health; USA. NLM UID: 8704590. 
KW  - Overdose -- Mortality -- United States
KW  - Narcotics -- Poisoning
KW  - Overdose -- Epidemiology -- United States
KW  - Emergency Service -- Statistics and Numerical Data
KW  - United States
KW  - Centers for Disease Control and Prevention (U.S.)
KW  - Substance Abuse
SP  - 1
EP  - 2
JO  - Occupational Health & Safety News
JF  - Occupational Health & Safety News
JA  - OCCUP HEALTH SAF NEWS
CY  - Chatsworth, California
PB  - 1105 Media, Inc.
SN  - 0896-3835
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128352812&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106327951
T1  - Intravenous bolus of ultra-low-dose naloxone added to morphine does not enhance analgesia in emergency department patients.
AU  - Bijur PE
AU  - Schechter C
AU  - Esses D
AU  - Chang AK
AU  - Gallagher EJ
Y1  - 2006/02//
N1  - Accession Number: 106327951. Language: English. Entry Date: 20060901. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100898657. 
KW  - Morphine -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Emergency Service
KW  - Pain Measurement
KW  - Scales
KW  - Dose-Response Relationship, Drug
KW  - Drug Combinations
KW  - Treatment Failure
KW  - Clinical Trials
KW  - Data Analysis Software
KW  - Chi Square Test
KW  - Fisher's Exact Test
KW  - Analysis of Variance
KW  - Confidence Intervals
KW  - Double-Blind Studies
KW  - Placebos
KW  - Adult
KW  - Middle Age
KW  - Human
SP  - 75
EP  - 81
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 7
IS  - 2
PB  - Churchill Livingstone, Inc.
AB  - 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. 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.
SN  - 1526-5900
AD  - Depts of Emergency Medicine and Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
U2  - PMID: 16459272.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106327951&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121191515
T1  - The New Opioid Epidemic: Prescriptions, Synthetics, and Street Drugs.
AU  - Rao, Rama B.
AU  - Nelson, Lewis S.
Y1  - 2017/02//
N1  - Accession Number: 121191515. Language: English. Entry Date: 20170214. Revision Date: 20170215. Publication Type: Article; case study; pictorial; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Public Health. 
KW  - Analgesics, Opioid
KW  - Substance Dependence
KW  - Street Drugs -- Adverse Effects
KW  - Overdose -- Risk Factors
KW  - Naloxone -- Therapeutic Use
KW  - Emergency Care
KW  - Female
KW  - Adult
SP  - 64
EP  - 70
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 49
IS  - 2
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
AD  - Chief of the division of medical toxicology, NY Presbyterian Weill Cornell Medical Center, New York, New York
AD  - Professor and chair of the department of emergency medicine, Rutgers New Jersey Medical School
DO  - 10.12788/emed.2017.0010
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121191515&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 121991394
T1  - We have to "think" before prescribing an opioid in Italian Emergency Department?
AU  - Lorenzati, Bartolomeo
AU  - Allione, Attilio
AU  - Pizzolato, Elisa
AU  - Dutto, Luca
AU  - Lauria, Giuseppe
Y1  - 2017/04//
N1  - Accession Number: 121991394. Language: English. Entry Date: 20170926. Revision Date: 20180402. Publication Type: letter; commentary. Journal Subset: Biomedical; Blind Peer Reviewed; Continental Europe; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. NLM UID: 101263418. 
KW  - Emergency Service
KW  - Analgesics, Opioid
SP  - 415
EP  - 416
JO  - Internal & Emergency Medicine
JF  - Internal & Emergency Medicine
JA  - INTERN EMERG MED
VL  - 12
IS  - 3
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
SN  - 1828-0447
AD  - Emergency Medicine, Emergency Department , A.O.S. Croce e Carle , Via Coppino 26 12100 Cuneo Italy
U2  - PMID: 28168588.
DO  - 10.1007/s11739-017-1621-0
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121991394&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110360501
T1  - Commentary on Gjersing & Bretteville-Jensen (2015): EMS-treated opioid overdose-an important opportunity for saving lives...Gjersing L, Bretteville-Jensen A. A prospective cohort study in Oslo, Norway among street-recruited people who inject drugs: are overdoses treated by ambulance services an opportunity for additional interventions? Addiction 2015; 110 :1767–74.
AU  - Dailey, Michael
Y1  - 2015/11//
N1  - Accession Number: 110360501. Language: English. Entry Date: 20151021. Revision Date: 20161031. Publication Type: Article; commentary; letter. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Emergency Medical Services -- Psychosocial Factors
KW  - Overdose -- Mortality
KW  - Narcotics
KW  - Death, Sudden, Cardiac -- Risk Factors
KW  - Overdose -- Prevention and Control
KW  - Death, Sudden, Cardiac -- Prevention and Control
KW  - Emergency Medical Technicians -- Psychosocial Factors
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Public Health Administration
KW  - Overdose -- Education
KW  - Consumers -- Education
KW  - Naloxone -- Supply and Distribution
SP  - 1775
EP  - 1776
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 110
IS  - 11
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - The article responds to the article "A Prospective Cohort Study in Oslo, Norway Among Street-Recruited People Who Inject Drugs: Are Overdoses Treated by Ambulance Services an Opportunity for Additional Interventions?" by L. Gjersing and A. Bretteville-Jensen. Topics include sudden cardiac arrest in relation to opioid overdoses, the treatment of overdose patients by emergency medical services (EMS) and emergency department (ED) providers, and heart attack prevention and risk.
SN  - 0965-2140
AD  - Division of Prehospital and Operational Medicine, Albany Medical College-Emergency Medicine
U2  - PMID: 26471158.
DO  - 10.1111/add.13093
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110360501&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109645956
T1  - Pharmacoepidemiology of chronic noncancer pain patients requiring chronic opioid therapy: A nationwide population-based study.
AU  - Chang, Shu-Ching
AU  - Ma, Chen-Chung
AU  - Lee, Chun-Te
AU  - Hsieh, Shao-Wei
Y1  - 2015/09//2015 Sep
N1  - Accession Number: 109645956. Language: English. Entry Date: 20150923. Revision Date: 20151125. Publication Type: journal article. Journal Subset: Asia; Biomedical; Peer Reviewed. NLM UID: 101214918. 
SP  - 89
EP  - 94
JO  - Acta Anaesthesiologica Taiwanica
JF  - Acta Anaesthesiologica Taiwanica
JA  - ACTA ANAESTHESIOL TAIWAN
VL  - 53
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Objective: This study was aimed to explore the pharmacoepidemiology of chronic noncancer pain (CNCP) patients who required chronic opioid therapy (COT) in the Taiwanese population.Methods: Using the Taiwan National Health Insurance Research Database during 2008-2009, COT-requiring CNCP patients were identified by the inclusion criteria of both chronic analgesic requirement for >3 months per year and long-term use of controlled opioids for >28 therapeutic days during any 3-month period in ambulatory visits with malignancy-related pain excluded. Their demographic data and pharmacoepidemiological characteristics of opioid consumption and opioid prescriptions issued in ambulatory visits were analyzed.Results: In total, 159 patients were enrolled as COT-requiring CNCP patients, and the prevalence was calculated at 0.016% in a 2-year period. Females were outnumbered by males (45.3% vs. 54.7%). Almost 60% of them were of working age and 93.7% belonged to low-income households, as in the health insurance claims, probably implying socioeconomic disadvantages associated with CNCP. The leading three diagnoses were unspecified myalgia and myositis, lumbago, and abdominal pain of unspecified site. The most common department from where these 159 CNCP patients obtained their opioid prescriptions was the emergency department (27.6%), ensued by a pain clinic (25.3%), but they could acquire only a few opioid therapeutic days through emergency department visits. Moreover, pain clinic satisfied the majority of opioid therapeutic days. Among all opioids, morphine was the most frequently prescribed in opioid-obtaining ambulatory visits, accounting for most of the opioid therapeutic days as well as opioid consumption.Conclusion: COT-requiring CNCP patients were easily associated with adverse socioeconomic liabilities and often visited emergency department as well as pain clinics. Morphine was the main opioid used for their chronic pain. Transfer of COT-requiring CNCP patients to appropriate departments is strongly recommended for efficient long-term pharmacotherapy for their chronic pain.
SN  - 1875-4597
U2  - PMID: 26026843.
DO  - 10.1016/j.aat.2015.04.002
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105428952
T1  - Intranasal naloxone is a viable alternative to intravenous naloxone for prehospital narcotic overdose.
AU  - Robertson TM
AU  - Hendey GW
AU  - Stroh G
AU  - Shalit M
Y1  - 2009/10//
N1  - Accession Number: 105428952. Language: English. Entry Date: 20091204. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. Instrumentation: Glasgow Coma Scale (GCS). NLM UID: 9703530. 
KW  - Administration, Intranasal
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Adverse Effects
KW  - Overdose -- Therapy
KW  - Prehospital Care -- Methods
KW  - Emergency Medical Services
KW  - Female
KW  - Glasgow Coma Scale
KW  - Male
KW  - Prehospital Care -- Evaluation
KW  - Scales
KW  - Human
SP  - 512
EP  - 515
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 13
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - OBJECTIVE: To compare the prehospital time intervals from patient contact and medication administration to clinical response for intranasal (IN) versus intravenous (IV) naloxone in patients with suspected narcotic overdose. METHODS: This was a retrospective review of emergency medical services (EMS) and hospital records, before and after implementation of a protocol for administration of intranasal naloxone by the Central California EMS Agency. We included patients with suspected narcotic overdose treated in the prehospital setting over 17 months, between March 2003 and July 2004. Paramedics documented dose, route of administration, and positive response times using an electronic record. Clinical response was defined as an increase in respiratory rate (breaths/min) or Glasgow Coma Scale score of at least 6. Main outcome variables included time from medication to clinical response and time from patient contact to clinical response. Secondary variables included numbers of doses administered and rescue doses given by an alternate route. Between-group comparisons were accomplished using t-tests and chi-square tests as appropriate. RESULTS: One hundred fifty-four patients met the inclusion criteria, including 104 treated with IV and 50 treated with IN naloxone. Clinical response was noted in 33 (66%) and 58 (56%) of the IN and IV groups, respectively (p = 0.3). The mean time between naloxone administration and clinical response was longer for the IN group (12.9 vs. 8.1 min, p = 0.02). However, the mean times from patient contact to clinical response were not significantly different between the IN and IV groups (20.3 vs. 20.7 min, p = 0.9). More patients in the IN group received two doses of naloxone (34% vs. 18%, p = 0.05), and three patients in the IN group received a subsequent dose of IV or IM naloxone. CONCLUSIONS: The time from dose administration to clinical response for naloxone was longer for the IN route, but the overall time from patient contact to response was the same for the IV and IN routes. Given the difficulty and potential hazards in obtaining IV access in many patients with narcotic overdose, IN naloxone appears to be a useful and potentially safer alternative.
SN  - 1090-3127
AD  - Department of Emergency Medicine, UCSF-Fresno, Medical Education Program, Fresno, CA
U2  - PMID: 19731165.
DO  - 10.1080/10903120903144866
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105915422
T1  - The epidemiologic association between opioid prescribing, non-medical use, and emergency department visits.
AU  - Wisniewski AM
AU  - Purdy CH
AU  - Blondell RD
Y1  - 2008/03//
N1  - Accession Number: 105915422. Language: English. Entry Date: 20080516. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9107051. 
KW  - Drug Utilization
KW  - Narcotics
KW  - Adult
KW  - Age Factors
KW  - Blacks
KW  - Correlation Coefficient
KW  - Cross Sectional Studies
KW  - Emergency Service -- Utilization
KW  - Exploratory Research
KW  - Female
KW  - Hispanics
KW  - Male
KW  - Minimum Data Set
KW  - Morphine
KW  - Oxycodone
KW  - P-Value
KW  - Prescriptions, Drug
KW  - Race Factors
KW  - Sex Factors
KW  - Surveys
KW  - Whites
KW  - Human
SP  - 1
EP  - 11
JO  - Journal of Addictive Diseases
JF  - Journal of Addictive Diseases
JA  - J ADDICT DIS
VL  - 27
IS  - 1
PB  - Taylor & Francis Ltd
AB  - Introduction: Since the 1990s prescriptions for and the non-medical use of opioids have increased. This study ex-amines associations between opioid prescribing, non-medical use, and emergency department (ED) visits.Methods: Data were abstracted from four federally sponsored, nationally representative, annual surveys (National Hospital Ambulatory Medical Care Survey, National Ambulatory Medical Care Survey, National Survey on Drug Use and Health, and Drug Abuse Warning Network).Results: For hydrocodone and oxycodone, associations between prescribing and non-medical use, and pre-scribing and ED visits were statistically significant (p-values < 0.04) and strongly associated (correlation coefficient range 0.73 to 0.87). Male gender, White race, and age >/= 35 were all statistically significant (p-values < 0.0001) predictors of receiving a hydrocodone or oxvcodone-containing prescription.Conclusion: The increased number of prescriptions written for hydrocodone and oxvcodone between 1995 and 2004 was associated with similar increases in non-medical use and the number of ED visits during this time period.
SN  - 1055-0887
AD  - University of Buffalo, School of Medicine and Biomedical Sciences, Department of Family Medicine, Family Medicine Research Institute, 462 Grider Street, Room CC-191, Buffalo, NY 14215; amw25@buffalo.edu
U2  - PMID: 18551883.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105871813
T1  - Predictors for opioid analgesia administration in children with abdominal pain presenting to the emergency department.
AU  - Goldman RD
AU  - Narula N
AU  - Klein-Kremer A
AU  - Finkelstein Y
AU  - Rogovik AL
Y1  - 2008/01//2008 Jan
N1  - Accession Number: 105871813. Language: English. Entry Date: 20080328. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8507389. 
KW  - Abdominal Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Adolescence
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Analysis of Variance
KW  - Child
KW  - Child, Preschool
KW  - Emergency Medical Services
KW  - Emergency Service
KW  - Female
KW  - Male
KW  - Prognosis
KW  - Retrospective Design
KW  - Triage
KW  - Human
SP  - 11
EP  - 15
JO  - Clinical Journal of Pain
JF  - Clinical Journal of Pain
JA  - CLIN J PAIN
VL  - 24
IS  - 1
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - OBJECTIVES: Abdominal pain is one of the most common symptoms in children. The aim of this study was to determine the rate of opioid analgesia in children with abdominal pain presenting to the pediatric Emergency Department (ED) and to identify factors associated with administration of opioids. METHODS: We retrospectively reviewed all charts of patients with abdominal pain <7 days presenting to the ED of a tertiary pediatric hospital over a 3-month period. Demographic and illness-related variables were recorded, and the primary outcome variable was whether opioid analgesia was used to relieve abdominal pain. We analyzed the data with a univariate analysis and a multivariate stepwise regression analysis to determine independent influences on the rate of opioid prescribing. RESULTS: Of 582 children included in the analysis, 53 (9%) received opioid analgesia. Pain in the right lower quadrant on examination, documentation of a pain score in triage, and the level of acuity as determined by the triage nurse were predictors of administration of opioids by the physician. Thirty-four (77%) of the opioids given were below the recommended dose for the child. CONCLUSIONS: Few pediatric patients with abdominal pain are treated with pain medications. The decision to use opioid analgesia for acute abdominal pain in the pediatric ED is influenced by acuity level, pain score documentation in triage, and location of abdominal pain. Efforts should be made to educate physicians on the appropriate administration and dose of opioids in children with abdominal pain in the ED.
SN  - 0749-8047
AD  - Division of Pediatric Emergency Medicine, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada; rgoldman@cw.bc.ca
U2  - PMID: 18180630.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103767825
T1  - Descriptive Study of Prescriptions for Opioids from a Suburban Academic Emergency Department Before New York's I-STOP Act.
AU  - Ung, Lyncean
AU  - Dvorkin, Ronald
AU  - Sattler, Steven
AU  - Yens, David
Y1  - 2015/01//
N1  - Accession Number: 103767825. Language: English. Entry Date: 20150306. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Narcotics -- Legislation and Jurisprudence -- New York
KW  - Medical Orders
KW  - Emergency Service
KW  - Academic Medical Centers
KW  - Prescribing Patterns
KW  - New York
KW  - Human
KW  - Retrospective Design
KW  - Record Review
KW  - Confidence Intervals
SP  - 62
EP  - 66
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 16
IS  - 1
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
SN  - 1936-900X
AD  - Good Samaritan Hospital Medical Center, Department of Emergency Medicine, West Islip, New York
AD  - Premier Care Physicians, Department of Emergency Medicine, Bellmore, New York
AD  - New York Colleges of Osteopathic Medicine Educational Consortium, New York, New York; Touro College of Osteopathic Medicine, Middletown, New York
DO  - 10.5811/westjem.2014.12.22669
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103767822
T1  - Feasibility of Tablet Computer Screening for Opioid Abuse in the Emergency Department.
AU  - Weiner, Scott G.
AU  - Horton, Laura C.
AU  - Green, Traci C.
AU  - Butler, Stephen F.
Y1  - 2015/01//
N1  - Accession Number: 103767822. Language: English. Entry Date: 20150306. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. Instrumentation: Revised Screener and Opioid Assessment for Patients with Pain (SOAPP®-R),. NLM UID: 101476450. 
KW  - Substance Abuse -- Prevention and Control
KW  - Narcotics -- Adverse Effects
KW  - Emergency Service
KW  - Computers, Hand-Held
KW  - Human
KW  - Questionnaires
KW  - Cross Sectional Studies
KW  - Convenience Sample
KW  - Urban Areas
KW  - Academic Medical Centers
KW  - Descriptive Statistics
KW  - Prospective Studies
KW  - Trauma Centers
KW  - Data Analysis Software
KW  - Adolescence
KW  - Adult
KW  - Middle Age
SP  - 18
EP  - 23
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 16
IS  - 1
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
SN  - 1936-900X
AD  - Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
AD  - Tufts University School of Medicine, Boston, Massachusetts
AD  - Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island; Inflexxion, Inc. Newton, Massachusetts
AD  - Inflexxion, Inc. Newton, Massachusetts
DO  - 10.5811/westjem.2014.11.23316
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 114783693
T1  - Emergency Visits for Prescription Opioid Overdose.
AU  - Ruan, Xiulu
AU  - Bydalek, Katherine
AU  - Kaye, Alan D.
Y1  - 2016/05//
N1  - Accession Number: 114783693. Language: English. Entry Date: 20161229. Revision Date: 20160826. Publication Type: commentary; letter. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8507389. 
KW  - Overdose
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - United States
KW  - Substance Use Disorders
KW  - Drugs, Prescription
KW  - Emergency Service
SP  - 459
EP  - 459
JO  - Clinical Journal of Pain
JF  - Clinical Journal of Pain
JA  - CLIN J PAIN
VL  - 32
IS  - 5
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 0749-8047
AD  - Department of Anesthesiology, Louisiana State University Health Science Center New Orleans, LA
AD  - College of Nursing, University of South Alabama, Mobile, AL
U2  - PMID: 26626300.
DO  - 10.1097/AJP.0000000000000330
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111359309
T1  - Longitudinal Analysis of Opioid Analgesic Dose and Diabetes Quality of Care Measures.
AU  - Gautam, Santosh
AU  - Franzini, Luisa
AU  - Mikhail, Osama I.
AU  - Wenyaw Chan
AU  - Turner, Barbara J.
Y1  - 2015/11//
N1  - Accession Number: 111359309. Language: English. Entry Date: 20151209. Revision Date: 20161031. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. Instrumentation: Charlson Comorbidity Index (Charlson et al). Grant Information: This study was supported by the UT System Patient Safety Committee OGC Grant # 150273.. NLM UID: 100894201. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Diabetes Mellitus
KW  - Quality of Care Research
KW  - Chronic Pain -- Drug Therapy
KW  - Human
KW  - Prospective Studies
KW  - Retrospective Design
KW  - Secondary Analysis
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - Odds Ratio
KW  - Confidence Intervals
KW  - Funding Source
KW  - Scales
SP  - 2134
EP  - 2141
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 16
IS  - 11
PB  - Oxford University Press / USA
AB  - Objective. To examine associations of opioid analgesic dose with quality of care for diabetes mellitus. Design. Longitudinal statewide cohort. Subjects. Subjects with diabetes filled one or more prescriptions for Schedule II/III opioids for noncancer pain in Blue Cross Blue Shield of Texas from 2008 through 2012. Methods. Opioid dose and outcomes were assessed in 6-month intervals after first filled prescription. Two morphine equivalent dose measures were daily dose and quartiles of total dose from all filled prescriptions. In fixed effects models adjusted for clinical and treatment variables, associations of opioid measures were examined for five outcomes: hemoglobin A1c (HbA1c) test, low density lipoprotein cholesterol (LDL) test, any hospitalization, any diabetes-related preventable hospitalization, and any emergency department (ED) visit. Results. All daily and total opioid doses were associated (P< 0.05) with poorer outcomes for all five measures. For HbA1c testing, adjusted odds ratios (AORs) were reduced by 19% for high daily dose (100 mg) and highest quartile total dose (>900 mg), respectively, vs no opioids but >900 mg total dose had the lowest AOR for LDL testing (0.74 [CI 0.68, 0.80]). The AORs of any hospitalization or diabetesrelated hospitalization were, respectively, 8.19 (CI 7.21, 9.30) and 2.76 (CI 2.19, 3.48) for >900 mg total dose but only 6.22 (CI 4.94, 7.83) and 2.16 (CI 1.34, 3.48) for >100 mg daily dose. Both opioid measures had nonmonotonic associations with ED use. Conclusions. Daily opioid dose but especially total dose of opioids was strongly associated with poorer diabetes quality of care in a statewide cohort.
SN  - 1526-2375
AD  - School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
AD  - University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103856809
T1  - Presentation of Prescription and Nonprescription Opioid Overdoses to US Emergency Departments.
AU  - Yokell, Michael A
AU  - Delgado, M Kit
AU  - Zaller, Nickolas D
AU  - Wang, N Ewen
AU  - McGowan, Samuel K
AU  - Green, Traci Craig
Y1  - 2014/12//
N1  - Accession Number: 103856809. Language: English. Entry Date: 20150313. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 101589534. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Overdose -- Diagnosis
KW  - Overdose -- Epidemiology
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Drugs, Prescription
KW  - Drugs, Non-Prescription
KW  - United States
SP  - 2034
EP  - 2037
JO  - JAMA Internal Medicine
JF  - JAMA Internal Medicine
JA  - JAMA INTERN MED
VL  - 174
IS  - 12
CY  - Chicago, Illinois
PB  - American Medical Association
SN  - 2168-6106
AD  - Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
AD  - Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia3Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
AD  - Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island5Department of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island6currently affiliated with Boozman College of Public Health, Univer.
AD  - Division of Emergency Medicine, Stanford University School of Medicine and Stanford Hospital, Stanford, California.
AD  - Department of Medicine, Rush Medical College, Chicago, Illinois.
AD  - Department of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island9Department of Emergency Medicine, Rhode Island Hospital, Providence.
U2  - PMID: 25347221.
DO  - 10.1001/jamainternmed.2014.5413
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104045023
T1  - Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010 Incremento en la Prescripción de Opiáceos en las Visitas de Adultos a los Servicios de Urgencias de Estados Unidos: 2001-2010.
AU  - Mazer-Amirshahi, Maryann
AU  - Mullins, Peter M.
AU  - Rasooly, Irit
AU  - den Anker, John
AU  - Pines, Jesse M.
Y1  - 2014/03//
N1  - Accession Number: 104045023. Language: English. Entry Date: 20140317. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9418450. 
KW  - Prescribing Patterns
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service
KW  - Office Visits
KW  - Emergency Medicine
KW  - United States
KW  - Human
KW  - Retrospective Design
KW  - Data Analysis
KW  - Demography
KW  - Middle Age
KW  - Race Factors
KW  - Medicare
KW  - Medicaid
KW  - Geographic Locations
SP  - 236
EP  - 243
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 21
IS  - 3
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - The Department of Emergency Medicine, The George Washington University; The Department of Clinical Pharmacology, Children's National Medical Center
AD  - The George Washington University School of Medicine and Health Sciences,
AD  - The Department of Clinical Pharmacology, Children's National Medical Center
AD  - The Department of Emergency Medicine, The George Washington University
U2  - PMID: 24628748.
DO  - 10.1111/acem.12328
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109804333
T1  - Les troubles liés à l'utilisation des opioïdes prescrits médicalement.
AU  - Brabant, Michel
AU  - Brissette, Suzanne
AU  - Lauzon, Pierre
AU  - Marsan, Stéphanie
AU  - Ouellet-Plamondon, Clairélaine
AU  - Pelletier, Marie-Chantal
Y1  - 2014/10//
N1  - Accession Number: 109804333. Language: French. Entry Date: 20150622. Revision Date: 20180306. Publication Type: Journal Article. Journal Subset: Biomedical; Blind Peer Reviewed; Canada; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Psychiatry/Psychology. NLM UID: 9424773. 
KW  - Substance Use Disorders
KW  - Chronic Pain -- Drug Therapy
KW  - Analgesics, Opioid
KW  - Drugs, Prescription
KW  - Prescriptions, Drug -- Trends -- Canada
KW  - Canada
KW  - Analgesics, Opioid -- Poisoning
KW  - Practice Guidelines
KW  - Substance Abuse -- Prevention and Control
SP  - 117
EP  - 132
JO  - Sante Mentale au Quebec
JF  - Sante Mentale au Quebec
JA  - SANTE MENTALE QUEBEC
VL  - 39
IS  - 2
CY  - Montreal, Quebec
PB  - Revue Sante Mentale au Quebec
AB  - Epidemiology Canada now has the second highest number of opioid prescriptions per capita in the world. The rate of prescriptions has increased over the last decade, most notably in adults over 55 years of age. A recognition of the importance of treating pain has influenced this increase, but higher rates of opioid prescribing have produced undesirable outcomes including the misuse of medication as well as an increased number of deaths and emergency department visits attributable to opioids. Diverse psychiatric disorders, such as major depression, now also occur in 40% of those with an opioid use disorder (OUD). Neuroscience We now understand that addictive behaviors are caused by both environmental and genetic factors. Although OUD has historically been perceived as a weakness of character, it is now clear that it is a chronic disease, which results from a complex interaction between a substance, such as opioid, environmental factors, and an individual’s genotype. Unfortunately, this evidence has yet to be successfully translated into clinical practice and most physicians are unable to diagnose and manage OUD patients appropriately. Clinical guidelines Many clinical guidelines for the management of chronic, noncancer pain are available. All guidelines identify the need to assess the patient appropriately and screen for factors associated with misuse before prescribing opioids. Guidelines generally acknowledge that patients should not be denied appropriate pain management, but that some patients will require close supervision and frequent follow-up to prevent the misuse of prescription opioids.
AB  - Épidémiologie Au cours des 10 à 15 dernières années, le Canada est devenu le deuxième plus grand consommateur d’opioïdes de prescription (OP), principalement pour le traitement de la douleur. Cette augmentation a été plus marquée chez les 55 ans et plus. Même si personne ne conteste le droit des patients à recevoir des traitements adéquats pour la douleur, il n’en demeure pas moins que cette disponibilité accrue a entraîné son lot de problèmes: augmentation des visites à l’urgence et des décès liés aux opioïdes ainsi que du trouble lié à l’utilisation (TLU) des opioïdes, trouble qui est d’ailleurs associé à une prévalence accrue, de l’ordre de 40%, de divers problèmes psychiatriques, dont les troubles dépressifs majeurs. Neuroscience De nouvelles connaissances issues des neurosciences nous permettent de mieux comprendre la réaction du cerveau lors de l’exposition à ces substances et le caractère chronique du TLU des opioïdes. Quoique historiquement perçu comme une faiblesse de caractère ou un vice, le TLU des opioïdes est maintenant reconnu comme une condition chronique résultant d’une interaction complexe entre une substance, des facteurs d’environnement et un génotype individuel. Malheureusement, ces évidences scientifiques ne sont pas encore largement appliquées à la clinique et la majorité des médecins n’ont pas les habiletés nécessaires pour diagnostiquer et traiter le TLU des opioïdes. Guides de pratique clinique Des recommandations et guides de pratique peuvent nous aider à identifier les personnes plus vulnérables à un mésusage, et à mieux encadrer la prescription et la gestion de la médication. Il ne s’agit pas de se désintéresser de ces patients et de les abandonner à leur sort mais plutôt de leur offrir des soins inspirés des meilleures pratiques et appuyés sur des évidences scientifiques de qualité.
SN  - 0383-6320
AD  - Service de médecine des toxicomanies CHUM; Professeur adjoint de clinique, Département de médecine familiale et médecine d'urgence (DMFMU), Université de Montréal
AD  - Service de médecine des toxicomanies et Centre de recherche CHUM; Professeur agrégé de clinique, Département de médecine familiale et médecine d'urgence (DMFMU), Université de Montréal
AD  - Service de médecine des toxicomanies CHUM; Chargé d'enseignement de clinique, Département de médecine familiale et médecine d'urgence (DMFMU), Université de Montréal
AD  - Unité de psychiatrie des toxicomanies CHUM; Professeur adjoint de clinique, Département de psychiatrie, Université de Montréal
DO  - 10.7202/1027835ar
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109804333&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103838989
T1  - Pain management perceptions among prescription opioid dependent individuals.
AU  - McCauley, Jenna L
AU  - Mercer, Mary Ashley
AU  - Barth, Kelly S
AU  - Brady, Kathleen T
AU  - Back, Sudie E
Y1  - 2014/09//
N1  - Accession Number: 103838989. Language: English. Entry Date: 20150508. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Psychiatry/Psychology. Instrumentation: Beck Depression Inventory (BDI); Pain Management Questionnaire. Grant Information: K12 DA031794/DA/NIDA NIH HHS/United States. NLM UID: 7513587. 
KW  - Analgesia -- Psychosocial Factors
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Pain -- Drug Therapy
KW  - Perception
KW  - Substance Use Disorders -- Psychosocial Factors
KW  - Adult
KW  - Depression -- Psychosocial Factors
KW  - Female
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Pain Measurement
KW  - Psychological Tests
KW  - Questionnaires
KW  - Substance Use Disorders -- Epidemiology
KW  - Treatment Outcomes
SP  - 354
EP  - 358
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 142
PB  - Elsevier B.V.
AB  - Background: Nearly two-thirds of prescription opioid dependent individuals report chronic pain conditions as both an initial and current motivation for prescription opioid use. However, to date, limited information exists regarding perceptions of the adequacy of pain management and pain management behaviors among prescription opioid dependent individuals with a history of treatment for chronic pain.Methods: The current study examined perceptions of the medical management of chronic pain among community-recruited individuals (N=39) who met DSM-IV-TR criteria for current prescription opioid dependence and reported a history of treatment for chronic pain. Prescription opioid dependence, symptoms of depression, and pain management perceptions were assessed using the Structured Clinical Interview for DSM disorders, Beck Depression Inventory, and the Pain Management Questionnaire, respectively.Results: Reports of insufficient pain management were common (46.2%), as was utilization of emergency room services for pain management (56.4%). Nearly half reported a physician as their initial source (46.2%) and pain management as their primary initial reason for prescription opioid use (53.8%), whereas 35.9% reported pain relief as their primary reason for current prescription opioid use. Symptoms of depression were common (51.3%), as was comorbid abuse of other substances and history of treatment for substance abuse.Conclusions: Results highlight the complicated clinical presentation and prevalent perception of the under-treatment of pain among this population. Findings underscore the importance of interdisciplinary approaches to managing the complex presentation of chronic pain patients with comorbid prescription opioid dependence. Implications for future research are discussed.
SN  - 0376-8716
AD  - Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States. Electronic address: mccaule@musc.edu.
AD  - Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
AD  - Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States.
U2  - PMID: 25034899.
DO  - 10.1016/j.drugalcdep.2014.06.024
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104136028
T1  - The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States.
AU  - Joynt, Michael
AU  - Train, Meghan K
AU  - Robbins, Brett W
AU  - Halterman, Jill S
AU  - Caiola, Enrico
AU  - Fortuna, Robert J
Y1  - 2013/12//
N1  - Accession Number: 104136028. Language: English. Entry Date: 20140822. Revision Date: 20150710. Publication Type: Journal Article; research. Commentary: Simon Lorna. Capsule commentary on joynt et Al., the impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. (J GEN INTERN MED) Dec2013; 28 (12): 1647-1647. Journal Subset: Biomedical; Continental Europe; Europe. NLM UID: 8605834. 
KW  - Analgesics, Opioid -- Economics
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Population
KW  - Emergency Service -- Economics
KW  - Practice Patterns -- Economics
KW  - Residence Characteristics
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Cross Sectional Studies
KW  - Female
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Pain -- Drug Therapy
KW  - Pain -- Economics
KW  - Pain -- Ethnology
KW  - Poverty -- Economics
KW  - Poverty
KW  - Social Class
KW  - United States -- Ethnology
KW  - Young Adult
SP  - 1604
EP  - 1610
JO  - JGIM: Journal of General Internal Medicine
JF  - JGIM: Journal of General Internal Medicine
JA  - J GEN INTERN MED
VL  - 28
IS  - 12
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
SN  - 0884-8734
U2  - PMID: 23797920.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104136028&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119540385
T1  - Variation in opioid prescribing patterns between ED providers.
AU  - Smulowitz, Peter
AU  - Cary, Chris
AU  - Boyle, Katherine
AU  - Novack, Victor
AU  - Jagminas, Liudvikas
AU  - Smulowitz, Peter B
AU  - Boyle, Katherine L
Y1  - 2016/12//
N1  - Accession Number: 119540385. Language: English. Entry Date: 20170926. Revision Date: 20171201. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Continental Europe; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Instrumentation: Functional Assessment of Cancer Therapy (FACT). NLM UID: 101263418. 
KW  - Emergency Medicine -- Methods
KW  - Emergency Medicine -- Manpower
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Drug Therapy -- Adverse Effects
KW  - Retrospective Design
KW  - Analgesics -- Adverse Effects
KW  - Pain -- Therapy
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Emergency Service -- Administration
KW  - Analgesics -- Therapeutic Use
KW  - Clinical Assessment Tools
SP  - 1121
EP  - 1124
JO  - Internal & Emergency Medicine
JF  - Internal & Emergency Medicine
JA  - INTERN EMERG MED
VL  - 11
IS  - 8
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
AB  - Abuse of opioid prescription drugs has become an epidemic across the developed world. Despite the fact that emergency physicians overall account for a small proportion of total opioids prescribed, the number of prescriptions has risen dramatically in the past decade and, to some degree, contributes to the available supply of opioids in the community, some of which are diverted for non-medical use. Since successfully reducing opioid prescribing on the individual level first requires knowledge of current prescribing patterns, we sought to determine to what extent variation exists in opioid prescribing patterns at our institution. This was a single-institution observational study at a community hospital with an annual ED volume of 47,000 visits. We determined the number of prescriptions written by each provider, both total number and accounting for the number of patients seen. Our primary outcome measure was the level of variation at the physician level for number of prescriptions written per patient. We also identified the mean number of pills written per prescription. We analyzed data from November 13, 2014 through July 31, 2015 for 21 full-time providers. There were a total of 2211 prescriptions for opioids written over this time period for a total of 17,382 patients seen. On a per-patient basis, the rate of opioid prescriptions written per patient during this period was 127 per 1000 visits (95 % CI 122-132). There was a variation on the individual provider level, with rates ranging from 33 per to 332 per 1000 visits. There was also substantial variation by provider in the number of pills written per prescription with coefficient of variation (standard deviation divided by mean) averaged over different opioids ranging from 16 to 40 %. There was significant variation in opioid prescribing patterns at the individual physician level, even when accounting for the number of patients seen.
SN  - 1828-0447
AD  - Department of Emergency Medicine , Beth Israel Deaconess Medical Center , Boston USA
AD  - Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center , Boston USA
AD  - Soroka University Medical Center and Faculty of Health Sciences , Ben-Gurion University of the Negev , Beersheba Israel
AD  - Department of Emergency Medicine , Beth Israel Deaconess Hospital-Plymouth , Plymouth USA
AD  - Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
U2  - PMID: 27424280.
DO  - 10.1007/s11739-016-1505-8
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104179936
T1  - 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.
AU  - Beaudoin, Francesca L.
AU  - Haran, John P.
AU  - Liebmann, Otto
AU  - Miner, James R.
Y1  - 2013/06//
N1  - Accession Number: 104179936. Language: English. Entry Date: 20130617. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care; Evidence-Based Practice. NLM UID: 9418450. 
KW  - Ultrasonography
KW  - Nerve Block
KW  - Femoral Nerve -- Anatomy and Histology
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Infusions, Parenteral
KW  - Analgesia -- Methods
KW  - Emergency Service
KW  - Hip Fractures
KW  - Emergency Medicine
KW  - Clinical Trials
KW  - Human
KW  - Academic Medical Centers
KW  - Training Support, Financial
KW  - Anoxia
KW  - Bupivacaine -- Administration and Dosage
KW  - Data Analysis
KW  - Analysis of Variance
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - Pearson's Correlation Coefficient
KW  - Aged, 80 and Over
KW  - Male
KW  - Female
KW  - Blood Pressure Determination
KW  - Outcomes (Health Care)
SP  - 584
EP  - 591
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 20
IS  - 6
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - Department of Emergency Medicine, Rhode Island Hospital The Alpert Medical School of Brown University
U2  - PMID: 23758305.
DO  - 10.1111/acem.12154
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104179936&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104449067
T1  - The seizurogenecity of naloxone in tramadol overdose.
AU  - Cowley, Alan
Y1  - 2012/05//
N1  - Accession Number: 104449067. Language: English. Entry Date: 20120612. Revision Date: 20150819. Publication Type: Journal Article; case study; tables/charts. Journal Subset: Allied Health; Europe; UK & Ireland. Special Interest: Emergency Care. 
KW  - Naloxone -- Adverse Effects
KW  - Seizures -- Chemically Induced
KW  - Tramadol -- Poisoning
KW  - Seizures -- Risk Factors
KW  - Overdose -- Drug Therapy
KW  - Prehospital Care
KW  - Ambulances
KW  - Pain -- Drug Therapy
KW  - United Kingdom
KW  - Male
KW  - Adult
KW  - Prescribing Patterns -- Trends
KW  - Analgesics, Opioid
KW  - Substance Abuse
KW  - Drug Interactions
SP  - 272
EP  - 276
JO  - Journal of Paramedic Practice
JF  - Journal of Paramedic Practice
JA  - J PARAMEDIC PRACT
VL  - 4
IS  - 5
PB  - Mark Allen Holdings Limited
SN  - 1759-1376
AD  - Paramedic, South East Coast Ambulance Service NHS Foundation Trust
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104607185
T1  - Medication dosing errors in pediatric patients treated by emergency medical services.
AU  - Hoyle JD
AU  - Davis AT
AU  - Putman KK
AU  - Trytko JA
AU  - Fales WD
Y1  - 2012/01//
N1  - Accession Number: 104607185. Language: English. Entry Date: 20120113. Revision Date: 20150820. Publication Type: Journal Article; research. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Dosage Calculation -- Evaluation
KW  - Medication Errors -- Prevention and Control
KW  - Child
KW  - Emergency Medical Technicians -- Evaluation
KW  - Human
KW  - Patient Safety -- Evaluation
KW  - Pediatrics
KW  - Prehospital Care
KW  - Safety
SP  - 59
EP  - 66
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 16
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background. Medication dosing errors occur in up to 17.8% of hospitalized children. There are limited data to describe pediatric medication errors by emergency medical services (EMS) paramedics. It has been shown that paramedics have infrequent encounters with pediatric patients. Objective. To characterize medication dosing errors in children treated by EMS. Methods. We studied patients aged <=11 years who were treated by paramedics from eight Michigan EMS agencies from January 2004 through March 2006. We defined a medication dosing error as >=20% deviation from the weight-appropriate dose, as determined by the patient's reported weight in the prehospital medical record or by use of the Broselow-Luten tape (BLT). We studied errors in administering six EMS medications commonly given to children: albuterol, atropine, dextrose, diphenhydramine, epinephrine, and naloxone. Results. There were 5,547 children aged <=11 years who were treated during the study period, of whom 230 (4.1%) received drugs and had a documented weight. These patients received a total of 360 medication administrations. Multiple drug administrations occurred in 73 cases. Medication dosing errors occurred in 125 of the 360 drug administrations (34.7%; 95% confidence interval [CI] 30.0, 39.8). Relative drug dosage errors (with 95% CI) were as follows: albuterol 23.3% (18.4, 29.1), atropine 48.8% (34.3, 63.5), diphenhydramine 53.8% (29.1, 76.8), and epinephrine 60.9% (49.9, 73.9). The mean error (± standard deviation) for intravenous/intraosseous 1:1000 epinephrine overdoses was 808% ± 428%. The mean error (± standard deviation) for intravenous/intraosseous 1:1000 epinephrine underdoses was 35.5% ± 27.4%. Conclusions. Medications delivered in the prehospital care of children were frequently administered outside of the proper dose range when compared with patient weights recorded in the prehospital medical record. EMS systems should develop strategies to reduce pediatric medication dosing errors. Key words: pediatric; medical errors; medications; emergency medical services; patient safety.
SN  - 1090-3127
AD  - From the Emergency Department, Helen DeVos Children's Hospital/Michigan State University College of Human Medicine (JDH), Grand Rapids, Michigan; Grand Rapids Medical Education and Research Center/Michigan State University (ATD), Grand Rapids, Michigan; Michigan State University/Kalamazoo Center for Medical Studies (KKP, WDF), Kalamazoo, Michigan; and Helen DeVos Children's Hospital (JAT), Grand Rapids, Michigan.
U2  - PMID: 21999707.
DO  - 10.3109/10903127.2011.614043
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103962978
T1  - Opioid Use Among Adolescent Patients Treated for Headache.
AU  - DeVries, Andrea
AU  - Koch, Thomas
AU  - Wall, Eric
AU  - Getchius, Thomas
AU  - Chi, Winnie
AU  - Rosenberg, Alan
Y1  - 2014/07//
N1  - Accession Number: 103962978. Language: English. Entry Date: 20140626. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Allied Health; Nursing; Peer Reviewed; Public Health; USA. Special Interest: Pain and Pain Management; Pediatric Care; Public Health. NLM UID: 9102136. 
KW  - Headache -- Drug Therapy -- In Adolescence
KW  - Narcotics -- Administration and Dosage -- In Adolescence
KW  - Human
KW  - Adolescence
KW  - Descriptive Statistics
KW  - Odds Ratio
KW  - Confidence Intervals
KW  - Nonexperimental Studies
KW  - Prospective Studies
KW  - P-Value
KW  - Emergency Care -- Evaluation
SP  - 128
EP  - 133
JO  - Journal of Adolescent Health
JF  - Journal of Adolescent Health
JA  - J ADOLESC HEALTH
VL  - 55
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Abstract: Purpose: To determine the pervasiveness of opioid prescribing for adolescents with headache and patient and provider characteristics associated with likelihood of opioid prescribing. Methods: This observational cohort analysis used commercial medical and pharmacy claims between January 1, 2007 and December 31, 2008. Included were adolescents (13–17 years of age) with newly diagnosed headache, ≥2 distinct claims for headache, and ≥12 months health plan eligibility preindex and postindex. Adolescents with a trauma diagnosis at any point were excluded. The primary outcome was current practice patterns, measured by a number of opioid claims, a percentage of patients prescribed opioids, a number of opioid prescriptions per year, a length of opioid therapy, and a frequency of specific comorbidities. A secondary outcome characterized providers and practice settings, comparing patients who received opioids with those who did not. Results and conclusions: Of 8,373 adolescents with headache, 46% (3,859 patients) received an opioid prescription. Nearly half (48%) received one opioid prescription during follow-up; 29% received ≥3 opioid prescriptions. Of those with opioid prescriptions, 25% (977 patients) had a migraine diagnosis at index date. Among adolescents who received opioids, 28% (1,076 adolescents) had an emergency department (ED) visit for headache during follow-up versus 14% (608 adolescents) who did not receive opioids (p < .01). ED visits with a headache diagnosis during follow-up were strongly correlated with opioid use after adjusting for other covariates (odds ratio, 2.02; 95% confidence interval, 1.79–2.29). Despite the treatment guidelines recommending against their use, a large proportion of adolescents with headache were prescribed opioids. ED visits were strongly correlated with opioid prescriptions.
SN  - 1054-139X
AD  - HealthCore, Inc., Wilmington, Delaware
AD  - American Academy of Pediatrics, Elk Grove Village, Illinois
AD  - American Academy of Family Physicians, Leawood, Kansas
AD  - American Academy of Neurology, Minneapolis, Minnesota
AD  - WellPoint, Inc., Indianapolis, Indiana
U2  - PMID: 24581795.
DO  - 10.1016/j.jadohealth.2013.12.014
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104166646
T1  - Opioid Analgesic-Treated Chronic Pain Patients at Risk for Problematic Use.
AU  - Tkacz, Joseph
AU  - Pesa, Jacqueline
AU  - Lien Vo
AU  - Kardel, Peter G.
AU  - Hyong Un
AU  - Volpicelli, Joseph R.
AU  - Ruetsch, Charles
Y1  - 2013/11//
N1  - Accession Number: 104166646. Language: English. Entry Date: 20131127. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Special Interest: Pain and Pain Management. Instrumentation: Charlson Comorbidity Index (CCI). Grant Information: This study was funded by Janssen Scientific Affairs, LLC.. NLM UID: 9613960. 
KW  - Narcotics -- Administration and Dosage
KW  - Chronic Pain -- Drug Therapy
KW  - Substance Abuse -- Risk Factors
KW  - Funding Source
KW  - Human
KW  - Adult
KW  - Middle Age
KW  - Male
KW  - Female
KW  - Retrospective Design
KW  - Record Review
KW  - Cross Sectional Studies
KW  - Health Care Costs -- Evaluation
KW  - Clinical Assessment Tools
KW  - Descriptive Statistics
KW  - Chi Square Test
KW  - Post Hoc Analysis
KW  - One-Way Analysis of Variance
KW  - Data Analysis, Statistical
KW  - Data Analysis Software
KW  - P-Value
KW  - Health Resource Utilization -- Evaluation
SP  - 871
EP  - 880
JO  - American Journal of Managed Care
JF  - American Journal of Managed Care
JA  - AM J MANAGE CARE
VL  - 19
IS  - 11
CY  - Plainsboro, New Jersey
PB  - Intellisphere, LLC
AB  - Objectives: To characterize potentially problematic opioid use (PPOU) among opioid analgesic- treated chronic pain (OAT-CP) patients and to compare their healthcare service utilization and expenditures with those of a control group of OAT-CP patients not exhibiting these behaviors. Study Design: Cross-sectional, retrospective analysis of health claims data. Methods: Members of a national health plan (n = 3891) with chronic pain and an opioid prescription were categorized into 3 groups: PPOU group (n = 1499), those displaying evidence of doctor shopping or rapid opioid dose escalation; buprenorphine/ naloxone group (n =199), those who filled a prescription for buprenorphine/naloxone, which served as a proxy for opioid dependence; and control group (n = 2193), those not meeting either of the above criteria. Groups were compared on 1-year healthcare service utilization and costs. Results: The PPOU group made up more than one-third of the study sample. Compared with the control group, they incurred significantly greater 1-year adjusted mean pharmacy costs ($6573 vs $6160), office costs ($5705 vs $4479), emergency department (ED) costs ($835 vs $388), inpatient costs ($15,646 vs $7445), and total healthcare costs ($39,048 vs $26,171) (all P <.05). The buprenorphine/naloxone group incurred significantly greater 1-year pharmacy costs ($6981 vs $6160) and ED costs ($1126 vs $388) (both P <.05) than the control group. Conclusions: The PPOU group had the highest healthcare service utilization and costs. Although drivers of elevated service utilization and cost among this population are not clear, health plans may want to focus on PPOU case identification and development of interventions.
SN  - 1088-0224
AD  - Health Analytics, LLC, Columbia, MD
AD  - Janssen Scientific Affairs, LLC , Raritan, NJ
AD  - Aetna Behavioral Health , Blue Bell, PA
AD  - Institute of Addiction Medicine, Plymouth Meeting, PA.
U2  - PMID: 24511985.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104567590
T1  - How Do Emergency Department Patients Store and Dispose of Opioids After Discharge? A Pilot Study.
AU  - Tanabe, Paula
AU  - Paice, Judith A.
AU  - Stancati, Jennifer
AU  - Fleming, Michael
Y1  - 2012/05//
N1  - Accession Number: 104567590. Language: English. Entry Date: 20120613. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 7605913. 
KW  - Medical Waste Disposal -- Methods
KW  - Narcotics
KW  - Emergency Patients
KW  - Drug Storage -- Methods
KW  - Pain -- Drug Therapy
KW  - Human
KW  - Emergency Service
KW  - Pilot Studies
KW  - Prospective Studies
KW  - Patient Discharge
KW  - Adult
KW  - Interviews
KW  - Data Analysis Software
KW  - Self Report
KW  - Descriptive Statistics
KW  - Emergency Nursing
SP  - 273
EP  - 279
JO  - JEN: Journal of Emergency Nursing
JF  - JEN: Journal of Emergency Nursing
JA  - J EMERG NURS
VL  - 38
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Introduction: Opioid abuse and overdose have increased drastically in recent years. Diversion of opioids used to treat pain, either through theft or sharing, is increasing and may contribute to this misuse. Based on these trends, we designed a study to investigate opioid storage and disposal practices of patients who were prescribed these agents in the emergency department. Methods: A prospective cohort pilot study was conducted. All adults (aged ≥18 years) with a chief complaint of either minor musculoskeletal trauma, renal colic, or acute back pain who were discharged home with an opioid prescription were eligible for inclusion; persons with chronic pain were excluded. Patients were asked to participate in two home interviews in which the research assistant viewed the storage location of the opioid prescription. Safe storage was defined as being stored in a locked container or cabinet. Safe disposal was defined as returning the drugs to a designated location or mixing unused pills with an undesirable substance, placing in a sealable container, and then in the trash. Patients self-reported disposal methods. Feasibility of study methods evaluated the ability to conduct home interviews after the ED visit. Descriptive statistics were used to analyze the data. Results: Twenty-five subjects consented to participate; 20 patients completed both home interviews. None of the medications were safely stored. Only 1 patient disposed of the medication, yet did so improperly. Conclusion: This pilot study revealed widespread improper storage and disposal of opioids. The study has major implications for education for ED physicians, nurses, and residents.
SN  - 0099-1767
U2  - PMID: 22204885.
DO  - 10.1016/j.jen.2011.09.023
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111497704
T1  - Predictors of Sustained Prescription Opioid Use After Admission for Trauma in Adolescents.
AU  - Whiteside, Lauren K.
AU  - Russo, Joan
AU  - Wang, Jin
AU  - Ranney, Megan L.
AU  - Neam, Victoria
AU  - Zatzick, Douglas F.
Y1  - 2016/01//
N1  - Accession Number: 111497704. Language: English. Entry Date: 20170918. Revision Date: 20170918. Publication Type: Article; research. Journal Subset: Allied Health; Nursing; Peer Reviewed; Public Health; USA. Special Interest: Pain and Pain Management. NLM UID: 9102136. 
KW  - Trauma -- In Adolescence
KW  - Analgesics, Opioid -- Administration and Dosage -- In Adolescence
KW  - Human
KW  - Adolescence
KW  - Predictive Research
KW  - Descriptive Research
KW  - Descriptive Statistics
KW  - Male
KW  - Female
KW  - Sex Factors
KW  - Random Sample
KW  - Trauma Centers
KW  - Prospective Studies
KW  - Self Report
KW  - Pain Measurement
KW  - Poisson Distribution
KW  - Interviews
KW  - Severity of Injury -- Evaluation
KW  - Cannabis
SP  - 92
EP  - 97
JO  - Journal of Adolescent Health
JF  - Journal of Adolescent Health
JA  - J ADOLESC HEALTH
VL  - 58
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Purpose The study objectives are to describe the longitudinal trajectory of prescription opioid use among adolescents requiring a trauma admission and then identify predictors of sustained opioid use. Methods Randomly sampled adolescents (12–18 years) admitted to a Level I trauma center were surveyed. Follow-up assessments were obtained at 2, 5, and 12 months. Self-reported prescription opioid use, defined as “taking an opioid prescribed by a physician,” was obtained at baseline and every follow-up time point. At the baseline interview, validated mental health measures and pain scales were obtained as well as preinjury substance use. A fixed-effects mixed Poisson regression analysis was performed to predict prescription opioid use over time. Results A total of 120 adolescents (mean age 15.5 years [1.9 standard deviation], 75% male) completed the baseline interview with 98% follow-up at 12 months. At baseline, 7% of adolescents reported prescription opioid use before their trauma, with rates of prescription opioid use of 52% at 2 months, 13.3% at 5 months, and 12.5% at 12 months after discharge. After adjusting for demographic characteristics and injury severity score, those with sustained prescription opioid use were more likely to report preinjury marijuana use and higher baseline pain scores. Conclusions Approximately one in eight adolescents (12.5%) was using prescription opioids 12 months after injury hospitalization. Readily identifiable risk factors predicted sustained prescription opioid use, including preinjury marijuana use and baseline pain score. Screening for substance use including marijuana at the time of injury could help identify patients at risk for both substance use problems and sustained prescription opioid use.
SN  - 1054-139X
AD  - Department of Medicine, Division of Emergency Medicine, University of Washington, Seattle, Washington
AD  - Harborview Injury Prevention & Research Center, Seattle, Washington
AD  - Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington
AD  - Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
DO  - 10.1016/j.jadohealth.2015.08.011
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120687721
T1  - Fatal Fentanyl: One Pill Can Kill.
AU  - Sutter, Mark E.
AU  - Gerona, Roy R.
AU  - Davis, M. Thais
AU  - Roche, Bailey M.
AU  - Colby, Daniel K.
AU  - Chenoweth, James A.
AU  - Adams, Axel J.
AU  - Owen, Kelly P.
AU  - Ford, Jonathan B.
AU  - Black, Hugh B.
AU  - Albertson, Timothy E.
Y1  - 2017/01//
N1  - Accession Number: 120687721. Language: English. Entry Date: 20170119. Revision Date: 20180101. Publication Type: Article; pictorial; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Fentanyl -- Administration and Dosage
KW  - Overdose
KW  - Street Drugs
KW  - Human
KW  - Female
KW  - Male
KW  - Adult
KW  - Naloxone -- Administration and Dosage
KW  - Chromatography, Liquid
KW  - Public Health
SP  - 106
EP  - 113
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 24
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objective The current national opioid epidemic is a public health emergency. We have identified an outbreak of exaggerated opioid toxicity caused by fentanyl adulterated tablets purchased on the street as hydrocodone/acetaminophen. Methods Over an 8-day period in late March 2016, a total of 18 patients presented to our institution with exaggerated opioid toxicity. The patients provided a similar history: ingesting their 'normal dose' of hydrocodone/acetaminophen tablets but with more pronounced symptoms. Toxicology testing and analysis was performed on serum, urine, and surrendered pills. Results One of the 18 patients died in hospital. Five patients underwent cardiopulmonary resuscitation, one required extracorporeal life support, three required intubation, and two received bag-valve-mask ventilation. One patient had recurrence of toxicity after 8 hours after naloxone discontinuation. Seventeen of 18 patients required boluses of naloxone, and four required prolonged naloxone infusions (26-39 hours). All 18 patients tested positive for fentanyl in the serum. Quantitative assays conducted in 13 of the sera revealed fentanyl concentrations of 7.9 to 162 ng/mL (mean = 52.9 ng/mL). Pill analysis revealed fentanyl amounts of 600-6,900 μg/pill. The pills are virtually indistinguishable from authentic hydrocodone/acetaminophen tablets and are similar in weight. To date, our county has reported 56 cases of fentanyl opioid toxicity, with 15 fatalities. In our institution, the outbreak has stressed the capabilities and resources of the emergency department and intensive care units. Conclusions A serious outbreak of exaggerated opioid toxicity caused by fentanyl-adulterated tablets purchased on the street as hydrocodone/acetaminophen is under way in California. These patients required higher dosing and prolonged infusions of naloxone. Additionally, observation periods off naloxone were extended due to delayed, recurrent toxicity. The outbreak has serious ramifications for public health and safety, law enforcement, and healthcare facilities and resources.
SN  - 1069-6563
AD  - Division of Medical Toxicology, Department of Emergency Medicine, University of California, Davis
AD  - Veterans Affairs Northern California
AD  - Division of Laboratory Medicine, University of California, San Francisco
AD  - University of California San Francisco School of Medicine
AD  - Division of Pulmonary and Critical Care, University of California, Davis Patient Services Support Building
DO  - 10.1111/acem.13034
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104625681
T1  - Economic Impact of Potential CYP450 Pharmacokinetic Drug-Drug Interactions Among Chronic Low Back Pain Patients Taking Opioids.
AU  - Pergolizzi, Joseph V.
AU  - Labhsetwar, Sumedha A.
AU  - Amy Puenpatom, R.
AU  - Ben-Joseph, Rami
AU  - Ohsfeldt, Robert
AU  - Summers, Kent H.
Y1  - 2012/01//Jan/Feb2012
N1  - Accession Number: 104625681. Language: English. Entry Date: 20120702. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Pain and Pain Management. Grant Information: This work was supported by Endo Pharmaceuticals. NLM UID: 101130835. 
KW  - Hemeproteins -- Drug Effects
KW  - Drug Interactions
KW  - Chronic Pain -- Economics
KW  - Low Back Pain -- Economics
KW  - Narcotics -- Pharmacokinetics
KW  - Narcotics -- Adverse Effects
KW  - Health Resource Utilization -- Economics
KW  - Health Care Costs -- Evaluation
KW  - Human
KW  - Retrospective Design
KW  - Databases
KW  - Billing and Claims
KW  - Observational Methods
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - T-Tests
KW  - Sensitivity and Specificity
KW  - Descriptive Statistics
KW  - Models, Statistical
KW  - Funding Source
SP  - 45
EP  - 56
JO  - Pain Practice
JF  - Pain Practice
JA  - PAIN PRACTICE
VL  - 12
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Chronic low back pain (cLBP) patients who take at least 1 CYP450-metabolized opioid analgesic agent concurrent with at least 1 other CYP450-metabolized medication experience a drug-drug exposure (DDE), which puts them at risk for a pharmacokinetic drug-drug interaction (PK DDI). This study compared utilization of healthcare resources and associated payments in cLBP patients with and without incident DDEs with the potential to cause PK DDIs. A retrospective database analysis examined the associated clinical events, healthcare utilization (measured in terms of claims for office visits, outpatient visits, emergency department visits, and hospitalization), and cost to the health plan, as defined as the sum of health plan payments for resources used. Patients were grouped into 2 cohorts by age (those under 65 and those 65 years and over). In the 6 months after exposure, total healthcare payments were significantly higher for DDE patients than those without DDEs (no-DDE), in both in the younger ($7,086, SD = $8,370) and $6,353, SD = $8,352, respectively, P < 0.001) and the older cohorts ($7,806 vs. $7,043, respectively, P = 0.013). Younger and older patients with DDE had significantly higher prescription payments than those without DDE ($2,041, SD = $2,706 vs. $1,565, SD = $2,349, respectively, P < 0.001 for younger and $2,482, SD = $2,481 vs. $2,286, SD = $2,521, respectively, P = 0.044 for older patients). Both older and younger patients with DDE had significantly more claims for office visits and higher associated payments than similar patients without DDE. Patients in the study who experienced DDEs that placed them at risk for PK DDIs had significantly greater utilization rates of healthcare resources and higher associated payments in the 6-month observation period following exposure. ▪
SN  - 1530-7085
AD  - Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology, Georgetown University School of Medicine, Washington, D.C.; NEMA Research, Naples, Florida
AD  - NEMA Research, Naples, Florida
AD  - Department of Health Outcomes and Pharmacoeconomics (HOPE), Endo Pharmaceuticals, Chadds Ford, Pennsylvania
AD  - Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas, U.S.A.
U2  - PMID: 21923882.
DO  - 10.1111/j.1533-2500.2011.00503.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109598013
T1  - Opioid poisonings in Washington State Medicaid: trends, dosing, and guidelines.
AU  - Fulton-Kehoe, Deborah
AU  - Sullivan, Mark D
AU  - Turner, Judith A
AU  - Garg, Renu K
AU  - Bauer, Amy M
AU  - Wickizer, Thomas M
AU  - Franklin, Gary M
Y1  - 2015/08//2015 Aug
N1  - Accession Number: 109598013. Language: English. Entry Date: 20150923. Revision Date: 20151007. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0230027. 
SP  - 679
EP  - 685
JO  - Medical Care
JF  - Medical Care
JA  - MED CARE
VL  - 53
IS  - 8
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Background: Opioid poisonings have increased as use of prescription opioid medications have increased. To reduce these poisonings, guidelines for chronic opioid use have been implemented. However, if opioid poisonings occur in individuals who do not have high prescribed doses and who are not chronic opioid users, the current guidelines may need revision.Objectives: To examine changes in rates of methadone and other opioid poisonings after implementation of the WA State Opioid Guideline in 2007 and to examine the prescription history before poisonings.Methods: The study sample consisted of individuals who had at least 1 paid claim for an opioid prescription in the Medicaid fee-for-service system between April 2006 and December 2010 and had an emergency department or inpatient hospital claim for an opioid poisoning.Results: Methadone poisonings occurred at 10 times the rate of other prescription opioid poisonings and increased between 2006 and 2010. Rates of other prescription opioid poisonings appeared to level off after implementation of the WA opioid guideline in 2007. Among individuals with nonmethadone opioid poisonings, only 44% had chronic opioid use, 17% had prescribed doses in the week before the poisoning >120 mg/d morphine-equivalent dose (MED), 28% had doses <50 mg/d MED, and 48% had concurrent sedative prescriptions.Conclusions: It may be prudent to revise guidelines to address opioid poisonings occurring at relatively low prescribed doses and with acute and intermittent opioid use. Research is needed to establish the best strategies to prevent opioid poisonings.
SN  - 0025-7079
U2  - PMID: 26172937.
DO  - 10.1097/MLR.0000000000000384
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105104573
T1  - Emergency department visits among recipients of chronic opioid therapy.
AU  - Braden JB
AU  - Russo J
AU  - Fan MY
AU  - Edlund MJ
AU  - Martin BC
AU  - DeVries A
AU  - Sullivan MD
Y1  - 2010/09/13/
N1  - Accession Number: 105104573. Language: English. Entry Date: 20101029. Revision Date: 20150711. Publication Type: Journal Article; research. Commentary: Vijayaragjavan Maya. Long-term opioid treatment of nonmalignant pain. (JCOM) 2010 Dec; 17 (12): 538-544. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0372440. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Utilization
KW  - Pain -- Drug Therapy
KW  - Drugs, Prescription -- Therapeutic Use
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Arkansas
KW  - Chronic Disease
KW  - Comorbidity
KW  - Female
KW  - Human
KW  - Hypnotics and Sedatives -- Administration and Dosage
KW  - Hypnotics and Sedatives -- Therapeutic Use
KW  - Male
KW  - Middle Age
KW  - Overdose
KW  - Drugs, Prescription -- Administration and Dosage
KW  - Regression
KW  - Risk Factors
KW  - Substance Use Disorders -- Diagnosis
KW  - Substance Use Disorders -- Etiology
SP  - 1425
EP  - 1432
JO  - Archives of Internal Medicine
JF  - Archives of Internal Medicine
JA  - ARCH INTERN MED
VL  - 170
IS  - 16
CY  - Chicago, Illinois
PB  - American Medical Association
SN  - 0003-9926
AD  - Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
U2  - PMID: 20837827.
DO  - 10.1001/archinternmed.2010.273
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106264416
T1  - Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department.
AU  - Berg ML
AU  - Idrees U
AU  - Ding R
AU  - Nesbit SA
AU  - Liang HK
AU  - McCarthy ML
Y1  - 2007/01/12/
N1  - Accession Number: 106264416. Language: English. Entry Date: 20070413. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Instrumentation: Objective Opioid Withdrawal Scale (OOWS); Short Opioid Withdrawal Scale (SOWS). Grant Information: Internal funds. NLM UID: 7513587. 
KW  - Buprenorphine -- Therapeutic Use
KW  - Emergency Service
KW  - Narcotics -- Adverse Effects
KW  - Substance Withdrawal Syndrome -- Drug Therapy
KW  - Academic Medical Centers
KW  - Adult
KW  - Chi Square Test
KW  - Clinical Assessment Tools
KW  - Comparative Studies
KW  - Funding Source
KW  - Length of Stay
KW  - Middle Age
KW  - Outcomes (Health Care)
KW  - Pilot Studies
KW  - Record Review
KW  - Retrospective Design
KW  - Scales
KW  - Substance Withdrawal Syndrome -- Symptoms
KW  - Human
SP  - 239
EP  - 244
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 86
IS  - 2/3
PB  - Elsevier B.V.
AB  - OBJECTIVES: To examine the use of buprenorphine for the treatment of opioid withdrawal (OW) in an emergency department (ED) setting. METHODS: The medical records of all adult patients who presented to the study ED during a 10 week period for OW were abstracted. Subjects were categorized as receiving buprenorphine, symptomatic treatment or no pharmacologic treatment for their OW. The three groups were compared by patient and service characteristics, withdrawal symptoms and outcomes. RESULTS: Of the 11,019 patients who presented to the ED during the 10 week study period, 158 (1.4%) were eligible. Subjects were more likely to receive buprenorphine (56%) compared to symptomatic treatment only (26%) or no pharmacologic treatment (18%). Subjects who received buprenorphine were more likely to have a history of suicide ideation (34% versus 12% p<0.05) compared to subjects who received symptomatic treatment(s) and were less likely to present with a gastrointestinal complaint (9% versus 25% p<0.05). Subjects who received buprenorphine were less likely to return to the same ED within 30 days for a drug-related visit (8%) compared to those who received symptomatic treatment (17%) (p<0.05). CONCLUSIONS: Buprenorphine was a common treatment for OW in this ED without any documented adverse outcomes. Given that it did not result in an increase in drug-related return ED visits and its proven efficacy in other settings, a prospective evaluation of its potential value to ED patients who present with OW is warranted.
SN  - 0376-8716
AD  - University of Illinois-Chicago, Edward Hospital, Department of Pharmacy, 801 S. Washington Street, Naperville, IL 60540, United States.
U2  - PMID: 16930865.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111928725
T1  - Impact of an Opioid Prescribing Guideline in the Acute Care Setting.
AU  - del Portal, Daniel A.
AU  - Healy, Megan E.
AU  - Satz, Wayne A.
AU  - McNamara, Robert M.
Y1  - 2016/01//
N1  - Accession Number: 111928725. Language: English. Entry Date: 20160507. Revision Date: 20170104. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Craig Handicap Assessment and Reporting Technique (CHART); Impact of Events Scale (IES). NLM UID: 8412174. 
KW  - Guideline Adherence
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Practice Guidelines
KW  - Aged
KW  - Emergency Service
KW  - Retrospective Design
KW  - Adolescence
KW  - Pennsylvania
KW  - Female
KW  - Male
KW  - Pain -- Drug Therapy
KW  - Adult
KW  - Young Adult
KW  - Middle Age
KW  - Impact of Events Scale
SP  - 21
EP  - 27
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 50
IS  - 1
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Death from opioid abuse is a major public health issue. The death rate associated with opioid overdose nearly quadrupled from 1999 to 2008. Acute care settings are a major source of opioid prescriptions, often for minor conditions and chronic noncancer pain.Objective: Our aim was to determine whether a voluntary opioid prescribing guideline reduces the proportion of patients prescribed opioids for minor and chronic conditions.Methods: A retrospective chart review was performed on records of adult emergency department visits from January 2012 to July 2014 for dental, neck, back, or unspecified chronic pain, and the proportion of patients receiving opioid prescriptions at discharge was compared before and after the guideline. Attending emergency physicians were surveyed on their perceptions regarding the impact of the guideline on prescribing patterns, patient satisfaction, and physician-patient interactions.Results: In our sample of 13,187 patient visits, there was a significant (p < 0.001) and sustained decrease in rates of opioid prescriptions for dental, neck, back, or unspecified chronic pain. The rate of opioid prescribing decreased from 52.7% before the guideline to 29.8% immediately after its introduction, and to 33.8% at an interval of 12 to 18 months later. The decrease in opioid prescriptions was observed in all of these diagnosis groups and in all age groups. All 31 eligible prescribing physicians completed a survey. The opioid prescribing guideline was supported by 100% of survey respondents.Conclusions: An opioid prescribing guideline significantly decreased the rates at which opioids were prescribed for minor and chronic complaints in an acute care setting.
SN  - 0736-4679
AD  - Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
U2  - PMID: 26281819.
DO  - 10.1016/j.jemermed.2015.06.014
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107868336
T1  - Intranasal Naloxone for Prehospital Opioid Overdose.
AU  - Roberts, James R.
Y1  - 2014/07//
N1  - Accession Number: 107868336. Language: English. Entry Date: 20140730. Revision Date: 20150712. Publication Type: Journal Article; pictorial. Journal Subset: Biomedical; USA. Special Interest: Emergency Care. NLM UID: 9000866. 
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Overdose
KW  - Substance Abuse
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Emergency Medicine
KW  - News
KW  - Physicians, Emergency
KW  - Substance Abusers
KW  - Emergency Service
KW  - Patient Care
SP  - 4
EP  - 6
JO  - Emergency Medicine News
JF  - Emergency Medicine News
JA  - EMERG MED NEWS
VL  - 36
IS  - 7
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 1054-0725
AD  - Chairman of emergency medicine and the director of the division of toxicology, Mercy Catholic Medical Center; Director of the division of toxicology, Mercy Catholic Medical Center; Professor of emergency medicine and toxicology, Drexel University College of Medicine, Philadelphia
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111558536
T1  - VA Patients With High Numbers of Opioid Prescriptions: A National Study of Sociodemographic and Diagnostic Characteristics, Health Service, and Psychotropic Medication Use.
AU  - Petrakis, Ismene L.
AU  - Sofuoglu, Mehmet
AU  - Rosenheck, Robert
Y1  - 2015/12//
N1  - Accession Number: 111558536. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101148822. 
KW  - Diagnosis, Dual (Psychiatry)
KW  - Mental Health
KW  - Substance Use Disorders
KW  - Antidepressive Agents -- Therapeutic Use
KW  - Public Health
KW  - Substance Abuse
KW  - Health Services
KW  - Middle East
KW  - Logistic Regression
KW  - Multiple Logistic Regression
KW  - Effect Size
KW  - Odds Ratio
KW  - Structured Interview
KW  - Confidence Intervals
KW  - Prospective Studies
KW  - Outpatients
KW  - Study Design
KW  - Sampling Methods
KW  - Regression
KW  - Surveys
KW  - Interviews
SP  - 167
EP  - 175
JO  - Addictive Disorders & Their Treatment
JF  - Addictive Disorders & Their Treatment
JA  - ADDICT DISORD THEIR TREAT
VL  - 14
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Background and Objectives: Prescription opioid use is a major public health concern, particularly among military personnel and veterans. This study used administrative data on Veterans Health Administration users to identify characteristics associated with high numbers of opioid prescriptions. Methods: Veterans Health Administration patients (n = 5,300,000) who attended ≥ 1 outpatient visit during fiscal year 2010 were classified into 5 groups: no opioid prescriptions, 1 to 2,3 to 10,10 to 19, and > 20 opioid prescriptions filled during the year. Bivariate comparisons and logistic regression were used to identify sociodemographic, diagnostic characteristics, health service, and psychotropic medication usage that differentiated the high opioid group (>20) from those who used none. Results: On bivariate analysis, the patients in the high opioid group (1% of sample) were more likely to be diagnosed with metastatic cancer, other medical illnesses, and various forms of pain, drug abuse, alcohol abuse, mood disorders, and anxiety. Psycho-tropic prescriptions were also associated with high opioid use. Logistic regression showed that drug abuse, depressive disorders, and dual diagnosis were independently associated with high prescription opioid use. Medical outpatient visits but not mental health or emergency room visits, and antidepressant prescriptions but not other psychotropics, were more independently associated with high opioid use. Service during the recent Middle East conflicts was associated with lower risk of high opioid use. Discussion and Conclusions: Drug use disorders, depression, and antidepressant medication prescriptions were independently associated with extensive opioid use. Providers should be attuned to high rates of comorbid drug use and depression and concomitant antidepressants among patients with high opioid prescription use.
SN  - 1531-5754
AD  - VISN I Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System
AD  - Department of Psychiatry, Yale University School of Medicine, West Haven, CT
DO  - 10.1097/ADT.0000000000000058
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111558536&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118267497
T1  - The Impact of Pain Management with Opioids among Older Adults Post Orthopedic Trauma.
AU  - Resnick, Barbara
AU  - Galik, Elizabeth
AU  - Wells, Chris L.
AU  - Boltz, Marie
AU  - Renn, Cynthia L.
AU  - Dorsey, Susan G.
Y1  - 2016/10//
N1  - Accession Number: 118267497. Language: English. Entry Date: In Process. Revision Date: 20161013. Publication Type: Article; research. Journal Subset: Blind Peer Reviewed; Core Nursing; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Gerontologic Care. NLM UID: 100890606. 
KW  - Gerontologic Nursing
KW  - Pain Management
KW  - Narcotics -- Therapeutic Use
KW  - Emergency Patients
KW  - Human
KW  - Male
KW  - Female
KW  - Trauma Centers
KW  - Secondary Analysis
KW  - Length of Stay
KW  - Hardiness
KW  - Functional Status
SP  - 302
EP  - 310
JO  - Pain Management Nursing
JF  - Pain Management Nursing
JA  - PAIN MANAGE NURS
VL  - 17
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - W B Saunders
AB  - Pain has a significant effect on physical and psychological outcomes for older adults post orthopedic trauma. The purpose of this study was to describe the management of pain among older trauma patients and consider differences between those who received 3 or more dosages daily of opioids versus those who did not. This was a secondary data analysis using data from an intervention study testing the effect of Function Focused Care among older orthopedic trauma patients (FFC-AC). The FFC-AC study was done on trauma units in two acute care settings designated as Level I or II trauma centers from September 2014 to September 2015. All participants from the parent FFC-AC study were included. Data collection for the parent study was done within 24 hours of admission and within 24 hours of discharge and included demographics, medications, assessment of function, physical activity, mood, physical resilience, and whether the patient had pain and their pain intensity. Patient records included all 89 individuals from the parent study, 59 (66%) of whom were female and 82 (92%) were white. Records indicated that those who received more than three dosages per day of opioids had a shorter length of stay, were younger, had more intense pain, and were more resilient compared with those who received less than three dosages per day. This secondary data analysis provides support for the importance of considering pain and pain management among older adults post trauma.
SN  - 1524-9042
AD  - University of Maryland, School of Nursing, Baltimore, Maryland
AD  - The University of Maryland, School of Medicine, Baltimore, Maryland
AD  - Boston College, Chestnut Hill, Massachusetts
DO  - 10.1016/j.pmn.2016.05.005
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104094347
T1  - Benzodiazepine use during buprenorphine treatment for opioid dependence: clinical and safety outcomes.
AU  - Schuman-Olivier, Zev
AU  - Hoeppner, Bettina B
AU  - Weiss, Roger D
AU  - Borodovsky, Jacob
AU  - Shaffer, Howard J
AU  - Albanese, Mark J
Y1  - 2013/10//
N1  - Accession Number: 104094347. Language: English. Entry Date: 20140502. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Psychiatry/Psychology. Grant Information: UL1RR025758/RR/NCRR NIH HHS/United States. NLM UID: 7513587. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Buprenorphine -- Therapeutic Use
KW  - Narcotics
KW  - Substance Use Disorders -- Drug Therapy
KW  - Substance Use Disorders -- Epidemiology
KW  - Accidents -- Trends
KW  - Adult
KW  - Antianxiety Agents, Benzodiazepine -- Adverse Effects
KW  - Emergency Medical Services -- Trends
KW  - Female
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Retrospective Design
KW  - Treatment Outcomes
SP  - 580
EP  - 586
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 132
IS  - 3
PB  - Elsevier B.V.
AB  - Background: Prescribing benzodiazepines during buprenorphine treatment is a topic of active discussion. Clinical benefit is unclear. Overdose, accidental injury, and benzodiazepine misuse remain concerns. We examine the relationship between benzodiazepine misuse history, benzodiazepine prescription, and both clinical and safety outcomes during buprenorphine treatment.Methods: We retrospectively examined outpatient buprenorphine treatment records, classifying patients by past-year benzodiazepine misuse history and approved benzodiazepine prescription at intake. Primary clinical outcomes included 12-month treatment retention and urine toxicology for illicit opioids. Primary safety outcomes included total emergency department (ED) visits and odds of an ED visit related to overdose or accidental injury during treatment.Results: The 12-month treatment retention rate for the sample (N=328) was 40%. Neither benzodiazepine misuse history nor benzodiazepine prescription was associated with treatment retention or illicit opioid use. Poisson regressions of ED visits during buprenorphine treatment revealed more ED visits among those with a benzodiazepine prescription versus those without (p<0.001); benzodiazepine misuse history had no effect. The odds of an accidental injury-related ED visit during treatment were greater among those with a benzodiazepine prescription (OR: 3.7, p<0.01), with an enhanced effect among females (OR: 4.7, p<0.01). Overdose was not associated with benzodiazepine misuse history or prescription.Conclusions: We found no effect of benzodiazepine prescriptions on opioid treatment outcomes; however, benzodiazepine prescription was associated with more frequent ED visits and accidental injuries, especially among females. When prescribing benzodiazepines during buprenorphine treatment, patients need more education about accidental injury risk. Alternative treatments for anxiety should be considered when possible, especially among females.
SN  - 0376-8716
AD  - Harvard Medical School, United States; Massachussets General Hospital, United States. Electronic address: zschuman@partners.org.
U2  - PMID: 23688843.
DO  - 10.1016/j.drugalcdep.2013.04.006
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104088618
T1  - Relationship of opioid prescription sales and overdoses, North Carolina.
AU  - Modarai, F
AU  - Mack, K
AU  - Hicks, P
AU  - Benoit, S
AU  - Park, S
AU  - Jones, C
AU  - Proescholdbell, S
AU  - Ising, A
AU  - Paulozzi, L
Y1  - 2013/09//
N1  - Accession Number: 104088618. Language: English. Entry Date: 20140328. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Psychiatry/Psychology. NLM UID: 7513587. 
KW  - Analgesics, Opioid -- Supply and Distribution
KW  - Overdose -- Epidemiology
KW  - Drugs, Prescription -- Supply and Distribution
KW  - Analgesics, Opioid -- Economics
KW  - Cluster Analysis
KW  - Business
KW  - Data Analysis, Statistical
KW  - Human
KW  - Linear Regression
KW  - North Carolina
KW  - Population Density
KW  - Drugs, Prescription -- Economics
KW  - Rural Population
KW  - Urban Population
SP  - 81
EP  - 86
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 132
IS  - 1/2
PB  - Elsevier B.V.
AB  - BACKGROUND: In the United States, fatal drug overdoses have tripled since 1991. This escalation in deaths is believed to be driven primarily by prescription opioid medications. This investigation compared trends and patterns in sales of opioids, opioid drug overdoses treated in emergency departments (EDs), and unintentional overdose deaths in North Carolina (NC). METHODS: Our ecological study compared rates of opioid sales, opioid related ED overdoses, and unintentional drug overdose deaths in NC. Annual sales data, provided by the Drug Enforcement Administration, for select opioids were converted into morphine equivalents and aggregated by zip code. These opioid drug sales rates were trended from 1997 to 2010. In addition, opioid sales were correlated and compared to opioid related ED visits, which came from a Centers for Disease Control and Prevention syndromic surveillance system, and unintentional overdose deaths, which came from NC Vital Statistics, from 2008 to 2010. Finally, spatial cluster analysis was performed and rates were mapped by zip code in 2010. RESULTS: Opioid sales increased substantially from 1997 to 2010. From 2008 to 2010, the quarterly rates of opioid drug overdoses treated in EDs and opioid sales correlated (r=0.68, p=0.02). Specific regions of the state, particularly in the southern and western corners, had both high rates of prescription opioid sales and overdoses. CONCLUSIONS: Temporal trends in sales of prescription opioids correlate with trends in opioid related ED visits. The spatial correlation of opioid sales with ED visit rates shows that opioid sales data may be a timely way to identify high-risk communities in the absence of timely ED data.
SN  - 0376-8716
AD  - Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Hwy, Mailstop F-62, Atlanta, GA 30341, United States. Electronic address: vqy8@cdc.gov.
U2  - PMID: 23399467.
DO  - 10.1016/j.drugalcdep.2013.01.006
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104088618&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125493744
T1  - 16 hospitalizations daily for opioid poisoning.
AU  - Collier, Roger
Y1  - 2017/10/02/
N1  - Accession Number: 125493744. Language: English. Entry Date: 20171021. Revision Date: 20171113. Publication Type: journal article. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 9711805. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Substance Use Disorders -- Therapy
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Incidence
KW  - Substance Use Disorders -- Epidemiology
KW  - Canada
SP  - E1248
EP  - E1248
JO  - CMAJ: Canadian Medical Association Journal
JF  - CMAJ: Canadian Medical Association Journal
JA  - CMAJ
VL  - 189
IS  - 39
CY  - Ottowa, Ontario
PB  - Joule Inc.
AB  - The article looks at a report titled "Hospitalizations and Emergency Department Visits Due to Opioid Poisoning in Canada" released by the Canadian Institute for Health Information. It mentions rise in visits for poisoning with heroin and synthetic opioids and the half of these incidents were considered accidental and a third the result of self-inflicted harm.
SN  - 0820-3946
U2  - PMID: 28970270.
DO  - 10.1503/cmaj.1095503
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125493744&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120353883
T1  - Opioidverschreibung bei Schmerz: Laxanzien nicht vergessen.
AU  - Busch, Christian
Y1  - 2016/07//
N1  - Accession Number: 120353883. Language: German. Entry Date: 20170128. Revision Date: 20170128. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 9109478. 
KW  - Pain -- Prevention and Control
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Constipation -- Prevention and Control
KW  - Cathartics -- Administration and Dosage
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Analgesics, Opioid -- Adverse Effects
KW  - United States
KW  - Constipation -- Chemically Induced
KW  - Middle Age
KW  - Aged
KW  - Male
KW  - Adolescence
KW  - Adult
KW  - Young Adult
SP  - 436
EP  - 439
JO  - AINS: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie
JF  - AINS: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie
JA  - ANASTHESIOL INTENSIVMED NOTFALLMED SCHMERZTHER
VL  - 51
IS  - 7/8
PB  - Georg Thieme Verlag Stuttgart
SN  - 0939-2661
U2  - PMID: 27479252.
DO  - 10.1055/s-0042-111842
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120353883&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109421253
T1  - Post-medication Hypotension after Administration of Sedatives and Opioids during Critical Care Transport.
AU  - Singh, Jeffrey M.
AU  - MacDonald, Russell D.
AU  - Ahghari, Mahvareh
Y1  - 2015/10//Oct-Dec2015
N1  - Accession Number: 109421253. Language: English. Entry Date: 20150915. Revision Date: 20170324. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Hypotension -- Diagnosis
KW  - Hypnotics and Sedatives -- Administration and Dosage
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Critical Care
KW  - Transportation of Patients
KW  - Drug Evaluation
KW  - Emergency Care
KW  - Prehospital Care
KW  - Hypotension -- Risk Factors
KW  - Human
KW  - Retrospective Design
KW  - Patient Safety
KW  - Adverse Drug Event
KW  - Aeromedical Transport
KW  - Outcomes (Health Care)
KW  - Patient Selection
KW  - Male
KW  - Female
KW  - Trauma
KW  - Confidence Intervals
KW  - Odds Ratio
SP  - 464
EP  - 474
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 19
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Objective.Identification of modifiable risk factors for hypotension during critical care transport is important to optimize patient preparation, crew training, and patient safety. We set out to determine the incidence of hemodynamic deterioration after administration of opioids or sedatives during critical care transport, and identify patient- and transport-level predictors.Methods.We assembled a retrospective cohort of adults undergoing urgent critical care transport between January 1, 2005, and December 31, 2010. The primary outcome was post-medication hypotension, defined by new hypotension or new vasopressor within 10 minutes of medication administration.Results.Opioids or sedatives were administered 28,592 times in 8,328 patient transports, with 159 episodes of post-medication hypotension (0.6% of all medication administrations). Mechanical ventilation (adjusted odds ratio [OR] 4.9; 95% confidence interval [95%CI] 2.7–8.9), baseline vasopressor requirement (adjusted OR 2.1; 95%CI 1.3–3.4), transport duration (adjusted OR 1.5; 95%CI 1.1–2.2) per log unit increment of duration), surgical diagnosis (adjusted OR 4.1; 95%CI 1.6–10.7 compared to trauma), and ACP crew level (adjusted OR 2.4 compared to baseline of CCP; 95%CI 1.5–3.8) were all associated with an increased odds of post-medication hypotension. ACP crew level remained associated with increased post-medication hypotension in a sensitivity analysis of 1,242 propensity-matched pairs (crude OR for ACP vs. CCP 3.0; 95%CI 1.4–6.5).Conclusions.Post-medication hypotension occurred once in every 160 drug administrations and was associated with mechanical ventilation, baseline hemodynamic instability, transport duration, surgical diagnosis, and ACP crew. These findings provide targets for improvements in patient preparation, crew training, and clinical practices.
SN  - 1090-3127
U2  - PMID: 25658022.
DO  - 10.3109/10903127.2014.995848
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 117909307
T1  - Titrated doses are optimal for opioids in pain trials - Authors' reply.
AU  - Pathan, Sameer A.
AU  - Mitra, Biswadev
AU  - Cameron, Peter A.
Y1  - 2016/09/03/
N1  - Accession Number: 117909307. Language: English. Entry Date: 20160921. Revision Date: 20160922. Publication Type: commentary; letter. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 2985213R. 
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
SP  - 961
EP  - 962
JO  - Lancet
JF  - Lancet
JA  - LANCET
VL  - 388 North American Edition
IS  - 10048
CY  - Philadelphia, Pennsylvania
PB  - Lancet
AB  - A response from the authors of the article "Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial" in the May 14, 2016 issue is presented.
SN  - 0099-5355
AD  - Hamad General Hospital, Hamad Medical Corporation, Doha PO Box 3050, Qatar.
AD  - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
U2  - PMID: 27598676.
DO  - 10.1016/S0140-6736(16)31494-5
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117909307&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

ID  - 117202951
T1  - A Promising Screening Tool for Prescription Opioid Use Disorders in Older Adults?
AU  - Douaihy, Antoine
Y1  - 2016/08//
N1  - Accession Number: 117202951. Language: English. Entry Date: 20180211. Revision Date: 20171128. Publication Type: editorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 9309609. 
SP  - 637
EP  - 638
JO  - American Journal of Geriatric Psychiatry
JF  - American Journal of Geriatric Psychiatry
JA  - AM J GERIATR PSYCHIATRY
VL  - 24
IS  - 8
CY  - New York, New York
PB  - Elsevier B.V.
AB  - The article discusses a study on the prevalence of prescription opioid misuse and prescription opioid use disorder (OUD) among older adult emergency department (ED) patients who used prescription opioids as well as the ability of the Prescription Drug Use Questionnaire (PDUQ)-patient version. Topics covered include the limitations in screening for misuse, questions included in the PDUQp, and the limitations of the study.
SN  - 1064-7481
AD  - Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
AD  - Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213
U2  - PMID: 27426211.
DO  - 10.1016/j.jagp.2016.05.006
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DP  - EBSCOhost
DB  - ccm
ER  - 

ID  - 114882083
T1  - Probable Tapentadol-Associated Serotonin Syndrome After Overdose.
AU  - Walczyk, Heather
AU  - Liu, Cheuk H. (Michael)
AU  - Alafris, Antonia
AU  - Cohen, Henry
Y1  - 2016/04//
N1  - Accession Number: 114882083. Language: English. Entry Date: 20170901. Revision Date: 20170901. Publication Type: Case Study; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0043175. 
KW  - Serotonin Syndrome
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Emergency Care
KW  - Overdose
KW  - Naloxone -- Administration and Dosage
SP  - 320
EP  - 327
JO  - Hospital Pharmacy
JF  - Hospital Pharmacy
JA  - HOSP PHARM
VL  - 51
IS  - 4
CY  - Thousand Oaks, California
PB  - Sage Publications Inc.
AB  - Purpose: Drug-induced serotonin syndrome is a potentially life-threatening condition. An Ovid MEDLINE, and PubMed search from 1950 to October 2015 revealed one published case report of suspected tapentadol-induced serotonin syndrome. We report a probable case of tapentadol-induced serotonin syndrome after overdose. Case Summary: A 48-year-old male was found unresponsive after a witnessed overdose of medications including tapentadol. After administration of naloxone by emergency medical services, the patient became combative and presented with altered mental status. Ele was managed with physical and pharmacologic restraints in the emergency department. Other medications that could be implicated in the patient's presentation include duloxetine and amitriptyline. It was suspected that the opioid properties of tapentadol were masking the patient's signs and symptoms of serotonin syndrome. The patient was admitted to the medical intensive care unit, remained stable, and was discharged 2 days later. Currently, there is one published case report of suspected tapentadol-induced serotonin syndrome after an overdose. The manufacturer of tapentadol reported no cases of serotonin syndrome during clinical trials, but there have been postmarketing cases reported with co-administration of other serotonergic drugs. Conclusion: We report a probable case of tapentadol-induced serotonin syndrome after overdose. Further research is needed to better understand the pharmacology and incidence behind this adverse event.
SN  - 0018-5787
AD  - SeaView Research, Miami, Florida
AD  - Department of Pharmacy, Yale-New Haven Hospital, New Haven, Connecticut
AD  - Department of Pharmacy, St. Barnabas Hospital, Bronx, New York
AD  - Department of Pharmacy Services, Kingsbrook Jewish Medical Center and Arnold & Marie Schwartz College of Pharmacy & Health Sciences of Long Island University, Division of Pharmacy Practice, Brooklyn, New York
DO  - 10.1310/hpj5104-320
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110660189
T1  - Health service use in a randomized clinical trial comparing three methods of emergency department interventions for opioid dependence.
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.
Y1  - 2015/11//
N1  - Accession Number: 110660189. Language: English. Entry Date: 20160622. Revision Date: 20160409. Publication Type: Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
SP  - e32
EP  - e32
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 156
PB  - Elsevier B.V.
SN  - 0376-8716
AD  - Yale University, New Haven, CT, United States
DO  - 10.1016/j.drugalcdep.2015.07.1005
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110659809
T1  - A randomized clinical trial of emergency department initiated treatment for opioid dependence: Two and six month outcomes.
AU  - D’Onofrio, Gail
AU  - O’Connor, Patrick
AU  - Pantalon, Michael
AU  - Chawarski, Marek
AU  - Busch, Susan
AU  - Owens, Patricia
AU  - Bernstein, Steven
AU  - Fiellin, David
Y1  - 2015/11//
N1  - Accession Number: 110659809. Language: English. Entry Date: 20160622. Revision Date: 20160409. Publication Type: Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
SP  - e53
EP  - e53
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 156
PB  - Elsevier B.V.
SN  - 0376-8716
AD  - Yale University, New Haven, CT, United States
DO  - 10.1016/j.drugalcdep.2015.07.1062
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112366621
T1  - Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department.
AU  - Genco, Emma K.
AU  - Forster, Jeri E.
AU  - Flaten, Hanna
AU  - Goss, Foster
AU  - Heard, Kennon J.
AU  - Hoppe, Jason
AU  - Monte, Andrew A.
Y1  - 2016/02//
N1  - Accession Number: 112366621. Language: English. Entry Date: 20160520. Revision Date: 20171231. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: K23 GM110516/GM/NIGMS NIH HHS/United States. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Adverse Drug Event
KW  - Emergency Service
KW  - Pharmacovigilance
KW  - Adverse Drug Event -- Prevention and Control
KW  - Decision Support Systems, Clinical
KW  - Medication Errors -- Prevention and Control
KW  - Retrospective Design
KW  - Male
KW  - Aged, 80 and Over
KW  - Female
KW  - Middle Age
KW  - Aged
KW  - Adolescence
KW  - Adult
KW  - Scales
SP  - 240
EP  - 248.e3
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 67
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: We examine the characteristics of clinical decision support alerts triggered when opioids are prescribed, including alert type, override rates, adverse drug events associated with opioids, and preventable adverse drug events.Methods: This was a retrospective chart review study assessing adverse drug event occurrences for emergency department (ED) visits in a large urban academic medical center using a commercial electronic health record system with clinical decision support. Participants include those aged 18 to 89 years who arrived to the ED every fifth day between September 2012 and January 2013. The main outcome was characteristics of opioid drug alerts, including alert type, override rates, opioid-related adverse drug events, and adverse drug event preventability by clinical decision support.Results: Opioid drug alerts were more likely to be overridden than nonopioid alerts (relative risk 1.35; 95% confidence interval [CI] 1.21 to 1.50). Opioid drug-allergy alerts were twice as likely to be overridden (relative risk 2.24; 95% CI 1.74 to 2.89). Opioid duplicate therapy alerts were 1.57 times as likely to be overridden (95% CI 1.30 to 1.89). Fourteen of 4,581 patients experienced an adverse drug event (0.31%; 95% CI 0.15% to 0.47%), and 8 were due to opioids (57.1%). None of the adverse drug events were preventable by clinical decision support. However, 46 alerts were accepted for 38 patients that averted a potential adverse drug event. Overall, 98.9% of opioid alerts did not result in an actual or averted adverse drug event, and 96.3% of opioid alerts were overridden.Conclusion: Overridden opioid alerts did not result in adverse drug events. Clinical decision support successfully prevented adverse drug events at the expense of generating a large volume of inconsequential alerts. To prevent 1 adverse drug event, providers dealt with more than 123 unnecessary alerts. It is essential to refine clinical decision support alerting systems to eliminate inconsequential alerts to prevent alert fatigue and maintain patient safety.
SN  - 0196-0644
AD  - Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO
AD  - Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO
AD  - VA VISN 19 Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO
U2  - PMID: 26553282.
DO  - 10.1016/j.annemergmed.2015.09.020
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112366621&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108095003
T1  - Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal.
AU  - Coffin PO
AU  - Sullivan SD
AU  - Coffin, Phillip O
AU  - Sullivan, Sean D
Y1  - 2013/01//1/1/2013
N1  - Accession Number: 108095003. Language: English. Entry Date: 20130315. Revision Date: 20171209. Publication Type: journal article; research. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: 5T32AI007140-33/AI/NIAID NIH HHS/United States. NLM UID: 0372351. 
KW  - Heroin -- Poisoning
KW  - Naloxone -- Economics
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Economics
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Adult
KW  - Cost Benefit Analysis
KW  - Decision Support Techniques
KW  - Substance Use Disorders -- Prevention and Control
KW  - Substance Use Disorders -- Drug Therapy
KW  - Health Facility Costs -- Economics
KW  - Human
KW  - Probability
KW  - United States
KW  - Young Adult
SP  - 1
EP  - 9
JO  - Annals of Internal Medicine
JF  - Annals of Internal Medicine
JA  - ANN INTERN MED
VL  - 158
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
AB  - Background: Opioid overdose is a leading cause of accidental death in the United States.Objective: To estimate the cost-effectiveness of distributing naloxone, an opioid antagonist, to heroin users for use at witnessed overdoses.Design: Integrated Markov and decision analytic model using deterministic and probabilistic analyses and incorporating recurrent overdoses and a secondary analysis assuming heroin users are a net cost to society.Data Sources: Published literature calibrated to epidemiologic data.Target Population: Hypothetical 21-year-old novice U.S. heroin user and more experienced users with scenario analyses.Time Horizon: Lifetime.Perspective: Societal.Intervention: Naloxone distribution for lay administration.Outcome Measures: Overdose deaths prevented and incremental cost-effectiveness ratio (ICER).Results Of Base-case Analysis: In the probabilistic analysis, 6% of overdose deaths were prevented with naloxone distribution; 1 death was prevented for every 227 naloxone kits distributed (95% CI, 71 to 716). Naloxone distribution increased costs by $53 (CI, $3 to $156) and quality-adjusted life-years by 0.119 (CI, 0.017 to 0.378) for an ICER of $438 (CI, $48 to $1706).Results Of Sensitivity Analysis: Naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity and scenario analyses, and it was cost-saving if it resulted in fewer overdoses or emergency medical service activations. In a "worst-case scenario" where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the ICER was $14 000. If national drug-related expenditures were applied to heroin users, the ICER was $2429.Limitation: Limited sources of controlled data resulted in wide CIs.Conclusion: Naloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions.Primary Funding Source: National Institute of Allergy and Infectious Diseases.
SN  - 0003-4819
AD  - San Francisco Department of Public Health, San Francisco, CA 94102, USA
AD  - San Francisco Department of Public Health, San Francisco, CA 94102, USA.
U2  - PMID: 23277895.
DO  - 10.7326/0003-4819-158-1-201301010-00003
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108095003&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123937867
T1  - Governor Rick Scott Issues Emergency Order On Opioid Epidemic.
Y1  - 2017/05//
N1  - Accession Number: 123937867. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; pictorial. Journal Subset: Biomedical; USA. NLM UID: 8804918. 
KW  - Disease Outbreaks
KW  - Emergencies
KW  - Organizations
KW  - Pharmacy, Retail
SP  - 9
EP  - 9
JO  - Florida Pharmacy Today
JF  - Florida Pharmacy Today
JA  - FLA PHARM TODAY
VL  - 80
IS  - 5
CY  - Tallahassee, Florida 32301, Florida
PB  - Florida Pharmacy Association
SN  - 0897-4616
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123937867&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104370226
T1  - Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department.
AU  - Cantrill SV
AU  - Brown MD
AU  - Carlisle RJ
AU  - Delaney KA
AU  - Hays DP
AU  - Nelson LS
AU  - O'Connor RE
AU  - Papa A
AU  - Sporer KA
AU  - Todd KH
AU  - Whitson RR
Y1  - 2012/10//
N1  - Accession Number: 104370226. Language: English. Entry Date: 20130111. Revision Date: 20150711. Publication Type: Journal Article; practice guidelines. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Standards
KW  - Pain -- Drug Therapy
KW  - Adult
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Low Back Pain -- Drug Therapy
KW  - Substance Use Disorders -- Prevention and Control
KW  - Risk Factors
SP  - 499
EP  - 525
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 60
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - American College of Emergency Physicians Opioid Guideline Writing Panel.
U2  - PMID: 23010181.
DO  - 10.1016/j.annemergmed.2012.06.013
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104370226&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106977853
T1  - Intravenous bolus or infusion of naloxone in opioid overdose.
AU  - Clarke S
A2  - Dargan P
Y1  - 2002/05//
N1  - Accession Number: 106977853. Language: English. Entry Date: 20021115. Revision Date: 20150820. Publication Type: Journal Article; brief item; case study; tables/charts. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 100963089. 
KW  - Antidotes -- Administration and Dosage
KW  - Methadone -- Poisoning
KW  - Naloxone -- Administration and Dosage
KW  - Male
KW  - Adult
KW  - Overdose -- Therapy
KW  - Infusions, Intravenous
KW  - Heroin
KW  - Substance Dependence -- Therapy
KW  - Medical Practice, Evidence-Based
KW  - Journal Clubs -- England
KW  - England
KW  - Emergency Care
KW  - Literature Review
KW  - Computerized Literature Searching
SP  - 249
EP  - 250
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
PB  - BMJ Publishing Group
AB  - A short cut review was carried out to establish whether intramuscular/subcutaneous naloxone is better than intravenous naloxone in opioid overdose. Altogether 185 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
SN  - 1472-0205
AD  - Specialist Registrar, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
U2  - PMID: 11971842.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106977853&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113188609
T1  - Acetylfentanyl: An Emerging Drug of Abuse.
AU  - Rogers, Jeremy S.
AU  - Rehrer, Seth J.
AU  - Hoot, Nathan R.
Y1  - 2016/03//
N1  - Accession Number: 113188609. Language: English. Entry Date: 20160623. Revision Date: 20161223. Publication Type: journal article; case study. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Glasgow Coma Scale (GCS). NLM UID: 8412174. 
KW  - Fentanyl -- Analogs and Derivatives
KW  - Analgesics, Opioid -- Poisoning
KW  - Respiratory Failure -- Chemically Induced
KW  - Substance Use Disorders -- Etiology
KW  - Psychotropic Drugs -- Poisoning
KW  - Fentanyl -- Poisoning
KW  - Adult
KW  - Male
KW  - Glasgow Coma Scale
SP  - 433
EP  - 436
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 50
IS  - 3
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Opioid analgesics are widely used in health care, yet have significant potential for abuse. High doses are associated with potentially fatal respiratory depression, which caused 21,314 deaths in the United States in 2011. Acetylfentanyl, a synthetic opioid agonist closely related to fentanyl, recently emerged as a drug of abuse linked to numerous deaths in North America.Case Report: A 36-year-old male developed the habit of using a propylene glycol electronic cigarette filled with acetylfentanyl to aid relaxation. He purchased the drug online in a manner that appeared legal to him, which compromised his insight about the danger of the substance. He had been using the e-cigarette with increasing frequency while on medical leave, and his wife reported finding him weakly responsive on more than one occasion. At approximately 3 am, the family activated 911 for altered mental status. His presentation included respiratory depression, pinpoint pupils, hypoxemia, and a Glasgow Coma Scale score of 6. He responded to serial doses of intravenous naloxone with improvement in his mental status and respiratory condition. Due to the need for repeated dosing, he was placed on a naloxone infusion and recovered uneventfully in intensive care. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Complications from emerging drugs of abuse, like acetylfentanyl, frequently present first to emergency departments. Prompt recognition and treatment can help avoid morbidity and mortality. Acetylfentanyl can be managed effectively with naloxone, although higher than conventional dosing may be required to achieve therapeutic effect.
SN  - 0736-4679
AD  - Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
U2  - PMID: 26589567.
DO  - 10.1016/j.jemermed.2015.10.014
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113188609&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 116079853
T1  - Respiratory depression in the intoxicated trauma patient: are opioids to blame?
AU  - Shenk, Eleni
AU  - Barton, Cassie A
AU  - Mah, Nathan D
AU  - Ran, Ran
AU  - Hendrickson, Robert G
AU  - Watters, Jennifer
Y1  - 2016/02//
N1  - Accession Number: 116079853. Language: English. Entry Date: 20160615. Revision Date: 20160622. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Instrumentation: Injury Severity Score (ISS). NLM UID: 8309942. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Respiratory Failure -- Chemically Induced
KW  - Ethanol -- Blood
KW  - Wounds and Injuries -- Drug Therapy
KW  - Pain -- Therapy
KW  - Hypnotics and Sedatives -- Therapeutic Use
KW  - Incidence
KW  - Glasgow Coma Scale
KW  - Trauma Centers
KW  - Trauma Severity Indices
KW  - Adult
KW  - Male
KW  - Retrospective Design
KW  - Female
KW  - Risk Factors
SP  - 250
EP  - 253
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 34
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Providing effective pain management to acutely intoxicated trauma patients represents a challenge of balancing appropriate pain management with the risk of potential respiratory depression from opioid administration. The objective of this study was to quantify the incidence of respiratory depression in trauma patients acutely intoxicated with ethanol who received opioids as compared with those who did not and identify potential risk factors for respiratory depression in this population. Retrospective medical record review was conducted for subjects identified via the trauma registry who were admitted as a trauma activation and had a detectable serum ethanol level upon admission. Risk factors and characteristics compared included demographics, Injury Severity Score, Glasgow Coma Score, serum ethanol level upon arrival, urine drug screen results, incidence of respiratory depression, and opioid and other sedative medication use. A total of 233 patients were included (78.5% male). Patients who received opioids were more likely to have a higher Injury Severity Score and initial pain score on admission as compared with those who did not receive opioids. Blood ethanol content was higher in patients who did not receive opioids (0.205 vs 0.237 mg/dL, P = .015). Patients who did not receive opioids were more likely to be intubated within 4 hours of admission (1.7% vs 12.1%, P = .02). Opioid administration was not associated with increased risk of respiratory depression (19.7% vs 22.4%, P = .606). Increased cumulative fentanyl dose was associated with increased risk of respiratory depression. Increased cumulative fentanyl dose, but not opioid administration alone, was found to be a risk factor for respiratory depression.
SN  - 0735-6757
AD  - Department of Pharmacy, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239
AD  - Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239
AD  - Department of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239
U2  - PMID: 26614581.
DO  - 10.1016/j.ajem.2015.10.053
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116079853&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118138831
T1  - A Second Look at ED-initiated Buprenorphine for Opioid Addiction.
Y1  - 2016/10//
N1  - Accession Number: 118138831. Language: English. Entry Date: 20160921. Revision Date: 20160922. Publication Type: Article. Note: For CE see Supplement page 120. Journal Subset: Nursing; USA. NLM UID: 9425690. 
KW  - Emergency Service
KW  - Buprenorphine -- Administration and Dosage
KW  - Substance Dependence -- Drug Therapy
KW  - Narcotics
KW  - Academic Medical Centers -- Connecticut
KW  - Hospital Programs
KW  - Transfer, Discharge
KW  - Substance Use Rehabilitation Programs
KW  - Connecticut
KW  - Collaboration
KW  - Patient Education
KW  - Overdose -- Education
KW  - Naloxone -- Administration and Dosage
KW  - Education, Continuing (Credit)
SP  - 113
EP  - 114
JO  - ED Management
JF  - ED Management
JA  - ED MANAGE
VL  - 28
IS  - 10
CY  - Atlanta, Georgia
PB  - AHC Media LLC
SN  - 1044-9167
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118138831&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123059428
T1  - Opioids and Objective Pain...Walker G. The Opioid-Lite Emergency Department. EMN. 2016; 38 (12) 31-31.
AU  - Mosley, Mark
AU  - Walker
Y1  - 2017/04//4/1/2017
N1  - Accession Number: 123059428. Language: English. Entry Date: 20170608. Revision Date: 20170608. Publication Type: Article; commentary; letter; response. Journal Subset: Biomedical; USA. NLM UID: 9000866. 
KW  - Narcotics -- Therapeutic Use
KW  - Pain -- Diagnosis
KW  - Pain -- Drug Therapy
KW  - Substance Dependence
KW  - Physician Attitudes
KW  - Kidney Calculi -- Drug Therapy
KW  - Antiinflammatory Agents, Non-Steroidal -- Therapeutic Use
KW  - Lidocaine -- Therapeutic Use
SP  - 36
EP  - 36
JO  - Emergency Medicine News
JF  - Emergency Medicine News
JA  - EMERG MED NEWS
VL  - 39
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 1054-0725
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123059428&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109637936
T1  - Impact of constipation on opioid therapy management among long-term opioid users, based on a patient survey.
AU  - Gupta, Shaloo
AU  - Patel, Haridarshan
AU  - Scopel, Justin
AU  - Mody, Reema R
Y1  - 2015/07//2015 Jul-Aug
N1  - Accession Number: 109637936. Language: English. Entry Date: 20150923. Revision Date: 20151029. Publication Type: journal article. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101234523. 
SP  - 325
EP  - 338
JO  - Journal of Opioid Management
JF  - Journal of Opioid Management
JA  - J OPIOID MANAGE
VL  - 11
IS  - 4
CY  - Weston, Massachusetts
PB  - Weston Medical Publishing, LLC
AB  - Objective: The authors sought to characterize health-related quality of life (HRQoL), medication adherence, productivity losses, and treatment satisfaction associated with modifications to opioid therapy due to opioid-induced constipation (OIC).Design: A cross-sectional, between-subjects design was used to examine health outcomes among US noncancer participants currently taking opioids.Patients, Participants: Participants were adults in the 2012 US National Health and Wellness Survey, who reported currently using opioids (> 30 days) and experiencing constipation. Respondents were categorized as making modifications to opioid therapy due to OIC (modifiers, n = 244) or making no modifications (nonmodifiers, n = 247).Main Outcome Measures: Patient Assessment of Constipation Quality of Life (PAC-QoL) and Symptoms (PAC-Sym), Morisky Medication Adherence Scale (MMAS-4), Work Productivity and Activity Impairment, and the Treatment Satisfaction Questionnaire for Medication (TSQM II) for OIC treatment were administered. Generalized linear models were adjusted to control for baseline characteristics (age, gender, comorbidities, opioid strength, etc).Results: Modifiers reported poorer HRQoL (PAC-QoL total: 1.74 vs 1.44, p < 0.001), worse constipation (PAC-Sym total: 1.56 vs 1.35, p = 0.003), more pain-related resource use (surgery: odds ratio (OR) = 3.72, p = 0.002; emergency room visits: OR = 1.88, p = 0.049; hospitalizations: OR = 2.47, p = 0.033), and lower adherence (MMAS-4 pain: OR = 0.12, p < 0.001; MMAS-4 OIC: OR = 0.39, p < 0.001) than nonmodifiers. Modifiers reported greater presenteeism (49.75 percent vs 38.28 percent, p = 0.038), but no significant differences were found for activity impairment or OIC treatment satisfaction.Conclusions: Treating OIC effectively may help prevent inadequate pain management secondary to opioid therapy modification, help increase HRQoL, lessen OIC symptoms, decrease productivity loss, and improve adherence to opioid and OIC treatments.
SN  - 1551-7489
U2  - PMID: 26312960.
DO  - 10.5055/jom.2015.0282
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 123059427
T1  - We Are Not the Problem...Gussow L. Toxicology Rounds: Who Said the Opioid Crisis Couldn't Get Any Worse? Emergency Medicine News. 2016;38(11):1.
AU  - Janson, Paul
Y1  - 2017/04//4/1/2017
N1  - Accession Number: 123059427. Language: English. Entry Date: 20170608. Revision Date: 20170608. Publication Type: Article; commentary; letter. Journal Subset: Biomedical; USA. NLM UID: 9000866. 
KW  - Fentanyl -- Analogs and Derivatives
KW  - Opioid Peptides -- Adverse Effects
KW  - Substance Abuse
KW  - Cannabis
KW  - Street Drugs -- Legislation and Jurisprudence
KW  - Public Policy
KW  - Physicians -- Psychosocial Factors
SP  - 36
EP  - 36
JO  - Emergency Medicine News
JF  - Emergency Medicine News
JA  - EMERG MED NEWS
VL  - 39
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 1054-0725
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123059427&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 114469192
T1  - Time to opioid administration after implementation of an intranasal fentanyl protocol.
AU  - Schaefer, Jared A
AU  - Mlekoday, Tamara J
Y1  - 2015/12//
N1  - Accession Number: 114469192. Language: English. Entry Date: 20160409. Revision Date: 20160412. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Patient Care
KW  - Fentanyl -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Emergency Service
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Historically Controlled Study
KW  - Infusions, Intravenous
KW  - Protocols
KW  - Male
KW  - Female
KW  - Adolescence
KW  - Child
KW  - Child, Preschool
KW  - Pain -- Diagnosis
KW  - Retrospective Design
KW  - Administration, Intranasal
SP  - 1805
EP  - 1807
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 33
IS  - 12
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Background: Prompt and effective analgesia is a mainstay of emergency department (ED) medicine; however, it is often delayed in times of overcrowding and by the need to establish intravenous (IV) access. Thus, noninvasive analgesic administration by means of the intranasal route could potentially reduce time to analgesic administration by eliminating IV line insertion.Methods: This retrospective study evaluated time from physician entry into patient's room to opioid administration after implementation of an intranasal fentanyl protocol. Data were collected on pediatric patients who received intranasal fentanyl in the ED 225 days after protocol implementation. Time to opioid administration was then evaluated against historical controls given IV opioids in the same ED 90 days before protocol implementation.Results: Seven patients were included in the intranasal fentanyl group and were evaluated against 47 patients given IV opioids. Time from physician entry into patient's room to opioid administration was significantly reduced for intranasal fentanyl (20.43 ± 11.54 minutes) vs IV opioids (42.04 ± 31.55 minutes; P = .002), and IV line insertion was avoided in all 7 intranasal fentanyl patients. No significant differences in adverse events were noted.Conclusion: This study provides evidence that administration of fentanyl via the intranasal route in the ED decreases time to administration of opioids in pediatric patients.
SN  - 0735-6757
AD  - INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112
U2  - PMID: 26452510.
DO  - 10.1016/j.ajem.2015.08.050
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114469192&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109591881
T1  - μ-Opioid Receptor Gene A118 G Variants and Persistent Pain Symptoms Among Men and Women Experiencing Motor Vehicle Collision.
AU  - Linnstaedt, Sarah D
AU  - Hu, JunMei
AU  - Bortsov, Andrey V
AU  - Soward, April C
AU  - Swor, Robert
AU  - Jones, Jeffrey
AU  - Lee, David
AU  - Peak, David
AU  - Domeier, Robert
AU  - Rathlev, Niels
AU  - Hendry, Phyllis
AU  - McLean, Samuel A
Y1  - 2015/07//
N1  - Accession Number: 109591881. Language: English. Entry Date: 20150923. Revision Date: 20161118. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management. Grant Information: R01 AR056328/AR/NIAMS NIH HHS/United States. NLM UID: 100898657. 
SP  - 637
EP  - 644
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 16
IS  - 7
PB  - Churchill Livingstone, Inc.
AB  - Unlabelled: The μ-opioid receptor 1 (OPRM1) binds endogenous opioids. Increasing evidence suggests that endogenous OPRM1 agonists released at the time of trauma may contribute to the development of posttraumatic musculoskeletal pain (MSP). In this prospective observational study, we evaluated the hypothesis that individuals with an AG or GG genotype at the OPRM1 A118 G allele, which results in a reduced response to opioids, would have less severe MSP 6 weeks after motor vehicle collision (MVC). Based on previous evidence, we hypothesized that this effect would be sex-dependent and most pronounced among women with substantial peritraumatic distress. European American men and women ≥ 18 years of age presenting to the emergency department after MVC and discharged to home after evaluation (N = 948) were enrolled. Assessments included genotyping and 6-week evaluation of overall MSP severity (0-10 numeric rating scale). In linear regression modeling, a significant A118 G Allele × Sex interaction was observed: an AG/GG genotype predicted reduced MSP severity among women with substantial peritraumatic distress (β = -.925, P = .014) but not among all women. In contrast, men with an AG/GG genotype experienced increased MSP severity at 6 weeks (β = .827, P = .019). Further studies are needed to understand the biologic mechanisms mediating observed sex differences in A118 G effects.Perspective: These results suggest a sex-dependent mechanism by which an emotional response to trauma (distress) contributes to a biologic mechanism (endogenous opioid release) that increases MSP in the weeks after stress exposure. These results also support the hypothesis that endogenous opioids influence pain outcomes differently in men and women.
SN  - 1526-5900
U2  - PMID: 25842347.
DO  - 10.1016/j.jpain.2015.03.011
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848497
T1  - 334 The Impact of Administration of Opiates or Benzodiazepines on Comprehension of Emergency Department Discharge Instructions.
AU  - Berman, J.
AU  - Burk, C.
AU  - Terp, S.
AU  - Burner, E.
AU  - Lam, C.N.
AU  - Menchine, M.
AU  - Arora, S.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848497. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S127
EP  - S128
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Keck School of Medicine at USC, Los Angeles, CA
AD  - Keck School of Medicine of USC, Los Angeles, CA
AD  - University of Southern California, Los Angeles, CA
DO  - 10.1016/j.annemergmed.2016.08.350
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 127724853
T1  - Defense Verdict in Spinal Fusion Case Despite Difficult Surgery, Complicated Post-op Needs.
Y1  - 2018/01/02/2018 Supplement
N1  - Accession Number: 127724853. Language: English. Entry Date: 20180209. Revision Date: 20180209. Publication Type: Article. Supplement Title: 2018 Supplement. Journal Subset: Health Services Administration; USA. NLM UID: 9889160. 
KW  - Spinal Fusion
KW  - Postoperative Complications
KW  - Postoperative Care -- Standards
KW  - Postoperative Pain -- Drug Therapy
KW  - Rapid Response (Emergency Care) -- Adverse Effects
KW  - Equipment Failure
KW  - Malpractice
KW  - Naloxone -- Administration and Dosage
KW  - Naloxone -- Adverse Effects
KW  - Damages, Legal
SP  - 3
EP  - 4
JO  - Healthcare Risk Management
JF  - Healthcare Risk Management
JA  - HEALTHC RISK MANAGE
VL  - 40
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - The article discusses a medical malpractice action in which a 53-year-old man who underwent a posterolateral spinal fusion surgery suffered a shortage of oxygen saturation level due to lack of medical care. The patient filed a medical malpractice action against the hospital and the physician assistant, in which he alleged improper management of his postoperative pain, and that he was over-sedated on narcotics, due to which manual chest compressions were performed to resuscitate him.
SN  - 1081-6534
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=127724853&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109859396
T1  - Centering the pendulum: the evolution of emergency medicine opioid prescribing guidelines.
AU  - Weiner, Scott G
AU  - Perrone, Jeanmarie
AU  - Nelson, Lewis S
Y1  - 2013/09//
N1  - Accession Number: 109859396. Language: English. Entry Date: 20150501. Revision Date: 20150923. Publication Type: Journal Article; editorial. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Emergency Service
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Practice Guidelines
KW  - Toothache -- Drug Therapy
KW  - Female
KW  - Male
SP  - 241
EP  - 243
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 62
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Department of Emergency Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
U2  - PMID: 23541629.
DO  - 10.1016/j.annemergmed.2013.02.028
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109859396&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 115790432
T1  - Opioid Addiction Facts.
Y1  - 2016/06//
N1  - Accession Number: 115790432. Language: English. Entry Date: 20160605. Revision Date: 20160608. Publication Type: Article; brief item; pictorial; statistics. Journal Subset: Allied Health; USA. 
KW  - Narcotics
KW  - Substance Abuse
SP  - 4
EP  - 4
JO  - PT in Motion
JF  - PT in Motion
JA  - PT MOTION
VL  - 8
IS  - 5
CY  - Alexandria, Virginia
PB  - American Physical Therapy Association
AB  - Statistics are presented on opioid addiction in the U.S. including the number of painkiller prescriptions written in 2012, the increase in emergency department visits from 2004-2008 involving non-medical use of opioids, and states with the highest number of opioid prescriptions.
SN  - 1949-3711
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115790432&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 124504653
T1  - High opioids tolerance due to transmucosal fentanyl abuse.
AU  - Eiden, Celine
AU  - Mathieu, Olivier
AU  - Donnadieu-Rigole, Hélène
AU  - Marrot, Cécile
AU  - Peyrière, Hélène
Y1  - 2017/09//
N1  - Accession Number: 124504653. Language: English. Entry Date: 20170817. Revision Date: 20170817. Publication Type: Letter; letter. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 1256165. 
KW  - Drug Tolerance
KW  - Analgesics, Opioid
KW  - Fentanyl -- Administration and Dosage
KW  - Substance Abuse
KW  - Fentanyl -- Adverse Effects
KW  - Mucous Membrane
KW  - Male
KW  - Middle Age
KW  - Patient Admission
KW  - Emergency Service
KW  - Substance Abusers
KW  - Pharmacovigilance
KW  - Reports
KW  - Fentanyl -- Blood
KW  - Substance Withdrawal, Controlled
SP  - 1195
EP  - 1196
JO  - European Journal of Clinical Pharmacology
JF  - European Journal of Clinical Pharmacology
JA  - EUR J CLIN PHARMACOL
VL  - 73
IS  - 9
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
SN  - 0031-6970
AD  - Centre Hospitalier Regional Universitaire de Montpellier , Montpellier France
DO  - 10.1007/s00228-017-2272-9
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124504653&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104258459
T1  - Leftover Prescription Opioids and Nonmedical Use Among High School Seniors: A Multi-Cohort National Study.
AU  - McCabe, Sean Esteban
AU  - West, Brady T.
AU  - Boyd, Carol J.
Y1  - 2013/04//
N1  - Accession Number: 104258459. Language: English. Entry Date: 20130403. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Allied Health; Nursing; Peer Reviewed; Public Health; USA. Special Interest: Pediatric Care; Public Health. NLM UID: 9102136. 
KW  - Narcotics -- Administration and Dosage -- In Adolescence
KW  - Students, High School -- Psychosocial Factors
KW  - Human
KW  - Adolescence
KW  - Questionnaires
KW  - Self Report
KW  - Male
KW  - Female
KW  - Descriptive Statistics
KW  - Logistic Regression
SP  - 480
EP  - 485
JO  - Journal of Adolescent Health
JF  - Journal of Adolescent Health
JA  - J ADOLESC HEALTH
VL  - 52
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Abstract: Purpose: To (1) estimate the proportion of nonmedical users of prescription opioids (i.e., used prescription opioids in the past year without a doctor's orders) who used leftover medications from their own previous prescriptions; (2) assess substance use behaviors as a function of diversion source; and (3) identify the sources for these prescribed opioids. Methods: We analyzed data collected via self-administered questionnaires from nationally representative samples of high school seniors (modal age, 18 years) as a part of the Monitoring the Future (MTF) study. The sample consisted of four cohorts (senior years of 2007–2010, n = 8,888), including 647 high school seniors who reported past-year nonmedical use of prescription opioids, of whom 53% were estimated to be women. Results: An estimated 36.9% of past-year nonmedical users of prescription opioids obtained these opioid medications from their own previous prescriptions. Logistic regression analyses indicated that nonmedical users who used leftover medications from their previous prescriptions were primarily motivated to relieve physical pain, whereas nonmedical users who obtained medications from other sources had significantly higher odds of prescription opioid abuse and other substance use behaviors. Based on a subanalysis of nonmedical users who obtained prescription opioids from their previous prescriptions in 2010 (n = 51), approximately 27.1% obtained them from a dentist, 45.0% obtained them from an emergency room physician, and 38.3% obtained them from another physician. Conclusions: Leftover prescription opioids from previous prescriptions represent a major source of nonmedical use of prescription opioids among high school seniors. These findings indicate that enhanced vigilance is needed when prescribing and monitoring prescription opioids among adolescents, to reduce leftover medications and nonmedical use.
SN  - 1054-139X
AD  - Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan; Substance Abuse Research Center, University of Michigan, Ann Arbor, Michigan
AD  - Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
U2  - PMID: 23298996.
DO  - 10.1016/j.jadohealth.2012.08.007
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104260054
T1  - Pilot Study of Human Recombinant Hyaluronidase-Enhanced Subcutaneous Hydration and Opioid Administration for Sickle Cell Disease Acute Pain Episodes.
AU  - Sandoval, Marcelo
AU  - Coleman, Patricia
AU  - Govani, Rahim
AU  - Siddiqui, Saima
AU  - Todd, Knox H.
Y1  - 2013/02/27/
N1  - Accession Number: 104260054. Language: English. Entry Date: 20130327. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management; Palliative Care/Hospice. Instrumentation: Numeric Pain Rating Scale (NPRS); Ramsay Sedation Scale. Grant Information: Funding for research was provided through a research grant from Baxter Healthcare Corporation. Funding for editorial assistance was provided by Halozyme Therapeutics.. NLM UID: 101125608. 
KW  - Recombinant Proteins
KW  - Anemia, Sickle Cell -- Complications
KW  - Pain -- Etiology
KW  - Pain -- Drug Therapy
KW  - Narcotics -- Administration and Dosage
KW  - Hyaluronidase -- Administration and Dosage
KW  - Drug Delivery Systems
KW  - Human
KW  - Pilot Studies
KW  - Scales
KW  - Descriptive Statistics
KW  - Male
KW  - Female
KW  - Narcotics -- Adverse Effects
KW  - Hyaluronidase -- Adverse Effects
KW  - New York
KW  - Academic Medical Centers
KW  - Adult
KW  - Middle Age
KW  - Morphine -- Administration and Dosage
KW  - Treatment Outcomes
KW  - Time Factors
KW  - Funding Source
SP  - 10
EP  - 18
JO  - Journal of Pain & Palliative Care Pharmacotherapy
JF  - Journal of Pain & Palliative Care Pharmacotherapy
JA  - J PAIN PALLIAT CARE PHARMACOTHER
VL  - 27
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - The objective of this study was to determine the feasibility of protocol-driven human recombinant hyaluronidase (rHuPH20)-enhanced subcutaneous (SC) hydration and opioid administration in adults presenting to the emergency department (ED) with sickle cell disease acute pain episodes (SCDAPE). Adults with SCDAPE were given 150 U of rHuPH20 and normal saline subcutaneously. Opioids were administered SC every 15 minutes for 4 hours until numerical rating scale (NRS) pain intensity scores fell to <5, or Ramsay Sedation Scores were >4. Pain intensity and pain relief were recorded hourly. Total morphine equivalents and fluid volume, total pain relief (TOTPAR), patient- and physician-perceived global efficacy, patient-perceived global SC needle discomfort, physician-rated ease of needle placement, and adverse effects were noted. Ten patients (6 males, 4 females), mean age 32.9 years (23-56 years) completed the trial. Mean pain intensity scores fell 25% (from 9.2 to 6.9) from baseline and mean 4-hour TOTPAR score was 4 (maximum: 16). A mean total of 119 mg (70-170 mg) morphine equivalents and 846 mL (200-1650 mL) normal saline were administered. Mean patient and physician global perceived efficacy ratings were 3.4 and 4.2 (of 5). Patient global discomfort of SC needle presence was 2.7 (of 10), and ease of needle placement was physician rated at 4 (of 4; easiest). Patients experienced mild swelling and stinging at the SC site, and no infusion required discontinuation. The authors conclude that rHuPH20-enhanced subcutaneous hydration and opioid administration appear feasible from this pilot study. These results need confirmation in a controlled clinical trial.
SN  - 1536-0288
AD  - Marcelo Sandoval, MD, is Assistant Professor, Department of Emergency Medicine, MD Anderson Cancer Center, Houston, Texas, USA. Patricia Coleman, RN, BSN, is with the Emergency Department, Beth Israel Medical Center, New York, New York, USA. Rahim Govani, MD, is Attending Physician, Department of Emergency Medicine, Kaiser Permanente Medical Center, Downey, California, USA. Saima Siddiqui, MPH, is Clinical Research Manager, Children's Hospital at Montefiore, Bronx, New York, USA. Knox H. Todd, MD, MPH, is Professor and Chair, Department of Emergency Medicine, MD Anderson Cancer Center, Houston, Texas, USA.
U2  - PMID: 23527666.
DO  - 10.3109/15360288.2012.758683
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121632900
T1  - Review of Intranasally Administered Medications for Use in the Emergency Department.
AU  - Bailey, Abby M
AU  - Baum, Regan A
AU  - Horn, Karolyn
AU  - Lewis, Tameka
AU  - Morizio, Kate
AU  - Schultz, Amy
AU  - Weant, Kyle
AU  - Justice, Stephanie N
Y1  - 2017/03//
N1  - Accession Number: 121632900. Language: English. Entry Date: 20171113. Revision Date: 20170817. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8412174. 
SP  - N.PAG
EP  - N.PAG
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 52
IS  - 3
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Intranasal (IN) medication delivery is a viable alternative to other routes of administration, including intravenous (IV) and intramuscular (IM) administration. The IN route bypasses the risk of needle-stick injuries and alleviates the emotional trauma that may arise from the insertion of an IV catheter.Objective: This review aims to evaluate published literature on medications administered via the IN route that are applicable to practice in emergency medicine.Discussion: The nasal mucosa is highly vascularized, and the olfactory tissues provide a direct conduit to the central nervous system, bypass first-pass metabolism, and lead to an onset of action similar to IV drug administration. This route of administration has also been shown to decrease delays in drug administration, which can have a profound impact in a variety of emergent scenarios, such as seizures, acutely agitated or combative patients, and trauma management. IN administration of midazolam, lorazepam, flumazenil, dexmedetomidine, ketamine, fentanyl, hydromorphone, butorphanol, naloxone, insulin, and haloperidol has been shown to be a safe, effective alternative to IM or IV administration. As the use of IN medications becomes a more common route of administration in the emergency department setting, and in prehospital and outpatient settings, it is increasingly important for providers to become more familiar with the nuances of this novel route of medication delivery.Conclusions: IN administration of the reviewed medications has been shown to be a safe and effective alternative to IM or IV administration. Use of IN is becoming more commonplace in the emergency department setting and in prehospital settings.
SN  - 0736-4679
AD  - Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky
AD  - Department of Pharmacy, Charleston Area Medical Center, Charleston, West Virginia
AD  - Department of Pharmacy, Medical University of South Carolina, Charleston, South Carolina
AD  - Department of Pharmacy, St. Claire Regional Medical Center, Morehead, Kentucky
U2  - PMID: 28259526.
DO  - 10.1016/j.jemermed.2017.01.020
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 118421066
T1  - ED opioid prescribing is not associated with higher patient satisfaction scores.
AU  - Kim, Howard S.
AU  - Lank, Patrick M.
AU  - Pang, Peter S.
AU  - Courtney, D. Mark
AU  - Lambert, Bruce L.
AU  - Gravenor, Stephanie J.
AU  - McCarthy, Danielle M.
Y1  - 2016/10//
N1  - Accession Number: 118421066. Language: English. Entry Date: 20170228. Revision Date: 20170820. Publication Type: letter. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Patient Satisfaction -- Statistics and Numerical Data
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Standards
KW  - Retrospective Design
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Adult
KW  - Middle Age
KW  - Illinois
KW  - Male
KW  - Female
SP  - 2032
EP  - 2034
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 34
IS  - 10
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0735-6757
AD  - Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
AD  - Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
AD  - Department of Communication Studies, Northwestern University, Chicago, IL
U2  - PMID: 27471063.
DO  - 10.1016/j.ajem.2016.07.033
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126511712
T1  - STREET SCIENCE. OVERDOSE CARE: What's the mortality rate for patients who receive naloxone and then refuse transport?
AU  - Wesley, Keith
AU  - Wesley, Karen
Y1  - 2017/11//
N1  - Accession Number: 126511712. Language: English. Entry Date: 20171229. Revision Date: 20171229. Publication Type: Article; commentary. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Treatment Refusal
KW  - Prehospital Care
KW  - Mortality
KW  - Emergency Patients
KW  - Emergency Medical Services
KW  - California
KW  - Record Review
KW  - Cause of Death
KW  - Prospective Studies
KW  - Liability, Legal
KW  - Patient Autonomy
SP  - 23
EP  - 23
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 42
IS  - 11
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Medical director for HealthEast Medical Transportation in St. Paul, Minn.
AD  - United EMS in Wisconsin Rapids, Wis.
AD  - Paramedic and educator for Mayo Clinic Medical Transport
AD  - Medic team leader for the Eau Claire County (Wis.) Regional SWAT team
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103794381
T1  - Timing of Opioid Administration as a Quality Indicator for Pain Crises in Sickle Cell Disease.
AU  - Mathias, Melissa D.
AU  - McCavit, Timothy L.
Y1  - 2015/03//
N1  - Accession Number: 103794381. Language: English. Entry Date: 20150501. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management; Pediatric Care. Instrumentation: Faces Pain Scale (FPS). NLM UID: 0376422. 
KW  - Anemia, Sickle Cell -- Complications
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Care
KW  - Quality of Health Care
KW  - Human
KW  - Retrospective Design
KW  - Descriptive Research
KW  - Descriptive Statistics
KW  - Patient Admission
KW  - Emergency Service
KW  - Univariate Statistics
KW  - Multivariate Analysis
KW  - Time Factors
KW  - Outcomes (Health Care) -- Evaluation
KW  - Child
KW  - Pain Measurement
KW  - Texas
KW  - Convenience Sample
KW  - Purposive Sample
KW  - Scales
KW  - Male
KW  - Female
KW  - Record Review
KW  - Medical Records
KW  - Odds Ratio
KW  - Confidence Intervals
KW  - Age Factors
KW  - Independent Variable
KW  - Adolescence
KW  - Length of Stay
SP  - 475
EP  - 482
JO  - Pediatrics
JF  - Pediatrics
JA  - PEDIATRICS
VL  - 135
IS  - 3
CY  - Chicago, Illinois
PB  - American Academy of Pediatrics
AB  - BACKGROUND AND OBJECTIVE: Time to opioid administration (TTO) has been suggested as a quality of care measure for sickle cell disease patients with vaso-occlusive crisis (VOC). We sought to determine whether TTO was associated with outcomes of emergency department (ED) visits for VOC. METHODS: We conducted a single-center retrospective cohort study of ED visits for VOC. The primary outcome was hospital admission, with secondary outcomes of change between the first 2 pain scores, area under the curve (AUC) for pain scores at 4 hours (pain score AUC), total ED length of stay and total intravenous opioids. In both univariate and multivariate analyses, mixed regression (logistic for admission, linear for secondary outcome variables) was used to evaluate association of TTO with outcome. RESULTS: In 177 subjects, 414 ED visits for VOC were identified. Inpatient admission occurred in 53% of visits. The median TTO for admitted patients was 86 minutes vs 87 minutes for those not admitted. TTO was not associated with inpatient admission in either univariate or multivariate analyses. In multivariate analyses with secondary outcomes, decreased TTO was associated with greater improvement between the first 2 pain scores, decreased pain score AUC, decreased total ED length of stay, and increased total opioids. CONCLUSIONS: Although TTO was not associated with admission, it was independently associated with 4 important secondary outcomes: change in initial pain scores, pain score AUC, total ED length of stay, and total intravenous opioids. The association of a process measure, TTO, with these outcomes encourages the institution of TTO reduction efforts in the ED.
SN  - 0031-4005
AD  - Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
AD  - Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; Center for Cancer and Blood Disorders, Children's Medical Center Dallas, Dallas, Texas
U2  - PMID: 25667245.
DO  - 10.1542/peds.2014-2874
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105422786
T1  - Outcomes after intravenous opioids in emergency patients: a prospective cohort analysis.
AU  - O'Connor AB
AU  - Zwemer FL
AU  - Hays DP
AU  - Feng C
Y1  - 2009/06//
N1  - Accession Number: 105422786. Language: English. Entry Date: 20090911. Revision Date: 20150711. Publication Type: Journal Article; research. Commentary: Hwang U. Outcomes research in review. Factors associated with poor analgesia when using intravenous opioids for acute pain. (JCOM) 2009 Aug; 16 (8): 352-354. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9418450. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Dihydromorphinone -- Administration and Dosage
KW  - Emergency Service
KW  - Morphine -- Administration and Dosage
KW  - Adult
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Dihydromorphinone -- Adverse Effects
KW  - Dihydromorphinone -- Therapeutic Use
KW  - Female
KW  - Infusions, Intravenous
KW  - Interviews
KW  - Logistic Regression
KW  - Male
KW  - Middle Age
KW  - Morphine -- Adverse Effects
KW  - Morphine -- Therapeutic Use
KW  - Outcome Assessment
KW  - Pain Measurement
KW  - Patient Satisfaction -- Statistics and Numerical Data
KW  - Prospective Studies
KW  - Human
SP  - 477
EP  - 487
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 16
IS  - 6
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - OBJECTIVES: Pain management continues to be suboptimal in emergency departments (EDs). Several studies have documented failures in the processes of care, such as whether opioid analgesics were given. The objectives of this study were to measure the outcomes following administration of intravenous (IV) opioids and to identify clinical factors that may predict poor analgesic outcomes in these patients. METHODS: In this prospective cohort study, emergency patients were enrolled if they were prescribed IV morphine or hydromorphone (the most commonly used IV opioids in the study hospital) as their initial analgesic. Patients were surveyed at the time of opioid administration and 1 to 2 hours after the initial opioid dosage. They scored their pain using a verbal 0-10 pain scale. The following binary analgesic variables were primarily used to identify patients with poor analgesic outcomes: 1) a pain score reduction of less than 50%, 2) a postanalgesic pain score of 7 or greater (using the 0-10 numeric rating scale), and 3) the development of opioid-related side effects. Logistic regression analyses were used to study the effects of demographic, clinical, and treatment covariates on the outcome variables. RESULTS: A total of 2,414 were approached for enrollment, of whom 1,312 were ineligible (658 were identified more than 2 hours after IV opioid was administered and 341 received another analgesic before or with the IV opioid) and 369 declined to consent. A total of 691 patients with a median baseline pain score of 9 were included in the final analyses. Following treatment, 57% of the cohort failed to achieve a 50% pain score reduction, 36% had a pain score of 7 or greater, 48% wanted additional analgesics, and 23% developed opioid-related side effects. In the logistic regression analyses, the factors associated with poor analgesia (both <50% pain score reduction and postanalgesic pain score of >or=7) were the use of long-acting opioids at home, administration of additional analgesics, provider concern for drug-seeking behavior, and older age. An initial pain score of 10 was also strongly associated with a postanalgesic pain score of >or=7. African American patients who were not taking opioids at home were less likely to achieve a 50% pain score reduction than other patients, despite receiving similar initial and total equianalgesic dosages. None of the variables we assessed were significantly associated with the development of opioid-related side effects. CONCLUSIONS: Poor analgesic outcomes were common in this cohort of ED patients prescribed IV opioids. Patients taking long-acting opioids, those thought to be drug-seeking, older patients, those with an initial pain score of 10, and possibly African American patients are at especially high risk of poor analgesia following IV opioid administration.
SN  - 1069-6563
AD  - Department of Internal Medicine , University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. alec_oconnor@urmc.rochester.edu
U2  - PMID: 19426295.
DO  - 10.1111/j.1553-2712.2009.00405.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848818
T1  - 129 Impact of Hospital “Best Practices” Mandates on Emergency Department Opioid Prescribing and Pain-Related Visits.
AU  - Sun, B.
AU  - Kim, H.
AU  - Lupulescu-Mann, N.
AU  - Charlesworth, C.
AU  - Hartung, D.
AU  - Deyo, R.
AU  - McConnell, K.J.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848818. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S51
EP  - S51
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Oregon Health and Science University, Portland, OR
AD  - OHSU, Portland, OR
DO  - 10.1016/j.annemergmed.2016.08.141
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848817
T1  - 250 Predictors of Opioid Analgesic Administration for Abdominal Pain in the Emergency Department.
AU  - Mazer-Amirshahi, M.
AU  - Mullins, P.M.
AU  - Richards, L.
AU  - Meltzer, A.
AU  - Pines, J.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848817. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S97
EP  - S97
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - MedStar Washington Hospital Center, Washington, DC
AD  - George Washington University, Washington, DC
DO  - 10.1016/j.annemergmed.2016.08.264
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848725
T1  - 255 Differences in Opioid Prescribing Patterns Among Emergency Medicine Independent Providers and Trainees.
AU  - Androski, C.P.
AU  - Michael, S.S.
AU  - Babu, K.M.
AU  - Reznek, M.A.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848725. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S99
EP  - S99
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of Massachusetts Medical School, Worcester, MA
DO  - 10.1016/j.annemergmed.2016.08.270
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848712
T1  - 208 Prospective Randomized Pilot Trial Measuring the Feasibility and Knowledge Retention of Opioid Education in Emergency Department Patients Using a Multimedia Platform.
AU  - Chakravarthy, B.
AU  - Somasundaram, S.
AU  - Mogi, J.
AU  - Burns, R.
AU  - Hoonpongsimanont, W.
AU  - Lotfipour, S.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848712. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S81
EP  - S81
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of California, Irvine, Irvine, CA
DO  - 10.1016/j.annemergmed.2016.08.222
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848698
T1  - 122 An Evaluation of Screening Tools to Predict Opioid Misuse in the Emergency Department.
AU  - Chalmers, C.E.
AU  - Wilson, M.P.
AU  - Mullinax, S.Z.
AU  - Brennan, J.J.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848698. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S48
EP  - S48
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - UC San Diego Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, San Diego, CA
DO  - 10.1016/j.annemergmed.2016.08.134
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848572
T1  - 373 A Randomized Trial of an Intervention to Influence Emergency Medicine Providers’ Opioid Prescribing.
AU  - Michael, S.S.
AU  - Babu, K.M.
AU  - Androski, C.
AU  - Reznek, M.A.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848572. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S143
EP  - S143
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of Massachusetts, Worcester, MA
DO  - 10.1016/j.annemergmed.2016.08.390
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848503
T1  - 233 Prevalence and Risk Factors for Episodic and Long-term Opioid Use After Initial Prescribing in the Emergency Department.
AU  - Mattson, A.E.
AU  - Scherber, K.
AU  - Dierkhising, R.
AU  - Rudis, M.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848503. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S91
EP  - S91
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Mayo Clinic, Rochester, MN
DO  - 10.1016/j.annemergmed.2016.08.247
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848437
T1  - 209 Assessing Risk of Opioid Abuse Among the Emergency Medicine Population.
AU  - Young, H.W.
AU  - Ryan, M.F.
AU  - Tyndall, J.A.
AU  - Cottler, L.B.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848437. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S81
EP  - S82
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of Florida, Gainesville, FL
DO  - 10.1016/j.annemergmed.2016.08.223
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118848412
T1  - 201EMF The Office or Emergency Department: Where Do Heavy Opioid Users Get Their Medications?
AU  - Menchine, M.
AU  - Axeen, S.
AU  - Seabury, S.A.
Y1  - 2016/10/02/Oct2016 Supplement
N1  - Accession Number: 118848412. Language: English. Entry Date: In Process. Revision Date: 20161024. Publication Type: Article. Supplement Title: Oct2016 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S79
EP  - S79
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 68
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - USC Keck School of Medicine; Schaeffer Center for Health Policy and Economics, Los Angeles, CA
AD  - Schaeffer Center for Health Policy and Economics, Los Angeles, CA
DO  - 10.1016/j.annemergmed.2016.08.215
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118848412&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 119556034
T1  - Opioid prescription practices at discharge and 30-day returns in children with sickle cell disease and pain.
AU  - Okorji, Leslie M
AU  - Muntz, Devin S
AU  - Liem, Robert I
Y1  - 2016/11//
N1  - Accession Number: 119556034. Language: English. Entry Date: 20170701. Revision Date: 20171101. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Impact of Events Scale (IES). NLM UID: 101186624. 
KW  - Anemia, Sickle Cell -- Pathology
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Pain -- Drug Therapy
KW  - Antiinflammatory Agents, Non-Steroidal -- Therapeutic Use
KW  - Adult
KW  - Child
KW  - Readmission -- Statistics and Numerical Data
KW  - Young Adult
KW  - Pain Measurement
KW  - Adolescence
KW  - Retrospective Design
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Patient Discharge
KW  - Impact of Events Scale
SP  - N.PAG
EP  - N.PAG
JO  - Pediatric Blood & Cancer
JF  - Pediatric Blood & Cancer
JA  - PEDIATR BLOOD CANCER
VL  - 63
IS  - 11
CY  - Hoboken, New Jersey
PB  - John Wiley & Sons, Inc.
AB  - Background: Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions.Methods: In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7-21 years hospitalized or discharged from the ED with acute pain. We reviewed demographic, treatment and discharge data, and 30-day returns, defined as ED revisits and readmissions within 30 days of discharge. Bivariate and multivariable analyses were performed to evaluate the association between discharge prescription practices and 30-day returns.Results: Compared to hospitalizations, treat-and-release ED visits for acute pain were associated with a higher incidence of 30-day returns (OR = 2.7 [95% CI: 1.5-4.8], P < 0.01). We found no association between prescribed opioid frequency (scheduled vs. as-needed) and 30-day returns (OR = 1.12 [95% CI: 0.62-2.02], P = 0.70). By multivariable logistic regression, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only, without opioids, after treat-and-release ED visits was independently associated with a higher frequency of 30-day ED revisits (OR = 6.9 [95% CI: 1.3-37.3], P = 0.03) but not readmissions.Conclusion: Variability exists in opioid prescription practices after discharge in children with SCD and pain episodes. Prescription of NSAIDs only, without opioids, was an independent predictor of higher 30-day ED revisits. Formalized studies to better understand factors that influence returns, including outpatient opioid management, are warranted in this population.
SN  - 1545-5009
AD  - Division of Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
AD  - Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
U2  - PMID: 27800652.
DO  - 10.1002/pbc.26319
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107325676
T1  - Palliative care rounds. Inappropriate use of naloxone in cancer patients with pain.
AU  - Manfredi PL
AU  - Ribeiro S
AU  - Chandler SW
AU  - Payne R
Y1  - 1996/02//1996 Feb
N1  - Accession Number: 107325676. Language: English. Entry Date: 19970601. Revision Date: 20150711. Publication Type: Journal Article; case study; diagnostic images; research. Journal Subset: Biomedical; Core Nursing; Nursing; Peer Reviewed; USA. NLM UID: 8605836. 
KW  - Cancer Pain -- Drug Therapy
KW  - Substance Withdrawal Syndrome
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Adverse Effects
KW  - Aged
KW  - Male
KW  - Hypercalcemia
KW  - Multiple Myeloma -- Complications
KW  - Record Review
KW  - Retrospective Design
KW  - Human
SP  - 131
EP  - 134
JO  - Journal of Pain & Symptom Management
JF  - Journal of Pain & Symptom Management
JA  - J PAIN SYMPTOM MANAGE
VL  - 11
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Opioid overdose is rarely the primary cause of altered mental status in cancer patients receiving opioid therapy. The inappropriate administration of naloxone to reverse an abnormal mental status can cause severe withdrawal symptoms and pain. To illustrate this problem, we report the case of a patient inappropriately treated with naloxone and the results of a retrospective review of the medical records of 15 consecutive patients with cancer treated with naloxone in the emergency department over a 5-month period. We offer guidelines for a more thoughtful approach to the management of patients with cancer who present with encephalopathy. (C) U.S. Cancer Pain Relief Committee, 1996 Published by Elsevier, New York, New York
SN  - 0885-3924
AD  - Department of Neuro-Oncology, Section of Pain and Symptom Management, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
U2  - PMID: 8907145.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107325676&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 115067763
T1  - Characteristics of heroin-dependent patients seeking asthma care in the ED.
AU  - Weeks, Matthew A.
AU  - Clark, Erin P.
AU  - Mycyk, Mark B.
Y1  - 2016/05//
N1  - Accession Number: 115067763. Language: English. Entry Date: 20160824. Revision Date: 20160831. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Asthma -- Complications
KW  - Attitude to Health
KW  - Patient Attitudes
KW  - Substance Use Disorders -- Complications
KW  - Emergency Service -- Utilization
KW  - Illinois
KW  - Middle Age
KW  - Adolescence
KW  - Surveys
KW  - Male
KW  - Adult
KW  - Pilot Studies
KW  - Asthma -- Therapy
KW  - Prospective Studies
KW  - Female
KW  - Young Adult
SP  - 895
EP  - 898
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 34
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Background: Limited data suggest that heroin worsens asthma severity, but little is known about heroin-dependent patients who seek emergency department (ED) care for asthma.Objectives: To describe what heroin-dependent patients know about their asthma and how they use health care resources.Methods: A prospective study of heroin-dependent patients seeking care for "asthma" at an urban ED with 130000 annual visits was conducted. Eligible subjects were English-speaking heroin-dependent adults seeking care for mild to moderate asthma symptoms. A closed-format survey instrument to assess opioid use, asthma knowledge, and health care use was developed by content experts, piloted for study performance, revised, and then administered to eligible patients prior to ED discharge. Descriptive analysis was done.Results: Thirty subjects participated. Mean age was 47.5 years; 21 (70%) were male. Most used heroin several times weekly. Intranasal was the most common route (93%). Almost half (47%) stated that their asthma was diagnosed in the ED, 13% by a primary care physician, 13% by a lung specialist, and 27% did not know how diagnosed. The ED was used as the primary source for asthma medications in 73% cases; 43% used the ED for breathing issues at least once per month. Most subjects (77%) felt that heroin worsened their asthma symptoms. Only 7 (23%) also abused prescription opioids, and only 7 (23%) knew about prescription naloxone.Conclusion: Patients with heroin dependence frequently use the ED for their health care needs related to asthma. Most do not have other health care providers, most have limited health literacy, and all would benefit from referral to a primary care provider and substance abuse resources.
SN  - 0735-6757
AD  - Cook County Health and Hospitals System, 1900 West Polk Street, Department of Emergency Medicine, Chicago, IL 60612
U2  - PMID: 26947370.
DO  - 10.1016/j.ajem.2016.02.005
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109632047
T1  - Opioid Prescribing in a Cross Section of US Emergency Departments.
AU  - Hoppe, Jason A
AU  - Nelson, Lewis S
AU  - Perrone, Jeanmarie
AU  - Weiner, Scott G
Y1  - 2015/09//
N1  - Accession Number: 109632047. Corporate Author: Prescribing Opioids Safely in the Emergency Department (POSED) Study Investigators. Language: English. Entry Date: 20150923. Revision Date: 20161118. Publication Type: journal article; research. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. Grant Information: UL1 RR025780/RR/NCRR NIH HHS/United States. NLM UID: 8002646. 
SP  - 253
EP  - 259.e1
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 66
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: Opioid pain reliever prescribing at emergency department (ED) discharge has increased in the past decade but specific prescription details are lacking. Previous ED opioid pain reliever prescribing estimates relied on national survey extrapolation or prescription databases. The main goal of this study is to use a research consortium to analyze the characteristics of patients and opioid prescriptions, using a national sample of ED patients. We also aim to examine the indications for opioid pain reliever prescribing, characteristics of opioids prescribed both in the ED and at discharge, and characteristics of patients who received opioid pain relievers compared with those who did not.Methods: This observational, multicenter, retrospective, cohort study assessed opioid pain reliever prescribing to consecutive patients presenting to the consortium EDs during 1 week in October 2012. The consortium study sites consisted of 19 EDs representing 1.4 million annual visits, varied geographically, and were predominantly academic centers. Medical records of all patients aged 18 to 90 years and discharged with an opioid pain reliever (excluding tramadol) were individually abstracted by standardized chart review by investigators for detailed analysis. Descriptive statistics were generated.Results: During the study week, 27,516 patient visits were evaluated in the consortium EDs; 19,321 patients (70.2%) were discharged and 3,284 (11.9% of all patients and 17.0% of discharged patients) received an opioid pain reliever prescription. For patients prescribed an opioid pain reliever, mean age was 41 years (SD 14 years) and 1,694 (51.6%) were women. Mean initial pain score was 7.7 (SD 2.4). The most common diagnoses associated with opioid pain reliever prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). The most common opioid pain relievers prescribed were oxycodone (52.3%), hydrocodone (40.9%), and codeine (4.8%). Greater than 99% of pain relievers were immediate release and 90.0% were combination preparations, and the mean and median number of pills was 16.6 (SD 7.6) and 15 (interquartile range 12 to 20), respectively.Conclusion: In a study of ED patients treated during a single week across the country, 17% of discharged patients were prescribed opioid pain relievers. The majority of the prescriptions had small pill counts and almost exclusively immediate-release formulations.
SN  - 0196-0644
U2  - PMID: 25952503.
DO  - 10.1016/j.annemergmed.2015.03.026
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 116135661
T1  - What you need to know about safe opioid prescribing.
AU  - Moore, Dorothy James
Y1  - 2016/06//
N1  - Accession Number: 116135661. Language: English. Entry Date: 20160623. Revision Date: 20160623. Publication Type: Article; pictorial. Journal Subset: Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 101291565. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Chronic Pain -- Drug Therapy
KW  - Overdose -- Prevention and Control
KW  - Drugs, Prescription
KW  - Substance Use Disorders -- Prevention and Control
KW  - Drug Labeling
KW  - Practice Guidelines
KW  - Emergency Service
KW  - Overdose -- Trends
KW  - Cause of Death
KW  - Substance Use Disorders -- Symptoms
KW  - Nursing Role
KW  - Patient Education
SP  - 12
EP  - 12
JO  - American Nurse Today
JF  - American Nurse Today
JA  - AM NURSE TODAY
VL  - 11
IS  - 6
CY  - Doylestown, Pennsylvania
PB  - HealthCom Media
SN  - 1930-5583
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116135661&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113188567
T1  - Extent and Impact of Opioid Prescribing for Acute Occupational Low Back Pain in the Emergency Department.
AU  - Lee, Sharon S.
AU  - Choi, YoonSun
AU  - Pransky, Glenn S.
Y1  - 2016/03//
N1  - Accession Number: 113188567. Language: English. Entry Date: 20160623. Revision Date: 20170104. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Work Environment Scale (WES) (Moos et al); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Impact of Events Scale (IES). NLM UID: 8412174. 
KW  - Low Back Pain -- Drug Therapy
KW  - Occupational Diseases -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Low Back Pain -- Economics
KW  - Female
KW  - Occupational Diseases -- Economics
KW  - Disability Evaluation
KW  - Health Care Costs
KW  - Absenteeism
KW  - Middle Age
KW  - Male
KW  - Multivariate Analysis
KW  - Adult
KW  - Worker's Compensation -- Statistics and Numerical Data
KW  - Retrospective Design
KW  - Analgesics, Opioid -- Economics
KW  - Impact of Events Scale
KW  - Scales
SP  - 376
EP  - 384.e2
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 50
IS  - 3
PB  - Pergamon Press - An Imprint of Elsevier Science
AB  - Background: Initial management of acute occupational low back pain (AOLBP) commonly occurs in the emergency department (ED), where opioid prescribing can vary from the clinical guidelines that recommend limited use.Objective: The objective of this study was to explore how opioids are prescribed in the ED and the impact on work disability and other outcomes in AOLBP.Methods: A retrospective cohort study was conducted. All acute compensable lost-time LBP cases seen initially in the ED with a date of injury from January 1, 2009 to December 31, 2011 were identified within a nationally representative Workers' Compensation dataset. Multivariate models estimated the effect of early opioids (received within 2 days of ED visit) on disability duration, long-term opioid use, total medical costs, and subsequent surgeries.Results: Of the cohort (N = 2887), 12% received early opioids; controlling for severity, this was significantly associated with long-term opioid use (adjusted risk ratio = 1.29; 95% confidence interval 1.05-1.58) and increased total medical costs for those in the highest opioid dosage quartile, but not associated with disability duration or subsequent low back surgery.Conclusions: Early opioid prescribing in the ED for uncomplicated AOLBP increased long-term opioid use and medical costs, and should be discouraged, as opioid use for low back pain has been associated with a variety of adverse outcomes. However, ED providers may be becoming more compliant with current LBP treatment guidelines.
SN  - 0736-4679
AD  - Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts
U2  - PMID: 26754559.
DO  - 10.1016/j.jemermed.2015.10.015
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108087828
T1  - Why do emergency providers choose one opioid over another? A prospective cohort analysis.
AU  - O'Connor AB
AU  - Rao A
Y1  - 2012/11//2012 Nov-Dec
N1  - Accession Number: 108087828. Language: English. Entry Date: 20130308. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101234523. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Adult
KW  - Aged
KW  - Analgesics, Opioid
KW  - Prospective Studies
KW  - Dose-Response Relationship, Drug
KW  - Female
KW  - Human
KW  - Dihydromorphinone
KW  - Dihydromorphinone -- Administration and Dosage
KW  - Male
KW  - Middle Age
KW  - Morphine
KW  - Morphine -- Administration and Dosage
KW  - Prospective Studies -- Therapeutic Use
KW  - Regression
SP  - 403
EP  - 413
JO  - Journal of Opioid Management
JF  - Journal of Opioid Management
JA  - J OPIOID MANAGE
VL  - 8
IS  - 6
CY  - Weston, Massachusetts
PB  - Weston Medical Publishing, LLC
SN  - 1551-7489
AD  - Associate Professor of Medicine, Hospital Medicine Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
U2  - PMID: 23264318.
DO  - 10.5055/jom.2012.0140
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108087828&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103950824
T1  - Prescription opioid misuse among ED patients discharged with opioids.
AU  - Beaudoin, Francesca L
AU  - Straube, Steven
AU  - Lopez, Jason
AU  - Mello, Michael J
AU  - Baird, Janette
Y1  - 2014/06//
N1  - Accession Number: 103950824. Language: English. Entry Date: 20140815. Revision Date: 20170802. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Substance Use Disorders -- Epidemiology
KW  - Patient Discharge -- Statistics and Numerical Data
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Female
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Prospective Studies
KW  - Risk Factors
KW  - Young Adult
SP  - 580
EP  - 585
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 32
IS  - 6
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - STUDY OBJECTIVES: The purposes of this study were to determine the prevalence of prescription opioid misuse in a cohort of discharged emergency department (ED) patients who received prescription opioids and to examine factors predictive of misuse. METHODS: This prospective observational study enrolled a sample of ED patients aged 18 to 55 years who were discharged with a prescription opioid. Participants completed surveys at baseline in the ED, then 3 and 30 days later. Follow-up surveys contained questions about opioid use and misuse, including screening questions from the National Epidemiologic Survey on Alcohol and Related Conditions. Patients were categorized as misusers if they (1) self-escalated their dose, (2) obtained additional prescription opioids without a prescription, or (3) used for a reason besides pain. RESULTS: Of the 85 patients who completed follow-ups, 36 (42%) reported misuse at either 3 or 30 days. There was no difference in demographic variables, pain scores, analgesic treatment, or discharge diagnoses between misusers and nonmisusers. Self-escalation of dose was the most common category of misuse (33/36; 92%). Taking prescription opioids without a doctor's prescription was reported by 39% (14/36), and taking pain medications for a reason other than pain was reported by 36% (13/36). The presence of disability, chronic pain, preexisting prescription opioid use, oxycodone use, and past 12-month risk of substance abuse were associated with misuse. CONCLUSIONS: Prescription opioid misuse was prevalent among this cohort of ED patients. A heterogeneous mixture of behaviors was captured. Future research should focus on the etiologies of misuse with directed screening and interventions to decrease misuse.
SN  - 0735-6757
AD  - Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA. Electronic address: flb@brown.edu.
AD  - Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA.
U2  - PMID: 24726759.
DO  - 10.1016/j.ajem.2014.02.030
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 128440588
T1  - Pennsylvania removes bupe prior authorization for Medicaid.
AU  - Knopf, Alison
Y1  - 2018/03/12/
N1  - Accession Number: 128440588. Language: English. Entry Date: 20180315. Revision Date: 20180316. Publication Type: Article. Journal Subset: Editorial Board Reviewed; Health Services Administration; Peer Reviewed; USA. NLM UID: 9000784. 
KW  - Rules and Regulations
KW  - Medicaid
KW  - Pennsylvania
KW  - Geographic Locations
KW  - Government Regulations
SP  - 6
EP  - 6
JO  - Alcoholism & Drug Abuse Weekly
JF  - Alcoholism & Drug Abuse Weekly
JA  - ALCOHOL DRUG ABUSE WKLY
VL  - 30
IS  - 11
CY  - Hoboken, New Jersey
PB  - John Wiley & Sons, Inc.
AB  - The article offers information on an initiative by Pennsylvania Governor Tom Wolf to remove barriers to medication-assisted treatment (MAT) for Medicaid patients with an opioid use disorder. Topics discussed include creating consistency in coverage across the health care sector in Pennsylvania; views of Patrick Gavin, chief executive officer of Crozer Keystone Health System, on the same; and Monitoring weekly naloxone use by emergency medical services providers.
SN  - 1042-1394
DO  - 10.1002/adaw.31893
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104298703
T1  - Injection Drug Users Trained by Overdose Prevention Programs: Responses to Witnessed Overdoses.
AU  - Lankenau, Stephen
AU  - Wagner, Karla
AU  - Silva, Karol
AU  - Kecojevic, Aleksandar
AU  - Iverson, Ellen
AU  - McNeely, Miles
AU  - Kral, Alex
Y1  - 2013/02//
N1  - Accession Number: 104298703. Language: English. Entry Date: 20130123. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health; USA. Special Interest: Public Health. Grant Information: This research was supported by NIH grants: K01DA031031, R21DA026789, and T32DA023356.. NLM UID: 7600747. 
KW  - Overdose -- Prevention and Control
KW  - Naloxone -- Administration and Dosage
KW  - Substance Abusers -- Psychosocial Factors
KW  - Funding Source
KW  - Human
KW  - California
KW  - Adult
KW  - Middle Age
KW  - Male
KW  - Female
KW  - Convenience Sample
KW  - Interviews
KW  - Audiorecording
KW  - Descriptive Statistics
KW  - Data Analysis, Statistical
KW  - Data Analysis Software
KW  - Emergency Care -- Evaluation
SP  - 133
EP  - 141
JO  - Journal of Community Health
JF  - Journal of Community Health
JA  - J COMMUNITY HEALTH
VL  - 38
IS  - 1
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
AB  - In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPPs), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n = 30) trained by two OPPs in Los Angeles were interviewed in 2010-2011 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPPs. Injecting the victim with naloxone was the most commonly recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPPs, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques.
SN  - 0094-5145
AD  - Department of Community Health and Prevention, School of Public Health, Drexel University, 1505 Race Street, 11th Floor Philadelphia 19102 USA
AD  - Division of Global Public Health, Department of Medicine, University of California, San Diego, 10111 North Torrey Pines Road La Jolla 92093 USA
AD  - Division of Adolescent Medicine, Childrens Hospital Los Angeles, 5000 Sunset Boulevard Los Angeles 90027 USA
AD  - RTI International, 114 Sansome Street San Francisco 94104 USA
U2  - PMID: 22847602.
DO  - 10.1007/s10900-012-9591-7
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107811900
T1  - OVERDOSE REVERSAL...“Naloxone Now Available for Emergency Home Use,” Drug Watch, August 2014
AU  - Spencer, Sherry
Y1  - 2015/01//
N1  - Accession Number: 107811900. Language: English. Entry Date: 20150107. Revision Date: 20150712. Publication Type: Journal Article; commentary; letter. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 0372646. 
KW  - Prescriptions, Drug
KW  - Naloxone
KW  - Overdose -- Drug Therapy
KW  - First Aid
SP  - 13
EP  - 13
JO  - AJN American Journal of Nursing
JF  - AJN American Journal of Nursing
JA  - AM J NURS
VL  - 115
IS  - 1
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 0002-936X
U2  - PMID: 25545511.
DO  - 10.1097/01.NAJ.0000459609.86788.ac
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103899065
T1  - The opioid abuse and misuse epidemic: Implications for pharmacists in hospitals and health systems.
AU  - Cobaugh, Daniel J.
AU  - Gainor, Carl
AU  - Gaston, Cynthia L.
AU  - Tai C. Kwong
AU  - Magnani, Barbarajean
AU  - Mcpherson, Mary Lynn
AU  - Painter, Jacob T.
AU  - Krenzelok, Edward P.
Y1  - 2014/09/15/
N1  - Accession Number: 103899065. Language: English. Entry Date: 20140930. Revision Date: 20150710. Publication Type: Journal Article; pictorial; practice guidelines; review; statistics; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 9503023. 
KW  - Substance Abuse -- Epidemiology -- United States
KW  - Analgesics, Opioid -- Metabolism
KW  - Overdose -- Drug Therapy
KW  - Inappropriate Prescribing -- Prevention and Control
KW  - Pharmacists
KW  - Professional Role
KW  - Hospital Policies
KW  - Drug Monitoring
KW  - Drugs, Prescription
KW  - United States
SP  - 1539
EP  - 1554
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 71
IS  - 18
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - Purpose. The current epidemic of prescription opioid abuse and misuse in the United States is discussed, with an emphasis on the pharmacist’s role in ensuring safe and effective opioid use. Summary. U.S. sales of prescription opioids increased fourfold from 1999 to 2010, with an alarming rise in deaths and emergency department visits associated with the use of fentanyl, hydrocodone, oxycodone, and other opioid medications. Signs and symptoms of opioid toxicity may include altered mental status, hypoventilation, decreased bowel motility, central nervous system and respiratory depression, peripheral vasodilation, pulmonary edema, hypotension, bradycardia, and seizures. In patients receiving long-term opioid therapy for chronic pain, urine drug testing is an important tool for monitoring and assessment of therapy; knowledge of opioid metabolic pathways and assay limitations is essential for appropriate use and interpretation of screening and confirmatory tests. In recent years, there has been an increase in federal enforcement actions against pharmacies and prescription drug wholesalers involved in improper opioid distribution, as well as increased reliance on state-level prescription drug monitoring programs to track patterns of opioid use and improper sales. Pharmacies are urged to implement or promote appropriate guidelines on opioid therapy, including the use of pain management agreement plans; policies to ensure adequate oversight of opioid prescribing, dispensing, and waste disposal; and educational initiatives targeting patients as well as hospital and pharmacy staff. Conclusion. Pharmacists in hospitals and health systems can play a key role in recognizing the various forms of opioid toxicity and in preventing inappropriate prescribing and diversion of opioids.
SN  - 1079-2082
AD  - Vice President, ASHP Research and Education Foundation, Bethesda, MD.
AD  - Clinical Assistant Professor, Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA.
AD  - Medication Use Policy Analyst, UW Health, Madison, WI.
AD  - Professor, Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY.; Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY.
AD  - Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA.; Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA.
AD  - Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore.
AD  - Assistant Professor, Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock.
AD  - Professor Emeritus, School of Pharmacy, University of Pittsburgh.
U2  - PMID: 25174015.
DO  - 10.2146/ajhp140157
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109783114
T1  - Association of emergency department opioid initiation with recurrent opioid use.
AU  - Hoppe, Jason A
AU  - Kim, Howard
AU  - Heard, Kennon
Y1  - 2015/05//
N1  - Accession Number: 109783114. Language: English. Entry Date: 20150703. Revision Date: 20150923. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service
KW  - Substance Use Disorders -- Etiology
KW  - Pain -- Drug Therapy
KW  - Drugs, Prescription -- Therapeutic Use
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Prospective Studies
KW  - Colorado
KW  - Female
KW  - Human
KW  - Logistic Regression
KW  - Male
KW  - Middle Age
KW  - Odds Ratio
KW  - Retrospective Design
KW  - Risk Factors
KW  - Young Adult
SP  - 493
EP  - 499.e4
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 65
IS  - 5
CY  - New York, New York
PB  - Elsevier B.V.
AB  - STUDY OBJECTIVE: Acute pain complaints are commonly treated in the emergency department (ED). Short courses of opioids are presumed to be safe for acute pain; however, the risk of recurrent opioid use after receipt of an ED opioid prescription is unknown. We describe the risk of recurrent opioid use in patients receiving an opioid prescription from the ED for an acute painful condition. METHODS: This is a retrospective cohort study of all patients discharged from an urban academic ED with an acute painful condition during a 5-month period. Clinical information was linked to data from Colorado's prescription drug monitoring program. We compared opioid-naive patients (no opioid prescription during the year before the visit) who filled an opioid prescription or received a prescription but did not fill it to those who did not receive a prescription. The primary outcome was the rate of recurrent opioid use, defined as filling an opioid prescription within 60 days before or after the first anniversary of the ED visit. RESULTS: Four thousand eight hundred one patients were treated for an acute painful condition; of these, 52% were opioid naive and 48% received an opioid prescription. Among all opioid-naive patients, 775 (31%) received and filled an opioid prescription, and 299 (12%) went on to recurrent use. For opioid-naive patients who filled a prescription compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 1.8 (95% confidence interval 1.3 to 2.3). For opioid-naive patients who received a prescription but did not fill it compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 0.8 (95% confidence interval 0.5 to 1.3). CONCLUSION: Opioid-naive ED patients prescribed opioids for acute pain are at increased risk for additional opioid use at 1 year.
SN  - 0196-0644
AD  - Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO. Electronic address: jason.hoppe@ucdenver.edu.
AD  - Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Denver Health Residency in Emergency Medicine, Denver, CO.
AD  - Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO.
U2  - PMID: 25534654.
DO  - 10.1016/j.annemergmed.2014.11.015
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104260356
T1  - The Prescription Opioid Epidemic: Repercussions on Pediatric Emergency Medicine.
AU  - Gugelmann, Hallam M.
AU  - Nelson, Lewis S.
Y1  - 2012/12//
N1  - Accession Number: 104260356. Language: English. Entry Date: 20130328. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Journal Subset: Biomedical; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 100887300. 
KW  - Prescribing Patterns
KW  - Disease Outbreaks -- Evaluation
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Medicine
KW  - Pediatrics
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Developed Countries
KW  - United States
KW  - Poisoning
KW  - Analgesia -- Methods
KW  - Analgesics, Opioid -- Pharmacokinetics
KW  - Mortality
KW  - Overdose -- Epidemiology
KW  - Neonatal Abstinence Syndrome -- Diagnosis
KW  - Methadone -- Administration and Dosage
KW  - Buprenorphine -- Administration and Dosage
KW  - Academic Medical Centers
KW  - Demography
KW  - Narcotics -- Adverse Effects
KW  - Practice Guidelines
KW  - Rules and Regulations
KW  - Outcomes (Health Care)
SP  - 260
EP  - 268
JO  - Clinical Pediatric Emergency Medicine
JF  - Clinical Pediatric Emergency Medicine
JA  - CLIN PEDIATR EMERG MED
VL  - 13
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 1522-8401
AD  - Department of Emergency Medicine, Hospital of the University of Pennsylvania, Ground Silverstein, Philadelphia, PA
AD  - Department of Emergency Medicine, New York University School of Medicine, New York ity Poison Control Center, New York, NY
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 117909297
T1  - Titrated doses are optimal for opioids in pain trials.
AU  - Riou, Bruno
AU  - Aubrun, Frédéric
Y1  - 2016/09/03/
N1  - Accession Number: 117909297. Language: English. Entry Date: 20160921. Revision Date: 20160922. Publication Type: commentary; letter. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 2985213R. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Pain -- Drug Therapy
KW  - Pain Measurement
SP  - 961
EP  - 961
JO  - Lancet
JF  - Lancet
JA  - LANCET
VL  - 388 North American Edition
IS  - 10048
CY  - Philadelphia, Pennsylvania
PB  - Lancet
AB  - A letter to the editor is presented in response to the article "Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial," by Sameer A. Pathan and colleagues in the May 14, 2016 issue.
SN  - 0099-5355
AD  - Department of Emergency Medicine and Surgery, GH Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris 75013, France.
AD  - Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
AD  - Department of Anesthesia and Critical Care, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
AD  - Claude Bernard Lyon 1 University, Lyon, France.
U2  - PMID: 27598675.
DO  - 10.1016/S0140-6736(16)31496-9
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107138886
T1  - Efficacy of combinated naloxone-nimodipine therapy in acute cerebral infarct.
AU  - Macías-Islas MA
AU  - Hernández-Chávez A
AU  - Ramírez-Casillas GA
Y1  - 1999/06//
N1  - Accession Number: 107138886. Language: English. Entry Date: 20001001. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Mexico & Central/South America; Peer Reviewed. Instrumentation: Toronto Stroke Scale Related to Clinical Bedside Assessment. NLM UID: 9612691. 
KW  - Naloxone -- Therapeutic Use
KW  - Nimodipine -- Therapeutic Use
KW  - Stroke -- Drug Therapy
KW  - Drug Therapy, Combination
KW  - Acute Disease
KW  - Clinical Trials
KW  - Outcomes Research
KW  - Random Assignment
KW  - Naloxone -- Administration and Dosage
KW  - Nimodipine -- Administration and Dosage
KW  - Clinical Assessment Tools
KW  - Severity of Illness Indices
KW  - Chi Square Test
KW  - Analysis of Variance
KW  - P-Value
KW  - Descriptive Statistics
KW  - Treatment Outcomes
KW  - Sex Factors
KW  - Male
KW  - Female
KW  - Inpatients
KW  - Hospitals
KW  - Mexico
KW  - Human
SP  - 129
EP  - 132
JO  - Archivos de Neurociencias
JF  - Archivos de Neurociencias
JA  - ARCHIVOS NEUROCIENCIAS
VL  - 4
IS  - 3
PB  - Instituto Nacional de Neurologia y Neurocirugia, Departamento de Publicaciones Cientificas
AB  - The rationale for using combined 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 (Chi square 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 (Chi square Yates 0.05). The mean of arrival time to the emergency room since the initial ischemic insult was 21 DS.12, for all groups. Combined 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.
SN  - 1028-5938
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107138886&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107086060
T1  - Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?
AU  - Vilke GM
AU  - Buchanan J
AU  - Dunford JV
AU  - Chan TC
Y1  - 1999/01/03/
N1  - Accession Number: 107086060. Language: English. Entry Date: 20000201. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Heroin
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Prehospital Care -- California
KW  - Treatment Refusal -- California
KW  - Death -- California
KW  - Retrospective Design
KW  - Record Review
KW  - Databases
KW  - California
KW  - Descriptive Statistics
KW  - Descriptive Research
KW  - Convenience Sample
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Male
KW  - Female
KW  - Human
SP  - 183
EP  - 186
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 3
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - OBJECTIVE: Naloxone is frequently used by prehospital care providers to treat suspected heroin and opioid overdoses. The authors' EMS system has operated a policy of allowing these patients, once successfully treated, to sign out against medical advice (AMA) in the field. This study was performed to evaluate the safety of this practice. METHODS: The authors retrospectively reviewed all 1996 San Diego County Medical Examiner's (ME's) cases in which opioid overdoses contributed to the cause of death. The records of all patients who were found dead in public or private residences or died in emergency departments of reasons other than natural causes or progression of disease, are forwarded to the ME office. ME cases associated with opiate use as a cause of death were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and, when available, ethnicity. RESULTS: There were 117 ME cases of opiate overdose deaths and 317 prehospital patients who received naloxone and refused further treatment. When compared by age, time, date, sex, location, and ethnicity, there was no case in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opiate overdose. CONCLUSIONS: Giving naloxone to heroin overdoses in the field and then allowing the patients to sign out AMA resulted in no death in the one-year period studied. This study did not evaluate for return visits by paramedics nor whether patients were later taken to hospitals by private vehicles.
SN  - 1090-3127
AD  - Department of Emergency Medicine, UC San Diego Medical Center, 200 West Arbor Drive, Mailcode #8676, San Diego, CA 92103. E-mail: gmvilke@ucsd.edu
U2  - PMID: 10424852.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107086060&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105598988
T1  - Hospitalizations for opioid poisoning: a nation-wide population-based study in Denmark, 1998-2004.
AU  - Bjørn AB
AU  - Jepsen P
AU  - Larsson HJ
AU  - Thomsen HF
AU  - Kieler H
AU  - Ehrenstein V
AU  - Christensen S
Y1  - 2009/01//
N1  - Accession Number: 105598988. Language: English. Entry Date: 20090213. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Emergency Care; Psychiatry/Psychology. NLM UID: 9304118. 
KW  - Hospitalization -- Statistics and Numerical Data -- Denmark
KW  - Narcotics -- Poisoning -- Denmark
KW  - Overdose -- Therapy
KW  - Analgesics -- Poisoning
KW  - Confidence Intervals
KW  - Denmark
KW  - Descriptive Statistics
KW  - Drugs, Prescription
KW  - Ecological Research
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Female
KW  - Heroin -- Poisoning
KW  - Male
KW  - Methadone -- Poisoning
KW  - Sex Factors
KW  - Human
SP  - 104
EP  - 108
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 104
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - AIMS: To assess hospitalization rates (HR) for poisoning with heroin, methadone or strong analgesics and relate them to quantities of prescribed methadone and strong analgesics in Denmark between 1998 and 2004. DESIGN: Population-based ecological study. SETTINGS: We extracted data on all emergency department visits and hospital admissions registered in the Danish National Patient Registry with a diagnosis of poisoning with heroin (n = 1688), methadone (n = 173) or strong analgesics (n = 384). To ascertain sale of prescribed medications we used data from the Danish Medicines Agency. MEASUREMENTS: Age- and gender-standardized HR and defined daily doses (DDD) per 1000 people per day. FINDINGS: HR for heroin poisoning was 4.4 [95% confidence interval (CI): 3.8-4.9] per 100,000 person-years (p-y) in 1998 and 4.6 (CI: 4.0-5.2) per 100,000 p-y in 2004. HR for methadone poisoning increased from 0.1 (CI: 0.0-0.2) per 100,000 p-y in 1998 to 1.1 (CI: 0.8-1.4) per 100,000 p-y in 2004. HR for poisoning with strong analgesics increased from 0.6 (CI: 0.4-0.9) per 100,000 p-y in 1998 to 2.1 (CI: 1.8-2.6) per 100,000 p-y in 2004. The sale of prescribed strong analgesics (5.0 DDD per 1000 people per day in 1998 to 5.9 DDD in 2004) and methadone (3.0 DDD per 1000 people per day in 1998 to 3.4 DDD in 2004) increased slightly between 1998 and 2004. CONCLUSION: Increasing sale of prescribed methadone and strong analgesics coincided with increasing HRs of poisoning with these drugs, whereas HR of heroin poisoning varied. Further longitudinal studies are important for the guidance of future policy making.
SN  - 0965-2140
AD  - Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
U2  - PMID: 19133894.
DO  - 10.1111/j.1360-0443.2008.02420.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126248994
T1  - B.C. OPIOID CRISIS PROMPTS NEW PARAMEDIC SPECIALISTS PROGRAM.
Y1  - 2017/10//Oct/Nov2017
N1  - Accession Number: 126248994. Language: English. Entry Date: 20180104. Revision Date: 20180104. Publication Type: Article; pictorial. Journal Subset: Allied Health; Canada. NLM UID: 101581998. 
KW  - Substance Abuse -- Epidemiology -- British Columbia
KW  - Emergency Medical Services -- Organizations -- British Columbia
KW  - Emergency Medical Technicians
KW  - Overdose
KW  - Program Development
KW  - Specialization
KW  - Emergency Patients
KW  - Job Characteristics
KW  - Job Performance
KW  - Prehospital Care
KW  - British Columbia
SP  - 20
EP  - 21
JO  - Canadian Paramedicine
JF  - Canadian Paramedicine
JA  - CAN PARAMED
VL  - 40
IS  - 6
CY  - Calgary, Alberta
PB  - Pendragon Publishing Ltd.
SN  - 1927-6710
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 114016337
T1  - Assessment of provider attitudes toward #naloxone on Twitter.
AU  - Haug, Nancy A.
AU  - Bielenberg, Jennifer
AU  - Linder, Steven H.
AU  - Lembke, Anna
Y1  - 2016/01//Jan-Mar2016
N1  - Accession Number: 114016337. Language: English. Entry Date: 20170920. Revision Date: 20170920. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8808537. 
KW  - Naloxone -- Therapeutic Use
KW  - Attitude of Health Personnel
KW  - Social Media
KW  - Overdose
KW  - Stigma
KW  - Emergency Medical Technicians
KW  - Burnout, Professional
KW  - Qualitative Studies
KW  - Grounded Theory
SP  - 35
EP  - 41
JO  - Substance Abuse
JF  - Substance Abuse
JA  - SUBST ABUSE
VL  - 37
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Background: As opioid overdose rates continue to pose a major public health crisis, the need for naloxone treatment by emergency first responders is critical. Little is known about the views of those who administer naloxone. The current study examines attitudes of health professionals on the social media platform Twitter to better understand their perceptions of opioid users, the role of naloxone, and potential training needs.Methods: Public comments on Twitter regarding naloxone were collected for a period of 3 consecutive months. The occupations of individuals who posted tweets were identified through Twitter profiles or hashtags. Categories of emergency service first responders and medical personnel were created. Qualitative analysis using a grounded theory approach was used to produce thematic content. The relationships between occupation and each theme were analyzed using Pearson chi-square statistics and post hoc analyses.Results: A total of 368 individuals posted 467 naloxone-related tweets. Occupations consisted of professional first responders such as emergency medical technicians (EMTs), firefighters, and paramedics (n= 122); law enforcement officers (n= 70); nurses (n= 62); physicians (n= 48); other health professionals including pharmacists, pharmacy technicians, counselors, and social workers (n= 31); naloxone-trained individuals (n= 12); and students (n= 23). Primary themes included burnout, education and training, information seeking, news updates, optimism, policy and economics, stigma, and treatment. The highest levels of burnout, fatigue, and stigma regarding naloxone and opioid overdose were among nurses, EMTs, other health care providers, and physicians. In contrast, individuals who self-identified as “naloxone-trained” had the highest optimism and the lowest amount of burnout and stigma.Conclusions: Provider training and refinement of naloxone administration procedures are needed to improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter may have potential for offering psychoeducation to health care providers.
SN  - 0889-7077
AD  - PGSP-Stanford University PsyD Consortium, Palo Alto University, Palo Alto, California, USA
AD  - Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
AD  - VA Palo Alto Health Care System, Palo Alto, California, USA
DO  - 10.1080/08897077.2015.1129390
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110360503
T1  - Are overdoses treated by ambulance services an opportunity for additional interventions? A prospective cohort study.
AU  - Gjersing, Linn
AU  - Bretteville-Jensen, Anne Line
Y1  - 2015/11//
N1  - Accession Number: 110360503. Language: English. Entry Date: 20151021. Revision Date: 20161031. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: This study was funded by the Norwegian Institute for Alcohol and Drug Research.. NLM UID: 9304118. 
KW  - Emergency Medical Services
KW  - Ambulances -- Utilization
KW  - Overdose -- Mortality
KW  - Mortality -- Risk Factors
KW  - Intravenous Drug Users -- Norway
KW  - Prospective Studies
KW  - Prehospital Care
KW  - Time Factors
KW  - Norway
KW  - Interviews -- Methods
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - T-Tests
KW  - Survival Analysis
KW  - Cox Proportional Hazards Model
KW  - Confidence Intervals
KW  - Odds Ratio
KW  - P-Value
KW  - Regression
KW  - Human
KW  - Male
KW  - Female
KW  - Adult
KW  - Overdose -- Drug Therapy
KW  - Overdose -- Etiology
KW  - Naloxone -- Administration and Dosage
KW  - Socioeconomic Factors
KW  - Funding Source
SP  - 1767
EP  - 1774
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 110
IS  - 11
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Aims To assess whether people who inject drugs (PWID) and who are treated for overdose by ambulance services have a greater mortality risk compared with other PWID, and to compare mortality risk within potentially critical time-periods (1 week, 1 month, 3 months, 6 months, 1 year, 5 years) after an overdose attendance with the mortality risk within potentially non-critical time-periods (time before and/or after critical periods). Design A prospective cohort study. Setting Oslo, Norway. Participants A total of 172 PWID street-recruited in 1997 and followed-up until the end of 2004. Measurements Interview data linked to data from ambulance records, Norwegian Correctional Services, Opioid Substitution Treatment records and National Cause of Death Registry. Separate Cox regression models (one for each critical time-period) were estimated. Findings Ambulance services treated 54% of the participants for an overdose during follow-up. The mortality rate was 2.8 per 100 person-years for those with an overdose and 3.3 for those without; the adjusted hazard ratio (HR) was 1.3 (95% CI = 0.6, 2.6, P = 0.482). Mortality risk was greater in all but the shortest critical time-period following ambulance attendance than in the non-critical periods. The mortality risk remained significantly elevated during critical periods, even when adjusted for total time spent in prison and substitution treatment. The HR ranged from 9.4 (95% CI = 3.5, 25.4) in the month after an overdose to 13.9 (95% CI = 6.4, 30.2) in the 5-year period. Conclusions Mortality risk among people who inject drugs is significantly greater in time-periods after an overdose attendance than outside these time-periods.
SN  - 0965-2140
AD  - Norwegian Institute for Alcohol and Drug Research (SIRUS)
U2  - PMID: 26118947.
DO  - 10.1111/add.13026
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104221651
T1  - Multidisciplinary intervention decreases the use of opioid medication discharge packs from 2 urban EDs.
AU  - Gugelmann, Hallam
AU  - Shofer, Frances S
AU  - Meisel, Zachary F
AU  - Perrone, Jeanmarie
Y1  - 2013/09//
N1  - Accession Number: 104221651. Language: English. Entry Date: 20131129. Revision Date: 20170802. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Medicine -- Education
KW  - Emergency Service -- Administration
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Multidisciplinary Care Team
KW  - Patient Discharge -- Statistics and Numerical Data
KW  - Adult
KW  - Aged
KW  - Decision Support Techniques
KW  - Female
KW  - Hospitals, Urban
KW  - Human
KW  - Male
KW  - Electronic Order Entry -- Administration
KW  - Middle Age
KW  - Substance Use Disorders -- Prevention and Control
KW  - Prospective Studies
KW  - Risk Factors
SP  - 1343
EP  - 1348
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 31
IS  - 9
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - INTRODUCTION: Prescription opioid overdoses and deaths constitute a public health epidemic, and recent studies show that emergency department (ED) prescribers may contribute to this crisis. We hypothesized that a multidisciplinary educational intervention would decrease ED opioid packs dispensed at discharge. METHODS: This prospective study implemented a 'bundle' of interdisciplinary educational modalities: lectures, journal clubs, case discussions, and an electronic medical record decision support tool. Implementation occurred in 2 urban EDs in the same health system at different times ('affiliate,' September 2011; 'primary,' January 2012) to better distinguish its effects. The primary outcome was preintervention/postintervention change in opioid discharge packs dispensed to all patients treated and discharged through August 2012 and was assessed by 2-way analysis of variance. The secondary outcome was bivariate analysis (using Fisher exact test) of change in opioid dispensing among patients with known risk factors for prescription opioid dependence: age less than 65 years, history of substance abuse, chronic pain, or psychiatric disorders. RESULTS: A total of 71,512 and 45,746 patients were evaluated and discharged from primary and affiliate EDs, respectively. Orders for opioid discharge packs decreased from 13.9% to 8.4% and 4.7% to 1.9% at the primary and affiliate hospitals (P < .0001). Dispensing among individuals at risk for opioid dependence at the primary ED decreased from 21.8% to 13.9%. CONCLUSIONS: A staged, multidisciplinary intervention targeting nurses, residents, nurse practitioners, and attending physicians was associated with decreased orders for opioid discharge packs in 2 urban EDs. Opioid discharge pack orders decreased slightly more among patients with risk factors for prescription opioid dependence.
SN  - 0735-6757
AD  - Department of Emergency Medicine, Hospital of the University of Pennsylvania. Electronic address: hallamg@gmail.com.
U2  - PMID: 23906621.
DO  - 10.1016/j.ajem.2013.06.002
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 114159205
T1  - Nurses stave off ill-conceived hold provision of opioid bill.
AU  - Markman, Joe
Y1  - 2016/01//Jan/Feb2016
N1  - Accession Number: 114159205. Language: English. Entry Date: 20170408. Revision Date: 20170408. Publication Type: Article; pictorial. Journal Subset: Nursing; USA. 
KW  - Substance Use Disorders -- Legislation and Jurisprudence -- Massachusetts
KW  - Involuntary Commitment -- Legislation and Jurisprudence -- Massachusetts
KW  - Emergency Service
KW  - Massachusetts Nurses Association
KW  - Lobbying
KW  - Massachusetts
KW  - Health Services Accessibility
KW  - Substance Use Rehabilitation Programs
KW  - Substance Abusers
SP  - 6
EP  - 6
JO  - National Nurse
JF  - National Nurse
JA  - NATL NURSE
VL  - 112
IS  - 1
CY  - Oakland, California
PB  - California Nurses Association
AB  - The article focuses on the efforts of Massachussets Nurses Association (MNA) leaders to remove the 72-hour hold provision for substance abuse patients in the legislative proposal of Massachussets governor Charlie Baker. Topics include meeting of MNA members with the American Civil Liberties Union and the Center for Ethics and Human Rights. Also mentioned are proposals for a pilot program in caring for mental illness patients outside the Emergency Department (ED) of Taunton State Hospital.
SN  - 2153-0386
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 125903034
T1  - With or without emergency designation, providers are moving forward with strategies to combat overdoses.
AU  - Johnson, Steven Ross
Y1  - 2017/10/23/
N1  - Accession Number: 125903034. Language: English. Entry Date: 20171030. Revision Date: 20171031. Publication Type: Article. Journal Subset: Health Services Administration; USA. NLM UID: 7801798. 
KW  - Overdose -- Prevention and Control -- United States
KW  - Analgesics, Opioid
KW  - Public Health -- United States
KW  - Illinois
KW  - United States Department of Health and Human Services
KW  - United States
KW  - Substance Use Rehabilitation Programs -- Illinois
KW  - Naloxone
KW  - Mental Health Services -- Illinois
SP  - 0020
EP  - 0020
JO  - Modern Healthcare
JF  - Modern Healthcare
JA  - MOD HEALTHC
VL  - 47
IS  - 43
CY  - Detroit, Michigan
PB  - Crain Communications Inc. (MI)
AB  - The article reports that healthcare providers have been staying active in looking for ways to help patients in need in relation to the opioid epidemic in the U.S. Topics discussed include the expectation for President Donald Trump to label the opioid epidemic a national emergency and Linden Oaks Behavioral Health, a mental health and substance abuse treatment provider affiliated with the Edward-Elmhurst Health system in the Chicago suburbs in Illinois.
SN  - 0160-7480
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120599961
T1  - Adult Intraosseous Access by Advanced EMTs: A Statewide Non-Inferiority Study.
AU  - Wolfson, Daniel L.
AU  - Tandoh, Margaret A.
AU  - Jindal, Mohit
AU  - Forgione, Patrick M.
AU  - Harder, Valerie S.
Y1  - 2017/01//Jan/Feb2017
N1  - Accession Number: 120599961. Language: English. Entry Date: 20170112. Revision Date: 20170118. Publication Type: Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Emergency Medical Technicians -- Evaluation
KW  - Infusions, Intraosseous -- Education
KW  - Human
KW  - Adult
KW  - Prehospital Care
KW  - Peripherally Inserted Central Catheters
KW  - Critically Ill Patients
KW  - Scope of Practice -- Evaluation
KW  - Chi Square Test
KW  - Confidence Intervals
KW  - Descriptive Statistics
KW  - Retrospective Design
KW  - Vermont
KW  - Geographic Locations
KW  - Data Analysis Software
KW  - Male
KW  - Female
KW  - Body Weight
KW  - Epinephrine -- Administration and Dosage
KW  - Naloxone
KW  - Glucose
KW  - Humerus -- Anatomy and Histology
KW  - Tibia -- Anatomy and Histology
KW  - Treatment Outcomes
SP  - 7
EP  - 13
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 21
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Objective:Intraosseous (IO) access is increasingly being used as an alternative to peripheral intravenous access, which is often difficult or impossible to establish in critically ill patients in the prehospital setting. Until recently, only Paramedics performed adult IO access. In 2014, Vermont Emergency Medical Services (EMS) expanded the Advanced Emergency Medical Technicians (AEMTs) scope of practice to include IO access in adult patients. This study compares successful IO access in adults performed by AEMTs compared to Paramedics in the prehospital setting.Methods:All Vermont EMS patient encounters between January 1, 2013 and November 30, 2015 were examined, and 543 adult patients with a documented IO access insertion attempt were identified. The proportion of successful IO insertions was compared between AEMTs and Paramedics using a Chi-Squared statistic and a non-inferiority test.Results:There was no significant difference in the percentage of successful IO access between AEMTs and Paramedics [95.2% and 95.6%, respectively; P = 0.84]. The confidence interval around this 0.4% difference (95% confidence interval = –4.2, 3.2) was within a pre-specified delta of ±10% indicating non-inferiority of AEMTs compared to Paramedics.Conclusions:This study's finding that successful IO access was not different among AEMTs and Paramedics lends evidence in support of expanding the scope of practice of AEMTs to include establishing IO access in adults.
SN  - 1090-3127
DO  - 10.1080/10903127.2016.1209262
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106212586
T1  - Factors associated with delay to opiate analgesia in emergency departments.
AU  - Arendts G
AU  - Fry M
Y1  - 2006/09//
N1  - Accession Number: 106212586. Language: English. Entry Date: 20070112. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100898657. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service
KW  - Pain -- Drug Therapy
KW  - Adolescence
KW  - Adult
KW  - Age Factors
KW  - Aged
KW  - Aged, 80 and Over
KW  - Australia
KW  - Chi Square Test
KW  - Child
KW  - Child, Preschool
KW  - Confidence Intervals
KW  - Data Analysis Software
KW  - Female
KW  - Infant
KW  - Infant, Newborn
KW  - Logistic Regression
KW  - Male
KW  - Mantel-Haenszel Test
KW  - Middle Age
KW  - Multivariate Analysis
KW  - Odds Ratio
KW  - Pearson's Correlation Coefficient
KW  - Prospective Studies
KW  - Retrospective Design
KW  - Time Factors
KW  - Treatment Outcomes
KW  - Triage
KW  - Univariate Statistics
KW  - Human
SP  - 682
EP  - 686
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 7
IS  - 9
PB  - Churchill Livingstone, Inc.
AB  - Patients presenting to an emergency department (ED) with painful conditions continue to experience significant delay to analgesia. It remains unclear whether demographic and clinical factors are associated with this outcome. The objectives of this study were to determine 1) the proportion of patients that require parenteral opiate analgesia for pain in an ED and who receive the opiate in less than 60 minutes; and 2) whether any factors are predictive for the first dose of analgesia being delayed beyond 60 minutes. A retrospective cohort study with descriptive and comparative data analysis was conducted. Over a 3-month period, the medical record of every patient receiving parenteral opiates in a tertiary emergency department was reviewed and analyzed. Of 857 patients, 451 (52.6%) received analgesia in less then 60 minutes. Multiple demographic and clinical factors are associated with statistically significant delay to analgesia, including age, triage code, seniority of treating doctor, diagnosis, and disposition from the ED. PERSPECTIVE: A considerable proportion of patients suffer delay to analgesia. Identifiable factors associated with a delay to analgesia exist. There is potential for clinicians to develop strategies to address the population in emergency departments at risk for delay to analgesia.
SN  - 1526-5900
AD  - Department of Emergency Medicine, St. George Hospital, Kogarah, Australia.
U2  - PMID: 16942954.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106212586&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107822658
T1  - Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.
AU  - Walley, Alexander Y
AU  - Xuan, Ziming
AU  - Hackman, H Holly
AU  - Quinn, Emily
AU  - Doe-Simkins, Maya
AU  - Sorensen-Alawad, Amy
AU  - Ruiz, Sarah
AU  - Ozonoff, Al
Y1  - 2013/01//
N1  - Accession Number: 107822658. Language: English. Entry Date: 20150116. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 8900488. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Health Education -- Methods
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Adult
KW  - Allied Health Personnel -- Education
KW  - Curriculum
KW  - Overdose -- Mortality
KW  - Overdose -- Prevention and Control
KW  - Emergency Service -- Utilization
KW  - Female
KW  - Harm Reduction
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Human
KW  - Male
KW  - Massachusetts
KW  - Drugs, Prescription -- Poisoning
KW  - Survival
SP  - f174
EP  - f174
JO  - BMJ: British Medical Journal (Clinical Research Edition)
JF  - BMJ: British Medical Journal (Clinical Research Edition)
JA  - BMJ BR MED J (CLIN RES ED)
VL  - 346
PB  - BMJ Publishing Group
SN  - 0959-8138
AD  - Clinical Addiction Research Education Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA. awalley@bu.edu
U2  - PMID: 23372174.
DO  - 10.1136/bmj.f174
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110660432
T1  - Emergency Department-Initiated Buprenorphine/Nalaxone Treatment for Opioid Dependence: A Randomized Clinical Trial: D’Onofrio G, O’Connor O, Pantalon MV, et al. JAMA. 2015;313:1636-1644.
AU  - Nacht, Jacob
Y1  - 2015/11//
N1  - Accession Number: 110660432. Language: English. Entry Date: 20160204. Revision Date: 20151103. Publication Type: Article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8412174. 
SP  - 831
EP  - 832
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 49
IS  - 5
PB  - Pergamon Press - An Imprint of Elsevier Science
SN  - 0736-4679
AD  - Denver Health Residency In Emergency Medicine, Denver, CO
DO  - 10.1016/j.jemermed.2015.09.039
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104939265
T1  - Intravenous opioids for severe acute pain in the emergency department.
AU  - Patanwala AE
AU  - Keim SM
AU  - Erstad BL
Y1  - 2010/11//
N1  - Accession Number: 104939265. Language: English. Entry Date: 20110304. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 9203131. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service
KW  - Pain -- Drug Therapy
KW  - Acute Disease
KW  - Adult
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Protocols
KW  - Dose-Response Relationship, Drug
KW  - Human
KW  - Infusions, Intravenous
KW  - Clinical Trials
KW  - Severity of Illness Indices
SP  - 1800
EP  - 1809
JO  - Annals of Pharmacotherapy
JF  - Annals of Pharmacotherapy
JA  - ANN PHARMACOTHER
VL  - 44
IS  - 11
CY  - Thousand Oaks, California
PB  - Sage Publications Inc.
SN  - 1060-0280
AD  - College of Pharmacy, University of Arizona, Tucson, AZ.
U2  - PMID: 20978218.
DO  - 10.1345/aph.1P438
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104947234
T1  - The effects of intravenous opioid on abdominal pain and peritoneal irritation in patients presenting to an emergency department.
AU  - Moharramzadeh P
AU  - Vahdati SS
Y1  - 2010/05//
N1  - Accession Number: 104947234. Language: English. Entry Date: 20110107. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts; randomized controlled trial. Journal Subset: Biomedical; Middle East. NLM UID: 9426245. 
KW  - Abdominal Pain -- Diagnosis
KW  - Narcotics -- Administration and Dosage
KW  - Peritonitis -- Diagnosis
KW  - Chi Square Test
KW  - Data Analysis Software
KW  - Double-Blind Studies
KW  - Human
KW  - Randomized Controlled Trials
KW  - Research Methodology
KW  - T-Tests
SP  - 285
EP  - 289
JO  - Marmara Medical Journal
JF  - Marmara Medical Journal
JA  - MARMARA MED J
VL  - 23
IS  - 2
PB  - Marmara Medical Journal
SN  - 1019-1941
AD  - Tabriz University of Medical Science, Emergency Department, Tabriz, Iran
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105563433
T1  - A prospective study of non-fatal heroin overdose.
AU  - Fatovich DM
AU  - Bartu A
AU  - Daly FFS
Y1  - 2008/10//
N1  - Accession Number: 105563433. Language: English. Entry Date: 20090116. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Emergency Care; Psychiatry/Psychology. Instrumentation: Glasgow Coma Scale (GCS). NLM UID: 100891385. 
KW  - Emergency Care
KW  - Heroin -- Poisoning
KW  - Overdose -- Epidemiology -- Western Australia
KW  - Substance Abuse -- Complications
KW  - Aboriginal Australians
KW  - Adolescence
KW  - Adult
KW  - Age of Onset
KW  - Chi Square Test
KW  - Coefficient Alpha
KW  - Data Analysis Software
KW  - Descriptive Research
KW  - Descriptive Statistics
KW  - Emergency Patients
KW  - Emergency Service
KW  - Epidemiological Research
KW  - Female
KW  - Glasgow Coma Scale
KW  - Health Resource Utilization
KW  - Length of Stay
KW  - Male
KW  - Marital Status
KW  - Middle Age
KW  - Naloxone -- Therapeutic Use
KW  - Neuropsychological Tests
KW  - Outpatients
KW  - Prospective Studies
KW  - Record Review
KW  - Recurrence
KW  - Retrospective Design
KW  - Self Report
KW  - Substance Abusers
KW  - Western Australia
KW  - Whites
KW  - Human
SP  - 299
EP  - 307
JO  - Journal of Substance Use
JF  - Journal of Substance Use
JA  - J SUBST USE
VL  - 13
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Aims: We aimed to study the prevalence, characteristics and outcomes of patients presenting withnon-fatal heroin overdose.Design: Prospective observational study.Setting: Emergency Department (ED).Participants: Patients attending with non-fatal heroin overdose.Intervention: Nil.Measurement: Descriptive and epidemiological data.Findings: Two-hundred-and-forty-nine overdoses in 224 patients (61.2% male, range 15DS49 years).Mean reported age of first heroin use was 18.8 years (range 10DS42). Forty-two per cent reported aprevious heroin overdose requiring hospital intervention. Co-ingestants included benzodiazepines(61, 27.2%), alcohol (35, 15.6%), cannabis (25, 11.1%), amphetamines (13, 5.8%) andhallucinogens (3, 1.3%). Most patients experienced a benign course; 81 of 115 ambulancepresentations (70.4%) received prehospital naloxone and 23 (9.2%) received naloxone in the ED;67.9% had no investigations and complications were uncommon (two aspiration, one hypoxic braininjury). Median length of stay was 180 min (15 min to 48 h). Only 29 (11.6%) presentations requiredadmission. There were 15 individuals (6.7%) who had 40 (16.1% of the total) repeat presentations.Conclusions: Heroin overdose tends to occur in experienced users who commonly co-ingest otherdrugs. There is a trend of overdose occurring with increasing frequency in teenage females. Repeatoverdosing is common. However, while morbidity is low, these patients require considerableresources.
SN  - 1465-9891
AD  - Department of Emergency Medicine, Royal Perth Hospital, Perth, Australia
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 117877371
T1  - Commentary on “Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care”.
AU  - Dailey, Michael W.
Y1  - 2016/09//Sep/Oct2016
N1  - Accession Number: 117877371. Language: English. Entry Date: 20160915. Revision Date: 20180223. Publication Type: Article; commentary. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Treatment Refusal
KW  - Prehospital Care
KW  - Emergency Care
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Substance Abuse -- Diagnosis
KW  - Overdose
KW  - Emergency Medical Technicians
SP  - 672
EP  - 673
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 20
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
SN  - 1090-3127
DO  - 10.3109/10903127.2016.1149653
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104057291
T1  - Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers.
AU  - Jones, Hendrée E
AU  - Deppen, Krisanna
AU  - Hudak, Mark L
AU  - Leffert, Lisa
AU  - McClelland, Carol
AU  - Sahin, Leyla
AU  - Starer, Jacquelyn
AU  - Terplan, Mishka
AU  - Thorp Jr, John M
AU  - Walsh, James
AU  - Creanga, Andreea A
AU  - Thorp, John M Jr
Y1  - 2014/04//
N1  - Accession Number: 104057291. Language: English. Entry Date: 20140530. Revision Date: 20170614. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Obstetric Care; Women's Health. NLM UID: 0370476. 
KW  - Substance Use Disorders -- Complications
KW  - Substance Use Disorders -- Therapy
KW  - Physician-Patient Relations
KW  - Pregnancy Complications -- Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Buprenorphine -- Therapeutic Use
KW  - Privacy and Confidentiality
KW  - Dose-Response Relationship, Drug
KW  - Emergency Service
KW  - Female
KW  - Labor Pain -- Drug Therapy
KW  - Labor
KW  - Mental Disorders -- Diagnosis
KW  - Methadone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Substance Use Disorders -- Diagnosis
KW  - Postoperative Pain -- Drug Therapy
KW  - Postnatal Care
KW  - Pregnancy
KW  - Pregnancy Complications -- Diagnosis
KW  - Prenatal Care
KW  - Referral and Consultation
KW  - Triage
SP  - 302
EP  - 310
JO  - American Journal of Obstetrics & Gynecology
JF  - American Journal of Obstetrics & Gynecology
JA  - AM J OBSTET GYNECOL
VL  - 210
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
AB  - We review clinical care issues that are related to illicit and therapeutic opioid use among pregnant women and women in the postpartum period and outline the major responsibilities of obstetrics providers who care for these patients during the antepartum, intrapartum, and postpartum periods. Selected patient treatment issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high-quality obstetric care and in coordinating services with other specialists as needed. Obstetrics providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment for patients with drug use disorders. Opioid-dependent pregnant women often can be treated effectively with methadone or buprenorphine. These medications are classified as pregnancy category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label." Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged because of a high relapse rate. Acute pain management in this population deserves special consideration because patients who use opioids can be hypersensitive to pain and because the use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, pregnant women who use opioids do not require more intense medical care than other pregnant patients to ensure adequate treatment and the best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for pregnant women who use opioids and women who use opioids in the postpartum period.
SN  - 0002-9378
AD  - UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC
AD  - UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC. Electronic address: hendree_jones@med.unc.edu.
AD  - Department of Family Medicine, Grant Medical Center, Columbus, OH.
AD  - Department of Pediatrics, University of Florida College of Medicine-Jacksonville, FL.
AD  - Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA.
AD  - UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC.
AD  - Pediatric and Maternal Health Staff, Maternal Health Team, Office of New Drugs, Food and Drug Administration, Silver Spring, MD.
AD  - Addiction Recovery Program, Brigham and Women's Faulkner Hospital, Boston, MA.
AD  - Department of Obstetrics, Gynecology & Reproductive Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
AD  - Addiction Recovery Service, Swedish Medical Center, Seattle, WA.
AD  - Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA.
U2  - PMID: 24120973.
DO  - 10.1016/j.ajog.2013.10.010
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107887659
T1  - Postdischarge nonmedical use of prescription opioids in at-risk drinkers admitted to urban level I trauma centers.
AU  - Field, Craig A
AU  - Cochran, Gerald
AU  - Caetano, Raul
AU  - Foreman, Michael
AU  - Brown, Carlos V R
Y1  - 2014/03//
N1  - Accession Number: 107887659. Language: English. Entry Date: 20140516. Revision Date: 20161117. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Critical Care; Emergency Care. Grant Information: R01AA013824/AA/NIAAA NIH HHS/United States. NLM UID: 101570622. 
KW  - Alcoholism -- Complications
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Therapy -- Statistics and Numerical Data
KW  - Trauma Centers -- Statistics and Numerical Data
KW  - Adult
KW  - Alcoholism -- Prevention and Control
KW  - Alcoholism -- Psychosocial Factors
KW  - Female
KW  - Hospitals, Urban -- Statistics and Numerical Data
KW  - Human
KW  - Male
KW  - Motivational Interviewing
KW  - Patient Discharge -- Statistics and Numerical Data
KW  - Risk Factors
SP  - 833
EP  - 839
JO  - Journal of Trauma & Acute Care Surgery
JF  - Journal of Trauma & Acute Care Surgery
JA  - J TRAUMA ACUTE CARE SURG
VL  - 76
IS  - 3
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Background: Nonmedical 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.Methods: This 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.Results: In 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.Conclusion: The 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 Evidence: Prognostic/epidemiologic study, level II.
SN  - 2163-0755
AD  - From the University of Texas at Austin (C.A.F.); and University Medical Center at Brackenridge (C.V.R.B.), Austin; and University of Texas School of Public Health and University of Texas Southwestern Medical Center (R.C.); and Baylor University Medical Center (M.F.), Dallas, Texas; University of Pittsburgh (G.C.), Pittsburgh, Pennsylvania.
U2  - PMID: 24553557.
DO  - 10.1097/TA.0000000000000100
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107828175
T1  - Armed with Naloxone.
AU  - Goodloe, Jeffrey M.
AU  - Dailey, Michael W.
AU  - Heightman, A. J.
Y1  - 2014/09//
N1  - Accession Number: 107828175. Language: English. Entry Date: 20140919. Revision Date: 20150820. Publication Type: Journal Article. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. 
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Prehospital Care
KW  - Emergency Medical Technicians
KW  - Police
KW  - Professional Practice
KW  - Emergency Medical Services
KW  - Overdose -- Epidemiology -- United States
KW  - Substance Abuse -- Epidemiology -- United States
KW  - Substance Dependence -- Epidemiology -- United States
KW  - Prescriptions, Drug
KW  - Street Drugs
KW  - Substance Abusers
KW  - Respiratory Failure -- Chemically Induced
KW  - Naloxone -- Adverse Effects
KW  - Health Services Accessibility
KW  - Urban Areas
KW  - Rural Areas
KW  - Drug Storage
KW  - Health Resource Allocation
KW  - Patient Safety
KW  - Outpatients
KW  - Emergency Patients
KW  - United States
SP  - 1
EP  - 7
JO  - EMS Insider
JF  - EMS Insider
JA  - EMS INSIDER
VL  - 41
IS  - 9
CY  - , <Blank>
PB  - Elsevier Public Safety
SN  - 1081-4507
AD  - Medical Director, EMS System, Metropolitan Oklahoma City and Tulsa.; Professor and EMS Section Chief, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa.
AD  - Regional EMS Medical Director, Hudson Mohawk Region of New York.; Associate Professor, Emergency Medicine, Albany Medical College.; Director, Prehospital Care and Education, Albany Medical College.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111823942
T1  - Naloxone Prescriptions by Emergency Physicians.
Y1  - 2016/01//
N1  - Accession Number: 111823942. Language: English. Entry Date: 20160507. Revision Date: 20160507. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Naloxone -- Therapeutic Use
KW  - Emergency Medicine -- Statistics and Numerical Data
KW  - United States
KW  - Medical Organizations
SP  - 149
EP  - 149
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 67
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
U2  - PMID: 26707531.
DO  - 10.1016/j.annemergmed.2015.11.023
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106413472
T1  - Changing opioid use for right lower quadrant abdominal pain in the emergency department.
AU  - Neighbor ML
AU  - Baird CH
AU  - Kohn MA
Y1  - 2005/12//
N1  - Accession Number: 106413472. Language: English. Entry Date: 20060324. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Abdominal Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Care
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Asians
KW  - Blacks
KW  - California
KW  - Chi Square Test
KW  - Comparative Studies
KW  - Confidence Intervals
KW  - Cox Proportional Hazards Model
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Emergency Patients
KW  - Emergency Service
KW  - Female
KW  - Hispanics
KW  - Homelessness
KW  - Hospitals, Urban
KW  - Male
KW  - Middle Age
KW  - Outpatients
KW  - Pain Measurement
KW  - Prospective Studies
KW  - Record Review
KW  - Retrospective Design
KW  - Survival Analysis
KW  - Tomography, X-Ray Computed
KW  - Univariate Statistics
KW  - Whites
KW  - Human
SP  - 1216
EP  - 1220
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 12
IS  - 12
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - OBJECTIVES: To compare the use of opioid analgesia in the treatment of emergency department patients with acute right lower quadrant (RLQ) abdominal pain between 1998 and 2003 and to explore the relationship between opioid use and abdominal computed tomography (CT) scanning. METHODS: This was a retrospective cohort study of patients presenting in 1998 and 2003 to an urban emergency department with a triage complaint of RLQ pain. The authors abstracted use and timing of abdominal CT scanning and opioid analgesia. Other predictor variables were patient demographics. Risk ratio for receiving opioids with CT scan versus without CT scan, stratifying by year, were calculated. Proportional-hazards analysis was used to control for time in the emergency department. RESULTS: Of the 187 patients seen in 1998, 38 (20%) underwent CT scanning and 43 (23%) received opioids. Of the 137 patients seen in 2003, 77 (56%) underwent CT scanning and 72 (53%) received opioids. In 1998, the risk ratio for receiving opioids in patients who underwent CT scanning (vs. without) was 3.7 (95% confidence interval [CI] = 2.3 to 6.1); in 2003, it was 1.5 (95% CI = 1.0 to 2.1). Opioids were overwhelmingly given before CT scanning in those patients who received both (81% in 1998 and 98% in 2003). The mean time to administration of the first opioid dose in 1998 was 155 minutes and in 2003 was 94 minutes. The proportional-hazards analysis confirmed a strong association between CT scanning and opioid administration in 1998 (relative hazard, 2.7; 95% CI = 1.5 to 5.1) and substantial attenuation of the association in 2003 (relative hazard, 1.3; 95% CI = 0.8 to 2.1). The hospitalization rate was not significantly different in 2003 (33%) versus 1998 (27%) (p = 0.28). The risk ratio of receiving opioids in admitted patients was 2.8 (95% CI = 1.7 to 4.6) in 1998 and 2.0 (95% CI = 1.5 to 2.7) in 2003. CONCLUSIONS: Opioid administration to patients with RLQ pain has dramatically increased between 1998 and 2003. During these five years, the number of patients receiving opioids more than doubled and the time to first administration of opioids decreased by one hour. The authors show that this cannot be attributed to an increased use of CT scanning.
SN  - 1069-6563
AD  - University of California, San Francisco; mneighbor@sfghed.ucsf.edu
U2  - PMID: 16293897.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106413472&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103856197
T1  - How do physicians adopt and apply opioid prescription guidelines in the emergency department? A qualitative study.
AU  - Kilaru, Austin S
AU  - Gadsden, Sarah M
AU  - Perrone, Jeanmarie
AU  - Paciotti, Breah
AU  - Barg, Frances K
AU  - Meisel, Zachary F
Y1  - 2014/11//
N1  - Accession Number: 103856197. Language: English. Entry Date: 20150508. Revision Date: 20161231. Publication Type: journal article; research. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. Grant Information: R18 HS021956-01/HS/AHRQ HHS/United States. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Standards
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Guideline Adherence -- Statistics and Numerical Data
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Adult
KW  - Female
KW  - Human
KW  - Interviews
KW  - Male
KW  - Middle Age
KW  - Practice Guidelines
KW  - Qualitative Studies
KW  - United States
SP  - 482
EP  - 489.e1
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 64
IS  - 5
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: An increase in prescriptions for opioid pain medications has coincided with increasing opioid overdose deaths. Guidelines designed to optimize opioid prescriptions written in the emergency department have been implemented, with substantial controversy. Little is known about how physicians perceive and apply these guidelines. We seek to identify key themes about emergency physicians' definition, awareness, use, and opinions of opioid-prescribing guidelines.Methods: We conducted semistructured qualitative interviews with a convenience sample of 61 emergency physicians attending the American College of Emergency Physicians Scientific Assembly (October 2012, Denver, CO). Participants varied with respect to age, sex, geographic region, practice setting, and years of practice experience. We analyzed the interview content with modified grounded theory, an iterative coding process to identify patterns of responses and derive key themes. The study team examined discrepancies in the coding process to ensure reliability and establish consensus.Results: When aware of opioid-prescribing guidelines, emergency physicians often defined them as policies developed by individual hospitals that sometimes reflected guidelines at the state or national level. Guidelines were primarily used by physicians to communicate decisions to limit prescriptions to patients on discharge rather than as tools for decisionmaking. Attitudes toward guidelines varied with regard to general attitudes toward opioid medications, as well as the perceived effects of guidelines on physician autonomy, public health, liability, and patient diversion.Conclusion: These exploratory findings suggest that hospital-based opioid guidelines complement and occasionally supersede state and national guidelines and that emergency physicians apply guidelines primarily as communication tools. The perspectives of providers should inform future policy actions that seek to address the problem of opioid abuse and overdose through practice guidelines.
SN  - 0196-0644
AD  - Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
AD  - Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
AD  - Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: zfm@upenn.edu.
U2  - PMID: 24743100.
DO  - 10.1016/j.annemergmed.2014.03.015
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103856197&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104374403
T1  - Response to: Who receives opioids for acute pain in emergency departments? Considering evidence, patient and provider preferences...Pain. 2012 May;153(5):967-73; Pain. 2012 May;153(5):941-2
AU  - McLean SA
AU  - Platts-Mills TF
AU  - Hunold KM
Y1  - 2012/11//
N1  - Accession Number: 104374403. Language: English. Entry Date: 20130802. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 7508686. 
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Utilization
KW  - Practice Patterns
KW  - Female
KW  - Male
SP  - 2300
EP  - 2301
JO  - Pain (03043959)
JF  - Pain (03043959)
JA  - PAIN
VL  - 153
IS  - 11
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 0304-3959
AD  - Department of Anesthesiology, and Department of Emergency Medicine, University of North Carolina, 170 Manning Drive CB#7594, Chapel Hill, NC 27599-7010, USA.
U2  - PMID: 22947223.
DO  - 10.1016/j.pain.2012.07.036
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104374403&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104554652
T1  - Who receives opioids for acute pain in emergency departments? Considering evidence, patient and provider preferences.
AU  - Fanciullo GJ
Y1  - 2012/05//
N1  - Accession Number: 104554652. Language: English. Entry Date: 20120824. Revision Date: 20150711. Publication Type: Journal Article; commentary. Original Study: Platts-Mills TF, Hunold KM, Bortsov AV, Soward AC, Peak DA, Jones JS, et al. More educated emergency department patients are less likely to receive opioids for acute pain. (PAIN) May2012; 153 (5): 967-973. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 7508686. 
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Utilization
KW  - Practice Patterns
KW  - Female
KW  - Male
SP  - 941
EP  - 942
JO  - Pain (03043959)
JF  - Pain (03043959)
JA  - PAIN
VL  - 153
IS  - 5
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 0304-3959
AD  - Department of Anesthesiology, Section of Pain Medicine, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756, USA.
U2  - PMID: 22445292.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104554652&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111055371
T1  - National Institutes of Health Study Shows Benefit of Emergency Department Use of Buprenorphine in Opiate Withdrawal.
AU  - Berger, Eric
Y1  - 2015/12//
N1  - Accession Number: 111055371. Language: English. Entry Date: 20160303. Revision Date: 20151128. Publication Type: Article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - A20
EP  - A22
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 66
IS  - 6
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
DO  - 10.1016/j.annemergmed.2015.08.010
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111055371&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104584247
T1  - 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.
AU  - Chang AK
AU  - Bijur PE
AU  - Gallagher EJ
Y1  - 2011/10//
N1  - Accession Number: 104584247. Language: English. Entry Date: 20120323. Revision Date: 20150711. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service
KW  - Dihydromorphinone -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Adult
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Protocols
KW  - Female
KW  - Human
KW  - Dihydromorphinone -- Adverse Effects
KW  - Dihydromorphinone -- Therapeutic Use
KW  - Injections, Intravenous
KW  - Male
KW  - Pain Measurement
KW  - Treatment Outcomes
KW  - Clinical Trials
SP  - 352
EP  - 359
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 58
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
AB  - STUDY OBJECTIVE: We 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. METHODS: This 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. RESULTS: Of 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. CONCLUSION: When 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.
SN  - 0196-0644
AD  - Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
U2  - PMID: 21507527.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104584247&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107805165
T1  - Take-home emergency naloxone to prevent deaths from heroin overdose.
AU  - Strang, John
AU  - Bird, Sheila M
AU  - Dietze, Paul
AU  - Gerra, Gilberto
AU  - McLellan, A Thomas
Y1  - 2014/03//
N1  - Accession Number: 107805165. Language: English. Entry Date: 20150313. Revision Date: 20150712. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 8900488. 
KW  - Overdose -- Drug Therapy
KW  - Substance Use Disorders -- Drug Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Overdose -- Mortality
KW  - Emergencies
KW  - Great Britain
KW  - Substance Use Disorders -- Mortality
SP  - g6580
EP  - g6580
JO  - BMJ: British Medical Journal (Clinical Research Edition)
JF  - BMJ: British Medical Journal (Clinical Research Edition)
JA  - BMJ BR MED J (CLIN RES ED)
VL  - 349
PB  - BMJ Publishing Group
SN  - 0959-8138
AD  - National Addiction Centre (Institute of Psychiatry and The Maudsley), King's College London, London SE5 8AF, UK john.strang@kcl.ac.uk.
AD  - MRC Biostatistics Unit, Cambridge CB2 0SR, UK.
AD  - Burnet Institute, Melbourne, Australia.
AD  - Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, Austria.
AD  - Treatment Research Institute, Philadelphia, PA 19106, USA.
U2  - PMID: 25378248.
DO  - 10.1136/bmj.g6580
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107805165&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106256311
T1  - Impact of outside regulatory investigation on opiate administration in the emergency department.
AU  - McErlean M
AU  - Triner W
AU  - Young A
Y1  - 2006/12//
N1  - Accession Number: 106256311. Language: English. Entry Date: 20070323. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100898657. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Utilization
KW  - Emergency Service
KW  - Pain -- Drug Therapy
KW  - Adolescence
KW  - Adult
KW  - Chi Square Test
KW  - Child
KW  - Child, Preschool
KW  - Data Analysis Software
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Pain Measurement
KW  - Patient Discharge
KW  - Prospective Studies
KW  - Record Review
KW  - Retrospective Design
KW  - Human
SP  - 947
EP  - 950
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 7
IS  - 12
PB  - Churchill Livingstone, Inc.
AB  - This study was conducted to determine whether outside regulatory investigation related to opiate prescription diversion changes the prescribing frequency of opiates in an emergency department (ED). The presence of ED administration of opiates and prescriptions for opiates on discharge were compared across a baseline period 90 days before arrest of a physician for opiate diversion, a period immediately surrounding the arrest, and a follow-up period 90 days later. At no time was there investigation of excessive opiate prescribing for patients in the ED. The likelihood of receiving opiate analgesia either in the ED or on discharge was not significantly different for patients reporting mild pain or severe pain across all three periods. Patients with moderate pain (self-reported pain scores of 4 to 6 out of 10) were less likely to receive opiates in the ED immediately after the arrest compared with the baseline period (likelihood ratio, 0.4; confidence interval, 0.2 to 0.7). Patients with moderate pain were also less likely to receive prescriptions for opiates on discharge from the ED immediately after the arrest (likelihood ratio, 0.5; confidence interval, 0.3 to 0.9). These effects had diminished by 90 days. PERSPECTIVE: This study indicates that factors outside of the provider-patient relationship influence the likelihood of receiving opiates during an ED visit. Awareness of this phenomenon might serve to reduce oligoanalgesia.
SN  - 1526-5900
AD  - Department of Emergency Medicine, Albany Medical College, Albany, New York.
U2  - PMID: 17157781.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106256311&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104074384
T1  - Opioids can be useful in the treatment of headache.
AU  - Finocchi, Cinzia
AU  - Viani, Erica
Y1  - 2013/05/02/May2013 Supplement
N1  - Accession Number: 104074384. Language: English. Entry Date: 20140207. Revision Date: 20171021. Publication Type: journal article. Supplement Title: May2013 Supplement. Journal Subset: Biomedical; Continental Europe; Europe. NLM UID: 100959175. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Migraine -- Drug Therapy
KW  - Human
KW  - Substance Use Disorders -- Epidemiology
KW  - Substance Use Disorders -- Etiology
SP  - 119
EP  - 124
JO  - Neurological Sciences
JF  - Neurological Sciences
JA  - NEUROL SCI
VL  - 34
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
AB  - The use of opioids in headache treatment is very controversial. In the migraine acute attack use of short-acting opioids is not recommended by the principal guidelines but is frequent in North American emergency departments. Their efficacy in migraine acute attack has not been extensively studied but seems to be similar to non-steroidal anti-inflammatory drugs and metoclopramide. Opioids have been never compared to triptans. The principal concerns about the use of opioids regard the possible association with an increased risk of medication-overuse headache and chronic migraine and the risk of abuse and dependence. These risks have to be considered but not overestimated. The association between frequent use and increased risk of chronic migraine has been observed for almost all categories of acute migraine attack drugs. Compared to the reference category of acetaminophen, risk of chronic migraine for opioid use is only moderately higher (with an OR = 1.48). In some cases, when treatment with triptans, non-steroidal anti-inflammatory drugs, or ergotamines is contraindicated or simply ineffective, a judicious prescription of a short-acting opioid for severe migraine attacks can be considered. Chronic migraine is a highly disabling condition. Although the options for prophylaxis therapy of migraine have expanded and improved considerably over recent years, chronic migraine remains very difficult to treat. The results coming from small clinical series are described, suggesting that in expert hands daily long-acting opioids provide an option for the treatment of some individuals with chronic intractable headaches.
SN  - 1590-1874
AD  - Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, University of Genova, Largo Daneo 3, 16132, Genova, Italy, cfinocchi@neurologia.unige.it.
U2  - PMID: 23695059.
DO  - 10.1007/s10072-013-1416-7
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104074384&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 109835275
T1  - Opioid Dependence Treatment in the Emergency Department...JAMA. 2015 Apr 28;313(16):1636-44
AU  - Swartz, Andrew W
Y1  - 2015/08/25/
N1  - Accession Number: 109835275. Language: English. Entry Date: 20150923. Revision Date: 20161112. Publication Type: commentary; commentary; letter. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Buprenorphine -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Female
KW  - Male
SP  - 834
EP  - 835
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 314
IS  - 8
CY  - Chicago, Illinois
PB  - American Medical Association
SN  - 0098-7484
U2  - PMID: 26305656.
DO  - 10.1001/jama.2015.8519
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109835275&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112190664
T1  - To the Editor...Hunold KM, Smith SA, Platts-Mills TF. Constipation prophylaxis is rare for adults prescribed outpatient opioid therapy from U.S. emergency departments. Acad Emerg Med 2015;22:1118 – 21
AU  - Wightman, Rachel S.
AU  - Howland, Mary Ann
AU  - Nelson, Lewis S.
Y1  - 2016/01//
N1  - Accession Number: 112190664. Language: English. Entry Date: 20160112. Revision Date: 20170102. Publication Type: Article; letter. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Constipation -- Prevention and Control
KW  - Emergency Medicine
KW  - Prescribing Patterns
KW  - Pain -- Therapy
KW  - Emergency Service
KW  - Analgesics, Opioid -- Adverse Effects
SP  - 106
EP  - 106
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 23
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - A letter to the editor is presented in response to an article by K. M. Hunold et al about the prescribing of constipation prophylaxis to patients receiving opioid prescriptions by emergency physicians.
SN  - 1069-6563
AD  - Department of Emergency Medicine, Division of Medical Toxicology, New York University School of Medicine
AD  - St John's University College of Pharmacy and Health Sciences, Department of Emergency Medicine, Division of Medical Toxicology
DO  - 10.1111/acem.12849
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112190664&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118881734
T1  - The Opioid Drug Epidemic and Sickle Cell Disease: Guilt by Association.
AU  - RUTA, NADIA S.
AU  - BALLAS, SAMIR K.
Y1  - 2016/10//
N1  - Accession Number: 118881734. Language: English. Entry Date: 20161021. Revision Date: 20171002. Publication Type: Article; review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 100894201. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Substance Abuse -- Complications
KW  - Anemia, Sickle Cell -- Diagnosis
KW  - Anemia, Sickle Cell -- Therapy
KW  - Pain -- Therapy
KW  - Disease Outbreaks
KW  - Overdose -- Mortality
KW  - National Institutes of Health (U.S.)
KW  - Practice Guidelines
KW  - Substance Abusers
KW  - United States
KW  - Prescribing Patterns
SP  - 1793
EP  - 1798
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 17
IS  - 10
PB  - Oxford University Press / USA
AB  - The article focuses on patients with sickle cell disease (SCD) whose pain was treated with opioids. Topics discussed include SCD patients are often assumed to be associated with opioid abuse and addiction, recommendations were included to improve the care of patients in the emergency department (ED), the Centers for Disease Control and Prevention (CDC) Multiple Cause of Death database covers number of deaths and patients who responded to hydroxyurea consumed less opioids during crises.
SN  - 1526-2375
AD  - Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
DO  - 10.1093/pm/pnw074
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118881734&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105862718
T1  - Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.
AU  - Pletcher MJ
AU  - Kertesz SG
AU  - Kohn MA
AU  - Gonzales R
AU  - Pletcher, Mark J
AU  - Kertesz, Stefan G
AU  - Kohn, Michael A
AU  - Gonzales, Ralph
Y1  - 2008/01/02/
N1  - Accession Number: 105862718. Language: English. Entry Date: 20080314. Revision Date: 20161112. Publication Type: journal article; research. Commentary: Hwang V. Racial and ethnic disparities continue for pain care in U.S. emergency departments. (JCOM) 2008 Apr; 15 (4): 173-174. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: R03 HS016238/HS/AHRQ HHS/United States. NLM UID: 7501160. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Utilization -- Trends
KW  - Emergency Service -- Utilization
KW  - Pain -- Drug Therapy
KW  - Pain -- Ethnology
KW  - Practice Patterns -- Trends
KW  - Clinical Indicators
KW  - Drug Utilization -- Statistics and Numerical Data
KW  - Emergency Service -- Trends
KW  - Ethnic Groups -- Classification
KW  - Ethnic Groups -- Statistics and Numerical Data
KW  - Female
KW  - Male
KW  - Pain -- Etiology
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Surveys
KW  - United States
KW  - Human
SP  - 70
EP  - 78
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 299
IS  - 1
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - Context: National quality improvement initiatives implemented in the late 1990s were followed by substantial increases in opioid prescribing in the United States, but it is unknown whether opioid prescribing for treatment of pain in the emergency department has increased and whether differences in opioid prescribing by race/ethnicity have decreased.Objectives: To determine whether opioid prescribing in emergency departments has increased, whether non-Hispanic white patients are more likely to receive an opioid than other racial/ethnic groups, and whether differential prescribing by race/ethnicity has diminished since 2000.Design and Setting: Pain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes from 13 years (1993-2005) of the National Hospital Ambulatory Medical Care Survey.Main Outcome Measure: Prescription of an opioid analgesic.Results: Pain-related visits accounted for 156 729 of 374 891 (42%) emergency department visits. Opioid prescribing for pain-related visits increased from 23% (95% confidence interval [CI], 21%-24%) in 1993 to 37% (95% CI, 34%-39%) in 2005 (P < .001 for trend), and this trend was more pronounced in 2001-2005 (P = .02). Over all years, white patients with pain were more likely to receive an opioid (31%) than black (23%), Hispanic (24%), or Asian/other patients (28%) (P < .001 for trend), and differences did not diminish over time (P = .44), with opioid prescribing rates of 40% for white patients and 32% for all other patients in 2005. Differential prescribing by race/ethnicity was evident for all types of pain visits, was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children. Statistical adjustment for pain severity and other factors did not substantially attenuate these differences, with white patients remaining significantly more likely to receive an opioid prescription than black patients (adjusted odds ratio, 0.66; 95% CI, 0.62-0.70), Hispanic patients (0.67; 95% CI, 0.63-0.72), and Asian/other patients (0.79; 95% CI, 0.67-0.93).Conclusion: Opioid prescribing for patients making a pain-related visit to the emergency department increased after national quality improvement initiatives in the late 1990s, but differences in opioid prescribing by race/ethnicity have not diminished.
SN  - 0098-7484
AD  - Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94107, USA
AD  - Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94107, USA. mpletcher@epi.ucsf.edu
U2  - PMID: 18167408.
DO  - 10.1001/jama.2007.64
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105862718&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109771118
T1  - Wasted, overdosed, or beyond saving - To act or not to act? Heroin users' views, assessments, and responses to witnessed overdoses in Malmö, Sweden.
AU  - Richert, Torkel
Y1  - 2015/01//
N1  - Accession Number: 109771118. Language: English. Entry Date: 20150918. Revision Date: 20150923. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9014759. 
KW  - Attitude to Health
KW  - Overdose -- Therapy
KW  - Heroin -- Poisoning
KW  - Substance Use Disorders -- Complications
KW  - Adult
KW  - Overdose -- Epidemiology
KW  - Female
KW  - Human
KW  - Interviews
KW  - Male
KW  - Middle Age
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Peer Group
KW  - Police
KW  - Sweden
KW  - Young Adult
SP  - 92
EP  - 99
JO  - International Journal of Drug Policy
JF  - International Journal of Drug Policy
JA  - INT J DRUG POLICY
VL  - 26
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
AB  - BACKGROUND: Overdose is a significant cause of death among heroin users. Frequently, other heroin users are present when an overdose occurs, which means the victim's life could be saved. There is a lack of studies that, based on heroin users own stories, examine their views, assessments, and responses to witnessed overdoses. METHODS: The study is based on qualitative interviews with thirty-five heroin users who witnessed someone else's overdose. RESULTS: The heroin users generally had a positive attitude towards assisting peers who had overdosed. A number of factors and circumstances, however, contribute to witnesses often experiencing resistance to or ambivalence about responding. The witness's own high, the difficulty in assessing the seriousness of the situation, an unwillingness to disturb someone else's high, uncertainty about the motive behind the overdose and whether the victim does or does not want assistance as well as fear of police involvement, were common factors that acted as barriers to adequate responses in overdose situations. CONCLUSION: The fact that being high makes it difficult to respond to overdoses, using traditional methods, argues for simpler and more effective response techniques. This can include intranasal naloxone programs for heroin users. The findings regarding the uncertainty about the intention of the overdose victim and the sensitivity to the experience of a good high argue for more up-front communication and discussion amongst using peers so that they can make their intentions clear to each other. Issues like this can be addressed in overdose education interventions. Overdose prevention measures also need to address the fact that fear of the police acts as a barrier to call emergency services.
SN  - 0955-3959
U2  - PMID: 25130869.
DO  - 10.1016/j.drugpo.2014.07.006
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109771118&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113998033
T1  - Guidelines encourage appropriate opioid use.
Y1  - 2016/04//
N1  - Accession Number: 113998033. Language: English. Entry Date: 20160328. Revision Date: 20160402. Publication Type: Article; brief item. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management. NLM UID: 7600137. 
KW  - Pain -- Drug Therapy
KW  - Narcotics -- Therapeutic Use
KW  - Prescribing Patterns
KW  - Practice Guidelines
SP  - 26
EP  - 26
JO  - Nursing
JF  - Nursing
JA  - NURSING
VL  - 46
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - The article reports on a 2016 study by D.A. Del Portal et al that reveals the effectiveness of a voluntary opioid prescribing guideline for avoiding inappropriate opioid prescriptions for minor disorders and chronic non-cancer pain in decreasing the rate of opioid prescriptions issued by emergency department physicians.
SN  - 0360-4039
DO  - 10.1097/01.NURSE.0000481433.71683.c7
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113998033&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104927987
T1  - Methadone maintenance and the cost and utilization of health care among individuals dependent on opioids in a commercial health plan.
AU  - McCarty D
AU  - Perrin NA
AU  - Green CA
AU  - Polen MR
AU  - Leo MC
AU  - Lynch F
AU  - McCarty, Dennis
AU  - Perrin, Nancy A
AU  - Green, Carla A
AU  - Polen, Michael R
AU  - Leo, Michael C
AU  - Lynch, Frances
Y1  - 2010/10//
N1  - Accession Number: 104927987. Language: English. Entry Date: 20110826. Revision Date: 20161116. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Psychiatry/Psychology. Grant Information: R01 DA016341/DA/NIDA NIH HHS/United States. NLM UID: 7513587. 
KW  - Drug Rehabilitation Programs -- Economics
KW  - Health Care Costs
KW  - Insurance, Health -- Economics
KW  - Methadone -- Administration and Dosage
KW  - Substance Use Disorders -- Economics
KW  - Adult
KW  - Electronic Health Records -- Economics
KW  - Female
KW  - Health Care Delivery -- Utilization
KW  - Insurance, Health -- Utilization
KW  - Male
KW  - Middle Age
KW  - Substance Use Disorders -- Drug Therapy
SP  - 235
EP  - 240
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 111
IS  - 3
PB  - Elsevier B.V.
AB  - Background: Few health plans provide maintenance medication for opioid dependence. This study assessed the cost of treating opioid-dependent members in a commercial health plan and the impacts of methadone maintenance on costs of care.Methods: Individuals with diagnoses of opioid dependence (two or more diagnoses per year) and at least 9 months of health plan eligibility each year were extracted from electronic health records for the years 2000 through 2004 (1,518 individuals and 2,523 observations across the study period-some individuals were in multiple years). Analyses examined the patterns and costs of health care for three groups of patients: (1) one or more methadone visits during the year (n=1,298; 51%); (2) no methadone visits and 0 or 1 visits in the Addiction Medicine Department (n=370; 15%); (3) no methadone visits and 2 or more visits in addiction medicine (n=855; 34%).Results: Primary care (86%), emergency department (48%) and inpatient (24%) visits were common. Mean total annual costs to the health plan were $11,200 (2004 dollars) per member per year. The health plan's costs for members receiving methadone maintenance were 50% lower ($7,163) when compared to those with two or more outpatient addiction treatment visits but no methadone ($14,157) and 62% lower than those with one or zero outpatient addiction treatment visits and no methadone treatment ($18,694).Conclusions: Use of opioid maintenance services was associated with lower total costs of care for opioid-dependent members in a commercial health plan.
SN  - 0376-8716
AD  - Oregon Health & Science University, Portland, OR 97239, USA
AD  - Oregon Health & Science University, Portland, OR 97239, United States.
U2  - PMID: 20627427.
DO  - 10.1016/j.drugalcdep.2010.04.018
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107832056
T1  - A new naloxone auto-injection device to treat opioid overdose.
AU  - Simonson, William
Y1  - 2014/09//Sep/Oct2014
N1  - Accession Number: 107832056. Language: English. Entry Date: 20141015. Revision Date: 20150818. Publication Type: Journal Article. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Special Interest: Emergency Care; Gerontologic Care; Psychiatry/Psychology. NLM UID: 8309633. 
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Prehospital Care
KW  - Injections, Intramuscular
KW  - Injections, Subcutaneous
KW  - Injections, Jet
SP  - 381
EP  - 382
JO  - Geriatric Nursing
JF  - Geriatric Nursing
JA  - GERIATR NURS
VL  - 35
IS  - 5
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0197-4572
AD  - Senior Research Professor (Pharmacy Practice), Oregon State University, Corvallis, OR, USA
U2  - PMID: 25277064.
DO  - 10.1016/j.gerinurse.2014.08.002
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107832056&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107134716
T1  - CE update -- drugs of abuse I. Emergency diagnosis of opioid intoxication.
AU  - Williams RH
AU  - Erickson T
Y1  - 2000/06//2000 Jun
N1  - Accession Number: 107134716. Language: English. Entry Date: 20001001. Revision Date: 20150819. Publication Type: Journal Article; CEU; diagnostic images; tables/charts. Journal Subset: Allied Health; Peer Reviewed; USA. NLM UID: 0250641. 
KW  - Overdose -- Diagnosis
KW  - Narcotics -- Adverse Effects
KW  - Emergency Care
KW  - Narcotics -- Metabolism
KW  - Diagnosis, Laboratory
KW  - Adult
KW  - Male
KW  - Education, Continuing (Credit)
SP  - 334
EP  - 342
JO  - Laboratory Medicine
JF  - Laboratory Medicine
JA  - LAB MED
VL  - 31
IS  - 6
PB  - Oxford University Press / USA
AB  - Opioids are widely used for analgesic purposes. If taken as prescribed, they are safe and effective. Overdosing, however, can cause coma and life-threatening respiratory depression. In the acute care setting, physicians often base treatment on the presence of classic 'opioid syndrome' characteristics-mental status depression, hypoventilation, miosis (pinpoint pupils), and reduced bowel motility. Rather than identify and quantify the specific agent, laboratories should confirm opioid intoxication qualitatively with a urine drug screen. With this information, physicians may expedite treatment with opioid antagonists (naloxone), which help patients to resume spontaneous respiration. Because the drug level does not always correlate with the severity of illness, quantitative drug levels are rarely needed. Hypoglycemia, hypoxia, and hypothermia are also seen with opioid overdose.
SN  - 0007-5027
AD  - University of Illinois at Chicago Medical Center, Dept of Pathology, Division of Clinical Pathology (M/C 750), 840 S Wood St, 201G CSB, Chicago, IL 60612; e-mail: rwilliam@uic.edu
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107134716&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 126914048
T1  - Underlying Factors in Drug Overdose Deaths.
AU  - Dowell, Deborah
AU  - Noonan, Rita K.
AU  - Houry, Debra
Y1  - 2017/12/19/
N1  - Accession Number: 126914048. Language: English. Entry Date: 20171231. Revision Date: 20180118. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Street Drugs -- Poisoning
KW  - Overdose -- Mortality
KW  - Fentanyl -- Poisoning
KW  - Analgesics, Opioid -- Poisoning
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Substance Use Disorders -- Mortality
KW  - United States
KW  - Overdose -- Drug Therapy
KW  - Substance Use Disorders -- Epidemiology
KW  - Naloxone -- Therapeutic Use
KW  - Mortality -- Trends
SP  - 2295
EP  - 2296
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 318
IS  - 23
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - The article discusses the authors' views about various factors which contribute to drug overdose deaths in the U.S., and it mentions the risks that are associated with the use of illicit drugs such as fentanyl, heroin, and synthetic nonmethadone opioids. The effectiveness of interventions to prevent drug overdoses is examined, along with the need to identify and engage the patients who are in need of opioid use disorder treatment. Hospital emergency department protocols are assessed.
SN  - 0098-7484
AD  - National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia.
U2  - PMID: 29049472.
DO  - 10.1001/jama.2017.15971
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126914048&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104364102
T1  - Dosing and titration of intravenous opioid analgesics administered to ED patients in acute severe pain.
AU  - Bijur, Polly E.
AU  - Esses, David
AU  - Chang, Andrew K.
AU  - Gallagher, E. John
Y1  - 2012/09//
N1  - Accession Number: 104364102. Language: English. Entry Date: 20131018. Revision Date: 20170802. Publication Type: Journal Article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service
KW  - Adult
KW  - Female
KW  - Injections, Intravenous
KW  - Male
KW  - Middle Age
KW  - Morphine -- Administration and Dosage
KW  - Pain Measurement
KW  - Young Adult
SP  - 1241
EP  - 1244
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 30
IS  - 7
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Abstract: Objectives: The objectives were to describe the dose of opioids and incidence of titration for management of acute pain in emergency department patients and, secondarily, to assess the association between change in pain and dose. Methods: Data from control groups of 2 randomized clinical trials were analyzed. Patients 21 to 64 years with acute pain judged to warrant intravenous (IV) opioids were eligible. We calculated the mean weight-based dose of IV opioids, distribution of dose, proportion of patients receiving additional IV opioids, and 95% confidence intervals. We compared these statistics to 3 recommendations: 0.1 mg/kg morphine, 10 mg morphine, and titration to analgesic effect. We used multiple linear regression to assess the association between change in pain measured on a numerical rating scale and dose. Results: There were 281 patients with an initial median pain score of 10 (interquartile range: 8, 10). Mean weight-based dose of IV opioids was 0.08 mg/kg (0.07, 0.08 mg/kg). A total of 268 patients (95.4% [92.2%, 97.5%]) received less than 10 mg IV morphine equivalents; 7 patients (2.5% [1.0%, 5.0%]) received additional opioids. There was a weak association between change in pain in the 15, 30, and 60 minutes after the initial bolus and dose: b = 0.22 (0.07, 0.37), b = 0.17 (0.02, 0.32), and b = 0.12 (−0.03, 0.28), respectively, after adjustment for baseline pain. Conclusion: Analgesic practice did not conform to recommended doses or regimens. There was only a weak association between change of pain and dose in the range of doses given. These findings suggest that oligoanalgesia continues to be a problem despite improvements over the past 20 years.
SN  - 0735-6757
U2  - PMID: 21908134.
DO  - 10.1016/j.ajem.2011.06.015
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106977851
T1  - Intravenous or intramuscular/subcutaneous naloxone in opioid overdose.
AU  - Clarke S
A2  - Dargan P
Y1  - 2002/05//
N1  - Accession Number: 106977851. Language: English. Entry Date: 20021115. Revision Date: 20150820. Publication Type: Journal Article; brief item; case study; tables/charts. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 100963089. 
KW  - Antidotes -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Male
KW  - Adult
KW  - Medical Practice, Evidence-Based
KW  - Heroin
KW  - Substance Dependence -- Therapy
KW  - Injections, Intramuscular
KW  - Injections, Subcutaneous
KW  - Injections, Intravenous
KW  - Emergency Care
KW  - Literature Review
KW  - Computerized Literature Searching
KW  - Journal Clubs -- England
KW  - England
SP  - 249
EP  - 249
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
PB  - BMJ Publishing Group
AB  - A short cut review was carried out to establish whether intravenous boluses of naloxone are better than intravenous infusion in opioid overdose. Altogether 188 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper is tabulated. A clinical bottom line is stated.
SN  - 1472-0205
AD  - Specialist Registrar, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
U2  - PMID: 11971843.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106977851&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109548579
T1  - 2 Ketamine as an Adjunct to Opiates for Acute Pain in the Emergency Department.
AU  - Bowers, K.J.
AU  - McAllister, K.B.
AU  - Ray, M.
AU  - Heitz, C.R.
Y1  - 2015/10/02/Oct2015 Supplement
N1  - Accession Number: 109548579. Language: English. Entry Date: In Process. Revision Date: 20150922. Publication Type: Article. Supplement Title: Oct2015 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S1
EP  - S2
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 66
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Virginia Tech Carilion School of Medicine, Roanoke, VA
AD  - Carilion Clinic, Roanoke, VA
AD  - University of Memphis, Memphis, TN
DO  - 10.1016/j.annemergmed.2015.07.031
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 113952028
T1  - (450) Emergency department visits related to opioid adverse events in patients receiving long-term low-or moderate-dose opioid therapy.
AU  - Lee, Y.
AU  - Liang, L.
AU  - Chen, T.
Y1  - 2016/04/02/Apr2016 Supplement
N1  - Accession Number: 113952028. Language: English. Entry Date: In Process. Revision Date: 20170208. Publication Type: journal article. Supplement Title: Apr2016 Supplement. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100898657. 
SP  - S87
EP  - S87
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 17
PB  - Churchill Livingstone, Inc.
SN  - 1526-5900
AD  - Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
U2  - PMID: 28162698.
DO  - 10.1016/j.jpain.2016.01.427
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113952028&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106622236
T1  - Factors affecting emergency department opioid administration to severely injured patients.
AU  - Neighbor ML
AU  - Honner S
AU  - Kohn MA
Y1  - 2004/12//
N1  - Accession Number: 106622236. Language: English. Entry Date: 20050429. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Commentary: McClelland HM. Research review. [Commentary on] Neighbor ML, Honner S, Kohn MA, 2004. Factors affecting emergency department opioid administration to severely injured patients. Academic Emergency Medicine 11(12), 1290-1296. (ACCID EMERG NURS) Apr2005; 13 (2): 138-138. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Revised Trauma Score (RTS); Glasgow Coma Scale (GCS); Injury Severity Score (ISS). NLM UID: 9418450. 
KW  - Analgesia
KW  - Emergency Care
KW  - Narcotics -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Trauma
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Asians
KW  - Blacks
KW  - California
KW  - Child
KW  - Confidence Intervals
KW  - Cox Proportional Hazards Model
KW  - Data Analysis Software
KW  - Descriptive Research
KW  - Descriptive Statistics
KW  - Emergency Patients
KW  - Female
KW  - Glasgow Coma Scale
KW  - Hispanics
KW  - Inpatients
KW  - Kaplan-Meier Estimator
KW  - Male
KW  - Middle Age
KW  - Multiple Logistic Regression
KW  - Odds Ratio
KW  - P-Value
KW  - Patient Admission
KW  - Prospective Studies
KW  - Record Review
KW  - Retrospective Design
KW  - Survival Analysis
KW  - T-Tests
KW  - Trauma Centers
KW  - Trauma Severity Indices
KW  - Treatment Outcomes
KW  - Univariate Statistics
KW  - Whites
KW  - Wilcoxon Rank Sum Test
KW  - Wounds and Injuries -- Etiology
KW  - Human
SP  - 1290
EP  - 1296
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 11
IS  - 12
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - OBJECTIVES: Studies of emergency department (ED) pain management in patients with trauma have been mostly restricted to patients with fractures, yet the potential for undertreatment of more severely injured patients is great. The authors sought to identify factors associated with failure to receive ED opioid administration in patients with acute trauma who subsequently required hospitalization. METHODS: At an urban Level 1 trauma center and teaching hospital, a retrospective cohort study of trauma team activation patients requiring hospitalization between January 1 and December 31, 1999, was conducted. The authors excluded patients receiving opioids only within ten minutes of chest tube insertion or fracture manipulation. The main outcome measure was ED opioid administration. RESULTS: A total of 540 charts of hospitalized first-tier trauma team activation patients were reviewed. A total of 258 (47.8%) received intravenous opioid analgesia within three hours of ED arrival. The median time to receiving the first dose of opioids was 95 minutes. Patients were independently less likely to receive opioids if they were younger or older, were intubated, had a lower Revised Trauma Score, or did not require fracture manipulation. Patients with these factors were less likely to receive opioids independent of the amount of time they spent in the ED. CONCLUSIONS: Many trauma activation patients requiring hospitalization do not receive opioid analgesia in the ED. Patients at particular risk for oligoanalgesia include those who are younger or older and those who are more seriously injured, as defined by a lower Revised Trauma Score, lower Glasgow Coma Scale score, and intubation.
SN  - 1069-6563
AD  - Department of Medicine, University of California, San Francisco, San Francisco, CA; neighbo@itsa.ucsf.edu
U2  - PMID: 15576519.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106622236&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106794975
T1  - Trends in opiate and opioid poisonings in addicts in north-east Paris and suburbs, 1995-99.
AU  - Gueye PN
AU  - Megarbane B
AU  - Borron SW
AU  - Adnet F
AU  - Galliot-Guilley M
AU  - Ricordel I
AU  - Tourneau J
AU  - Goldgran-Toledano D
AU  - Baud FJ
Y1  - 2002/10//
N1  - Accession Number: 106794975. Language: English. Entry Date: 20030110. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Narcotics -- Poisoning
KW  - Overdose -- Trends -- France
KW  - Poisoning -- Trends -- France
KW  - France
KW  - Prospective Studies
KW  - Poisoning -- Mortality
KW  - Poisoning -- Epidemiology
KW  - Overdose -- Mortality
KW  - Overdose -- Epidemiology
KW  - Retrospective Design
KW  - Buprenorphine -- Poisoning
KW  - Mortality
KW  - Heroin -- Poisoning
KW  - Propoxyphene -- Poisoning
KW  - Cocaine -- Poisoning
KW  - Methadone -- Poisoning
KW  - Record Review
KW  - Toxicology
KW  - Substance Abuse Detection
KW  - Chi Square Test
KW  - Chromatography
KW  - Inpatients
KW  - Female
KW  - Male
KW  - Adult
KW  - Glasgow Coma Scale
KW  - Poisoning -- Classification
KW  - Human
SP  - 1295
EP  - 1304
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 97
IS  - 10
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - AIMS: (1). To assess the trends in the number, mortality and the nature of severe opiate/opioid poisonings from 1995 to 1999 in north-east Paris and adjacent suburbs and (2). to examine the effects of the introduction of high-dose buprenorphine on these parameters. DESIGN: Retrospective, 5-year study with review of pre-hospital, hospital and post-mortem data. SETTING AND PARTICIPANTS: Eighty patients from the toxicological intensive care unit (TICU) in north-east Paris, 421 patients from the pre-hospital emergency medical service in a north-east suburb of Paris (SAMU 93) and 40 deaths from the coroner's office in Paris. MEASUREMENTS AND RESULTS: We found that the number of pre-hospital opiate/opioid poisonings and deaths decreased over 5 years. During the same time frame, opiate/opioid poisoning admissions to our TICU remained steady, but the number of deaths declined. From 1995 to 1999, the detection of buprenorphine among opiate/opioid-poisoned TICU patients increased from two to eight occurrences per year while detection of opiates diminished from 17 to 10 occurrences per year. Increased buprenorphine detection correlated directly with increasing sales over this time period. In spite of the increased use of buprenorphine, the mortality associated with opiate/opioid poisonings has diminished in the pre-hospital environment from 9% in 1995 to 0% in 1999, and in the TICU from 12% in 1995 to 0% in 1997 and thereafter. We found a high frequency of multiple opiate/opioid use in severe poisonings, as well as the frequent association of other psychoactive drugs including ethanol. CONCLUSIONS: The number and the mortality of opiate/opioid poisonings appear to be stable or decreasing in our region. The association of multiple opiates/ opioids appears nearly as common as the association with other psychoactive drugs. The introduction of high-dose buprenorphine coincides with a decrease in opiate/opioid poisoning mortality. Further study will be necessary to clarify this observation.
SN  - 0965-2140
U2  - PMID: 12359034.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107831925
T1  - Naloxone's Basic Benefit.
AU  - Furlano, Emma
Y1  - 2014/10//
N1  - Accession Number: 107831925. Language: English. Entry Date: 20141015. Revision Date: 20150819. Publication Type: Journal Article; pictorial; questions and answers; review. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101466002. 
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Prehospital Care
KW  - Substance Dependence -- Complications
KW  - Emergency Medical Services
KW  - Community Programs
KW  - Emergency Medical Technicians
KW  - Police
KW  - Firefighters
KW  - Narcotics -- Pharmacodynamics
KW  - Narcotics -- Adverse Effects
KW  - Naloxone -- Pharmacodynamics
KW  - Naloxone -- Pharmacokinetics
KW  - Health Education
KW  - Program Development
KW  - New York
KW  - New Mexico
KW  - Massachusetts
KW  - Patient Safety
SP  - 28
EP  - 34
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 43
IS  - 10
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
SN  - 1946-9365
AD  - Stony Brook University School of Medicine
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109548833
T1  - 336 Opioid Prescribing in the Emergency Department.
AU  - Moretti, K.
AU  - Suffoletto, B.
AU  - Callaway, C.
Y1  - 2015/10/02/Oct2015 Supplement
N1  - Accession Number: 109548833. Language: English. Entry Date: In Process. Revision Date: 20150922. Publication Type: Article. Supplement Title: Oct2015 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S121
EP  - S121
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 66
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of Pittsburgh, Pittsburgh, PA
DO  - 10.1016/j.annemergmed.2015.07.372
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109548777
T1  - 405 Do Emergency Department Patients Seeking Treatment for Opioid Addiction Get Treatment?
AU  - Tadros, A.
AU  - Tillotson, R.
AU  - Layman, S.M.
AU  - Burrell, C.
Y1  - 2015/10/02/Oct2015 Supplement
N1  - Accession Number: 109548777. Language: English. Entry Date: In Process. Revision Date: 20150922. Publication Type: Article. Supplement Title: Oct2015 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S146
EP  - S146
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 66
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - West Virginia University, Morgantown, WV
DO  - 10.1016/j.annemergmed.2015.07.442
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109548598
T1  - 334 EMF Feasibility of Using a Novel Text Messaging Program to Improve Linkage to Outpatient Services for Emergency Department Patients Seeking Treatment for Opioid Abuse.
AU  - Yanta, J.H.
AU  - Kristan, J.T.
AU  - Douiahy, A.B.
AU  - Suffoletto, B.P.
Y1  - 2015/10/02/Oct2015 Supplement
N1  - Accession Number: 109548598. Language: English. Entry Date: In Process. Revision Date: 20150922. Publication Type: Article. Supplement Title: Oct2015 Supplement. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
SP  - S121
EP  - S121
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 66
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of Pittsburgh, Pittsburgh, PA
DO  - 10.1016/j.annemergmed.2015.07.370
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107772165
T1  - Site Offers Free Online Naloxone Training.
Y1  - 2015/02//
N1  - Accession Number: 107772165. Language: English. Entry Date: 20150217. Revision Date: 20150712. Publication Type: Journal Article; brief item; pictorial. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101466002. 
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Prehospital Care
KW  - First Aid
KW  - World Wide Web
KW  - Health Information
SP  - 14
EP  - 14
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 44
IS  - 2
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
SN  - 1946-9365
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107772165&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106121961
T1  - Emergency naloxone for heroin overdose: naloxone is not the only opioid antagonist...Strang J, Kelleher M, Best D, Mayet S, Manning V. Emergency naloxone for heroin overdose. BMJ 2006;333:614-5. (23 September.)
AU  - Brewer C
Y1  - 2006/10/07/
N1  - Accession Number: 106121961. Language: English. Entry Date: 20070720. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; pictorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101090866. 
KW  - Drugs, Non-Prescription -- Therapeutic Use
KW  - Heroin -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Overdose -- Drug Therapy
SP  - 754
EP  - 755
JO  - BMJ: British Medical Journal (International Edition)
JF  - BMJ: British Medical Journal (International Edition)
JA  - BMJ
VL  - 333
IS  - 7571
PB  - BMJ Publishing Group
SN  - 0959-8146
U2  - PMID: 17023477.
DO  - 10.1136/bmj.333.7571.754-b
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106526099
T1  - Low-dose naloxone does not improve morphine-induced nausea, vomiting, or pruritus.
AU  - Greenwald PW
AU  - Provataris J
AU  - Coffey J
AU  - Bijur P
AU  - Gallagher EJ
Y1  - 2005/01//2005 Jan
N1  - Accession Number: 106526099. Language: English. Entry Date: 20051014. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Naloxone -- Administration and Dosage
KW  - Nausea -- Drug Therapy
KW  - Vomiting -- Drug Therapy
KW  - Pruritus -- Drug Therapy
KW  - Morphine -- Adverse Effects
KW  - Pain -- Drug Therapy
KW  - Visual Analog Scaling
KW  - Scales
KW  - Pain Measurement
KW  - Infusions, Intravenous
KW  - Morphine -- Administration and Dosage
KW  - Nausea -- Chemically Induced
KW  - Vomiting -- Chemically Induced
KW  - Pruritus -- Chemically Induced
KW  - Treatment Outcomes
KW  - Clinical Trials
KW  - Double-Blind Studies
KW  - Data Analysis Software
KW  - Confidence Intervals
KW  - Placebos
KW  - Adult
KW  - Middle Age
KW  - Female
KW  - Male
KW  - Human
SP  - 35
EP  - 39
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 23
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - OBJECTIVE: We tested the hypothesis that low-dose naloxone delivered with intravenous (IV) bolus morphine to emergency department patients in pain would reduce nausea. METHODS: Randomized, 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. RESULTS: One 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. CONCLUSION: Addition 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.
SN  - 0735-6757
AD  - New York-Presbyterian Emergency Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032; pg2014@columbia.edu
U2  - PMID: 15672335.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106311684
T1  - Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department.
AU  - Heins JK
AU  - Heins A
AU  - Grammas M
AU  - Costello M
AU  - Huang K
AU  - Mishra S
Y1  - 2006/06//
N1  - Accession Number: 106311684. Language: English. Entry Date: 20060804. Revision Date: 20150818. Publication Type: Journal Article; CEU; exam questions; research; tables/charts. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. NLM UID: 7605913. 
KW  - Analgesics -- Administration and Dosage
KW  - Emergency Care
KW  - Narcotics -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Physicians, Emergency
KW  - Prescribing Patterns
KW  - Prescriptions, Drug
KW  - Academic Medical Centers
KW  - Adolescence
KW  - Adult
KW  - Age Factors
KW  - Aged
KW  - Data Analysis Software
KW  - Descriptive Research
KW  - Education, Continuing (Credit)
KW  - Emergency Service
KW  - Female
KW  - Interrater Reliability
KW  - Interviews
KW  - Kappa Statistic
KW  - Logistic Regression
KW  - Male
KW  - Medical Practice
KW  - Middle Age
KW  - Pain Measurement
KW  - Race Factors
KW  - Record Review
KW  - Socioeconomic Factors
KW  - Urban Areas
KW  - Human
SP  - 219
EP  - 291
JO  - JEN: Journal of Emergency Nursing
JF  - JEN: Journal of Emergency Nursing
JA  - J EMERG NURS
VL  - 32
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - INTRODUCTION: Healthy People 2010 seeks to eliminate racial and ethnic disparities in health care; however, disparities due to age and race have been described in emergency department pain treatment. Although pain is a common patient complaint in emergency departments, many people receive no analgesia. This study examined the influence of patient and provider characteristics on ED and discharge analgesia and opioid prescribing practices. METHODS: This descriptive study used chart review of selected variables from ED patients 18 years and older who presented with musculoskeletal pain and were treated by core ED faculty. Logistic regression analyses were performed to determine whether analgesia- and opioid-prescribing disparities existed and were influenced by patient and provider characteristics. RESULTS: A total of 868 patient records were examined. Physician characteristics and wide variation in practice were the only sources of disparities in the prescription of analgesics in the emergency department, but patient characteristics including race, age, chronic pain, and trauma influenced prescription of ED opioids and discharge analgesics. No gender or financial status disparities were found. Fewer opioids and discharge analgesics were prescribed for black patients than for white patients. Younger patients, those with trauma, and those with chronic pain received more opioids and discharge analgesics compared with older patients and those without trauma or chronic pain. Providers who completed emergency medicine residencies and had fewer than 3 years' experience prescribed more analgesics in the emergency department. DISCUSSION: Pain management in our emergency department is widely variable, with some disparities based on patient and physician characteristics. Multicenter prospective studies are needed to validate these findings and examine knowledge and attitude development about pain and its management. Protocols for nurse-initiated analgesia may help improve and standardize ED pain care.
SN  - 0099-1767
U2  - PMID: 16730276.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107799306
T1  - The effect of preoperative counseling on duration of postoperative opiate use in orthopaedic trauma surgery: a surgeon-based comparative cohort study.
AU  - Holman, Joel E
AU  - Stoddard, Gregory J
AU  - Horwitz, Daniel S
AU  - Higgins, Thomas F
Y1  - 2014/09//2014 Sep
N1  - Accession Number: 107799306. Language: English. Entry Date: 20150206. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Physical Therapy. NLM UID: 8807705. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Counseling
KW  - Musculoskeletal System -- Surgery
KW  - Postoperative Pain -- Drug Therapy
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Aged, 80 and Over
KW  - Child
KW  - Female
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Musculoskeletal System -- Injuries
KW  - Practice Patterns
KW  - Preoperative Care
KW  - Retrospective Design
KW  - Time Factors
KW  - Trauma Centers
KW  - Young Adult
SP  - 502
EP  - 506
JO  - Journal of Orthopaedic Trauma
JF  - Journal of Orthopaedic Trauma
JA  - J ORTHOP TRAUMA
VL  - 28
IS  - 9
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - OBJECTIVE: The prudent use of prescription opiates is a central aspect of current postsurgical pain management, but surgeons have no guidelines on appropriate duration of opiate treatment. Furthermore, there are no established data on the effect of physician counseling on the duration of opiate use postoperatively. DESIGN: Retrospective surgeon-controlled cohort study. SETTING: Level I regional academic trauma center. PATIENTS: All Utah residents admitted to the orthopaedic trauma service with isolated operative musculoskeletal injury. INTERVENTION: One group of patients was instructed at the time of index procedure that they would receive prescription opiates for a maximum of 6 weeks. The remaining patients were not counseled preoperatively on duration of opiate use postoperatively. MAIN OUTCOME MEASURES: The presence and frequency of prescription opiate use before injury, cessation of opiate use by 6 weeks postoperatively, cessation of opiates by 12 weeks postoperatively, and continuation of prescription opiates greater than 12 weeks postoperatively. RESULTS: Six hundred thirteen patients met inclusion criteria. Those counseled preoperatively to cease opiate use by 6 weeks were significantly more likely to do so than those who did not receive counseling (73% and 64%, respectively; P = 0.012). By 12 weeks, this effect was no longer seen, and patients were just as likely to have stopped (80% and 80%, respectively; P = 0.90). CONCLUSIONS: The orthopaedic trauma population is significantly more likely than the general population to be using prescription opiates before injury. Physician discussion of 6-week opiate prescription limitation at the time of injury seems to lead to a lower rate of use at the 6-week postoperative mark but has no effect on rates of longer-term use. Twenty percent of patients in either group will continue to use opiates after 12 weeks, compared with 15% before injury. Given the scope of prescription opiate use in the United States, surgeons may want to consider preoperative discussion of this issue, but it may not have any effect on usage rates at longer intervals. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
SN  - 0890-5339
AD  - *Department of Orthopaedics, University of Utah, Salt Lake City, UT; and tGeisinger Medical Center, Danville, PA.
U2  - PMID: 24667804.
DO  - 10.1097/BOT.0000000000000085
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107868172
T1  - Armed with NALOXONE.
AU  - Goodloe, Jeffrey M.
AU  - Dailey, Michael W.
AU  - Heightman, A. J.
Y1  - 2014/08//
N1  - Accession Number: 107868172. Language: English. Entry Date: 20140805. Revision Date: 20150820. Publication Type: Journal Article; algorithm; pictorial; protocol; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Substance Abuse -- Complications
KW  - Narcotics -- Poisoning
KW  - Overdose -- Diagnosis
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Prehospital Care
KW  - Emergency Medical Services
KW  - Substance Abusers
KW  - Emergency Patients
KW  - Substance Abuse -- Epidemiology -- United States
KW  - United States
KW  - Prescriptions, Drug -- Utilization
KW  - Drug Monitoring
KW  - Police
KW  - Overdose -- Symptoms
KW  - Heart Arrest -- Therapy
KW  - Resuscitation, Cardiopulmonary
KW  - Substance Withdrawal Syndrome
KW  - Respiratory Failure -- Drug Therapy
KW  - Algorithms
KW  - Patient Assessment
KW  - Physical Examination
KW  - Protocols
KW  - Administration, Intranasal
KW  - Drug Storage
KW  - First Aid
KW  - Outpatients
KW  - Decision Making, Clinical
SP  - 28
EP  - 33
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 39
IS  - 8
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Medical Director, EMS System, Metropolitan Oklahoma City and Tulsa.; Professor, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa.; EMS Section Chief, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa.
AD  - Regional EMS Medical Director, Hudson Mohawk Region of New York.; Associate Professor, Emergency Medicine, Albany Medical College.; Director, Prehospital Care and Education, Albany Medical College.; Medical Director, Town of Colonie, Albany, Schenectady and Watervliet.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109783121
T1  - Choosing Analgesics Wisely: What We Know (and Still Need to Know) About Long-Term Consequences of Opioids.
AU  - Perrone, Jeanmarie
AU  - Nelson, Lewis S
AU  - Yealy, Donald M
Y1  - 2015/05//
N1  - Accession Number: 109783121. Language: English. Entry Date: 20150703. Revision Date: 20150923. Publication Type: Journal Article; editorial. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service
KW  - Substance Use Disorders -- Etiology
KW  - Pain -- Drug Therapy
KW  - Drugs, Prescription -- Therapeutic Use
KW  - Female
KW  - Male
SP  - 500
EP  - 502
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 65
IS  - 5
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
U2  - PMID: 25749404.
DO  - 10.1016/j.annemergmed.2015.01.021
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104657223
T1  - Emergency Rule Making on Opioid Treatment Services.
Y1  - 2011/06//
N1  - Accession Number: 104657223. Language: English. Entry Date: 20110815. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; USA. Special Interest: Consumer Health; Public Health. 
KW  - Substance Abuse -- Therapy
KW  - Narcotics
KW  - Health Services Accessibility
KW  - Legislation
KW  - Rules and Regulations
KW  - Costs and Cost Analysis
SP  - 12
EP  - 12
JO  - New York Family Medicine News
JF  - New York Family Medicine News
JA  - NY FAM MED NEWS
CY  - Albany, New York
PB  - New York State Academy of Family Physicians
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112313199
T1  - Emergency Opioid Overdose-Counteracting Medication Approved.
Y1  - 2016/01//
N1  - Accession Number: 112313199. Language: English. Entry Date: 20180117. Revision Date: 20180118. Publication Type: Article; brief item. Journal Subset: Biomedical; USA. NLM UID: 8917834. 
KW  - Emergencies
KW  - Overdose
SP  - 5
EP  - 5
JO  - Medical Malpractice Law & Strategy
JF  - Medical Malpractice Law & Strategy
JA  - MED MALPRACT LAW STRATEGY
VL  - 33
IS  - 3
CY  - NY, New York
PB  - Law Journal Newsletters
SN  - 0747-8925
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105418950
T1  - Oral versus intravenous opioid dosing for the initial treatment of acute musculoskeletal pain in the emergency department.
AU  - Miner JR
AU  - Moore J
AU  - Gray RO
AU  - Skinner L
AU  - Biros MH
Y1  - 2008/12//
N1  - Accession Number: 105418950. Language: English. Entry Date: 20091016. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management. Grant Information: Funded in part by the Emergency Medicine Foundation. NLM UID: 9418450. 
KW  - Administration, Intravenous
KW  - Administration, Oral
KW  - Emergency Care
KW  - Morphine -- Administration and Dosage
KW  - Oxycodone -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Aged, 80 and Over
KW  - Chi Square Test
KW  - Child
KW  - Clinical Trials
KW  - Comparative Studies
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Dose-Response Relationship, Drug
KW  - Emergency Patients
KW  - Emergency Service
KW  - Female
KW  - Fisher's Exact Test
KW  - Funding Source
KW  - Hospitals, Urban
KW  - Male
KW  - Middle Age
KW  - Minnesota
KW  - Outpatients
KW  - P-Value
KW  - Pain Measurement
KW  - Patient Satisfaction
KW  - Prospective Studies
KW  - Scales
KW  - Summated Rating Scaling
KW  - Visual Analog Scaling
KW  - Wilcoxon Signed Rank Test
KW  - Human
SP  - 1234
EP  - 1240
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 15
IS  - 12
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
U2  - PMID: 18945240.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105418950&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105639359
T1  - Psychological comorbidities predicting prescription opioid abuse among patients in chronic pain presenting to the emergency department.
AU  - Wilsey BL
AU  - Fishman SM
AU  - Tsodikov A
AU  - Ogden C
AU  - Symreng I
AU  - Ernst A
Y1  - 2008/11//
N1  - Accession Number: 105639359. Language: English. Entry Date: 20090227. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 100894201. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Utilization
KW  - Mental Disorders -- Physiopathology
KW  - Mental Disorders -- Psychosocial Factors
KW  - Pain -- Drug Therapy
KW  - Pain -- Psychosocial Factors
KW  - Substance Use Disorders -- Psychosocial Factors
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Comorbidity
KW  - Male
KW  - Middle Age
KW  - Psychological Tests
KW  - Regression
KW  - Substance Use Disorders -- Physiopathology
KW  - Human
SP  - 1107
EP  - 1117
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 9
IS  - 8
PB  - Oxford University Press / USA
SN  - 1526-2375
U2  - PMID: 18266809.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105639359&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105679324
T1  - Assessment of the delta opioid agonist DADLE in a rat model of lethal hemorrhage treated by emergency preservation and resuscitation.
AU  - Drabek T
AU  - Han F
AU  - Garman RH
AU  - Stezoski J
AU  - Tisherman SA
AU  - Stezoski SW
AU  - Morhard RC
AU  - Kochanek PM
Y1  - 2008/05//
N1  - Accession Number: 105679324. Language: English. Entry Date: 20081031. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Perioperative Care. NLM UID: 0332173. 
KW  - Cardiopulmonary Bypass
KW  - Enkephalins -- Pharmacodynamics
KW  - Hypothermia, Induced
KW  - Resuscitation -- Methods
KW  - Shock, Hemorrhagic -- Therapy
KW  - Animals
KW  - Male
KW  - Models, Biological
KW  - Nonparametric Statistics
KW  - Random Assignment
KW  - Rats
KW  - Survival
KW  - Animal Studies
SP  - 220
EP  - 228
JO  - Resuscitation
JF  - Resuscitation
JA  - RESUSCITATION
VL  - 77
IS  - 2
PB  - Elsevier B.V.
SN  - 0300-9572
AD  - Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States. drabekt@anes.upmc.edu
U2  - PMID: 18207625.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105679324&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110365480
T1  - Changes in Substance Abuse Treatment Use Among Individuals With Opioid Use Disorders in the United States, 2004-2013.
AU  - Saloner, Brendan
AU  - Karthikeyan, Shankar
Y1  - 2015/10/13/
N1  - Accession Number: 110365480. Language: English. Entry Date: 20151017. Revision Date: 20161112. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Substance Use Disorders -- Therapy
KW  - Time Factors
KW  - Mental Health Services -- Statistics and Numerical Data
KW  - Child
KW  - Adolescence
KW  - Young Adult
KW  - Adult
KW  - United States
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Female
KW  - Practitioner's Office -- Statistics and Numerical Data
KW  - Hospitals -- Statistics and Numerical Data
KW  - Ambulatory Care Facilities -- Statistics and Numerical Data
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Substance Use Disorders -- Epidemiology
KW  - Correctional Facilities
KW  - Male
KW  - Support Groups -- Statistics and Numerical Data
SP  - 1515
EP  - 1517
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 314
IS  - 14
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - The article discusses the changes in the use of substance abuse treatment by individuals 12 years old and older in the U.S. with opioid use disorders (OUDs) from 2004-2013. Topics mentioned include the use of the National Survey of Drug Use and Health (NSDUH), the increase of individuals revealed in the unadjusted analysis between 2004-2008 and 2009-2013, and the care settings treatment in physician's offices and inpatient.
SN  - 0098-7484
AD  - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
AD  - Institute for Health and Social Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
U2  - PMID: 26462001.
DO  - 10.1001/jama.2015.10345
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110365480&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108094631
T1  - Prescription drug monitoring programs and other interventions to combat prescription opioid abuse.
AU  - Chakravathy, Bharath
AU  - Shah, Shyam
AU  - Lotfipour, Shahram
Y1  - 2012/11//2012 Nov
N1  - Accession Number: 108094631. Language: English. Entry Date: 20130215. Revision Date: 20150712. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101476450. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Prescriptions, Drug
KW  - Substance Abuse -- Prevention and Control
KW  - Centers for Disease Control and Prevention (U.S.)
KW  - Data Collection
KW  - Emergency Medicine
KW  - Emergency Service
KW  - Medical Practice
KW  - Patient Care
KW  - Physicians
KW  - Policy Making
KW  - Substance Abusers -- Evaluation
SP  - 422
EP  - 425
JO  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JF  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
JA  - WEST J EMERG MED
VL  - 13
IS  - 5
CY  - Orange, California
PB  - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
AB  - The Center for Disease Control and Prevention (CDC) has published significant data and trendsrelated to opioid prescription pain relievers (OPR). In 2008, 20,044 deaths were attributedto prescription drug overdose of which 14,800 (73.8%) were due to OPR, an amount greaterthan the number of overdose deaths from heroin and cocaine combined. The majority of thesedeaths were unintentional. Between 1999-2008, overdose deaths from OPR increased almostfour-fold. Correspondingly, sales of OPR were four times greater in 2010 than in 1999. Mostsignificant to emergency physicians is the estimate that 39% of all opioids prescribed, administeredor continued come from the emergency department (ED). We present findings from theCDC's Morbidity and Mortality Weekly Report (MMWR) with commentary on current recommendationsand policies for curtailing the OPR epidemic.1
SN  - 1936-900X
AD  - University of California Irvine, School of Medicine, Department of Emergency Medicine, Irvinie, California
U2  - PMID: 23357954.
DO  - 10.5811/westjem.2012.7.12936
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108094631&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104378994
T1  - Correlates of higher-dose opioid medication use for low back pain in primary care.
AU  - Kobus AM
AU  - Smith DH
AU  - Morasco BJ
AU  - Johnson ES
AU  - Yang X
AU  - Petrik AF
AU  - Deyo RA
AU  - Kobus, Amy M
AU  - Smith, David H
AU  - Morasco, Benjamin J
AU  - Johnson, Eric S
AU  - Yang, Xiuhai
AU  - Petrik, Amanda F
AU  - Deyo, Richard A
Y1  - 2012/11//
N1  - Accession Number: 104378994. Language: English. Entry Date: 20130426. Revision Date: 20180322. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management. Grant Information: UL1 RR024140/RR/NCRR NIH HHS/United States. NLM UID: 100898657. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Low Back Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Comorbidity
KW  - Confidence Intervals
KW  - Demography
KW  - Prescriptions, Drug
KW  - Drug Utilization
KW  - Female
KW  - Health Behavior
KW  - Health Services
KW  - Human
KW  - Hypnotics and Sedatives
KW  - Low Back Pain
KW  - Low Back Pain -- Complications
KW  - Male
KW  - Medicare
KW  - Mental Disorders
KW  - Mental Disorders -- Complications
KW  - Middle Age
KW  - Odds Ratio
KW  - Outpatients
KW  - Primary Health Care
KW  - Risk Assessment
KW  - Sex Factors
KW  - United States
SP  - 1131
EP  - 1138
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 13
IS  - 11
PB  - Churchill Livingstone, Inc.
AB  - Unlabelled: Factors associated with high-dose opioid therapy for noncancer pain are poorly understood. We documented the prevalence of high-dose opioid use as well as associated demographic, clinical, and health service utilization correlates among low back pain patients. Patients prescribed higher doses of opioids (≥100 mg/day morphine equivalent at last dispensing; n = 453) and receiving opioids for 90+ consecutive days were compared to 2 groups: lower-dose opioid group (1-99 mg/day; n = 4,815) or no-opioid group (n = 10,184). Higher-dose opioid use occurred in 2.9% of patients who received any opioids and in 8.6% of patients who received opioids long-term. The median dose in the higher-dose group was 180.0 mg/day. Compared to the no-opioid group, higher-dose users reported poorer health. Compared to either comparison group, patients in the higher-dose group had higher rates of mental health and substance use disorders, concurrent sedative-hypnotic use (60.5%; n = 274), and health service utilization. After adjusting for select covariates, male gender (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.37-2.06), higher comorbidity, Medicare coverage (OR = 1.65, 95% CI = 1.22-2.23), any mental health or substance use diagnosis (OR = 1.58, 95% CI = 1.28-1.95), co-prescriptions of sedative-hypnotics (OR = 1.75, 95% CI = 1.42-2.16), and more emergency department and specialty pain clinic visits were associated with higher likelihood of high-dose prescriptions.Perspective: Higher-dose opioid therapy is being prescribed to 8.6% of back pain patients who receive long-term opioids. These patients had higher mental health and medical comorbidities and co-prescriptions of sedative-hypnotics, raising potential safety concerns.
SN  - 1526-5900
AD  - Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
AD  - Oregon Health & Science University, Portland, Oregon. Electronic address: kobusa@ohsu.edu.
U2  - PMID: 23117108.
DO  - 10.1016/j.jpain.2012.09.003
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104378994&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105522631
T1  - A case series of abuse of a new opioid combination, Norjizak.
AU  - Siavash M
AU  - Janghorbani M
AU  - Gheshlaghi F
AU  - Adeli SH
AU  - Saljoughi M
AU  - Moradi F
AU  - Majidinezhad M
Y1  - 2009/06//
N1  - Accession Number: 105522631. Language: English. Entry Date: 20090619. Revision Date: 20150711. Publication Type: Journal Article; pictorial; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Evidence-Based Practice; Psychiatry/Psychology. NLM UID: 9107051. 
KW  - Cushing's Syndrome -- Chemically Induced
KW  - Drug Combinations -- Adverse Effects
KW  - Narcotics -- Adverse Effects
KW  - Street Drugs -- Adverse Effects
KW  - Substance Abuse -- Complications
KW  - Adult
KW  - Case Studies
KW  - Chromatography, High Pressure Liquid
KW  - Dexamethasone -- Analysis
KW  - Drug Combinations -- Analysis
KW  - Female
KW  - Glucocorticoids -- Analysis
KW  - Interviews
KW  - Intravenous Drug Users
KW  - Iran
KW  - Male
KW  - Middle Age
KW  - Narcotics -- Analysis
KW  - Prospective Studies
KW  - Questionnaires
KW  - Record Review
KW  - Self Report
KW  - Human
SP  - 180
EP  - 185
JO  - Journal of Addictive Diseases
JF  - Journal of Addictive Diseases
JA  - J ADDICT DIS
VL  - 28
IS  - 2
PB  - Taylor & Francis Ltd
AB  - Cushing's syndrome results from lengthy and inappropriate exposure to excessive concentrations of either endogenous or exogenous glucocorticoids. This study described 30 patients with a novel type of severe exogenous Cushing's syndrome in a group of intravenous drug users due to illicit use and dependence on a new opioid combination, Norjizak. Thirty consecutive patients (2 women and 28 men) who presented with a novel type of severe exogenous Cushing's syndrome and other complications were admitted to the emergency departments of Qom and Isfahan University of Medical Sciences, Isfahan, Iran, between September 2005 and September 2007 were enrolled. All participating patients were intravenous drug users who used a narcotic drug called Norjizak, a combination of different opioids with dexamethason or benzodiazepines. Patients were first evaluated and managed based on the current illness, and then entered into a detoxification program by a medical team. Clinical data were collected by an open interview and the patient's files using a standard form. High-performance liquid chromatography was used to determined glucocorticoid existence in the brand. The major complaints and clinical findings were withdrawal symptoms, severe edema, osteoporotic fracture, impairment in glucose tolerance, decreased libido, and sepsis (including necrotizing pneumonia, cutaneous infection, multivalvular endocarditis, osteomyelitis, and urogenital infection). Most patients had started with 2 or 3 vials per day and then increased the dose compulsively to maximum of approximately 15 to 20 vials per day. The concentration of Dexamethhasone disodium phosphate in each 2 mL vial was 0.4 to 1 mg/mL. Heroin was also found in them. We are witnessing a special exogenous Cushing syndrome due to the mixing of opiates and dexamethasone. Norjizak syndrome is the clinical condition of poisoning with a second material when it is combined with opiates due to compulsive dose increment and long duration.
SN  - 1055-0887
AD  - Isfahan Endocrine & Metabolism Research Center, Isfahan, Iran.
U2  - PMID: 19340681.
DO  - 10.1080/10550880902772928
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105522631&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103846044
T1  - Resuscitation characteristics and outcomes in suspected drug overdose-related out-of-hospital cardiac arrest.
AU  - Koller, Allison C
AU  - Salcido, David D
AU  - Callaway, Clifton W
AU  - Menegazzi, James J
Y1  - 2014/10//
N1  - Accession Number: 103846044. Language: English. Entry Date: 20150612. Revision Date: 20180322. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Perioperative Care. Grant Information: 5U01 HL077863/HL/NHLBI NIH HHS/United States. NLM UID: 0332173. 
KW  - Heart Arrest -- Chemically Induced
KW  - Heart Arrest -- Therapy
KW  - Overdose -- Complications
KW  - Prehospital Care
KW  - Resuscitation
KW  - Adult
KW  - Aged
KW  - Emergency Medical Services
KW  - Female
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Retrospective Design
KW  - Survival
KW  - Treatment Outcomes
SP  - 1375
EP  - 1379
JO  - Resuscitation
JF  - Resuscitation
JA  - RESUSCITATION
VL  - 85
IS  - 10
PB  - Elsevier B.V.
AB  - Introduction: We sought to compare characteristics of emergency medical services-treated out-of-hospital cardiac arrests resulting from suspected drug overdose with non-overdose cases and test the relationship between suspected overdose and survival to hospital discharge.Methods: Data from emergency medical services-treated, non-traumatic out-of-hospital cardiac arrests from 2006 to 2008 and late 2009 to 2011 were obtained from four EMS agencies in the Pittsburgh, Pennsylvania metropolitan area. Case definition for suspected drug overdose was naloxone administration, indication on the patient care report and/or indication by a review of hospital records. Resuscitation parameters included chest compression fraction, rate, and depth and the administration of resuscitation drugs. Demographic and outcome variables compared by suspected overdose status included age, sex, and survival to hospital discharge.Results: From 2342 treated out-of-hospital cardiac arrests, 180 were suspected overdose cases (7.7%) and were compared to 2162 non-overdose cases. Suspected overdose cases were significantly younger (45 vs. 65, p<0.001), less likely to be witnessed by a bystander (29% vs. 41%, p<0.005), and had a higher rate of survival to hospital discharge (19% vs. 12%, p=0.014) than non-overdoses. Suspected overdose cases had a higher overall chest compression fraction (0.69 vs. 0.67, p=0.018) and higher probability of adrenaline, sodium bicarbonate, and atropine administration (p<0.001). Suspected overdose status was predictive of survival to hospital discharge when controlling for other variables (p<0.001).Conclusion: Patients with suspected overdose-related out-of-hospital cardiac arrest were younger, received different resuscitative care, and survived more often than non-overdose cases.
SN  - 0300-9572
AD  - Department of Emergency Medicine, University of Pittsburgh, School of Medicine, United States. Electronic address: ack40@pitt.edu.
AD  - Department of Emergency Medicine, University of Pittsburgh, School of Medicine, United States.
U2  - PMID: 24973558.
DO  - 10.1016/j.resuscitation.2014.05.036
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107948406
T1  - Understanding Overdose.
AU  - Snyder, Scott R.
AU  - Kiviehan, Sean M.
AU  - Collopy, Kevin T.
Y1  - 2013/06//
N1  - Accession Number: 107948406. Language: English. Entry Date: 20130613. Revision Date: 20150819. Publication Type: Journal Article; case study; pictorial; tables/charts. Note: For CE see EMSWorld.com/cetest or www.rapidce.com. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101466002. 
KW  - Narcotics -- Poisoning
KW  - Overdose -- Diagnosis
KW  - Overdose -- Therapy
KW  - Prehospital Care
KW  - Emergency Medical Services
KW  - Education, Continuing (Credit)
KW  - Male
KW  - Middle Age
KW  - Emergency Patients
KW  - Outpatients
KW  - Overdose -- Mortality -- United States
KW  - Overdose -- Epidemiology -- United States
KW  - United States
KW  - Narcotics -- Pharmacodynamics
KW  - Narcotics -- Pharmacokinetics
KW  - Physical Examination
KW  - Patient History Taking
KW  - Respiration Disorders -- Chemically Induced
KW  - Airway Management
KW  - Oxygen Therapy
KW  - Pulse Oximetry
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Symptoms
KW  - Overdose -- Drug Therapy
KW  - Overdose -- Physiopathology
KW  - Charcoal -- Administration and Dosage
KW  - Child
KW  - Adult
SP  - 57
EP  - 61
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 42
IS  - 6
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
SN  - 1946-9365
AD  - Faculty member, Public Safety Training Center, Emergency Care Program, Santa Rosa Junior College, CA
AD  - Emergency medicine resident, University of California, San Francisco
AD  - Performance improvement coordinator, Vitalink/Airlink, Wilmington, NC; Lead instructor, Wilderness Medical Associates
U2  - PMID: 23822044.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107948406&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108071672
T1  - Treatment of guanfacine toxicity with naloxone.
AU  - Tsze DS
AU  - Dayan PS
Y1  - 2012/10//2012 Oct
N1  - Accession Number: 108071672. Language: English. Entry Date: 20130405. Revision Date: 20150712. Publication Type: Journal Article; case study; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 8507560. 
KW  - Antihypertensive Agents -- Adverse Effects
KW  - Hypotension -- Drug Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Antihypertensive Agents -- Therapeutic Use
KW  - Attention Deficit Hyperactivity Disorder -- Drug Therapy
KW  - Attention Deficit Hyperactivity Disorder -- Physiopathology
KW  - Blood Pressure -- Drug Effects
KW  - Child, Preschool
KW  - Electrocardiography
KW  - Prospective Studies
KW  - Human
KW  - Hypotension -- Chemically Induced
KW  - Hypotension -- Physiopathology
KW  - Male
KW  - Narcotic Antagonists -- Therapeutic Use
SP  - 1060
EP  - 1061
JO  - Pediatric Emergency Care
JF  - Pediatric Emergency Care
JA  - PEDIATR EMERG CARE
VL  - 28
IS  - 10
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - ABSTRACT: We describe a 4-year-old boy who presents to the emergency department with lethargy, bradycardia, and initial hypertension followed by hypotension due to guanfacine toxicity after ingestion of standard doses of the extended release formulation. This is the first case report to describe the use of naloxone to treat these symptoms and document improvements in level of consciousness, blood pressure, and heart rate associated with this therapy.
SN  - 0749-5161
AD  - From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
U2  - PMID: 23034493.
DO  - 10.1097/PEC.0b013e31826ce9f1
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108071672&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104143923
T1  - The Economic Burden of Opioid-Related Poisoning in the United States.
AU  - Inocencio, Timothy J.
AU  - Carroll, Norman V.
AU  - Read, Edward J.
AU  - Holdford, David A.
Y1  - 2013/10//
N1  - Accession Number: 104143923. Language: English. Entry Date: 20131021. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 100894201. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Narcotics -- Poisoning
KW  - Drug Toxicity -- Economics -- United States
KW  - Overdose -- Mortality
KW  - Health Care Costs
KW  - Costs and Cost Analysis
KW  - Human
KW  - United States
KW  - Descriptive Statistics
KW  - Emergency Care -- Economics
KW  - Hospitalization -- Economics
KW  - Data Analysis Software
KW  - Heroin
KW  - Health Resource Utilization -- Economics
KW  - Confidence Intervals
KW  - Absenteeism
SP  - 1534
EP  - 1547
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 14
IS  - 10
PB  - Oxford University Press / USA
SN  - 1526-2375
AD  - Avalere Health
AD  - School of Pharmacy, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University
AD  - School of Medicine, Department of Emergency Medicine, Virginia Commonwealth University
U2  - PMID: 23841538.
DO  - 10.1111/pme.12183
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104143923&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104231707
T1  - Side Effects From Oral Opioids in Older Adults During the First Week of Treatment for Acute Musculoskeletal Pain.
AU  - Hunold, Katherine M.
AU  - Esserman, Denise A.
AU  - Isaacs, Cameron G.
AU  - Dickey, Ryan M.
AU  - Pereira, Greg F.
AU  - Fillingim, Roger B.
AU  - Sloane, Philip D.
AU  - McLean, Samuel A.
AU  - Platts-Mills, Timothy F.
Y1  - 2013/09//
N1  - Accession Number: 104231707. Language: English. Entry Date: 20130923. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9418450. 
KW  - Education, Medical, Continuing
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Treatment Duration
KW  - Acute Disease
KW  - Pain -- Therapy
KW  - Musculoskeletal System -- Anatomy and Histology
KW  - Emergency Medicine
KW  - Human
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Age Factors
KW  - Middle Age
KW  - Musculoskeletal Diseases -- Diagnosis
KW  - Cross Sectional Studies
KW  - Analgesics -- Administration and Dosage
KW  - Emergency Service
KW  - Telephone
KW  - Interviews
KW  - After Care
KW  - Medical Organizations
KW  - Health Services Accessibility -- Evaluation
KW  - Patient Selection -- Methods
KW  - Antiinflammatory Agents, Non-Steroidal -- Administration and Dosage
KW  - Race Factors
KW  - Male
KW  - Female
KW  - Comorbidity
KW  - Data Analysis
KW  - Data Analysis Software
KW  - Protocols
KW  - Descriptive Statistics
KW  - Aged
KW  - Whites
KW  - Antiinflammatory Agents, Non-Steroidal -- Adverse Effects
KW  - Nausea -- Diagnosis
KW  - Vomiting -- Diagnosis
KW  - Dizziness -- Diagnosis
SP  - 872
EP  - 879
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 20
IS  - 9
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - Department of Biostatistics, University of North Carolina Chapel Hill
AD  - Department of Biostatistics, University of North Carolina Chapel Hill; Division of General Medicine and Clinical Epidemiology, University of North Carolina Chapel Hill
AD  - School of Medicine, University of North Carolina Chapel Hill
AD  - Department of Anesthesiology, University of North Carolina Chapel Hill
AD  - College of Dentistry University of Florida
AD  - Department of Family Medicine, University of North Carolina Chapel Hill
AD  - Department of Anesthesiology, University of North Carolina Chapel Hill; Department of Emergency Medicine, University of North Carolina Chapel Hill
U2  - PMID: 24033733.
DO  - 10.1111/acem.12212
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104231707&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104057986
T1  - Opioid overdose: when good drugs break bad.
AU  - Berge, Keith H
AU  - Burkle, Christopher M
Y1  - 2014/04//
N1  - Accession Number: 104057986. Language: English. Entry Date: 20140606. Revision Date: 20150710. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0405543. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Cause of Death
KW  - Emergency Service -- Utilization
KW  - Substance Use Disorders -- Diagnosis
KW  - Substance Use Disorders -- Epidemiology
KW  - Female
KW  - Male
SP  - 437
EP  - 439
JO  - Mayo Clinic Proceedings
JF  - Mayo Clinic Proceedings
JA  - MAYO CLIN PROC
VL  - 89
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0025-6196
AD  - Department of Anesthesiology, Mayo Clinic, Rochester, MN. Electronic address: berge.keith@mayo.edu.
AD  - Department of Anesthesiology, Mayo Clinic, Rochester, MN.
U2  - PMID: 24629442.
DO  - 10.1016/j.mayocp.2014.02.007
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104057986&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106958777
T1  - Intranasal administration of naloxone by paramedics.
AU  - Barton ED
AU  - Ramos J
AU  - Colwell C
AU  - Benson J
AU  - Baily J
AU  - Dunn W
Y1  - 2002/01//
N1  - Accession Number: 106958777. Language: English. Entry Date: 20020913. Revision Date: 20150820. Publication Type: Journal Article; forms; pictorial; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Prehospital Care
KW  - Overdose -- Drug Therapy
KW  - Narcotics -- Poisoning
KW  - Administration, Intranasal
KW  - Prospective Studies
KW  - Colorado
KW  - Descriptive Statistics
KW  - Emergency Medical Technicians
KW  - Treatment Outcomes
KW  - Human
SP  - 54
EP  - 58
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 6
IS  - S2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - INTRODUCTION: Naloxone is a medication that is frequently administered in the field by paramedics for suspected opioid overdoses. Most prehospital protocols, however, require this medication to be given to patients intravenously (i.v.) or intramuscularly (i.m.). Unfortunately, intravenous line placement may be problematic and time-consuming in chronic i.v. drug users. There may also be a delay in patient response to opioid reversal with i.m. absorption of naloxone. Additionally, routine use of needles in high-risk populations poses an increased risk of occupational blood exposures to paramedics. OBJECTIVE: To prospectively test the effectiveness of intranasal (i.n.) naloxone administration by paramedics. This preliminary report summarizes the first month's experience in the city of Denver. METHODS: Naloxone was first administered to patients found unconscious in the field using a nasal mucosal atomizer device (MAD). Patients were then treated using standard prehospital protocols, which included i.v. line placement and medications, if they did not immediately respond to i.n. naloxone. Time to patient response was recorded. RESULTS: A total of 30 patients received i.n. naloxone in the field over a one-month period. Of these, 11 patients responded to either i.n. or i.v. naloxone. Ten (91%) patients responded to i.n. naloxone alone, with an average response time of 3.4 minutes. Seven patients (64%) did not require an i.v. in the field after response to i.n. naloxone. CONCLUSIONS: Intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses in the field. Use of this route may decrease paramedic exposures to blood-borne diseases. The addition of i.n. naloxone administration to prehospital protocols should be considered as an initial therapy for suspected opioid abusers.
SN  - 1090-3127
AD  - University of Utah Health Science Center, Division of Emergency Medicine, 1150 Moran Building, 175 North Medical Drive East, Salt Lake City, UT 84132; edbarton@worldnet.att.net
U2  - PMID: 11789651.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106958777&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104642741
T1  - Predictors of pain relief and adverse events in patients receiving opioids in a prehospital setting.
AU  - Bounes, Vincent
AU  - Barniol, Caroline
AU  - Minville, Vincent
AU  - Houze-Cerfon, Charles-Henri
AU  - Ducassé, Jean Louis
Y1  - 2011/06//
N1  - Accession Number: 104642741. Language: English. Entry Date: 20110629. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management. Instrumentation: Numeric Pain Rating Scale (NPRS). NLM UID: 8309942. 
KW  - Prehospital Care
KW  - Pain -- Drug Therapy
KW  - Narcotics -- Adverse Effects
KW  - Human
KW  - Prospective Studies
KW  - Nonexperimental Studies
KW  - Scales
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Descriptive Statistics
KW  - Univariate Statistics
KW  - Multivariate Analysis
KW  - Male
KW  - Female
KW  - Confidence Intervals
KW  - France
KW  - Data Analysis Software
KW  - Logistic Regression
KW  - Odds Ratio
SP  - 512
EP  - 517
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 29
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Abstract: Objective: The aim of the study was to analyze factors predicting pain relief and adverse events in patients receiving opioids for acute pain in a prehospital setting. Methods: In this prospective, observational clinical study, adult patients with a numerical rating scale (NRS) score of 5 of 10 or higher who required treatment with intravenous opioids for pain control were included. The primary outcome variable was final analgesia defined by an NRS score of 3 of 10 or lower upon arrival to the emergency department. Univariable and multivariable analyses were performed to identify predictive factors of pain relief and adverse effects. Results: In total, 277 patients (age, 49 ± 22 years), 205 (74%) of whom were male and 154 (56%) with a traumatic pain were included in the analysis. Median (interquartile range) NRS scores at baseline and at discharge were 8 of 10 (7-10) and 3 of 10 (2-5), respectively. The final model had 3 independent variables reaching significance. Physician-staffed ambulance transportation (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.07-5.49) was the only independent predictor of patients'' final pain relief. High initial pain scores and acetaminophen use were predictive factors for failure of analgesia (OR, 0.79; 95% CI, 0.68-0.93 for one unit/10; P < .01; and OR, 0.40; 95% CI, 0.21-0.77; P < .01, respectively). In the entire sample, 25 (9.0%) presented one adverse effect, all mild to moderate in severity, with no significant predictive factors. Conclusion: Despite advancement in prehospital pain management, pain relief at discharge is still inadequate in some patients. Finally, one important message of our study is that patients in pain have to be transported by well-equipped and staffed ambulances to reevaluate and alleviate pain.
SN  - 0735-6757
AD  - SAMU 31, Pôle de médecine d'urgences, Hôpitaux Universitaires, 31059 Toulouse cedex 9, France
AD  - Emergency Department, Pôle de médecine d'urgences, Hôpitaux Universitaires, 31059 Toulouse cedex 9, France
AD  - Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires, 31059 Toulouse cedex 9, France
U2  - PMID: 20825821.
DO  - 10.1016/j.ajem.2009.12.005
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104642741&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105514978
T1  - Evaluating the use and timing of opioids for the treatment of migraine headaches in the emergency department.
AU  - Tornabene SV
AU  - Deutsch R
AU  - Davis DP
AU  - Chan TC
AU  - Vilke GM
Y1  - 2009/05//
N1  - Accession Number: 105514978. Language: English. Entry Date: 20090911. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8412174. 
KW  - Analgesics, Nonnarcotic -- Therapeutic Use
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Medical Services -- Statistics and Numerical Data
KW  - Migraine -- Drug Therapy
KW  - Migraine -- Epidemiology
KW  - Analgesics, Nonnarcotic -- Administration and Dosage
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Drug Administration Schedule
KW  - Female
KW  - Male
KW  - Medical Records
KW  - Middle Age
KW  - Polypharmacy
KW  - Readmission -- Statistics and Numerical Data
KW  - Recurrence
KW  - Retrospective Design
KW  - Self Administration
KW  - United States
KW  - Human
SP  - 333
EP  - 337
JO  - Journal of Emergency Medicine (0736-4679)
JF  - Journal of Emergency Medicine (0736-4679)
JA  - J EMERG MED
VL  - 36
IS  - 4
PB  - Pergamon Press - An Imprint of Elsevier Science
SN  - 0736-4679
AD  - Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Oakland, Oakland, California.
U2  - PMID: 18280084.
DO  - 10.1016/j.jemermed.2007.07.068
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105514978&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121261604
T1  - ER/LA Opioid Analgesics REMS: Overview of Ongoing Assessments of Its Progress and Its Impact on Health Outcomes.
AU  - Cepeda, M. Soledad
AU  - Coplan, Paul M.
AU  - Kopper, Nathan W.
AU  - Maziere, Jean-Yves
AU  - Wedin, Gregory P.
AU  - Wallace, Laura E.
Y1  - 2017/01//
N1  - Accession Number: 121261604. Language: English. Entry Date: 20170218. Revision Date: 20180101. Publication Type: Article; review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 100894201. 
KW  - Chronic Pain -- Drug Therapy
KW  - Substance Abuse -- Prevention and Control
KW  - Delayed-Action Preparations -- Administration and Dosage
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Patient Education
KW  - Education, Medical, Continuing
KW  - Prescriptions, Drug
KW  - Inappropriate Prescribing -- Prevention and Control
KW  - Risk Management
KW  - Outcomes (Health Care)
KW  - Prescribing Patterns
KW  - United States Food and Drug Administration
KW  - Professional Knowledge
KW  - Patient Satisfaction
KW  - Health Knowledge
KW  - Substance Abuse -- Epidemiology -- United States
KW  - United States
KW  - Substance Abuse -- Mortality
KW  - Health Services Accessibility
KW  - Health Resource Utilization
KW  - Emergency Service -- Utilization
KW  - Evaluation Research
KW  - Audit
KW  - Surveys
SP  - 78
EP  - 85
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 18
IS  - 1
PB  - Oxford University Press / USA
AB  - Objective. Opioid abuse is a serious public health concern. In response, the Food and Drug Administration (FDA) determined that a risk evaluation and mitigation strategy (REMS) for extended-release and long-acting (ER/LA) opioids was necessary to ensure that the benefits of these analgesics continue to outweigh the risks. Key components of the REMS are training for prescribers through accredited continuing education (CE), and providing patient educational materials. Methods. The impact of this REMS has been assessed using diverse metrics including evaluation of prescriber and patient understanding of the risks associated with opioids; patient receipt and comprehension of the medication guide and patient counseling document; patient satisfaction with access to opioids; drug utilization and changes in prescribing patterns; and surveillance of ER/LA opioid misuse, abuse, overdose, addiction, and death. Results and Conclusions. The results of these assessments indicate that the increasing rates of opioid abuse, addiction, overdose, and death observed prior to implementation of the REMS have since leveled off or started to decline. However, these benefits cannot be attributed solely to the ER/LA opioid analgesics REMS since many other initiatives to prevent abuse occurred contemporaneously. These improvements occurred while preserving patient access to opioids as a large majority of patients surveyed expressed satisfaction with their access to opioids.
SN  - 1526-2375
AD  - Department of Epidemiology, Janssen Research and Development, Titusville, New Jersey
AD  - Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, Connecticut
AD  - Adjunct, Department of Epidemiology, University of Pennsylvania School of Medicine
AD  - Department of Drug Safety, Mallinckrodt Pharmaceuticals, Inc., Hazelwood, Missouri
AD  - REMS, Labeling, Drug Safety, Boehringer Ingelheim Roxane, Inc./Roxane Laboratories, Inc. Columbus, Ohio
AD  - Department of Drug Safety, Upsher-Smith Laboratories, Inc., Maple Grove, Minnesota, USA
DO  - 10.1093/pm/pnw129
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121261604&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107837770
T1  - NOTES ON NALOXONE...August issue article “Armed with Naloxone: The first responders’ ultimate weapon in the war on opioid use?
AU  - M., Jacob
AU  - C., Steve
Y1  - 2014/11//
N1  - Accession Number: 107837770. Language: English. Entry Date: 20141113. Revision Date: 20150712. Publication Type: Journal Article; commentary; letter. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Emergency Medical Services
KW  - Prehospital Care
KW  - Overdose -- Drug Therapy
KW  - Narcotics -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Police
KW  - Ventilation, Manual
KW  - Respiration
SP  - 12
EP  - 12
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 39
IS  - 11
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107837770&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109319123
T1  - Information for CME Credit — Emergency Department Visits and Overdose Deaths From Combined Use of Opioids and Benzodiazepines.
Y1  - 2015/10//
N1  - Accession Number: 109319123. Language: English. Entry Date: 20160703. Revision Date: 20150915. Publication Type: Article. Journal Subset: Biomedical; Health Promotion/Education; USA. NLM UID: 8704773. 
SP  - A3
EP  - A3
JO  - American Journal of Preventive Medicine
JF  - American Journal of Preventive Medicine
JA  - AM J PREV MED
VL  - 49
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0749-3797
DO  - 10.1016/S0749-3797(15)00468-7
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109319123&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 109835276
T1  - Opioid Dependence Treatment in the Emergency Department--Reply...JAMA. 2015 Aug 25;314(8):834-5; JAMA. 2015 Apr 28;313(16):1636-44
AU  - Fiellin, David A
AU  - O'Connor, Patrick G
AU  - D'Onofrio, Gail
Y1  - 2015/08/25/
N1  - Accession Number: 109835276. Language: English. Entry Date: 20150923. Revision Date: 20161112. Publication Type: commentary; commentary; letter. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Buprenorphine -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Female
KW  - Male
SP  - 835
EP  - 835
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 314
IS  - 8
CY  - Chicago, Illinois
PB  - American Medical Association
SN  - 0098-7484
U2  - PMID: 26305657.
DO  - 10.1001/jama.2015.8527
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109835276&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106704350
T1  - Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport.
AU  - Vilke GM
AU  - Sloane C
AU  - Smith AM
AU  - Chan TC
Y1  - 2003/08//
N1  - Accession Number: 106704350. Language: English. Entry Date: 20040220. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Heroin -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Overdose -- Mortality
KW  - Patient Discharge
KW  - Prehospital Care
KW  - Transportation of Patients
KW  - Treatment Refusal
KW  - Adolescence
KW  - Adult
KW  - Age Factors
KW  - Aged
KW  - Aged, 80 and Over
KW  - California
KW  - Confidence Intervals
KW  - Coroners and Medical Examiners
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Emergency Medical Services
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Naloxone -- Administration and Dosage
KW  - Outpatients
KW  - Prospective Studies
KW  - Protocols
KW  - Record Review
KW  - Resource Databases, Health
KW  - Retrospective Design
KW  - Sex Factors
KW  - Substance Dependence
KW  - Human
SP  - 893
EP  - 896
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 10
IS  - 8
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Naloxone frequently is used to treat suspected heroin and opioid overdoses in the out-of-hospital setting. The authors' emergency medical services system has operated a policy of allowing these patients, when successfully treated, to sign out against medical advice (AMA) in the field. OBJECTIVES: To evaluate the safety of this AMA policy. METHODS: This is a retrospective review of out-of-hospital and medical examiner (ME) databases over a five-year period. The authors reviewed all ME cases in which opioid overdoses were listed as contributing to the cause of death. These cases were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and ethnicity when available. RESULTS: There were 998 out-of-hospital patients who received naloxone and refused further treatment and 601 ME cases of opioid overdose deaths. When compared by age, time, date, sex, location, and ethnicity, there were no cases in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opioid overdose. CONCLUSIONS: Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.
SN  - 1069-6563
AD  - Department of Emergency Medicine, UC San Diego Medical Center, 200 West Arbor Drive, Mailcode #8676, San Diego, CA 92103; gmvilke@ucsd.edu
U2  - PMID: 12896894.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106704350&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103864068
T1  - 'Hard' and 'soft' patient cues that influence ED prescribing for potential opioid misusers.
AU  - Mannina, Lisa
AU  - Varney, Shawn M
AU  - Bebarta, Vikhyat S
AU  - Ganem, Victoria J
AU  - Carey, Kathy R
AU  - Ramos, Rose G
Y1  - 2015/01//
N1  - Accession Number: 103864068. Language: English. Entry Date: 20150306. Revision Date: 20170802. Publication Type: Journal Article; letter. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Cues
KW  - Emergency Service
KW  - Nursing Practice -- Statistics and Numerical Data
KW  - Substance Use Disorders -- Diagnosis
KW  - Pain -- Drug Therapy
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Adult
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Questionnaires
SP  - 109
EP  - 111
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 33
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0735-6757
AD  - SAUSHEC Emergency Medicine PGYII, San Antonio Military Medical Center, San Antonio, TX. Electronic address: mannina.1@gmail.com.
AD  - Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX. Electronic address: smvarney@gmail.com.
AD  - Department of Emergency Medicine, San Antonio Military Medical Center and Air Force Enroute Care Research Center, San Antonio, TX. Electronic address: vikbebarta@yahoo.com.
AD  - Department of Emergency Medicine, San Antonio Military Medical Center and Air Force Enroute Care Research Center, San Antonio, TX. Electronic address: victoria.j.ganem.vol@mail.mil.
AD  - The Geneva Foundation, San Antonio, TX. Electronic address: KCarey@genevausa.org.
AD  - Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX. Electronic address: rosemarieramos@hotmail.com.
U2  - PMID: 25445857.
DO  - 10.1016/j.ajem.2014.09.034
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109880224
T1  - Assessing pediatric and young adult substance use through analysis of prehospital data.
AU  - Seaman, Elizabeth L
AU  - Levy, Mathew J
AU  - Lee Jenkins, J
AU  - Godar, Cassandra Chiras
AU  - Seaman, Kevin G
AU  - Jenkins, J Lee
Y1  - 2014/10//2014 Oct
N1  - Accession Number: 109880224. Language: English. Entry Date: 20150923. Revision Date: 20161001. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health; USA. Special Interest: Emergency Care. NLM UID: 8918173. 
SP  - 468
EP  - 472
JO  - Prehospital & Disaster Medicine
JF  - Prehospital & Disaster Medicine
JA  - PREHOSPITAL DISASTER MED
VL  - 29
IS  - 5
PB  - Cambridge University Press
AB  - Introduction: Substance use in young adults is a significant and growing problem. Emergency Medical Services (EMS) personnel often encounter this problem, yet the use of prehospital data to evaluate the prevalence and magnitude of substance abuse has been limited.Hypothesis/problem: This study evaluated drug and alcohol use through the use of prehospital and EMS data in one suburban county in Maryland (USA). The primary hypothesis was that the type of drug being abused is associated with age. The secondary hypothesis was substance abuse incidence is associated with location. The tertiary hypothesis was that substance abuse is associated with a history of mental illness.Methods: Deidentified patient care reports (PCRs) were obtained during a 24-month period from October 2010 through September 2012 for patients 0 through 25 years of age. Inclusion criteria included chief complaint of alcohol overdose, drug overdose, or the use of naloxone.Results: The primary hypothesis was supported that age was associated with drug category (P < .001). Younger adolescents were more likely to use household items, prescription drugs, or over-the-counter drugs, whereas older adolescents were more likely to use illicit drugs. The secondary hypothesis was supported that both alcohol (P < .001) and drugs (P < .001) were associated with location of call. Calls involving alcohol were more likely to be at a home or business, whereas calls involving drugs were more likely to be at home or at a public venue. The tertiary hypothesis was supported that both alcohol (P = .001) and drug use (P < .001) were associated with history of mental illness. Older adolescents were more likely to report a history of mental illness. Chi-squared tests indicated there were significant differences between genders and drug category (P = .002) and gender and current suicide attempt (P = .004). Females were more likely to use prescription drugs, whereas males were more likely to use illicit drugs. Calls involving younger adolescents under 18 were more likely to be at school or the mall, whereas calls involving older adolescents were likely to be at a prison, public venue, or a business.Conclusion: All three hypotheses were supported: the type of substance being abused was associated with both age and location, and substance abuse was associated with a history of mental illness. This research has important implications for understanding how EMS resources are utilized for substance use. This information is valuable in not only the education and training of prehospital care providers, but also for the targeting of future public health interventions.
SN  - 1049-023X
AD  - 2Department of Emergency Medicine,Johns Hopkins University School of Medicine,Baltimore,MarylandUSA
U2  - PMID: 25088538.
DO  - 10.1017/S1049023X1400079X
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111169879
T1  - Strong opioids for noncancer pain due to musculoskeletal diseases: Not more effective than acetaminophen or NSAIDs.
AU  - Berthelot, Jean-Marie
AU  - Darrieutort-Lafitte, Christelle
AU  - Le Goff, Benoit
AU  - Maugars, Yves
Y1  - 2015/12//
N1  - Accession Number: 111169879. Language: English. Entry Date: 20160909. Revision Date: 20160909. Publication Type: journal article; review. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 100938016. 
KW  - Antiinflammatory Agents, Non-Steroidal -- Therapeutic Use
KW  - Morphine -- Therapeutic Use
KW  - Acetaminophen -- Therapeutic Use
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Drug Tolerance
KW  - Time Factors
KW  - Morphine -- Pharmacodynamics
KW  - Analgesics, Opioid -- Pharmacodynamics
KW  - Treatment Outcomes
SP  - 397
EP  - 401
JO  - Joint Bone Spine
JF  - Joint Bone Spine
JA  - JOINT BONE SPINE
VL  - 82
IS  - 6
CY  - New York, New York
PB  - Elsevier B.V.
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 100mg/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 100mg/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.
SN  - 1297-319X
AD  - Service de rhumatologie, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France
U2  - PMID: 26453108.
DO  - 10.1016/j.jbspin.2015.08.003
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105047324
T1  - Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer.
AU  - Setoguchi S
AU  - Glynn RJ
AU  - Stedman M
AU  - Flavell CM
AU  - Levin R
AU  - Stevenson LW
AU  - Setoguchi, Soko
AU  - Glynn, Robert J
AU  - Stedman, Margaret
AU  - Flavell, Carol M
AU  - Levin, Raisa
AU  - Stevenson, Lynne Warner
Y1  - 2010/07//
N1  - Accession Number: 105047324. Language: English. Entry Date: 20100903. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Grant Information: R56 AG018833/AG/NIA NIH HHS/United States. NLM UID: 0370465. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Heart Failure -- Drug Therapy
KW  - Hospice Care
KW  - Intensive Care Units
KW  - Neoplasms -- Drug Therapy
KW  - Aged, 80 and Over
KW  - Cause of Death -- Trends
KW  - Female
KW  - Prospective Studies
KW  - Health Care Costs
KW  - Heart Failure -- Mortality
KW  - Hospital Mortality -- Trends
KW  - Human
KW  - Male
KW  - Neoplasms -- Mortality
KW  - Retrospective Design
KW  - Survival -- Trends
KW  - United States
SP  - 139
EP  - 144
JO  - American Heart Journal
JF  - American Heart Journal
JA  - AM HEART J
VL  - 160
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Background: Advances in heart failure (HF) treatments have prolonged survival, but more patients die of HF than of any type of cancer. Little is known about the current practice in end-of-life (EOL) care in HF.Methods: Two EOL cohorts (HF and cancer) were identified using Medicare data linked with pharmacy and cancer registry data. We assessed use of hospice, opiates, and acute care services (hospitalizations, emergency department [ED] visits, intensive care unit [ICU] admissions, and death in acute care). Time trends and predictors of use were assessed using multivariate regression including demographics and cardiovascular and noncardiovasuclar comorbidities.Results: Among 5,836 HF patients with median age of 85, 77% female and 4% black, 20% were referred to hospice compared to 51% of 7,565 cancer patients. A modest rise in hospice use over time was parallel in the 2 groups. Twenty-two percent of HF patients filled opiate prescriptions during 60 days before death compared to 46% of cancer patients. Use of acute care services in the 30 days before death was higher for HF (64% vs 39% for ED visits, 60% vs 45% for hospitalizations, and 19% vs 7% for ICU admission). More HF patients died during acute hospitalizations than cancer patients (39% vs 21%).Conclusion: Patients dying of HF were less likely to be supported by hospice and opiates but more likely to die in hospitals than patients with cancer. Our study suggests that opportunities may exist to improve hospice and opiate use in HF patients.
SN  - 0002-8703
AD  - Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
AD  - Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. ssetoguchi@partners.org
U2  - PMID: 20598984.
DO  - 10.1016/j.ahj.2010.03.038
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104528482
T1  - Rescue Therapy for Acute Migraine, Part 3: Opioids, NSAIDs, Steroids, and Post-Discharge Medications.
AU  - Kelley, Nancy E.
AU  - Tepper, Deborah E.
Y1  - 2012/03//
N1  - Accession Number: 104528482. Language: English. Entry Date: 20120326. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management. NLM UID: 2985091R. 
KW  - Migraine -- Drug Therapy
KW  - Narcotics
KW  - Antiinflammatory Agents, Non-Steroidal
KW  - Steroids
KW  - Acute Disease
KW  - After Care
KW  - Infusions, Parenteral
KW  - Meperidine -- Administration and Dosage
KW  - Tramadol -- Administration and Dosage
KW  - Nalbuphine -- Administration and Dosage
KW  - Emergency Service
SP  - 467
EP  - 482
JO  - Headache: The Journal of Head & Face Pain
JF  - Headache: The Journal of Head & Face Pain
JA  - HEADACHE
VL  - 52
IS  - 3
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objective.- The final section of this 3-part review analyzes published reports involving the acute treatment of migraine with opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and steroids in the emergency department (ED), urgent care, and headache clinic settings, as well as post-discharge medications. In the Conclusion, there is a general discussion of all the therapies presented in the 3 sections. Method.- Using the terms ('migraine' AND 'emergency') AND ('therapy' OR 'treatment'), the author searched MEDLINE for reports from ED and urgent care settings that involved all routes of medication delivery. Reports from headache clinic settings were included only if medications were delivered by a parenteral route. Results.- Seventy-five reports were identified that compared the efficacy and safety of multiple acute migraine medications for rescue. Of the medications reviewed in Part 3, opioids, NSAIDs, and steroids all demonstrated some effectiveness. When used alone, nalbuphine and metamizole were superior to placebo. NSAIDs were inferior to the combination of metoclopramide and diphenhydramine. Meperidine was arguably equivalent when compared with ketorolac and dihydroergotamine (DHE) but was inferior to chlorpromazine and equivalent to the other dopamine antagonists. Steroids afford some protection against headache recurrence after the patient leaves the treatment center. Conclusions.- All 3 opioids most frequently studied - meperidine, tramadol, and nalbuphine - were superior to placebo in relieving migraine pain, although meperidine combined with promethazine was not. Opioid side effects included dizziness, sedation, and nausea. With ketorolac being the most frequently studied drug in the class, NSAIDs were generally well tolerated, and they may provide benefit even when given late in the migraine attack. The rate of headache recurrence within 24-72 hours after discharge from the ED can be greater than 50%. Corticosteroids can be useful in reducing headache recurrence after discharge. As discussed in Parts 1, 2, and 3, there are effective medications for provider-administered 'rescue' in all the classes discussed. Prochlorperazine and metoclopramide are the most frequently studied of the anti-migraine medications in the emergent setting, and their effectiveness is superior to placebo. Prochlorperazine is superior or equivalent to all other classes of medications in migraine pain relief. Although there are fewer studies involving sumatriptan and DHE, relatively 'migraine-specific' medications, they appear to be equivalent to the dopamine antagonists for migraine pain relief. Lack of comparisons with placebo and the frequent use of combinations of medications in treatment arms complicate the comparison of single agents to one another. When used alone, prochlorperazine, promethazine, metoclopramide, nalbuphine, and metamizole were superior to placebo. Droperidol and prochlorperazine were superior or equal in efficacy to all other treatments, although they also are more likely to produce side effects that are difficult for a patient to tolerate (especially akathisia). Metoclopramide was equivalent to prochlorperazine, and, when combined with diphenhydramine, was superior in efficacy to triptans and NSAIDs. Meperidine was arguably equivalent when compared with ketorolac and DHE but was inferior to chlorpromazine and equivalent to the other neuroleptics. Sumatriptan was inferior or equivalent to the neuroleptics and equivalent to DHE when only paired comparisons were considered. The overall percentage of patients with pain relief after taking sumatriptan was equivalent to that observed with droperidol or prochlorperazine. ( Headache 2012;52:467-482)
SN  - 0017-8748
AD  - From the Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
U2  - PMID: 22404708.
DO  - 10.1111/j.1526-4610.2012.02097.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104633557
T1  - Opioid Use and Dependence Among Persons With Migraine: Results of the AMPP Study.
AU  - Buse, Dawn C.
AU  - Pearlman, Starr H.
AU  - Reed, Michael L.
AU  - Serrano, Daniel
AU  - Ng-Mak, Daisy S.
AU  - Lipton, Richard B.
Y1  - 2012/01//
N1  - Accession Number: 104633557. Language: English. Entry Date: 20120201. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management. Instrumentation: Migraine Disability Assessment Scale (MIDAS); Primary Care Evaluation of Mental Disorders (PRIME-MD); Patient Health Questionnaire (PHQ). Grant Information: The American Migraine Prevalence and Prevention Study is funded through a research grant to the National Headache Foundation from Ortho-McNeil Neurologics, Inc.,Titusville, NJ. Additional analyses and manuscript preparation were supported by a grant to the National Headache Foundation from Merck & Co., Inc.,Whitehouse Station, NJ.. NLM UID: 2985091R. 
KW  - Migraine -- Drug Therapy
KW  - Narcotics -- Administration and Dosage
KW  - Substance Dependence -- Epidemiology
KW  - Funding Source
KW  - Human
KW  - Questionnaires
KW  - Clinical Assessment Tools
KW  - Descriptive Statistics
KW  - Surveys
KW  - Random Sample
KW  - Prospective Studies
KW  - Self Report
KW  - Scales
KW  - Depression -- Epidemiology
KW  - Anxiety -- Epidemiology
KW  - Health Resource Utilization -- Evaluation
KW  - Data Analysis, Statistical
KW  - Data Analysis Software
KW  - Male
KW  - Female
KW  - Adult
KW  - Middle Age
KW  - Analysis of Variance
KW  - P-Value
KW  - Confidence Intervals
KW  - Relative Risk
SP  - 18
EP  - 36
JO  - Headache: The Journal of Head & Face Pain
JF  - Headache: The Journal of Head & Face Pain
JA  - HEADACHE
VL  - 52
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Objective.- To assess the frequency of opioid use for acute migraine treatment and characterize use groups by sociodemographics, health-care resource utilization (HRU), comorbidities and probable dependence within a large, US population-based sample of persons with migraine. Background.- Opioids are used in the acute treatment of migraine. However, their use is controversial. Methods.- Data from the 2009 American Migraine Prevalence and Prevention (AMPP) study were used to categorize persons with migraine into 4 groups based on reported opioid use: nonusers (between 2005 and 2009), previous users (history of use between 2005 and 2008 but no-use in 2009), and current opioid users (those reporting use of opioids in the 3 months preceding the 2009 American Migraine Prevalence and Prevention survey). Current opioid users were divided into nondependent and probable dependence users according to criteria for dependence adapted for inclusion in the survey from the Diagnostic and Statistical Manual of Mental Disorders-4th edition. All opioid-use groups were contrasted by sociodemographics, headache characteristics, medical and psychiatric comorbidities (depression [measured by the Patient Health Questionnaire-9], anxiety [measured by the Primary Care Evaluation of Mental Health Disorders, PRIME-MD], and cardiovascular events and risk factors), and headache-related HRU. Results.- In a sample of 5796 migraineurs, 4076 (70.3%) were opioid nonusers, 798 (13.8%) were previous users, and 922 (15.9%) were current opioid users. Among current opioid users, 153 (16.6%) met criteria for probable dependence and 769 (83.4%) did not. Headache-related disability (Migraine Disability Assessment sum scores) increased across groups as follows: nonusers: 7.8, previous users: 13.3, current nondependent users: 19.1, and current probable dependence users: 44.4, as did monthly headache frequency: nonusers: 3.2 days/month, previous users: 4.3 days/month, current nondependent users: 5.6 days/month, and current probable dependence users: 8.6 days/month. The prevalence of depression and anxiety was highest among current users with probable dependence. Rates of headache-related HRU were higher for all opioid-use groups for emergency department/urgent care, primary care, and specialty care visits compared to nonusers. Conclusions.- Opioid use for migraine is associated with more severe headache-related disability, symptomology, comorbidities (depression, anxiety, and cardiovascular disease and events), and greater HRU for headache. Longitudinal studies are needed to further assess the directionality and causality between opioid use and the outcomes we examined.
SN  - 0017-8748
AD  - From the Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Montefiore Headache Center, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Armstrong Atlantic State University, Savannah, GA, USA (S.H. Pearlman); Vedanta Research, Chapel Hill, NC, USA (M.L. Reed, D. Serrano); Merck Sharp & Dohme Corp., West Point, PA, USA (D.S. Ng-Mak); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton).
U2  - PMID: 22268775.
DO  - 10.1111/j.1526-4610.2011.02050.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107079068
T1  - A rural emergency medical technician with selected advanced skills.
AU  - Haynes BE
AU  - Pritting J
Y1  - 1999/01/04/
N1  - Accession Number: 107079068. Language: English. Entry Date: 20000101. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Grant Information: Supported in part by grant #5029 from the California Emergency Medical Services Authority. NLM UID: 9703530. 
KW  - Emergency Medical Technicians
KW  - Rural Health Services
KW  - Life Support Care
KW  - Descriptive Statistics
KW  - Evaluation Research
KW  - California
KW  - Record Review
KW  - Audiorecording
KW  - Clinical Competence -- Evaluation
KW  - Funding Source
KW  - Human
SP  - 343
EP  - 346
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 3
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - OBJECTIVE: To educate rural emergency medical technician basics (EMTs) in selected advanced skills, and then evaluate the safety and effectiveness of practice. METHODS: After a minimum 72 hours of training, EMTs employed three skills (Combitube, glucometry, automated external defibrillation) and seven medications (albuterol, nitroglycerin, naloxone, epinephrine, glucagon, activated charcoal, and aspirin). Written patient care records and audiotapes were reviewed. Congruence between prehospital assessment and emergency department (ED) diagnosis was assessed, along with correct use of airway skills (18 of 36 months). The completeness of documentation, appropriateness of treatment, and patient response (by explicit criteria) were determined. Errors and complications were recorded. RESULTS: During three years of the program, 266 patients were treated, primarily for chest pain and respiratory distress. No significant errors or complications occurred. Treatment was judged 94% appropriate, with improvement in 60% of patients. Documentation had major omissions in 3% of cases. Field and ED diagnostic congruence was present in 97/129 (75%) when evaluated during the first 18 months. EMT skill levels were maintained. The mean time to traditional advanced life support (ALS) care was 41 minutes. CONCLUSIONS: Basic-level EMTs in rural areas can be trained in selected advanced skills, and provide ALS-level care quickly and appropriately. Close medical oversight involving review of care and follow-up education is an important part of the program.
SN  - 1090-3127
AD  - Emergency Medical Services Agency, Public Health Department, County of Imperial, California
U2  - PMID: 10534037.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108191638
T1  - Pulmonary hemorrhage: a rare complication of opioid overdose.
AU  - Porter R
AU  - O'Reilly H
Y1  - 2011/08//2011 Aug
N1  - Accession Number: 108191638. Language: English. Entry Date: 20120323. Revision Date: 20150712. Publication Type: Journal Article; case study. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 8507560. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Hemorrhage -- Chemically Induced
KW  - Lung Diseases -- Chemically Induced
KW  - Morphine -- Adverse Effects
KW  - Adolescence
KW  - Bronchi -- Blood Supply
KW  - Bronchoscopy
KW  - C-Reactive Protein -- Analysis
KW  - Disease Progression
KW  - Emergency Service
KW  - Male
KW  - Naloxone -- Adverse Effects
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Adverse Effects
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Overdose
KW  - Blood Circulation
KW  - Status Asthmaticus -- Diagnosis
SP  - 742
EP  - 744
JO  - Pediatric Emergency Care
JF  - Pediatric Emergency Care
JA  - PEDIATR EMERG CARE
VL  - 27
IS  - 8
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Children and adolescents with pulmonary hemorrhage are infrequently encountered in the emergency department (ED). We describe a case of a 16 year-old boy who presented to a pediatric ED with pulmonary hemorrhage and respiratory distress. The patient's unusual initial presentation resulted in the consideration of a broad differential diagnosis for his symptoms, including traumatic, neurological, respiratory, and toxicological causes. After resuscitation in the ED, a prolonged admission, and extensive testing, no cause could be found other than severe opioid toxicity. This case illustrates a rare, life-threatening presentation of opiod toxicity in a healthy adolescent and underlines the potentially serious nature of such exposures.
SN  - 0749-5161
AD  - From the Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, Canada.
U2  - PMID: 21822085.
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 103891581
T1  - Physician and Nonphysician Health-care Provider Perspectives on Resuscitation of Suspected Drug-related Out-of-Hospital Cardiac Arrest.
AU  - Koller, Allison C.
AU  - Salcido, David D.
AU  - Menegazzi, James J.
Y1  - 2014/10/02/
N1  - Accession Number: 103891581. Language: English. Entry Date: 20140925. Revision Date: 20160325. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Physicians
KW  - Health Personnel
KW  - Resuscitation -- Methods
KW  - Substance Abuse -- Complications
KW  - Outpatients
KW  - Heart Arrest -- Etiology
KW  - Emergency Care
KW  - Prehospital Care
KW  - Human
KW  - Heart Arrest -- Diagnosis
KW  - United States
KW  - Overdose
KW  - Surveys
KW  - Congresses and Conferences
KW  - Emergency Medical Services
KW  - American Heart Association
KW  - Substance Abuse -- Therapy
KW  - Academic Medical Centers
KW  - Research Subject Recruitment
KW  - Decision Making
SP  - 483
EP  - 488
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 18
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Introduction. In the United States, out-of-hospital cardiac arrest from drug overdose (OD-OHCA) caused over 38,000 deaths in 2010. A study in Pittsburgh found that OD-OHCA patients differed demographically and in the resuscitation treatments they received, despite identical AHA resuscitation guidelines. We hypothesized that health-care provider perceptions affect decision-making in the treatment of OD-OHCA versus non-OD OHCA. Methods. We conducted this survey at the National Association of EMS Physicians 2013 Scientific Assembly. Physicians and non-physician health-care providers were given one of two surveys containing 19 questions pertaining to the respondents' affiliated EMS agencies, the estimated proportion of OD-OHCA as well as the drugs involved, and the respondents' belief about the treatments for OD versus non-OD OHCA. Results. One hundred ninety-three respondents participated in this survey. Of the 193, 144 (75%) were physicians and 49 (25%) were nonphysicians. Seventy-nine percent of physicians identified current status as a medical director and 76% of nonphysicians identified as a paramedic. Participants estimated the average monthly proportion of all OHCA due to OD to be 9.4%. Participants ranked opioids, alcohol, antidepressants, and benzodiazepines as the most commonly utilized agents in OD-OHCA. The majority of physicians (42%) felt that the incidence of OD-OHCA was not changing while the majority of nonphysicians (53%) felt the incidence was increasing. Eighty-four percent of all respondents reported the use of naloxone during OD-OHCA resuscitation, while 13% reported administering naloxone during non-OD OHCA resuscitation. Eighty-nine percent of physicians and 67% of nonphysicians indicated that OD-OHCA patients had different demographics than non-OD OHCA, with primary reported differences being age, comorbidities, and socioeconomic status. Sixty-three percent of physicians and 71% of nonphysicians felt that OD-OHCA patients should be treated differently, with primary differences being the incorporation of etiology-specific treatments, performing different CPR with a focus on airway support, and transporting earlier. Conclusions. When surveyed, physicians and nonphysician providers report perceiving OD-OHCA treatment, outcomes, and patient demographics differently than non-OD OHCA and making different treatment decisions based on these perceptions. This may result in etiology-oriented resuscitation in the out-of-hospital setting, despite the lack of OD-specific resuscitation guidelines.
SN  - 1090-3127
U2  - PMID: 24831102.
DO  - 10.3109/10903127.2014.897780
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 112311422
T1  - Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to 2012.
AU  - Kuo, Yong-Fang
AU  - Raji, Mukaila A.
AU  - Chen, Nai-Wei
AU  - Hasan, Hunaid
AU  - Goodwin, James S.
Y1  - 2016/02//
N1  - Accession Number: 112311422. Language: English. Entry Date: 20160517. Revision Date: 20171129. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Instrumentation: Arthritis Impact Measurement Scale (AIMS) (Meenan); Impact of Events Scale (IES). Grant Information: P30-AG024832/AG/NIA NIH HHS/United States. NLM UID: 0267200. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Medicare
KW  - Pain -- Therapy
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Aged
KW  - Female
KW  - Overdose -- Epidemiology
KW  - Male
KW  - Risk Factors
KW  - Chronic Pain -- Drug Therapy
KW  - United States
KW  - Arthritis Impact Measurement Scales
KW  - Impact of Events Scale
SP  - 221.e21
EP  - 221.e30
JO  - American Journal of Medicine
JF  - American Journal of Medicine
JA  - AM J MED
VL  - 129
IS  - 2
PB  - Excerpta Medica Publishing Group
AB  - Background: There is growing concern about potential overuse of, and toxicity from, opioid analgesics. No nationally representative study has examined inter-state variations in opioid use and impact of policy on opioid use among older adults.Methods: We used national Medicare data from 2007-2012 to assess temporal and geographic trends in rates of opioid prescription and relationship to opioid toxicity and different state regulations in Part D Medicare recipients. We excluded those with a cancer diagnosis. Multilevel, multivariable regression analyses evaluated rates of prolonged prescriptions for schedule II, schedule III, and combination II/III opioid for each state, adjusting for patient characteristics.Results: The percent of Part D recipients receiving prescriptions for combined schedule II/III opioid more than 90 days in a year increased from 4.62% in 2007 to 7.35% in 2012. Large variations existed among states in rates of opioid prescriptions: from 2.84% in New York to 10.93% in Utah, in 2012 data. The state variation was larger for schedule III than schedule II. Individual characteristics independently associated with prolonged use included older age, female gender, white race, low income, living in a lower-education area, and comorbidity of drug abuse, rheumatoid arthritis, and depression. Only state law regulating pain clinic was associated with reduction of schedule II opioid prescriptions. Prolonged opioid prescription use increased the odds of opioid overdose-related emergency room visits or hospitalization by 60%.Conclusions: Analyses of Medicare Part D data demonstrated a substantial growth in opioid prescriptions from 2007 to 2011 and large variation in opioid prescriptions across states.
SN  - 0002-9343
AD  - Department of Internal Medicine, The University of Texas Medical Branch, Galveston
AD  - Sealy Center on Aging, The University of Texas Medical Branch, Galveston
AD  - Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston
AD  - Institute for Translational Science, The University of Texas Medical Branch, Galveston
U2  - PMID: 26522794.
DO  - 10.1016/j.amjmed.2015.10.002
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105215813
T1  - Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters.
AU  - Stanley B
AU  - Sher L
AU  - Wilson S
AU  - Ekman R
AU  - Huang YY
AU  - Mann JJ
AU  - Stanley, Barbara
AU  - Sher, Leo
AU  - Wilson, Scott
AU  - Ekman, Rolf
AU  - Huang, Yung-yu
AU  - Mann, J John
Y1  - 2010/07//
N1  - Accession Number: 105215813. Language: English. Entry Date: 20100903. Revision Date: 20161204. Publication Type: journal article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Psychiatry/Psychology. Grant Information: R01 MH062665-05/MH/NIMH NIH HHS/United States. NLM UID: 7906073. 
KW  - Opioid Peptides -- Cerebrospinal Fluid
KW  - Enkephalins -- Cerebrospinal Fluid
KW  - Acids, Carbocyclic
KW  - Indoles -- Cerebrospinal Fluid
KW  - Personality Disorders -- Cerebrospinal Fluid
KW  - Self-Injurious Behavior -- Cerebrospinal Fluid
KW  - Suicide, Attempted -- Psychosocial Factors
KW  - Endorphins -- Cerebrospinal Fluid
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Arousal -- Physiology
KW  - Female
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Personality Disorders -- Psychosocial Factors
KW  - Reference Values
KW  - Self-Injurious Behavior -- Psychosocial Factors
KW  - Young Adult
SP  - 134
EP  - 140
JO  - Journal of Affective Disorders
JF  - Journal of Affective Disorders
JA  - J AFFECT DISORD
VL  - 124
IS  - 1/2
PB  - Elsevier B.V.
AB  - Background: Self-inflicted injury, including cutting or burning, is the most frequent reason for psychiatric visits to medical emergency departments. This behavior, particularly when there is no apparent suicidal intent, is poorly understood from both biological and clinical perspectives.Objective: To examine the role of endogenous opioids and monoamine neurotransmitters in non-suicidal self-injury (NSSI).Methods: We compared cerebrospinal fluid (CSF) levels of endogenous opioids, 5 hydroxyindolacetic acid (5-HIAA) and homovanillic acid (HVA) in individuals with a history of repetitive non-suicidal self-injury with a diagnostically-matched group of individuals who had never engaged in non-suicidal self-injury. History of suicidal behavior, demographic background and psychopathology was assessed. All patients were diagnosed with a Cluster B personality disorder (i.e. borderline, antisocial, narcissistic or histrionic) (N=29) and had a history of at least one suicide attempt. Fourteen participants had a history of repeated non-suicidal self-injurious behavior (NSSI) in adulthood and 15 did not (no NSSI).Results: The NSSI group had significantly lower levels of CSF beta-endorphin and met-enkephalin when compared with the non-NSSI group. CSF dynorphin, HVA and 5-HIAA levels did not differ. Severity of depression, hopelessness and overall psychopathology was greater in the NSSI group.Conclusion: beta-endorphin and met-enkephalin, opioids acting upon receptors involved in mediating stress-induced and physical pain analgesia respectively, are implicated in NSSI. Serotonergic and dopaminergic dysfunctions do not appear to be related to NSSI. Based on our findings, we propose a model of non-suicidal self-injury. Our results suggest that drugs acting on the opioid system warrant exploration as pharmacological treatments for NSSI.
SN  - 0165-0327
AD  - Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York 10032, USA
AD  - Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York 10032, USA. bhs2@columbia.edu
U2  - PMID: 19942295.
DO  - 10.1016/j.jad.2009.10.028
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103885645
T1  - Are Discharge Prescriptions of Opioids From the Emergency Department Truly Rising?
AU  - Kea, Bory
AU  - Fu, Rochelle
AU  - Deyo, Richard A.
AU  - Sun, Benjamin C.
Y1  - 2014/08//
N1  - Accession Number: 103885645. Language: English. Entry Date: 20140903. Revision Date: 20150803. Publication Type: Journal Article; letter. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9418450. 
KW  - Prescribing Patterns -- Evaluation
KW  - Patient Discharge
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Service
KW  - Emergency Medicine
KW  - Overdose
KW  - Public Policy
KW  - Safety
KW  - Oxycodone -- Administration and Dosage
SP  - 946
EP  - 946
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 21
IS  - 8
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
AD  - Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University
AD  - Department of Public Health and Preventive Medicine, Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University
AD  - Kaiser Permanente Professor of Evidence-Based Family Medicine, Department of Family Medicine, Department of Medicine, Department of Public Health & Preventive Medicine, Oregon Health & Science University
U2  - PMID: 25156157.
DO  - 10.1111/acem.12425
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105112917
T1  - The optimum intravenous dose of opioid analgesics in treating acute pain in the emergency department: an evidence-based approach to a controversial issue.
AU  - Motov SM
Y1  - 2010///2010 Fall
N1  - Accession Number: 105112917. Language: English. Entry Date: 20101126. Revision Date: 20150711. Publication Type: Journal Article; review. Journal Subset: Biomedical; Expert Peer Reviewed; USA. Special Interest: Emergency Care; Evidence-Based Practice; Pain and Pain Management. 
KW  - Administration, Intravenous
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Care
KW  - Medical Practice, Evidence-Based
KW  - Pain -- Drug Therapy
KW  - Adult
KW  - Aged
KW  - Child
KW  - Dihydromorphinone -- Administration and Dosage
KW  - Dosage Calculation
KW  - Dose-Response Relationship, Drug
KW  - Drug Monitoring
KW  - Emergency Patients
KW  - Emergency Service
KW  - Fentanyl -- Administration and Dosage
KW  - Meperidine -- Administration and Dosage
KW  - Morphine -- Administration and Dosage
KW  - Pain Measurement
KW  - Treatment Outcomes
SP  - 30
EP  - 33
JO  - Pain Practitioner
JF  - Pain Practitioner
JA  - PAIN PRACT
VL  - 20
IS  - 3
CY  - Sonora, California
PB  - American Academy of Pain Management
AD  - Assistant Professor Clinical Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York, NY, USA
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107945734
T1  - Guidelines for opioid prescription: why emergency physicians need support.
AU  - Kunins, Hillary V
AU  - Farley, Thomas A
AU  - Dowell, Deborah
Y1  - 2013/06/04/
N1  - Accession Number: 107945734. Language: English. Entry Date: 20130816. Revision Date: 20150712. Publication Type: Journal Article. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. NLM UID: 0372351. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Prescriptions, Drug
KW  - Emergency Service
KW  - Practice Guidelines
KW  - Chronic Pain -- Drug Therapy
KW  - Medical Practice, Evidence-Based
KW  - New York
KW  - Substance Use Disorders
KW  - Patient Discharge
KW  - United States
SP  - 841
EP  - 842
JO  - Annals of Internal Medicine
JF  - Annals of Internal Medicine
JA  - ANN INTERN MED
VL  - 158
IS  - 11
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
SN  - 0003-4819
AD  - New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA.
U2  - PMID: 23567824.
DO  - 10.7326/0003-4819-158-11-201306040-00631
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106235142
T1  - Linking opioid-dependent hospital patients to drug treatment: health care use and costs 6 months after randomization.
AU  - Barnett PG
AU  - Masson CL
AU  - Sorensen JL
AU  - Wong W
AU  - Hall S
Y1  - 2006/12//
N1  - Accession Number: 106235142. Language: English. Entry Date: 20070216. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Instrumentation: Addictions Severity Index (ASI). Grant Information: Supported by grants from the National Institute on Drug Abuse (P50DA14922, K05DA16752, K01DA00408, U10DA15815, R01DA14922). NLM UID: 9304118. 
KW  - Case Management
KW  - Health Care Costs -- California
KW  - Narcotics
KW  - Substance Dependence -- Therapy
KW  - California
KW  - Chi Square Test
KW  - Clinical Trials
KW  - Emergency Service
KW  - Funding Source
KW  - Health Resource Utilization
KW  - Hospitals, Public
KW  - Interviews
KW  - Intravenous Drug Users
KW  - Kruskal-Wallis Test
KW  - Mann-Whitney U Test
KW  - Methadone -- Therapeutic Use
KW  - Post Hoc Analysis
KW  - Random Assignment
KW  - Regression
KW  - Repeated Measures
KW  - Research Instruments
KW  - Self Report
KW  - Wilcoxon Rank Sum Test
KW  - Human
SP  - 1797
EP  - 1804
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 101
IS  - 12
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 0965-2140
AD  - Department of Psychiatry, University of California, San Francisco, San Francisco General Hospital, San Francisco, CA, USA
U2  - PMID: 17156179.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106235142&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106545680
T1  - Reducing hospital presentations for opioid overdose in patients treated with sustained release naltrexone implants.
AU  - Hulse GK
AU  - Tait RJ
AU  - Comer SD
AU  - Sullivan MA
AU  - Jacobs IG
AU  - Arnold-Reed D
AU  - Hulse, Gary K
AU  - Tait, Robert J
AU  - Comer, Sandra D
AU  - Sullivan, Maria A
AU  - Jacobs, Ian G
AU  - Arnold-Reed, Diane
Y1  - 2005/09//
N1  - Accession Number: 106545680. Language: English. Entry Date: 20051202. Revision Date: 20161114. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: 3P50 DA 009236-10S2/DA/NIDA NIH HHS/United States. NLM UID: 7513587. 
KW  - Drug Implants
KW  - Naltrexone -- Administration and Dosage
KW  - Naltrexone -- Therapeutic Use
KW  - Narcotics -- Poisoning
KW  - Overdose -- Prevention and Control
KW  - Substance Abuse -- Drug Therapy
KW  - Adult
KW  - Databases, Health
KW  - Descriptive Statistics
KW  - Emergency Service
KW  - Female
KW  - Hospitalization
KW  - Hypnotics and Sedatives -- Poisoning
KW  - Male
KW  - Pretest-Posttest Design
KW  - Substance Abusers
KW  - Western Australia
KW  - Funding Source
KW  - Human
SP  - 351
EP  - 357
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 79
IS  - 3
PB  - Elsevier B.V.
AB  - Background: Non-fatal overdoses represent a significant morbidity for regular heroin users. Naltrexone is an opioid antagonist capable of blocking the effects of heroin, thereby preventing accidental overdose. However, treatment with oral naltrexone is often associated with non-compliance. An alternative is the use of a sustained release preparation of naltrexone. The aim of this study was to assess the change in number of opioid and other drug overdoses in a large cohort of heroin dependent persons (n=361; 218 males) before and after treatment with a sustained release naltrexone implant. A sub-group of this cohort (n=146; 83 males) had previously received treatment with oral naltrexone, which also allowed a comparison of overdoses pre- and post-oral and also post-implant treatments.Method: We used a pre-post design, with data prospectively collected via the West Australian Health Services Research Linked Database, and the Emergency Department Information System. Participants were treated under the Australian Therapeutic Goods Administration's special access guidelines.Results: Most (336, 93%) of the cohort was in one or both databases. We identified 21 opioid overdoses involving 20 persons in the 6 months pre-treatment that required emergency department presentation or hospital admission: none were observed in the 6 months post-treatment. This is consistent with the existing pharmacokinetic data on this implant, which indicates maintenance of blood naltrexone levels at or above 2 ng/ml for approximately 6 months. A reduced number of opioid overdoses were also observed 7-12 months post-implant. The study found a significant increase in sedative "overdoses", some of which occurred in the 10 days following implant treatment and were likely associated with opioid withdrawal and/or implant treatment. For those previously treated with oral naltrexone, more opioid overdoses occurred in both the 6-months prior to and after oral compared to the 6-months post-implant treatment.Conclusions: The findings support the clinical efficacy of this sustained release naltrexone implant in preventing opioid overdose. However, given the high prevalence of poly-substance use among dependent heroin users, programs offering this type of treatment should also focus on preventing, detecting and managing poly-substance use.
SN  - 0376-8716
AD  - School of Psychiatry & Clinical Neurosciences, University of Western Australia, QE II Medical Centre, Nedlands, WA 6009, Australia
U2  - PMID: 15899557.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104573783
T1  - A qualitative evaluation of a peer-implemented overdose response pilot project in Gejiu, China.
AU  - Bartlett N
AU  - Xin D
AU  - Zhang H
AU  - Huang B
Y1  - 2011/07//
N1  - Accession Number: 104573783. Language: English. Entry Date: 20120323. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9014759. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Harm Reduction
KW  - Telephone Information Services
KW  - Substance Use Disorders -- Psychosocial Factors
KW  - Substance Use Disorders -- Therapy
KW  - Peer Group
KW  - Street Drugs -- Poisoning
KW  - Adult
KW  - Attitude of Health Personnel
KW  - China
KW  - Privacy and Confidentiality
KW  - Economic Aspects of Illness
KW  - Female
KW  - Heroin -- Poisoning
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Substance Use Disorders -- Economics
KW  - Substance Use Disorders -- Epidemiology
KW  - Organizations -- Economics
KW  - Overdose
KW  - Pilot Studies
KW  - Risk Factors
KW  - Urban Health Services -- Economics
SP  - 301
EP  - 305
JO  - International Journal of Drug Policy
JF  - International Journal of Drug Policy
JA  - INT J DRUG POLICY
VL  - 22
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
AB  - BACKGROUND: A harm reduction NGO in southern Yunnan operating an emergency overdose response hotline service successfully reversed 76 overdoses through the administration of naloxone in one of the first interventions of its kind in China. METHOD: To explore local understandings of risk factors related to overdose, assess ongoing barriers to overdose response, and solicit client input on how to further reduce opiate overdose mortality in Gejiu, the authors conducted qualitative interviews with 30 clients, including 15 individuals who received naloxone injections to reverse an overdose and 15 individuals who called the hotline in response to the overdose of a peer. RESULTS: Participants pointed to a number of local structural shifts in heroin use including the ageing of the opiate using population and drug mixing practises that contribute to the city's overdose toll. Concerns over medical professionals' willingness to treat drug users, protection of confidentiality, and financial costs associated with treatment frequently cause drug users to avoid contact with the city's emergency service providers. Participants suggest directly distributing naloxone to clients as one strategy to further reduce overdose mortality. CONCLUSION: The authors explore possible strategies, including targeted trainings and new partnerships with local hospitals, to further reduce opiate overdose mortality in this resource-poor setting.
SN  - 0955-3959
AD  - University of California, San Francisco, Department of Anthropology, History and Social Medicine, United States.
U2  - PMID: 21658931.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104357313
T1  - What is the Role of Urine Drug Testing (UDT) in the Management of Chronic Non-Cancer Pain with Opioids?
AU  - Schonwald, Gabriel
Y1  - 2012/07//
N1  - Accession Number: 104357313. Language: English. Entry Date: 20121226. Revision Date: 20150711. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 100894201. 
KW  - Urinalysis
KW  - Substance Abuse Detection -- Methods
KW  - Analgesics, Opioid
KW  - Pain
KW  - Medical Practice
KW  - Serial Publications
KW  - Emergency Service
KW  - Substance Abusers
SP  - 853
EP  - 856
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 13
IS  - 7
PB  - Oxford University Press / USA
SN  - 1526-2375
AD  - Adjunct Clinical Assistant Professor, Stanford University School of Medicine, Department of Anesthesia, Pain Management Division
U2  - PMID: 22804903.
DO  - 10.1111/j.1526-4637.2012.01440.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108025379
T1  - Pain in the Emergency Department: Mysterious Pattern Of Opioid Prescriptions--and Passionate Debate About It.
Y1  - 2013/02//2013 Feb
N1  - Accession Number: 108025379. Language: English. Entry Date: 20130308. Revision Date: 20150712. Publication Type: Journal Article; pictorial. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management; Physical Therapy. NLM UID: 9884284. 
KW  - Emergency Service
KW  - Narcotics -- Administration and Dosage
KW  - Substance Abuse
SP  - 16
EP  - 17
JO  - Back Letter
JF  - Back Letter
JA  - BACKLETTER
VL  - 28
IS  - 2
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 0894-7376
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 110359360
T1  - Addressing the Opioid Epidemic.
AU  - Nelson, Lewis S.
AU  - Juurlink, David N.
AU  - Perrone, Jeanmarie
Y1  - 2015/10/13/
N1  - Accession Number: 110359360. Language: English. Entry Date: 20151017. Revision Date: 20161112. Publication Type: commentary; editorial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Drug Therapy -- Trends
KW  - Substance Use Disorders -- Epidemiology
KW  - Substance Use Disorders -- Therapy
KW  - Male
KW  - Female
SP  - 1453
EP  - 1454
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 314
IS  - 14
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - The authors discuss the opioid epidemic and ways to address the problem, with opioid as the second most common cause of poisoning in patients being presented to North American emergency departments. They explore a study by Han and colleagues within the issue of the journal on the trend opioid epidemic in the U.S. which found a decreasing overall trends in self-reported nonmedical use of prescription opioids, but with increased prevalence of prescription opioid use disorders and mortality.
SN  - 0098-7484
AD  - Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
AD  - Sunnybrook Research Institute, Toronto, Ontario, Canada
AD  - Department of Medicine, University of Toronto, Toronto, Ontario, Canada
U2  - PMID: 26461995.
DO  - 10.1001/jama.2015.12397
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118832281
T1  - Opioid epidemic brings OTPs into R.I. corrections system.
AU  - Knopf, Alison
Y1  - 2016/10/17/
N1  - Accession Number: 118832281. Language: English. Entry Date: 20161023. Revision Date: 20170417. Publication Type: Article. Journal Subset: Editorial Board Reviewed; Health Services Administration; Peer Reviewed; USA. NLM UID: 9000784. 
KW  - Substance Use Rehabilitation Programs
KW  - Substance Use Disorders -- Drug Therapy
KW  - Methadone -- Therapeutic Use
KW  - Buprenorphine -- Therapeutic Use
KW  - Correctional Facilities -- Rhode Island
KW  - Rhode Island
KW  - Medicaid
KW  - Emergency Service
KW  - Health Services Accessibility
KW  - Referral and Consultation
SP  - 5
EP  - 6
JO  - Alcoholism & Drug Abuse Weekly
JF  - Alcoholism & Drug Abuse Weekly
JA  - ALCOHOL DRUG ABUSE WKLY
VL  - 28
IS  - 40
CY  - Hoboken, New Jersey
PB  - John Wiley & Sons, Inc.
AB  - The article reports that opioid abusing patients of the Rhode Island correction facility are being treated with methadone and buprenorphine drugs under the opioid treatment program (OTP). Topics discussed include significance of medication treatment of abusers over abstinence-based treatment; regular interaction of opioid users with prisons and courts; importance of the drugs; and views of Miriam Hospital's director of the Center for Prisoner Health and Human Rights Josiah D. Rich on the same.
SN  - 1042-1394
DO  - 10.1002/adaw.30739
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105159634
T1  - Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA.
AU  - Wagner KD
AU  - Valente TW
AU  - Casanova M
AU  - Partovi SM
AU  - Mendenhall BM
AU  - Hundley JH
AU  - Gonzalez M
AU  - Unger JB
AU  - Wagner, Karla D
AU  - Valente, Thomas W
AU  - Casanova, Mark
AU  - Partovi, Susan M
AU  - Mendenhall, Brett M
AU  - Hundley, James H
AU  - Gonzalez, Mario
AU  - Unger, Jennifer B
Y1  - 2010/05//
N1  - Accession Number: 105159634. Language: English. Entry Date: 20100709. Revision Date: 20161119. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: R01 DA016310/DA/NIDA NIH HHS/United States. NLM UID: 9014759. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Education
KW  - Homeless Persons -- Education
KW  - Overdose -- Prevention and Control
KW  - Patient Education -- Methods
KW  - Adult
KW  - California
KW  - Female
KW  - Attitude to Health
KW  - Male
KW  - Middle Age
KW  - Naloxone -- Therapeutic Use
KW  - Overdose -- Drug Therapy
KW  - Program Evaluation
KW  - Substance Abuse, Intravenous -- Mortality
SP  - 186
EP  - 193
JO  - International Journal of Drug Policy
JF  - International Journal of Drug Policy
JA  - INT J DRUG POLICY
VL  - 21
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Background: Fatal opioid overdose is a significant cause of mortality among injection drug users (IDUs).Methods: We evaluated an overdose prevention and response training programme for IDUs run by a community-based organisation in Los Angeles, CA. During a 1-h training session participants learned skills to prevent, recognise, and respond to opioid overdoses, including: calling for emergency services, performing rescue breathing, and administering an intramuscular injection of naloxone (an opioid antagonist). Between September 2006 and January 2008, 93 IDUs were trained. Of those, 66 (71%) enrolled in the evaluation study and 47 participants (71%) completed an interview at baseline and 3-month follow-up.Results: Twenty-one percent of participants were female, 42% were white, 29% African American, and 18% Latino. Most were homeless or lived in temporary accommodation (73%). We found significant increases in knowledge about overdose, in particular about the use of naloxone. Twenty-two participants responded to 35 overdoses during the follow-up period. Twenty-six overdose victims recovered, four died, and the outcome of five cases was unknown. Response techniques included: staying with the victim (85%), administering naloxone (80%), providing rescue breathing (66%), and calling emergency services (60%). The average number of appropriate response techniques used by participants increased significantly from baseline to follow-up (p<0.05). Half (53%) of programme participants reported decreased drug use at follow-up.Conclusion: Overdose prevention and response training programmes may be associated with improved overdose response behaviour, with few adverse consequences and some unforeseen benefits, such as reductions in personal drug use.
SN  - 0955-3959
AD  - Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, CA 91803, USA
AD  - Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, CA 91803, USA. kdwagner@usc.edu
U2  - PMID: 19268564.
DO  - 10.1016/j.drugpo.2009.01.003
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105159634&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107930158
T1  - Toxicologic Emergencies in the Intensive Care Unit.
AU  - Patel, Sruti R.
Y1  - 2013/10//Oct-Dec2013
N1  - Accession Number: 107930158. Language: English. Entry Date: 20131015. Revision Date: 20150712. Publication Type: Journal Article. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Special Interest: Critical Care; Emergency Care. NLM UID: 8704517. 
KW  - Poisoning -- Drug Therapy
KW  - Overdose -- Drug Therapy
KW  - Antidotes -- Therapeutic Use
KW  - Insulin -- Therapeutic Use
KW  - Glucagon -- Therapeutic Use
KW  - Flumazenil -- Therapeutic Use
KW  - Fat Emulsions, Intravenous -- Therapeutic Use
KW  - Naloxone -- Therapeutic Use
KW  - Acetylcysteine -- Therapeutic Use
KW  - Sodium Bicarbonate -- Therapeutic Use
KW  - Emergencies
KW  - Intensive Care Units
KW  - Ethanol -- Poisoning
KW  - Methanol -- Poisoning
KW  - Ethylene Glycols -- Poisoning
KW  - Antidotes -- Administration and Dosage
KW  - Drug Toxicity
KW  - Calcium Channel Blockers -- Poisoning
KW  - Receptors, Adrenergic, Beta -- Poisoning
KW  - Insulin -- Administration and Dosage
KW  - Infusions, Intravenous
KW  - Antianxiety Agents, Benzodiazepine -- Poisoning
KW  - Injections, Intravenous
KW  - Narcotics -- Poisoning
KW  - Acetaminophen -- Poisoning
KW  - Hepatotoxicity -- Prevention and Control
KW  - Acetylcysteine -- Administration and Dosage
KW  - Antidepressive Agents, Tricyclic -- Poisoning
KW  - Salicylates -- Poisoning
KW  - Inpatients
SP  - 335
EP  - 344
JO  - Critical Care Nursing Quarterly
JF  - Critical Care Nursing Quarterly
JA  - CRIT CARE NURS Q
VL  - 36
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - Purpose: To review the most common drugs implicated in overdoses admitted to the intensive care unit focusing on antidotes and reversal agents used in their management. Summary: Poisonings and overdoses due to pharmaceutical agents result in more than 100 000 critical care unit admissions each year. Ingestion of toxic alcohols, calcium channel blockers, beta-adrenergic antagonists, benzodiazepines, opioids, acetaminophen, tricyclic antidepressants, and salicylates are associated with a high rate of morbidity and mortality. Reviewing the mechanism of toxicity due to specific agents along with the mechanism of action, dosing, and adverse effects of appropriate antidotes is important for the successful management of these patients within the critical care unit. Conclusion: Understanding the most prevalent overdoses and their management using reversal agents and antidotes is essential to the overall treatment of these critically ill patients.
SN  - 0887-9303
AD  - Emergency Department, John Peter Smith Hospital, Fort Worth, Texas
U2  - PMID: 24002424.
DO  - 10.1097/CNQ.0b013e3182a10cbd
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107930158&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110536901
T1  - Rhode Island links naloxone rescues to treatment.
Y1  - 2015/10/26/
N1  - Accession Number: 110536901. Language: English. Entry Date: 20151028. Revision Date: 20160425. Publication Type: Article. Journal Subset: Editorial Board Reviewed; Health Services Administration; Peer Reviewed; USA. Special Interest: Emergency Care; Psychiatry/Psychology. NLM UID: 9000784. 
KW  - Naloxone -- Therapeutic Use
KW  - Substance Use Disorders -- Rehabilitation -- Rhode Island
KW  - Overdose -- Drug Therapy
KW  - Early Intervention
KW  - Emergency Service
KW  - Rhode Island
KW  - Program Implementation
KW  - Substance Withdrawal, Controlled
SP  - 5
EP  - 6
JO  - Alcoholism & Drug Abuse Weekly
JF  - Alcoholism & Drug Abuse Weekly
JA  - ALCOHOL DRUG ABUSE WKLY
VL  - 27
IS  - 41
CY  - Hoboken, New Jersey
PB  - John Wiley & Sons, Inc.
AB  - The article discusses the substance abuse program in Rhode Island in which people who are overdosed on opioids and were rescued with naloxone are being connected to treatment in hospitals. The said program is funded by the state's Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (DBHDDH). Information on the program called AnchorED that supplies recovery coaches to hospitals is offered.
SN  - 1042-1394
DO  - 10.1002/adaw
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106779066
T1  - Variability in emergency physician decisionmaking about prescribing opioid analgesics.
AU  - Tamayo-Sarver JH
AU  - Dawson NV
AU  - Cydulka RK
AU  - Wigton RS
AU  - Baker DW
Y1  - 2004/04//2004 Apr
N1  - Accession Number: 106779066. Language: English. Entry Date: 20040924. Revision Date: 20150818. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Grant Information: Agency for Health Care Research and Quality Training Grant HS-00059-06 and grant R03 HS11948-01, and Case Western Reserve University. NLM UID: 8002646. 
KW  - Decision Making, Clinical
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Medicine
KW  - Models, Theoretical
KW  - Vignettes
KW  - Medical Practice
KW  - Scales
KW  - Surveys
KW  - Random Sample
KW  - Coefficient Alpha
KW  - Spearman's Rank Correlation Coefficient
KW  - Data Analysis Software
KW  - Funding Source
KW  - Human
SP  - 483
EP  - 493
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 43
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
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.
SN  - 0196-0644
AD  - Dept of Emergency Medicine, MetroHealth Medical Center, Cleveland, OH
U2  - PMID: 15039692.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103916921
T1  - CORRECTION: Take-home emergency naloxone to prevent deaths from heroin overdose.
Y1  - 2014/11/15/
N1  - Accession Number: 103916921. Language: English. Entry Date: 20141118. Revision Date: 20150710. Publication Type: Journal Article; corrected article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. 
KW  - Naloxone -- Therapeutic Use
SP  - 10
EP  - 10
JO  - BMJ: British Medical Journal
JF  - BMJ: British Medical Journal
JA  - BMJ BR MED J
VL  - 349
IS  - 7983
PB  - BMJ Publishing Group
SN  - 1756-1833
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103916921&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103915332
T1  - Take-home emergency naloxone to prevent deaths from heroin overdose.
AU  - Strang, John
AU  - Bird, Sheila M.
AU  - Dietze, Paul
AU  - Gerra, Gilberto
AU  - McLellan, A. Thomas
Y1  - 2014/11/08/
N1  - Accession Number: 103915332. Language: English. Entry Date: 20141111. Revision Date: 20150710. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. 
KW  - Emergencies
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Administration and Dosage
KW  - Death -- Prevention and Control
KW  - Overdose
KW  - Heroin -- Adverse Effects
KW  - Serial Publications
KW  - United Kingdom
KW  - World Health Organization
KW  - Practice Guidelines
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Physicians -- Education
KW  - Emergency Medical Technicians -- Education
SP  - g6580
EP  - g6580
JO  - BMJ: British Medical Journal
JF  - BMJ: British Medical Journal
JA  - BMJ BR MED J
VL  - 349
IS  - 7982
PB  - BMJ Publishing Group
SN  - 1756-1833
AD  - Professor, National Addiction Centre (Institute of Psychiatry and Maudsley), King's College London, London SE5 8AF, UK
AD  - Professor, Biostatistics Unit, Cambridge CB2 0SR, UK
AD  - Professor, Burnet Institute, Melbourne, Australia
AD  - Chief, UNODC Drug Prevention and Health Branch Division, United Nations Office on Drugs and Crime, Vienna, Austria
AD  - Chief executive officer, Treatment Research Institute, Philadelphia, PA 19106, USA
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103915332&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 
TY  - JOUR
ID  - 104785765
T1  - Opiate and cocaine consumers attending Barcelona emergency rooms: a one year survey (1989)
AU  - Domingo-Salvany, A
AU  - Hartnoll, R L
AU  - Antó, J M
Y1  - 1993/09//
N1  - Accession Number: 104785765. Language: English. Entry Date: 20110610. Revision Date: 20170831. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Cocaine
KW  - Emergency Service -- Utilization
KW  - Substance Use Disorders -- Epidemiology
KW  - Adolescence
KW  - Adult
KW  - Age Factors
KW  - Female
KW  - Surveys
KW  - Documentation
KW  - Hospitalization
KW  - Human
KW  - Male
KW  - Prevalence
KW  - Reproducibility of Results
KW  - Retrospective Design
KW  - Sex Factors
KW  - Spain
SP  - 1247
EP  - 1256
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 88
IS  - 9
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Due to the limitations of standard epidemiological methods, indirect indicators have often been used to describe the characteristics of drug abusing populations and to assess prevalence trends in illegal drug use. In Barcelona (Spain), a study of emergency room (ER) attendance was carried out to describe the population of opiate/cocaine consumers across the whole city who use this service. Three thousand four hundred and five consumers of opiates and/or cocaine, aged 15-44 years, who attended ERs during 1989, were identified. They accounted for 6807 episodes in the hospitals surveyed. Their mean age was 26 years, men (73%) being 1 year older than women (25.2 years). The drug of abuse was specified in the clinical records of 60% of individuals, heroin being the most frequently specified (56%). The main reason for attendance was 'other medical condition' (OMC) (55% of episodes), followed by withdrawal (34%) and overdoses (6%). Seventy-one percent of individuals were residents of Barcelona city, yielding a rate of 3.2 opiate/cocaine consumers attending ERs per thousand Barcelona residents aged 15-44. The geographical distribution of the rates in the city showed a very large difference between districts, the most deprived ones having a higher rate of consumers attending ERs. ER data can provide valuable insights into the nature and dimensions of drug abuse problems.
SN  - 0965-2140
AD  - Institut Municipal d'Investigació Médica, Barcelona, Spain.
U2  - PMID: 8241924.
DO  - 10.1111/j.1360-0443.1993.tb02147.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107943050
T1  - Associations between public health indicators and injecting prescription opioids by prescription opioid abusers in substance abuse treatment.
AU  - Black, Ryan A
AU  - Trudeau, Kimberlee J
AU  - Cassidy, Theresa A
AU  - Budman, Simon H
AU  - Butler, Stephen F
Y1  - 2013/01//2013 Jan-Feb
N1  - Accession Number: 107943050. Language: English. Entry Date: 20130719. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101234523. 
KW  - Substance Abusers
KW  - Substance Use Disorders -- Rehabilitation
KW  - Public Health
KW  - Substance Use Rehabilitation Programs
KW  - Substance Abuse, Intravenous -- Rehabilitation
KW  - Adult
KW  - Chemistry, Pharmaceutical
KW  - Economic Aspects of Illness
KW  - Cross Sectional Studies
KW  - Emergency Service
KW  - Female
KW  - HIV Infections
KW  - Homeless Persons
KW  - Human
KW  - Injections, Intravenous
KW  - Linear Regression
KW  - Liver Diseases
KW  - Logistic Regression
KW  - Male
KW  - Odds Ratio
KW  - Substance Use Disorders
KW  - Drugs, Prescription
KW  - Questionnaires -- Utilization
KW  - Substance Abuse, Intravenous
KW  - Unemployment
KW  - United States
SP  - 5
EP  - 17
JO  - Journal of Opioid Management
JF  - Journal of Opioid Management
JA  - J OPIOID MANAGE
VL  - 9
IS  - 1
CY  - Weston, Massachusetts
PB  - Weston Medical Publishing, LLC
SN  - 1551-7489
AD  - Nova Southeastern University, Ft. Lauderdale, Florida.
U2  - PMID: 23709299.
DO  - 10.5055/jom.2013.0142
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107943050&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120757665
T1  - Managing Pain without Opiates or the Pain Scale...Alexis LaPietra
AU  - WALKER, GRAHAM
Y1  - 2017/01//
N1  - Accession Number: 120757665. Language: English. Entry Date: 20170308. Revision Date: 20170308. Publication Type: Article; interview; pictorial. Journal Subset: Biomedical; USA. Special Interest: Pain and Pain Management. NLM UID: 9000866. 
KW  - Pain -- Drug Therapy
KW  - Narcotics -- Adverse Effects
KW  - Substance Dependence -- Prevention and Control
KW  - Emergency Service
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Prescribing Patterns
KW  - Substance Abuse -- Prevention and Control
KW  - Trigger Point
KW  - Injections, Intramuscular -- Methods
KW  - Staff Development
KW  - Health Education
KW  - Narcotics -- Economics
KW  - LaPietra A
SP  - 24
EP  - 25
JO  - Emergency Medicine News
JF  - Emergency Medicine News
JA  - EMERG MED NEWS
VL  - 39
IS  - 1
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 1054-0725
AD  - Emergency physician at Kaiser San Francisco
AD  - Developer and co-creator of MDCalc
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 121432801
T1  - A 35-year-old woman with low mood and concerns about her alcohol use.
AU  - Samokhvalov, Andriy V.
AU  - Le Foll, Bernard
Y1  - 2017/02/27/
N1  - Accession Number: 121432801. Language: English. Entry Date: 20170421. Revision Date: 20180302. Publication Type: journal article; case study. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Instrumentation: Longitudinal Interval Follow-Up Evaluation (LIFE); Social Readjustment Rating Scale (SRRS) (Holmes and Rahe). NLM UID: 9711805. 
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Depression -- Drug Therapy
KW  - Naltrexone -- Therapeutic Use
KW  - Alcoholism -- Therapy
KW  - Antidepressive Agents -- Therapeutic Use
KW  - Sertraline Hydrochloride -- Therapeutic Use
KW  - Counseling
KW  - Depression -- Complications
KW  - Patient Care Plans
KW  - Female
KW  - Depression -- Diagnosis
KW  - Alcoholism -- Complications
KW  - Alcoholism -- Diagnosis
KW  - Adult
KW  - Social Readjustment Rating Scale
SP  - E317
EP  - E318
JO  - CMAJ: Canadian Medical Association Journal
JF  - CMAJ: Canadian Medical Association Journal
JA  - CMAJ
VL  - 289
IS  - 8
CY  - Ottowa, Ontario
PB  - Joule Inc.
AB  - The article presents a case study of a 35-year-old single woman with concerns about her alcohol use and emotional problems. It mentions drinking has affected her relationships and social life and emergency department showed moderately elevated serum levels of γ-glutamyltransferase, aspartate transaminase and alanine transaminase, and a larger mean corpuscular volume. It also mentions diagnosis of alcohol use disorder and monitoring by abstinence.
SN  - 0820-3946
AD  - Addictions Division Institute for Mental Health Policy Research
AD  - Department of Psychiatry, Faculty of Medicine; Institute of Medical Science
AD  - Translational Addiction Research Laboratory and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health
AD  - Departments of Pharmacology and Toxicology, and Family and Community Medicine, University of Toronto, Toronto, Ont
U2  - PMID: 28246225.
DO  - 10.1503/cmaj.160132
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104513394
T1  - Antidotes for toxicological emergencies: A practical review.
AU  - Marraffa, Jeanna M.
AU  - Cohen, Victor
AU  - Howland, Mary Ann
Y1  - 2012/02//2/1/2012
N1  - Accession Number: 104513394. Language: English. Entry Date: 20120306. Revision Date: 20150711. Publication Type: Journal Article; review. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9503023. 
KW  - Antidotes -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Pharmacy Service
KW  - Drug Monitoring
KW  - Antidotes -- Pharmacodynamics
KW  - Drug Toxicity -- Drug Therapy
KW  - Emergency Care
KW  - Time Factors
KW  - Inventories
KW  - Methanol -- Poisoning
KW  - Ethanol -- Administration and Dosage
KW  - Ethylene Glycols -- Metabolism
KW  - Alcoholic Intoxication -- Complications
KW  - Calcium Channel Blockers -- Poisoning
KW  - Adrenergic Beta-Antagonists -- Poisoning
KW  - Blood Glucose Monitoring
KW  - Calcium Chloride -- Administration and Dosage
KW  - Atropine -- Administration and Dosage
KW  - Hypercalcemia -- Risk Factors
KW  - Glucagon -- Administration and Dosage
KW  - Insulin -- Administration and Dosage
KW  - Dose-Response Relationship, Drug
KW  - Cyanides -- Poisoning
KW  - Amyl Nitrite -- Administration and Dosage
KW  - Amyl Nitrite -- Pharmacodynamics
KW  - Digitalis Toxicity -- Drug Therapy
KW  - Antianxiety Agents, Benzodiazepine -- Poisoning
KW  - Flumazenil -- Administration and Dosage
KW  - Flumazenil -- Adverse Effects
KW  - Fat Emulsions, Intravenous -- Administration and Dosage
KW  - Bupivacaine -- Poisoning
KW  - Acetaminophen -- Poisoning
KW  - Acetylcysteine -- Administration and Dosage
KW  - Analgesics, Opioid -- Poisoning
KW  - Naloxone -- Administration and Dosage
KW  - Octreotide Acetate -- Administration and Dosage
KW  - Sulfonylurea Compounds -- Adverse Effects
KW  - Hypoglycemia -- Chemically Induced
KW  - Treatment Outcomes
SP  - 199
EP  - 212
JO  - American Journal of Health-System Pharmacy
JF  - American Journal of Health-System Pharmacy
JA  - AM J HEALTH SYST PHARM AJHP
VL  - 69
IS  - 3
CY  - Bethesda, Maryland
PB  - American Society of Health System Pharmacists
AB  - Purpose. Appropriate therapies for commonly encountered poisonings, medication overdoses, and other toxicological emergencies are reviewed, with discussion of pharmacists' role in ensuring their ready availability and proper use. Summary. Poisoning is the second leading cause of injury-related morbidity and mortality in the United States, with more than 2.4 million toxic exposures reported each year. Recently published national consensus guidelines recommend that hospitals providing emergency care routinely stock 24 antidotes for a wide range of toxicities, including toxic-alcohol poisoning, exposure to cyanide and other industrial agents, and intentional or unintentional overdoses of prescription medications (e.g., calcium-channel blockers, β-blockers, digoxin, isoniazid). Pharmacists can help reduce morbidity and mortality due to poisonings and overdoses by (1) recognizing the signs and symptoms of various types of toxic exposure, (2) guiding emergency room staff on the appropriate use of antidotes and supportive therapies, (3) helping to ensure appropriate monitoring of patients for antidote response and adverse effects, and (4) managing the procurement and stocking of antidotes to ensure their timely availability. Conclusion. Pharmacists can play a key role in reducing poisoning and overdose injuries and deaths by assisting in the early recognition of toxic exposures and guiding emergency personnel on the proper storage, selection, and use of antidotal therapies.
SN  - 1079-2082
AD  - Clinical Toxicologist, Upstate New York Poison Center, Syracuse; Assistant Professor, Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse
AD  - Assistant Professor of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY; Clinical Pharmacy Manager, Maimonides Medical Center, New York, NY
AD  - Clinical Professor of Pharmacy, College of Pharmacy and Allied Health Professions, St. John¿s University, Queens, NY; Adjunct Professor of Emergency Medicine, New York University (NYU) School of Medicine, New York; Senior Consultant in Residence, New York City Poison Center
U2  - PMID: 22261941.
DO  - 10.2146/ajhp110014
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104513394&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107229331
T1  - Double-blind, randomized study of nalmefene and naloxone in emergency department patients with suspected narcotic overdose.
AU  - Kaplan JL
AU  - Marx JA
AU  - Calabro JJ
AU  - Gin-Shaw SL
AU  - Spiller JD
AU  - Spivey WL
AU  - Gaddis GM
AU  - Zhao N
AU  - Harchelroad FP Jr.
Y1  - 1999/07//1999 Jul
N1  - Accession Number: 107229331. Language: English. Entry Date: 19991201. Revision Date: 20150818. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Instrumentation: Opioid Withdrawal Scale (OWS); Neurobehavioral Assessment Scale (NAS). Grant Information: Supported by Ohmeda (formerly Anaquest), Inc., Liberty Corner, NJ. NLM UID: 8002646. 
KW  - Narcotics -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Funding Source
KW  - Overdose -- Drug Therapy
KW  - Scales
KW  - Clinical Assessment Tools
KW  - Neurologic Examination
KW  - Respiration -- Drug Effects
KW  - Treatment Outcomes
KW  - Clinical Trials
KW  - Double-Blind Studies
KW  - Data Analysis Software
KW  - Fisher's Exact Test
KW  - Confidence Intervals
KW  - Analysis of Variance
KW  - Repeated Measures
KW  - Male
KW  - Human
SP  - 42
EP  - 50
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 34
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Department of Emergency Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141; e-mail: kaplanj@aehn2.einstein.edu
U2  - PMID: 10381993.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107229331&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104026143
T1  - A performance improvement prescribing guideline reduces opioid prescriptions for emergency department dental pain patients...Ann Emerg Med. 2013 Sep;62(3):237-40
AU  - Doyon, Suzanne
Y1  - 2014/03//
N1  - Accession Number: 104026143. Language: English. Entry Date: 20140425. Revision Date: 20150710. Publication Type: Journal Article; commentary; letter. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Emergency Service
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Practice Guidelines
KW  - Toothache -- Drug Therapy
KW  - Female
KW  - Male
SP  - 371
EP  - 371
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 63
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD.
U2  - PMID: 24528948.
DO  - 10.1016/j.annemergmed.2013.09.033
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104026143&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120777785
T1  - In older adults with COPD, new opioid use was linked to increased risk for respiratory and all-cause mortality.
AU  - Levine, Mitchell
Y1  - 2017/01/17/
N1  - Accession Number: 120777785. Language: English. Entry Date: 20170123. Revision Date: 20171211. Publication Type: journal article; abstract; commentary; tables/charts. Original Study: Vozoris NT. Incident opioid drug use and adverse respiratory outcomes among older adults with COPD. (Eur Respir J.) 2016; 48: 683-93. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Gerontologic Care; Patient Safety. NLM UID: 9104824. 
KW  - Pulmonary Disease, Chronic Obstructive -- Drug Therapy -- In Old Age
KW  - Narcotics -- Adverse Effects -- In Old Age
KW  - Treatment Outcomes -- In Old Age
KW  - Gerontologic Care
KW  - Prospective Studies
KW  - Retrospective Design
KW  - Databases, Health
KW  - Ontario
KW  - Community Living
KW  - Male
KW  - Female
KW  - Aged
KW  - Prescriptions, Drug
KW  - Disease Exacerbation
KW  - Health Resource Utilization
KW  - Hospitalization
KW  - Pulmonary Disease, Chronic Obstructive -- Mortality
KW  - Pneumonia -- Mortality
KW  - Intensive Care Units
KW  - Emergency Service
KW  - Nonexperimental Studies
KW  - Decision Making, Clinical
KW  - Confidence Intervals
KW  - Descriptive Statistics
SP  - 10
EP  - 10
JO  - ACP Journal Club
JF  - ACP Journal Club
JA  - ACP J CLUB
VL  - 166
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
AB  - In older adults with COPD, new opioid use was linked to increased risk for respiratory and all-cause mortality
SN  - 1056-8751
AD  - McMaster University Hamilton, Ontario, Canada
U2  - PMID: 28114467.
DO  - 10.7326/ACPJC-2017-166-2-011
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120777785&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103925345
T1  - Opioid Overdoses Burden the U.S. Health Care System.
Y1  - 2014/12//
N1  - Accession Number: 103925345. Language: English. Entry Date: 20141215. Revision Date: 20150710. Publication Type: Journal Article; brief item; statistics. Journal Subset: Alternative/Complementary Therapies; USA. Special Interest: Chiropractic Care. 
KW  - Overdose
KW  - Analgesics, Opioid
KW  - Narcotics
KW  - Emergency Service -- Utilization
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Health Care Costs
SP  - 9
EP  - 9
JO  - ACA News (American Chiropractic Association)
JF  - ACA News (American Chiropractic Association)
JA  - ACA NEWS
VL  - 10
IS  - 10
CY  - Arlington, Virginia
PB  - American Chiropractic Association
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103925345&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104117404
T1  - Capsule commentary on joynt et Al., the impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States.
AU  - Simon, Lorna
Y1  - 2013/12//
N1  - Accession Number: 104117404. Language: English. Entry Date: 20140822. Revision Date: 20150710. Publication Type: Journal Article; commentary. Original Study: Joynt Michael, Train Meghan K, Robbins Brett W, Halterman Jill S, Caiola Enrico, Fortuna Robert J. The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. (J GEN INTERN MED) Dec2013; 28 (12): 1604-1610. Journal Subset: Biomedical; Continental Europe; Europe. NLM UID: 8605834. 
KW  - Analgesics, Opioid -- Economics
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Population
KW  - Emergency Service -- Economics
KW  - Practice Patterns -- Economics
KW  - Residence Characteristics
KW  - Female
KW  - Male
SP  - 1647
EP  - 1647
JO  - JGIM: Journal of General Internal Medicine
JF  - JGIM: Journal of General Internal Medicine
JA  - J GEN INTERN MED
VL  - 28
IS  - 12
CY  - , <Blank>
PB  - Springer Science & Business Media B.V.
SN  - 0884-8734
AD  - Center for Mental Health Services Research, University of Massachusetts Medical School, Worcester, MA, 01655, USA, Lorna.simon@umassmed.edu.
U2  - PMID: 23925802.
DO  - 10.1007/s11606-013-2547-5
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104117404&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103808163
T1  - Voluntary guidelines for emergency physicians: clarifying New York city's efforts to curb opioid misuse.
AU  - Huffman, Alan
Y1  - 2013/08//
N1  - Accession Number: 103808163. Language: English. Entry Date: 20150501. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Medicine -- Standards
KW  - Inappropriate Prescribing -- Prevention and Control
KW  - Practice Guidelines
KW  - New York
SP  - 13A
EP  - 14A
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 62
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
U2  - PMID: 24083312.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103808163&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104189657
T1  - Controlling opioid abuse in the emergency department: legitimate public policy or 'legislative medicine'?
AU  - Huffman, Alan
Y1  - 2013/06//
N1  - Accession Number: 104189657. Language: English. Entry Date: 20130802. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Emergency Service -- Legislation and Jurisprudence
KW  - Substance Use Disorders -- Prevention and Control
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - United States
SP  - 13A
EP  - 15A
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 61
IS  - 6
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
U2  - PMID: 23828953.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104189657&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110412530
T1  - Opiate refractory pain from an intestinal obstruction responsive to an intravenous lidocaine infusion.
AU  - Bafuma, Patrick J.
AU  - Nandi, Arun
AU  - Weisberg, Michael
Y1  - 2015/10//
N1  - Accession Number: 110412530. Language: English. Entry Date: 20151217. Revision Date: 20151223. Publication Type: journal article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Abdominal Pain -- Radiography
KW  - Anesthetics, Local -- Therapeutic Use
KW  - Intestinal Obstruction -- Radiography
KW  - Lidocaine -- Therapeutic Use
KW  - Abdominal Pain -- Drug Therapy
KW  - Antiemetics -- Therapeutic Use
KW  - Anesthetics, Local -- Administration and Dosage
KW  - Lidocaine -- Administration and Dosage
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Young Adult
KW  - Female
KW  - Diagnosis, Differential
KW  - Oxycodone -- Therapeutic Use
KW  - Infusions, Intravenous
KW  - Dihydromorphinone -- Therapeutic Use
KW  - Tomography, X-Ray Computed
KW  - Colostomy
KW  - Metoclopramide -- Therapeutic Use
KW  - Emergency Service
SP  - 1544
EP  - 1544
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 33
IS  - 10
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - A 24-year-old female patient presented to our community emergency department (ED) for abdominal pain that had progressively worsened over the last 28 hours. Of note, 1 month prior to her presentation, the patient had a colostomy due to a rectal abscess and required stoma revision 5 days prior to her visit to our ED. The patient's pain was refractory to opiate analgesia in our ED, but experienced significant relief after an intravenous lidocaine infusion. Computer tomography of the abdomen and pelvis ultimately revealed a large bowel obstruction just proximal to the colostomy site. Historically, options for ED management of severe pain have been limited beyond narcotic analgesia. For patients whom are refractory to opiates in the ED, or for whom opiates are contraindicated, lidocaine infusions have shown promise for a variety of both acute and chronic painful conditions.
SN  - 0735-6757
AD  - Emergency Medicine, Columbia Memorial Hospital, 71 Prospect Avenue, Hudson, NY 12534
U2  - PMID: 26306434.
DO  - 10.1016/j.ajem.2015.07.027
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110412530&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103924440
T1  - Pitfalls of Intranasal Narcan - Response to a Letter to the Editor.
AU  - Zuckerman, Matthew
AU  - Weisberg, Stacy N.
AU  - Boyer, Edward W.
Y1  - 2015/01//
N1  - Accession Number: 103924440. Language: English. Entry Date: 20141217. Revision Date: 20160624. Publication Type: Journal Article; letter. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intranasal
KW  - Prehospital Care
KW  - Emergency Care
KW  - Practice Guidelines
KW  - Patient Care
KW  - Naloxone -- Therapeutic Use
KW  - Emergency Medical Technicians
SP  - 138
EP  - 139
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 19
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
SN  - 1090-3127
DO  - 10.3109/10903127.2014.942485
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103924440&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105422785
T1  - Prescriptions for schedule II opioids and benzodiazepines increase after the introduction of computer-generated prescriptions.
AU  - McGerald G
AU  - Dvorkin R
AU  - Levy D
AU  - Lovell-Rose S
AU  - Sharma A
Y1  - 2009/06//
N1  - Accession Number: 105422785. Language: English. Entry Date: 20090911. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9418450. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Prescriptions, Drug -- Statistics and Numerical Data
KW  - Adult
KW  - Analgesics, Opioid -- Classification
KW  - Codeine -- Therapeutic Use
KW  - Confidence Intervals
KW  - Drug and Narcotic Control
KW  - Emergency Service
KW  - Female
KW  - Male
KW  - Middle Age
KW  - New York
KW  - Oxycodone -- Therapeutic Use
KW  - Prospective Studies
KW  - Retrospective Design
KW  - Human
SP  - 508
EP  - 512
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 16
IS  - 6
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - BACKGROUND: Prescriptions for controlled substances decrease when regulatory barriers are put in place. The converse has not been studied. OBJECTIVES: The objective was to determine whether a less complicated prescription writing process is associated with a change in the prescribing patterns of controlled substances in the emergency department (ED). METHODS: The authors conducted a retrospective nonconcurrent cohort study of all patients seen in an adult ED between April 19, 2005, and April 18, 2007, who were discharged with a prescription. Prior to April 19, 2006, a specialized prescription form stored in a locked cabinet was obtained from the nursing staff to write a prescription for benzodiazepines or Schedule II opioids. After April 19, 2006, New York State mandated that all prescriptions, regardless of schedule classification, be generated on a specialized bar-coded prescription form. The main outcome of the study was to compare the proportion of Schedule III-V opioids to Schedule II opioids and benzodiazepines prescribed in the ED before and after the introduction of a less cumbersome prescription writing process. RESULTS: Of the 26,638 charts reviewed, 2.1% of the total number of prescriptions generated were for a Schedule II controlled opioid before the new system was implemented compared to 13.6% after (odds ratio [OR] = 7.3, 95% confidence interval [CI] = 6.4 to 8.4). The corresponding percentages for Schedule III-V opioids were 29.9% to 18.1% (OR = 0.52, 95% CI = 0.49 to 0.55) and for benzodiazepines 1.4% to 3.9% (OR = 2.8, 95% CI = 2.4 to 3.4). CONCLUSIONS: Patients were more likely to receive a prescription for a Schedule II opioid or a benzodiazepine after a more streamlined computer-generated prescription writing process was introduced in this ED.
SN  - 1069-6563
AD  - Department of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY, USA. genmcger2000@yahoo.com
U2  - PMID: 19388914.
DO  - 10.1111/j.1553-2712.2009.00398.x
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105422785&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104308615
T1  - Emergency department visits and hospitalizations for buprenorphine ingestion by children--United States, 2010-2011.
Y1  - 2013/01/25/
N1  - Accession Number: 104308615. Corporate Author: Centers for Disease Control and Prevention (CDC). Language: English. Entry Date: 20130322. Revision Date: 20180123. Publication Type: journal article. Journal Subset: Biomedical; Public Health; USA. Special Interest: Public Health. NLM UID: 7802429. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Buprenorphine -- Poisoning
KW  - Emergency Service -- Utilization
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Buprenorphine -- Administration and Dosage
KW  - Child, Preschool
KW  - Eating
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Infant
KW  - United States
SP  - 56
EP  - 56
JO  - MMWR: Morbidity & Mortality Weekly Report
JF  - MMWR: Morbidity & Mortality Weekly Report
JA  - MMWR MORB MORTAL WKLY REP
VL  - 62
IS  - 3
CY  - Atlanta, Georgia
PB  - Centers for Disease Control & Prevention (CDC)
AB  - Buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) received Food and Drug Administration approval in 2002 for the treatment of opioid dependence. Introduction of these drugs expanded the availability of opioid-dependence treatment options to reduce the morbidity and mortality associated with opioid abuse, and buprenorphine has become an increasingly prescribed component of office-based treatment. However, unsupervised ingestion of buprenorphine-containing products by children is a growing concern.
SN  - 0149-2195
U2  - PMID: 23344700.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104308615&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105473189
T1  - News and innovations. Illicit substance use by emergency department patients seeking opioids.
Y1  - 2008/12//
N1  - Accession Number: 105473189. Language: English. Entry Date: 20090320. Revision Date: 20150711. Publication Type: Journal Article; brief item. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management; Palliative Care/Hospice. NLM UID: 101125608. 
KW  - Emergency Patients
KW  - Street Drugs
KW  - Substance Abuse
KW  - Back Pain -- Drug Therapy
KW  - Headache -- Drug Therapy
KW  - Narcotics
KW  - Substance Abuse Detection
KW  - Toothache -- Drug Therapy
SP  - 352
EP  - 353
JO  - Journal of Pain & Palliative Care Pharmacotherapy
JF  - Journal of Pain & Palliative Care Pharmacotherapy
JA  - J PAIN PALLIAT CARE PHARMACOTHER
VL  - 22
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
SN  - 1536-0288
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105473189&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104509755
T1  - Paediatric tricyclic antidepressant overdose.
AU  - Levas, Michael
AU  - Condra, Cole
Y1  - 2011/12//
N1  - Accession Number: 104509755. Language: English. Entry Date: 20120209. Revision Date: 20150819. Publication Type: Journal Article; case study; tracings. Journal Subset: Allied Health; Europe; UK & Ireland. Special Interest: Emergency Care; Pediatric Care; Psychiatry/Psychology. 
KW  - Antidepressive Agents, Tricyclic -- Poisoning -- In Adolescence
KW  - Overdose -- Diagnosis -- In Adolescence
KW  - Overdose -- Therapy -- In Adolescence
KW  - Prehospital Care -- In Adolescence
KW  - Emergency Medical Services
KW  - Suicide, Attempted -- In Adolescence
KW  - Emergency Patients
KW  - Electrocardiography
KW  - Male
KW  - Adolescence
KW  - Depression -- Drug Therapy
KW  - Patient History Taking
KW  - Physical Examination
KW  - Oxygen Therapy
KW  - Intravenous Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Hospitals, Pediatric
KW  - Emergency Service
KW  - Intubation, Intratracheal
KW  - Charcoal -- Administration and Dosage
KW  - Sodium Bicarbonate -- Administration and Dosage
KW  - Polypharmacy
KW  - Overdose -- Drug Therapy
KW  - Antidepressive Agents, Tricyclic -- Pharmacodynamics
KW  - Antidepressive Agents, Tricyclic -- Pharmacokinetics
KW  - Antidepressive Agents, Tricyclic -- Adverse Effects
KW  - Inpatients
KW  - Tachycardia -- Chemically Induced
KW  - Mental Status
SP  - 701
EP  - 705
JO  - Journal of Paramedic Practice
JF  - Journal of Paramedic Practice
JA  - J PARAMEDIC PRACT
VL  - 3
IS  - 12
PB  - Mark Allen Holdings Limited
SN  - 1759-1376
AD  - Assistant Professor of Paediatrics, Paediatric Emergency Medicine, Children¿s Hospital of Wisconsin, Milwaukee, WI, USA
AD  - Assistant Professor of Paediatrics, Paediatric Emergency Medicine, Children¿s Mercy Hospital, Kansas City, MO, USA
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104509755&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109632044
T1  - Patient Perspectives of Acute Pain Management in the Era of the Opioid Epidemic.
AU  - Smith, Robert J
AU  - Rhodes, Karin
AU  - Paciotti, Breah
AU  - Kelly, Sheila
AU  - Perrone, Jeanmarie
AU  - Meisel, Zachary F
Y1  - 2015/09//
N1  - Accession Number: 109632044. Language: English. Entry Date: 20150923. Revision Date: 20170504. Publication Type: journal article; research. Commentary: McCarthy Danielle M., Kim Howard S. Patients are aware of risks of opioid dependence, yet note poor communication from providers about pain and pain management. (EVID BASED NURS) Jul2016; 19 (3): 88-88. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
SP  - 246
EP  - 252.e1
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 66
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Study Objective: To inform the development of interventions that could improve patient engagement around the risks and benefits of alternative approaches to pain management in the emergency department (ED), we seek to capture the perspectives and experiences of patients treated for pain in this setting.Methods: Three trained interviewers conducted semistructured open-ended telephone interviews with patients discharged from a single urban academic ED after presenting with acute pain related to fracture, renal colic, or musculoskeletal back injury. We recruited subjects until achieving thematic saturation according to periodic review of the interview transcripts. Interviews were audio recorded, professionally transcribed, and uploaded into QSR NVivo (version 10.0) for coding and analysis using modified grounded theory. An interdisciplinary team double coded the data and convened to review emerging themes, ensure interrater reliability, and establish consensus on discrepancies.Results: We had 23 completed subject interviews, the majority of which were women. Interrater reliability for coding exceeded 90%. The major themes elicited centered on domains of patient awareness of the potential for opioid dependence and patient-provider communication relating to pain management. From the patient perspective, emergency physicians typically do not present alternative pain management options or discuss the risks of opioid dependence. Patients with negative experiences related to pain management describe deficiencies in patient-provider communication leading to misunderstanding of clinical diagnoses, fragmentation of care among their health care providers, and a desire to be involved in the decisionmaking process around their pain management. Patients with positive experiences commented on regular communication with their care team, rapid pain management, and the empathetic nature of their care providers. Patients communicate fears about the risks of opioid addiction, beliefs that following a prescribed opioid regimen is protective of developing opioid dependence, and an understanding of the broader tensions that providers face relating to the prescription of opioid therapy.Conclusion: Patients identified a deficit of communication around opioid risk and pain management options in the ED.
SN  - 0196-0644
U2  - PMID: 25865093.
DO  - 10.1016/j.annemergmed.2015.03.025
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108219892
T1  - Prescription opioid abuse update for the clinical nurse specialist.
AU  - O'Malley PA
Y1  - 2012/01//2012 Jan-Feb
N1  - Accession Number: 108219892. Language: English. Entry Date: 20120217. Revision Date: 20150819. Publication Type: Journal Article; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Advanced Nursing Practice; Pain and Pain Management. NLM UID: 8709115. 
KW  - Advanced Nursing Practice
KW  - Clinical Nurse Specialists
KW  - Drugs, Prescription
KW  - Narcotics
KW  - Pain -- Drug Therapy
KW  - Substance Abuse -- Epidemiology -- United States
KW  - Substance Abuse -- Prevention and Control
KW  - Adolescence
KW  - Adult
KW  - Drug and Narcotic Control
KW  - Emergency Care -- Utilization
KW  - Narcotics -- Poisoning
KW  - Overdose -- Mortality
KW  - Patient Education
KW  - Substance Abuse -- Risk Factors
KW  - United States
SP  - 19
EP  - 21
JO  - Clinical Nurse Specialist: The Journal for Advanced Nursing Practice
JF  - Clinical Nurse Specialist: The Journal for Advanced Nursing Practice
JA  - CLIN NURSE SPEC
VL  - 26
IS  - 1
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 0887-6274
AD  - Author Affiliation: Nurse Researcher, CNS Palliative Care Services, Miami Valley Hospital, Dayton, Ohio. The author reports no conflicts of interest.
U2  - PMID: 22146269.
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 106572587
T1  - An intentional opiate intoxication of an infant: when medical toxicology and child maltreatment services merge.
AU  - Perez A
AU  - Scribano PV
AU  - Perry H
Y1  - 2004/11//
N1  - Accession Number: 106572587. Language: English. Entry Date: 20050128. Revision Date: 20150711. Publication Type: Journal Article; case study; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8507560. 
KW  - Child Abuse
KW  - Narcotics -- Poisoning -- In Infancy and Childhood
KW  - Emergency Care
KW  - Immunoassay
KW  - Infant
KW  - Munchausen Syndrome
SP  - 769
EP  - 772
JO  - Pediatric Emergency Care
JF  - Pediatric Emergency Care
JA  - PEDIATR EMERG CARE
VL  - 20
IS  - 11
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - We present an instructive case of a 5-week-old infant seen in the emergency department with acute inspiratory stridor and depressed level of consciousness. His emergency department course identified an acute opiate intoxication. The child also developed chest wall rigidity, a rare complication of narcotic use. We discuss the emergency department management, as well as the toxicologic and child protection investigations.
SN  - 0749-5161
AD  - Division of Medical Toxicology, Department of Emergency Medicine and Traumatology, University of Connecticut Health Center, Farmington, CT
U2  - PMID: 15502660.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105264899
T1  - ISMP Medication Safety Alert!® Beware of basal opioid infusions with PCA therapy...reprinted with permission from ISMP Medication Safety Alert! Nurse Advise-ERR (ISSN 1550-6304) October 2009 Volume 7 Issue 10 ©2009 Institute for Safe Medical Practices (ISMP)
Y1  - 2009///2009 Winter
N1  - Accession Number: 105264899. Language: English. Entry Date: 20100129. Revision Date: 20151019. Publication Type: Journal Article; statistics; tables/charts. Journal Subset: Canada; Editorial Board Reviewed; Nursing; Peer Reviewed. Special Interest: Pain and Pain Management. NLM UID: 100883278. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Patient-Controlled Analgesia
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Fractures
KW  - Male
KW  - Middle Age
KW  - Pain -- Drug Therapy
KW  - Pulse Oximetry
KW  - Sleep Apnea, Obstructive -- Diagnosis
SP  - 12
EP  - 13
JO  - Alberta RN
JF  - Alberta RN
JA  - ALBERTA RN
VL  - 65
IS  - 9
CY  - Edmonton, Alberta
PB  - College & Association of Registered Nurses of Alberta
AB  - A 63-year-old, 109 kg, opioid-naïve patient (one who has not recently received regular daily doses of opioids) was admitted to a hospital with fractures sustained from a fall. She was given two doses of morphine (4 mg) and one dose of HYDROmorphone (1 mg) in the emergency department prior to admission. Upon arrival to the in-patient unit, she was started on HYDROmorphone via patient controlled analgesia (PCA), which included a continuous basal infusion of 0.5 mg per hour, an on-demand dose of 0.2 mg with a lockout interval of 10 minutes, and a four-hour dose limit of 6 mg. Continuous pulse oximetry was not in use. About five hours later, the patient was found unresponsive. She was breathing six times a minute and her nail beds were turning blue. Oxygen saturation was checked with pulse oximetry and found to be 44 percent.
SN  - 1481-9988
U2  - PMID: 20063582.
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 107896180
T1  - Emergence of opiate-induced neonatal abstinence syndrome.
AU  - Healy, D
AU  - English, F
AU  - Daniels, A
AU  - Ryan, C A
Y1  - 2014/02//2014 Feb
N1  - Accession Number: 107896180. Language: English. Entry Date: 20140418. Revision Date: 20150819. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 0430275. 
KW  - Narcotics -- Adverse Effects
KW  - Neonatal Abstinence Syndrome -- Epidemiology
KW  - Substance Use Disorders -- Complications
KW  - Pregnancy Complications
KW  - Adult
KW  - Female
KW  - Prospective Studies
KW  - Human
KW  - Incidence
KW  - Infant, Newborn
KW  - Ireland
KW  - Male
KW  - Mothers
KW  - Neonatal Abstinence Syndrome -- Etiology
KW  - Pregnancy
KW  - Prognosis
KW  - Retrospective Design
KW  - Young Adult
SP  - 46
EP  - 46
JO  - Irish Medical Journal
JF  - Irish Medical Journal
JA  - IR MED J
VL  - 107
IS  - 2
PB  - Irish Medical Journal
SN  - 0332-3102
U2  - PMID: 24654482.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107343994
T1  - Emergency admissions of opioid drug abusers for overdose: a chronobiological study of enhanced risk.
AU  - Manfredini R
AU  - Gallerani M
AU  - Calo G
AU  - Pasin M
AU  - Govoni M
AU  - Fersini C
Y1  - 1994/10//1994 Oct
N1  - Accession Number: 107343994. Language: English. Entry Date: 19971101. Revision Date: 20150818. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Overdose
KW  - Narcotics -- Poisoning
KW  - Substance Abuse
KW  - Circadian Rhythm
KW  - Italy
KW  - Emergency Service
KW  - Risk Factors
KW  - Time Factors
KW  - Confidence Intervals
KW  - Prospective Studies
KW  - Coma -- Chemically Induced
KW  - Bivariate Statistics
KW  - Probability
KW  - Adult
KW  - Male
KW  - Female
KW  - Human
SP  - 615
EP  - 618
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 24
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
U2  - PMID: 8092587.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 124740342
T1  - Fentanyl laced heroin and its contribution to a spike in heroin overdose in Miami-Dade County.
AU  - Bode, Alexander Diaz
AU  - Singh, Mallika
AU  - Andrews, James
AU  - Kapur, Girish B.
AU  - Baez, Amado Alejandro
Y1  - 2017/09//
N1  - Accession Number: 124740342. Language: English. Entry Date: 20170917. Revision Date: 20170928. Publication Type: letter. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Heroin -- Poisoning
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Epidemiology
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Fentanyl -- Poisoning
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Cross Sectional Studies
KW  - Retrospective Design
KW  - Florida
SP  - 1364
EP  - 1365
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 35
IS  - 9
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0735-6757
AD  - University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United States
AD  - Jackson Memorial Hospital Department of Emergency Medicine, 1611 NW 12th Ave, Miami, FL 33136, United States
U2  - PMID: 28268113.
DO  - 10.1016/j.ajem.2017.02.043
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105876757
T1  - Prophylactic metoclopramide with intravenous opioid analgesia in the emergency department: does this constitute quality use of medicines?...6th International Conference for Emergency Nurses: Future Directions, Future ChallengesEL Beyond Tomorrow, 11-13 October 2007, Melbourne, Victoria, Australia
AU  - Tori K
AU  - Oxley J
Y1  - 2007/11//
N1  - Accession Number: 105876757. Language: English. Entry Date: 20080404. Revision Date: 20150711. Publication Type: Journal Article; abstract. Journal Subset: Australia & New Zealand; Core Nursing; Nursing; Peer Reviewed. 
KW  - Administration, Intravenous
KW  - Emergency Care
KW  - Metoclopramide -- Administration and Dosage
KW  - Narcotics -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Drug Therapy, Combination
KW  - Emergency Service
KW  - Nausea and Vomiting -- Prevention and Control
SP  - 212
EP  - 213
JO  - Australasian Emergency Nursing Journal
JF  - Australasian Emergency Nursing Journal
JA  - AUSTRALAS EMERG NURS J
VL  - 10
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 1574-6267
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 106011073
T1  - Suboxone (buprenorphine/naloxone) toxicity in pediatric patients: a case report.
AU  - Schwarz KA
AU  - Cantrell FL
AU  - Vohra RB
AU  - Clark RF
Y1  - 2007/09//2007 Sep
N1  - Accession Number: 106011073. Language: English. Entry Date: 20080229. Revision Date: 20150711. Publication Type: Journal Article; case study. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8507560. 
KW  - Buprenorphine -- Poisoning
KW  - Naloxone -- Poisoning
KW  - Narcotic Antagonists -- Poisoning
KW  - Child, Preschool
KW  - Male
KW  - Vomiting
SP  - 651
EP  - 652
JO  - Pediatric Emergency Care
JF  - Pediatric Emergency Care
JA  - PEDIATR EMERG CARE
VL  - 23
IS  - 9
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - BACKGROUND: Suboxone, a combination of buprenorphine and naloxone in sublingual tablet form, was recently approved in the United States for management of opioid dependence. Little information exists regarding the potential for opioid toxicity after Suboxone exposure in the pediatric population. We report a case of opioid toxicity after exposure to Suboxone in a pediatric patient and a review of other cases of pediatric Suboxone ingestion in the literature. CASE: A previously healthy 2-year-old boy was found with 1 tablet of Suboxone (8 mg buprenorphine/2 mg naloxone) in his mouth. Remnants of the partly dissolved tablet were immediately removed from the child's oropharynx. The child experienced 1 episode of spontaneous emesis and became drowsy en route to the emergency department 30 minutes after the exposure. The patient was observed in the emergency department; no interventions were necessary, and the child was discharged asymptomatic and stable 6 hours post ingestion. CONCLUSION: Suboxone, a combination of buprenorphine and naloxone, may produce opioid toxicity via sublingual absorption or ingestion by children. We present the case of a child with mild central nervous system depression after exposure to Suboxone. Pediatric case reports that demonstrate more significant central nervous system and respiratory depressant effects from Suboxone ingestion are emerging.
SN  - 0749-5161
U2  - PMID: 17876257.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105857253
T1  - Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Epidural analgesia/anaesthesia versus systemic intravenous opioid analgesia in the management of blunt thoracic trauma.
AU  - Parris R
Y1  - 2007/12//
N1  - Accession Number: 105857253. Language: English. Entry Date: 20080314. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 100963089. 
KW  - Analgesia, Epidural
KW  - Thoracic Injuries -- Complications
KW  - Wounds, Nonpenetrating -- Complications
KW  - Aged
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Male
KW  - Medical Practice, Evidence-Based
KW  - Rib Fractures -- Complications
SP  - 848
EP  - 849
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
VL  - 24
IS  - 12
PB  - BMJ Publishing Group
AB  - A short cut review was carried out to establish whether an epidural infusion provided any advantage over intravenous analgesia in the management of blunt thoracic trauma. Only four papers presented evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are presented in table 2. The clinical bottom line is that epidural analgesia may provide better pain relief, but may not alter clinical outcomes.
SN  - 1472-0205
AD  - Royal Bolton Hospital, UK.
U2  - PMID: 18029522.
DO  - 10.1136/emj.2007.054973
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104747745
T1  - Local anaesthetic-opioid mixture for emergency Caesarean section.
AU  - Benhamou, D
Y1  - 2007/12//
N1  - Accession Number: 104747745. Language: English. Entry Date: 20110610. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 0370524. 
KW  - Analgesia, Epidural -- Methods
KW  - Analgesia, Obstetrical -- Methods
KW  - Cesarean Section
KW  - Analgesics, Opioid
KW  - Anesthetics, Local
KW  - Female
KW  - Fentanyl
KW  - Pregnancy
KW  - Sufentanil
SP  - 1298
EP  - 1298
JO  - Anaesthesia
JF  - Anaesthesia
JA  - ANAESTHESIA
VL  - 62
IS  - 12
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 0003-2409
U2  - PMID: 17991279.
DO  - 10.1111/j.1365-2044.2007.05362_1.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104248156
T1  - Determination of substance overdose in two Iranian centers: Comparison between opioids and non-opioids.
AU  - Taghaddosinejad, Fakhreddin
AU  - Arefi, Mohammad
AU  - Fayaz, Amir Farshid
AU  - Tanhaeivash, Roozbeh
Y1  - 2013/04//
N1  - Accession Number: 104248156. Language: English. Entry Date: 20131004. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 101300022. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Narcotics
KW  - Administration, Inhalation
KW  - Adult
KW  - Demography
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Educational Status
KW  - Emergency Service
KW  - Female
KW  - Iran
KW  - Male
KW  - Marital Status
KW  - Middle Age
KW  - Narcotics -- Administration and Dosage
KW  - Substance Use Disorders -- Epidemiology
KW  - Young Adult
SP  - 155
EP  - 157
JO  - Journal of Forensic & Legal Medicine
JF  - Journal of Forensic & Legal Medicine
JA  - J FORENSIC LEGAL MED
VL  - 20
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 1752-928X
AD  - Department of Forensic Medicine, Tehran University of Medical Sciences, P.O. Box 13185-1678, Tehran, Iran.
U2  - PMID: 23472794.
DO  - 10.1016/j.jflm.2012.06.012
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104419753
T1  - The Joint Commission and the FDA take steps to curb adverse events related to the use and misuse of opioid drugs.
Y1  - 2012/10//
N1  - Accession Number: 104419753. Language: English. Entry Date: 20120926. Revision Date: 20150711. Publication Type: Journal Article; statistics; tables/charts. Note: For CE see Supplement page 119. Journal Subset: Nursing; USA. Special Interest: Emergency Care; Pain and Pain Management. NLM UID: 9425690. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Substance Use Disorders -- Risk Factors
KW  - Pain -- Therapy
KW  - Overdose -- Prevention and Control
KW  - Adverse Drug Event -- Trends
KW  - Joint Commission
KW  - United States Food and Drug Administration
KW  - Emergency Service -- Organizations
KW  - Education, Medical, Continuing
KW  - Prescribing Patterns
KW  - Practice Guidelines
KW  - Physician-Patient Relations
KW  - Patient Identification
KW  - Pharmacists
KW  - Drug Interactions
KW  - Delayed-Action Preparations
KW  - Methadone -- Administration and Dosage
KW  - Education, Continuing (Credit)
SP  - 112
EP  - 116
JO  - ED Management
JF  - ED Management
JA  - ED MANAGE
VL  - 24
IS  - 10
CY  - Atlanta, Georgia
PB  - AHC Media LLC
SN  - 1044-9167
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104419753&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104935114
T1  - Intravenous opioid dosing and outcomes in emergency patients: a prospective cohort analysis.
AU  - O'Connor AB
AU  - Zwemer FL
AU  - Hays DP
AU  - Feng C
Y1  - 2010/11//
N1  - Accession Number: 104935114. Language: English. Entry Date: 20110218. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Administration, Intravenous
KW  - Outcomes (Health Care)
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Patient Care -- Methods
KW  - Prospective Studies
KW  - Human
KW  - Pain -- Therapy
KW  - Dosage Forms
KW  - Analgesia -- Methods
KW  - Emergency Service
KW  - United States
KW  - Health Screening -- Methods
KW  - Data Collection
KW  - Data Analysis -- Methods
KW  - Sensitivity and Specificity
KW  - Demography
SP  - 1041
EP  - 1050.e6
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 28
IS  - 9
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Abstract: Objectives: Pain management in emergency department (ED) patients is variable and often inadequate. This study sought to (1) describe the variability in intravenous opioid dosing and (2) compare the outcomes that result from the most commonly prescribed opioid doses. Methods: This prospective cohort study enrolled emergency patients who were prescribed intravenous morphine or hydromorphone as their initial analgesic. Subjects were interviewed at the time of opioid administration and 1 to 2 hours after opioid administration. Outcomes included the numeric pain score change (using a 0-10 scale), the proportion achieving a 50% pain score reduction, and the proportion developing side effects. Logistic regression was used to assess the effects of demographic, clinical, and treatment variables on outcomes. Results: Six hundred ninety-one patients were analyzed. Initial equianalgesic dosages varied by a factor of 27 (from 1 mg morphine to 4 mg hydromorphone). Opioid dose titration occurred in only 21% of patients. Outcomes were similar across the range of opioid dosages before and after adjusting for potentially confounding variables. Among patients not taking opioids at home who received a total of 4 mg of morphine or less. 48% achieved at least a 50% pain score reduction and 60% did not want additional analgesics. Conclusions: We found marked opioid dosing variability and infrequent opioid dose titration. A substantial number of ED patients with severe pain responded well to relatively low opioid dosages. Improved ability to predict opioid dose requirements and strategies that increase the use of opioid dose titration in ED patients are needed.
SN  - 0735-6757
AD  - Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
U2  - PMID: 20825766.
DO  - 10.1016/j.ajem.2009.06.009
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 118492708
T1  - Black Patients Are Less Likely to Receive Opioids for Back Pain, Abdominal Pain, But Not for "Definitive" Pain.
AU  - BAUER, JEFF
Y1  - 2016/09//
N1  - Accession Number: 118492708. Language: English. Entry Date: 20161102. Revision Date: 20161102. Publication Type: Article; brief item; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. 
KW  - Pain -- Drug Therapy
KW  - Narcotics -- Administration and Dosage
KW  - Blacks
KW  - Emergency Care
KW  - Healthcare Disparities
SP  - 392
EP  - 392
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 48
IS  - 9
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118492708&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104863492
T1  - Update on: 'Treating the unexpected: the opiate overdose patient'...Willis S (2010) Treating the unexpected: the opiate overdose patient. JPP 2(12): 572–7
AU  - Boor, Sally
AU  - Doble, Simon
AU  - Willis, Sam
Y1  - 2011/03//
N1  - Accession Number: 104863492. Language: English. Entry Date: 20110512. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Allied Health; Europe; UK & Ireland. Special Interest: Emergency Care. 
KW  - Overdose -- Drug Therapy
KW  - Narcotics -- Poisoning
KW  - Prehospital Care
KW  - Emergency Medical Services
KW  - Naloxone -- Administration and Dosage
KW  - Infusions, Intravenous
KW  - Injections, Intramuscular
KW  - Patient Safety
KW  - Emergency Patients
KW  - Outpatients
KW  - Flumazenil -- Therapeutic Use
KW  - Flumazenil -- Adverse Effects
SP  - 114
EP  - 115
JO  - Journal of Paramedic Practice
JF  - Journal of Paramedic Practice
JA  - J PARAMEDIC PRACT
VL  - 3
IS  - 3
PB  - Mark Allen Holdings Limited
SN  - 1759-1376
AD  - Clinical Nurse Manager, Emergency Department, Truro, Cornwall
AD  - Training Officer with the London Ambulance Service NHS Trust
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104959068
T1  - Prescription for danger.
AU  - Collopy KT
AU  - Friese G
Y1  - 2010/12//
N1  - Accession Number: 104959068. Language: English. Entry Date: 20110209. Revision Date: 20150819. Publication Type: Journal Article; case study; pictorial; tables/charts. Note: For CE see website. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 101466002. 
KW  - Substance Abuse -- Diagnosis -- In Adolescence
KW  - Substance Abuse -- Therapy -- In Adolescence
KW  - Drugs, Prescription
KW  - Prehospital Care
KW  - Emergency Medical Services
KW  - Overdose -- Diagnosis -- In Adolescence
KW  - Overdose -- Drug Therapy -- In Adolescence
KW  - Education, Continuing (Credit)
KW  - Male
KW  - Patient History Taking
KW  - Physical Examination
KW  - Patient Assessment
KW  - Emergency Medical Technicians
KW  - Substance Abuse -- Risk Factors
KW  - Substance Abuse -- Epidemiology
KW  - Narcotics -- Adverse Effects
KW  - Hypnotics and Sedatives -- Adverse Effects
KW  - Central Nervous System Stimulants -- Adverse Effects
KW  - Emergency Patients
KW  - Ethnic Groups
KW  - United States
KW  - Substance Abuse Detection
KW  - Substance Abuse -- Symptoms
KW  - Substance Abuse -- Complications
KW  - Child
KW  - Adolescence
KW  - Aggression
KW  - Restraint, Physical
KW  - Airway Management
KW  - Outpatients
KW  - Oxygen Therapy
KW  - Electrocardiography
KW  - Intravenous Therapy
KW  - Hypertension -- Drug Therapy
KW  - Nitroglycerin -- Administration and Dosage
KW  - Body Temperature Determination
KW  - Cryotherapy
KW  - Fever -- Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Administration and Dosage
KW  - Flumazenil -- Administration and Dosage
KW  - Charcoal -- Therapeutic Use
KW  - Long Term Care
SP  - 34
EP  - 45
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 39
IS  - 12
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
SN  - 1946-9365
U2  - PMID: 21214011.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104067857
T1  - INTRANASAL DRUG ADMINISTRATION: AN INNOVATIVE APPROACH TO TRADITIONAL CARE.
AU  - Collopy, Kevin T.
AU  - Snyder, Scott
Y1  - 2011/05//
N1  - Accession Number: 104067857. Language: English. Entry Date: 20131218. Revision Date: 20150819. Publication Type: Journal Article; pictorial; tables/charts. Note: For CE go online to EMSWorld.com/cetest. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101466002. 
KW  - Administration, Intranasal -- Methods
KW  - Prehospital Care
KW  - Emergency Medical Technicians
KW  - Professional Practice
KW  - Emergency Medical Services
KW  - Education, Continuing (Credit)
KW  - Emergency Patients
KW  - Nasal Mucosa
KW  - Pharmacokinetics
KW  - Syringes
KW  - Nebulizers and Vaporizers
KW  - Occupational Safety
KW  - Narcotics -- Administration and Dosage
KW  - Narcotics -- Pharmacokinetics
KW  - Narcotics -- Poisoning
KW  - Ketorolac -- Administration and Dosage
KW  - Ketorolac -- Pharmacokinetics
KW  - Midazolam -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Glucagon -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Seizures -- Drug Therapy
KW  - Overdose -- Drug Therapy
KW  - Hypoglycemia -- Drug Therapy
SP  - 45
EP  - 50
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 40
IS  - 5
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
SN  - 1946-9365
AD  - Educator, e-learning content developer; Flight paramedic, Ministry Spirit Medical Transportation, Central Wisconsin; Lead instructor, Wilderness Medical Associates
AD  - EMS education manager, San Francisco Paramedic Association, San Francisco, CA
U2  - PMID: 21650113.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104067857&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104962202
T1  - Effectiveness and safety of fentanyl compared with morphine for out-of-hospital analgesia.
AU  - Fleischman, Ross J.
AU  - Frazer, David G.
AU  - Daya, Mohamud
AU  - Jui, Jonathon
AU  - Newgard, Craig D.
Y1  - 2010/04//Apr-Jun2010
N1  - Accession Number: 104962202. Language: English. Entry Date: 20110311. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. Instrumentation: Glasgow Coma Scale (GCS). Grant Information: Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1 RR024140 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. NLM UID: 9703530. 
KW  - Analgesia -- Methods
KW  - Fentanyl -- Administration and Dosage
KW  - Morphine -- Administration and Dosage
KW  - Outpatients
KW  - Safety
KW  - Administration, Intravenous
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Aged, 80 and Over
KW  - Analgesics -- Therapeutic Use
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Comorbidity
KW  - Confidence Intervals
KW  - Data Analysis Software
KW  - Data Analysis -- Methods
KW  - Emergency Medical Services
KW  - Emergency Service
KW  - Female
KW  - Fentanyl -- Pharmacokinetics
KW  - Funding Source
KW  - Glasgow Coma Scale
KW  - Human
KW  - Male
KW  - Middle Age
KW  - Morphine -- Pharmacokinetics
KW  - Pain -- Diagnosis
KW  - Pain -- Therapy
KW  - Prehospital Care
KW  - Retrospective Panel Studies
KW  - Scales
SP  - 167
EP  - 175
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 14
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - BACKGROUND: Fentanyl has several potential advantages for out-of-hospital analgesia, including rapid onset, short duration, and less histamine release. Objective. To compare the effectiveness and safety of fentanyl with that of morphine. METHODS: This was a retrospective before-and-after study of a protocol change from morphine to fentanyl in an advanced life support emergency medical services system in January 2007. Charts from nine months prior to the change and for nine months afterward were abstracted by two reviewers using a standardized instrument. The first three months after the change were excluded. Effectiveness was measured by change in pain scores on a 0-10 scale. A priori-defined adverse events included out-of-hospital events: respiratory rate <12 breaths/min, pulse oximetry <92%, systolic blood pressure <90 mmHg, any fall in Glasgow Coma Scale score, nausea or vomiting, intubation, and use of antiemetic agents or naloxone. Emergency department charts were reviewed for initial pain scores and the same adverse events during the first two hours. Events clearly not attributable to the opioid were discounted. The changes in pain scores were also compared adjusting for confounders by multivariable linear regression. RESULTS: Three hundred fifty-five patients aged 13 to 99 years received morphine during the nine months before the protocol change and 363 received fentanyl following the washout period. Initial pain scores for morphine (8.1) and fentanyl (8.3) were comparable (95% confidence interval [CI] for difference -1.1 to 0.3). Fentanyl patients received a higher equivalent dose of opioid (7.7 mg morphine equivalents for morphine, 9.2 mg for fentanyl, CI for the difference 0.9 to 2.3). The mean decreases in pain score were similar between the drugs (2.9 for morphine, 3.1 for fentanyl, CI for the difference -0.3 to 0.7). With regard to adverse events, 9.9% of the morphine patients and 6.6% of the fentanyl patients experienced an adverse event in the field (CI for the difference -0.8 to 7.3%). The most common event was nausea, with a rate of 7.0% for morphine vs. 3.8% for fentanyl (CI for the difference -0.1% to 6.5%). CONCLUSION: Morphine and fentanyl provide similar degrees of out-of-hospital analgesia, although this was achieved with a higher dose of fentanyl. Both medications had low rates of adverse events, which were easily controlled.
SN  - 1090-3127
AD  - Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon USA
U2  - PMID: 20199230.
DO  - 10.3109/10903120903572301
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106328952
T1  - Lack of influence of patient self-report of pain intensity on administration of opioids for suspected long-bone fractures.
AU  - Bijur PE
AU  - Bérard A
AU  - Esses D
AU  - Nestor J
AU  - Schechter C
AU  - Gallagher EJ
Y1  - 2006/06//
N1  - Accession Number: 106328952. Language: English. Entry Date: 20060908. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: Agency for Healthcare Research and Quality, 1 R01 HS13924. NLM UID: 100898657. 
KW  - Analgesics -- Therapeutic Use
KW  - Decision Making, Clinical
KW  - Fractures -- Complications
KW  - Pain -- Drug Therapy
KW  - Adult
KW  - Chi Square Test
KW  - Confidence Intervals
KW  - Convenience Sample
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Emergency Care
KW  - Fractures -- Radiography
KW  - Mantel-Haenszel Test
KW  - Middle Age
KW  - Narcotics -- Therapeutic Use
KW  - Pain Measurement
KW  - Poisson Distribution
KW  - Power Analysis
KW  - Prospective Studies
KW  - Regression
KW  - Relative Risk
KW  - Self Report
KW  - T-Tests
KW  - Visual Analog Scaling
KW  - Funding Source
KW  - Human
SP  - 438
EP  - 444
JO  - Journal of Pain
JF  - Journal of Pain
JA  - J PAIN
VL  - 7
IS  - 6
PB  - Churchill Livingstone, Inc.
AB  - The purpose of the present study was to prospectively investigate the extent to which emergency providers base their decisions about pain management of suspected long-bone fracture on patient's self-reported pain intensity. Of 100 long-bone fracture patients presenting to 2 inner-city emergency departments, 69% received opioids as compared to 30% of 110 patients without long-bone fracture (RR = 2.3; 95% CI 1.6 to 3.1). After stratification by pain ratings on a validated self-reported numerical rating scale, fracture patients remained twice as likely to receive opioids as those without fracture (RR = 2.0; 95% CI 1.5 to 2.7). Similarly, multivariate adjustment for self-reported pain intensity had little effect on the observed association (RR = 2.1; 95% CI 1.6 to 2.8). We conclude that emergency providers do not primarily base their decisions about pain management of suspected long-bone fractures on patient self-reporting of pain intensity. PERSPECTIVE: This article addresses the question of the role of self-reported pain intensity rating on the treatment of suspected fractures. The findings indicate that self-reported pain is not used as the most important measure of pain as recommended by expert panels. We speculate this may contribute to oligoanalgesia in the Emergency Department.
SN  - 1526-5900
AD  - Departments of Emergency Medicine and Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
U2  - PMID: 16750800.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107781125
T1  - What Characteristics Might Help Physicians Detect 'Doctor Shoppers' in Pursuit of Opioids?
Y1  - 2015/04//
N1  - Accession Number: 107781125. Language: English. Entry Date: 20150327. Revision Date: 20150712. Publication Type: Journal Article; pictorial. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management; Physical Therapy; Psychiatry/Psychology. NLM UID: 9884284. 
KW  - Narcotics
KW  - Substance Abuse
KW  - Patient Assessment -- Methods
KW  - Pain -- Drug Therapy
KW  - Prescriptions, Drug
KW  - Drug Hypersensitivity
KW  - Emergency Care
KW  - Decision Making, Clinical
SP  - 42
EP  - 43
JO  - Back Letter
JF  - Back Letter
JA  - BACKLETTER
VL  - 30
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 0894-7376
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106118582
T1  - Managing acute heroin overdose.
AU  - Dixon P
Y1  - 2007/05//
N1  - Accession Number: 106118582. Language: English. Entry Date: 20070713. Revision Date: 20150820. Publication Type: Journal Article; algorithm; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Europe; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 9208913. 
KW  - Emergency Care
KW  - Heroin -- Poisoning
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Nursing
KW  - Overdose -- Therapy
KW  - Decision Making, Clinical
KW  - Decision Trees
KW  - Emergency Nursing
KW  - Heroin -- Pharmacodynamics
KW  - Overdose -- Complications
KW  - Overdose -- Diagnosis
KW  - Overdose -- Etiology
SP  - 30
EP  - 35
JO  - Emergency Nurse
JF  - Emergency Nurse
JA  - EMERG NURSE
VL  - 15
IS  - 2
PB  - RCNi
AB  - PAMELA DIXON has developed an algorithm for managing opioid overdose to provide an evidence based treatment pathway for patients in emergency departments.
SN  - 1354-5752
AD  - Sister, A&E, Jersey General Hospital
U2  - PMID: 17542332.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105965825
T1  - Persistence with oral naltrexone for alcohol treatment: implications for health-care utilization.
AU  - Kranzler HR
AU  - Stephenson JJ
AU  - Montejano L
AU  - Wang S
AU  - Gastfriend DR
Y1  - 2008/11//
N1  - Accession Number: 105965825. Language: English. Entry Date: 20081212. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Psychiatry/Psychology. Grant Information: Supported by Alkermes, Inc., Cephalon, Inc. and NIAAA grant K24 AA13736. NLM UID: 9304118. 
KW  - Alcohol Abuse -- Drug Therapy
KW  - Alcoholism -- Drug Therapy
KW  - Health Resource Utilization
KW  - Medication Compliance
KW  - Naltrexone -- Administration and Dosage
KW  - Naltrexone -- Therapeutic Use
KW  - Administration, Oral
KW  - Adult
KW  - Chi Square Test
KW  - Correlational Studies
KW  - Descriptive Statistics
KW  - Drugs, Prescription
KW  - Female
KW  - Funding Source
KW  - Logistic Regression
KW  - Male
KW  - Middle Age
KW  - Patient Attitudes
KW  - Retrospective Design
KW  - T-Tests
KW  - Univariate Statistics
KW  - Human
SP  - 1801
EP  - 1808
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 103
IS  - 11
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - AIMS: Concerns have been raised about patients' failure to persist in alcohol treatment. We examined prescriptions for oral naltrexone in a large, nationally distributed treatment population to identify characteristics and health-care utilization patterns associated with persistence. DESIGN: Data from the 2000-2004 MarketScan Commercial Claims and Encounters Database were used to identify patients with alcohol-related claims who were prescribed naltrexone. MEASUREMENTS: Analysis identified patient characteristics that predicted persistence with naltrexone (defined as having filled prescriptions for >or=80% of the 6-month treatment period) and its association to health-care utilization. FINDINGS: Of 1138 patients, 162 (14.2%) were persistent in obtaining naltrexone. Non-persistent patients were significantly younger, more likely to be hourly employees and to live in an area with a lower median income, and less likely to be newly diagnosed with an alcohol-related disorder. Non-persistence in obtaining naltrexone was associated with significantly more intensive treatments, including inpatient detoxification, emergency room visits and hospitalizations. CONCLUSIONS: Over a 6-month period, 85.8% of patients who filled an initial prescription for naltrexone did not persist in obtaining the medication. Non-persistence was associated with significantly greater use of costly health-care services. Because the study was correlational, it is not possible to conclude that persistence reduced health-care costs, as patients with a better prognosis may have been more persistent. Research is needed to determine whether interventions that enhance persistence with naltrexone therapy improve treatment outcomes and reduce health-care costs.
SN  - 0965-2140
AD  - Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
U2  - PMID: 19032530.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 120757654
T1  - Initiative Battles Opioid Abuse.
Y1  - 2017/01//
N1  - Accession Number: 120757654. Language: English. Entry Date: 20170308. Revision Date: 20170308. Publication Type: Article; brief item. Journal Subset: Biomedical; USA. NLM UID: 9000866. 
KW  - Substance Abuse -- Prevention and Control
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Prescribing Patterns
KW  - Emergency Service -- Statistics and Numerical Data
SP  - 8
EP  - 8
JO  - Emergency Medicine News
JF  - Emergency Medicine News
JA  - EMERG MED NEWS
VL  - 39
IS  - 1
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 1054-0725
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106976105
T1  - Street drug toxicity resulting from opiates combined with anticholinergics.
AU  - Wang HE
Y1  - 2002/07//2002 Jul-Sep
N1  - Accession Number: 106976105. Language: English. Entry Date: 20021108. Revision Date: 20150820. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Substance Abuse
KW  - Heroin -- Poisoning
KW  - Alprazolam -- Poisoning
KW  - Overdose -- Therapy
KW  - Drug Interactions
KW  - Pennsylvania
KW  - Prehospital Care
KW  - Naloxone -- Adverse Effects
KW  - Agitation
KW  - Adult
KW  - Female
SP  - 351
EP  - 354
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 6
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
SN  - 1090-3127
AD  - Department of Emergency Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 400, Pittsburgh, PA 15238; wanghe@msx.upmc.edu
U2  - PMID: 12109584.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106976105&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105175893
T1  - Emergency medicine.
AU  - Abbott L
Y1  - 2010/03//
N1  - Accession Number: 105175893. Language: English. Entry Date: 20100604. Revision Date: 20150711. Publication Type: Journal Article; commentary. Original Study: Johansson P, et al. The effect of combined treatment with morphine sulphate and lowdose ketamine in a prehospital setting. Scand J Trauma Resus Emerg Med 2009; 17: 61; Rickman S, Taylor DM, Taylor SE. An intervention trial increases the evidence-based use of bupivacaine in hand injuries. (EMERG MED J) Jan2010; 27 (1): 17-21; Holdgate A, Cao A, Lo KM. The implementation of intranasal fentanyl for children in a mixed adult and pediatric emergency department reduces time to analgesic administration. (ACAD EMERG MED) Feb2010; 17 (2): 214-217; Kerr D, Kelly A, Dietze P, Jolley D, Barger B. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. (ADDICTION) Dec2009; 104 (12): 2067-2074. Journal Subset: Australia & New Zealand; Biomedical. Special Interest: Evidence-Based Practice. 
KW  - Bupivacaine
KW  - Fentanyl
KW  - Naloxone
KW  - Administration, Intranasal
KW  - Child
KW  - Emergency Medicine
KW  - Heroin -- Poisoning
SP  - 65
EP  - 66
JO  - Journal of Pharmacy Practice & Research
JF  - Journal of Pharmacy Practice & Research
JA  - J PHARM PRACT RES
VL  - 40
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1445-937X
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105000497
T1  - Treating the unexpected: the opiate overdose patient.
AU  - Willis, Sam
Y1  - 2010/12//
N1  - Accession Number: 105000497. Language: English. Entry Date: 20110401. Revision Date: 20150819. Publication Type: Journal Article; pictorial; review; tables/charts. Journal Subset: Allied Health; Europe; UK & Ireland. Special Interest: Emergency Care. 
KW  - Narcotics
KW  - Patient Assessment
KW  - Prehospital Care
KW  - Substance Abuse -- Diagnosis
KW  - Substance Abuse -- Therapy
KW  - Antianxiety Agents, Benzodiazepine
KW  - Consent
KW  - Ethics
KW  - Naloxone -- Therapeutic Use
KW  - Substance Abuse -- Complications
SP  - 572
EP  - 577
JO  - Journal of Paramedic Practice
JF  - Journal of Paramedic Practice
JA  - J PARAMEDIC PRACT
VL  - 2
IS  - 12
PB  - Mark Allen Holdings Limited
SN  - 1759-1376
AD  - Training Officer, London Ambulance Service NHS Trust and Fellow of the Higher Education Academy (FHEA)
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105332558
T1  - Over-the-counter overdoses.
AU  - Collopy KT
Y1  - 2009/10//
N1  - Accession Number: 105332558. Language: English. Entry Date: 20091204. Revision Date: 20150711. Publication Type: Journal Article; case study; pictorial. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101466002. 
KW  - Drugs, Non-Prescription -- Poisoning
KW  - Emergency Medical Services
KW  - Overdose -- Diagnosis
KW  - Overdose -- Therapy
KW  - Prehospital Care
KW  - Acetaminophen -- Administration and Dosage
KW  - Acetaminophen -- Pharmacokinetics
KW  - Acetaminophen -- Poisoning
KW  - Adolescence
KW  - Adult
KW  - Airway Management
KW  - Charcoal -- Therapeutic Use
KW  - Child
KW  - Dextromethorphan -- Administration and Dosage
KW  - Dextromethorphan -- Poisoning
KW  - Diphenhydramine -- Poisoning
KW  - Drug Monitoring
KW  - Electrocardiography
KW  - Emergency Patients
KW  - Female
KW  - Ibuprofen -- Poisoning
KW  - Intubation, Gastrointestinal
KW  - Ipecac -- Therapeutic Use
KW  - Male
KW  - Naloxone -- Administration and Dosage
KW  - Outpatients
KW  - Overdose -- Risk Factors
KW  - Overdose -- Symptoms
KW  - Oxygen Therapy
KW  - Patient Assessment
KW  - Patient History Taking
KW  - Physical Examination
KW  - Treatment Refusal
SP  - 78
EP  - 82
JO  - EMS Magazine
JF  - EMS Magazine
JA  - EMS MAG
VL  - 38
IS  - 10
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
AB  - We were called at 2 a.m. to a university apartment for a 21-year-old female who had overdosed. We arrived on scene to find a very distraught woman. After a fight with her boyfriend eariler in the evening, she had swallowed several handfuls of ibuprofen.
SN  - 1946-4967
AD  - Spirit Medical Transportation Service, Wisconsin
U2  - PMID: 19856783.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107516902
T1  - Naloxone hydrochloride: a review.
AU  - Goodrich PM
Y1  - 1990/02//
N1  - Accession Number: 107516902. Language: English. Entry Date: 19900601. Revision Date: 20150712. Publication Type: Journal Article; review. Journal Subset: Blind Peer Reviewed; Core Nursing; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 0431420. 
KW  - Naloxone -- Pharmacodynamics
KW  - Naloxone -- Adverse Effects
KW  - Drug Antagonism
KW  - Narcotics
KW  - Anesthesia
KW  - Intraoperative Care
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Administration and Dosage
SP  - 14
EP  - 16
JO  - AANA Journal
JF  - AANA Journal
JA  - AANA J
VL  - 58
IS  - 1
CY  - Park Ridge, Illinois
PB  - American Association of Nurse Anesthetists
AB  - Naloxone hydrochloride is a widely used opioid antagonist. Narcotic analgesics administered to patients bind to opioid receptor sites within the central nervous system. Activation of these receptor sites initiates an analgesic response. Blocking of the receptor sites by opioid antagonists, such as naloxone hydrochloride, reverses the effects of the narcotic agonist. Although often used in an emergency room setting in high doses (up to 2 mg), such doses may not be advantageous in an operating room setting where the goal would be the reversal of the respiratory depressant effects of the narcotic while retaining the analgesic properties. Ultimately, the clinician will find that titrating naloxone hydrochloride in small doses (starting as low as .05 mg) will produce the most desirable response.
SN  - 0094-6354
U2  - PMID: 2180244.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107516902&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108087821
T1  - Intranasal sufentanil and its emerging clinical applications: beyond its role in the emergency department...J Opioid Manag. 2012 Jul-Aug;8(4):237-41
AU  - Kapoor S
Y1  - 2012/11//2012 Nov-Dec
N1  - Accession Number: 108087821. Language: English. Entry Date: 20130308. Revision Date: 20150712. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101234523. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Extremities -- Injuries
KW  - Pain -- Drug Therapy
KW  - Sufentanil -- Administration and Dosage
KW  - Wounds and Injuries -- Complications
KW  - Female
KW  - Male
SP  - 341
EP  - 341
JO  - Journal of Opioid Management
JF  - Journal of Opioid Management
JA  - J OPIOID MANAGE
VL  - 8
IS  - 6
CY  - Weston, Massachusetts
PB  - Weston Medical Publishing, LLC
SN  - 1551-7489
U2  - PMID: 23264311.
DO  - 10.5055/jom.2012.0133
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108087821&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105813734
T1  - Meet Narcan: the amazing drug that helps save overdose patients.
AU  - Barker K
AU  - Hunjadi D
Y1  - 2008/08//2008 Aug
N1  - Accession Number: 105813734. Language: English. Entry Date: 20080912. Revision Date: 20150820. Publication Type: Journal Article; case study; pictorial; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Naloxone -- Therapeutic Use
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Prehospital Care
KW  - Substance Abuse -- Complications
KW  - Administration, Intranasal
KW  - Administration, Intravenous
KW  - Adolescence
KW  - Dose-Response Relationship, Drug
KW  - Emergency Medical Services
KW  - Emergency Patients
KW  - Injections, Intramuscular
KW  - Male
KW  - Naloxone -- Administration and Dosage
KW  - Naloxone -- Adverse Effects
KW  - Naloxone -- Pharmacodynamics
KW  - Naloxone -- Pharmacokinetics
KW  - Outpatients
KW  - Resuscitation
SP  - 72
EP  - 76
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 33
IS  - 8
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Paramedic Educator, Gateway Technical College, Burlington, WI; barkerk@gtc.edu
U2  - PMID: 18692733.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105813734&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103982288
T1  - In reply-The Contribution of Patient Satisfaction to the Opiate Abuse Epidemic...Mayo Clin Proc. 2014 Aug;89(8):1168; Mayo Clin Proc. 2014 Apr;89(4):437-9
AU  - Berge, Keith H
AU  - Burkle, Christopher M
Y1  - 2014/08//
N1  - Accession Number: 103982288. Language: English. Entry Date: 20141114. Revision Date: 20150710. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0405543. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Cause of Death
KW  - Emergency Service -- Utilization
KW  - Substance Use Disorders -- Diagnosis
KW  - Substance Use Disorders -- Epidemiology
KW  - Female
KW  - Male
SP  - 1168
EP  - 1168
JO  - Mayo Clinic Proceedings
JF  - Mayo Clinic Proceedings
JA  - MAYO CLIN PROC
VL  - 89
IS  - 8
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0025-6196
AD  - Mayo Clinic, Rochester, MN.
U2  - PMID: 25092371.
DO  - 10.1016/j.mayocp.2014.06.007
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103982288&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103982287
T1  - The contribution of patient satisfaction to the opiate abuse epidemic...Mayo Clin Proc. 2014 Apr;89(4):437-9
AU  - Hirsch, Ronald Lauren
Y1  - 2014/08//
N1  - Accession Number: 103982287. Language: English. Entry Date: 20141114. Revision Date: 20150710. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0405543. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Cause of Death
KW  - Emergency Service -- Utilization
KW  - Substance Use Disorders -- Diagnosis
KW  - Substance Use Disorders -- Epidemiology
KW  - Female
KW  - Male
SP  - 1168
EP  - 1168
JO  - Mayo Clinic Proceedings
JF  - Mayo Clinic Proceedings
JA  - MAYO CLIN PROC
VL  - 89
IS  - 8
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0025-6196
AD  - Chicago, Ilinois.
U2  - PMID: 25092370.
DO  - 10.1016/j.mayocp.2014.06.006
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103982287&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 109732247
T1  - A retrospective, matched cohort study of potential drug-drug interaction prevalence and opioid utilization in a diabetic peripheral neuropathy population initiated on pregabalin or duloxetine.
AU  - Ellis, Jeffrey J
AU  - Sadosky, Alesia B
AU  - Ten Eyck, Laura L
AU  - Mudumby, Pallavi
AU  - Cappelleri, Joseph C
AU  - Ndehi, Lilian
AU  - Suehs, Brandon T
AU  - Parsons, Bruce
Y1  - 2015/01//
N1  - Accession Number: 109732247. Language: English. Entry Date: 20150923. Revision Date: 20160518. Publication Type: journal article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 101088677. 
SP  - 159
EP  - 159
JO  - BMC Health Services Research
JF  - BMC Health Services Research
JA  - BMC HEALTH SERV RES
VL  - 15
IS  - 1
PB  - BioMed Central
AB  - Background: Anticipating and controlling drug-drug interactions (DDIs) in older patients with painful diabetic peripheral neuropaty (pDPN) presents a significant challenge to providers. The purpose of this study was to examine the impact of newly initiated pregabalin or duloxetine treatment on Medicare Advantage Prescription Drug (MAPD) plan pDPN patients' encounters with potential drug-drug interactions, the healthcare cost and utilization consequences of those interactions, and opioid utilization.Methods: Study subjects required a pregabalin or duloxetine pharmacy claim between 07/01/2008-06/30/2012 (index event), ≥1 inpatient or ≥2 outpatient medical claims with pDPN diagnosis between 01/01/2008-12/31/2012, and ≥12 months pre- and ≥6 post-index enrollment. Propensity score matching was used to balance the pregabalin and duloxetine cohorts on pre-index demographics and comorbidities. Potential DDIs were defined by Micromedex 2.0 and identified by prescription claims. Six-month post-index healthcare utilization (HCU) and costs were calculated using pharmacy and medical claims.Results: No significant differences in pre-index demographics or comorbidities were found between pregabalin subjects (n = 446) and duloxetine subjects (n = 446). Potential DDI prevalence was significantly greater (p < 0.0001) among duoxetine subjects (56.7%) than among pregabalin subjects (2.9%). There were no significant differences in HCU or costs between pregablin subjects with and without a potential DDI. By contrast, duloxetine subjects with a potential DDI had higher mean all-cause costs ($13,908 vs. $9,830; p = 0.001), more subjects with ≥1 inpatient visits (35.6% vs 25.4%; p = 0.02), and more subjects with ≥1 emergency room visits (32.8% vs. 20.7%; p = 0.005) in comparison to duloxetine subjects without a potential DDI. There was a trend toward a difference between pregabalin and duloxetine subjects in their respective pre-versus-post differences in milligrams (mg) of morphine equivalents/30 days used (60.2 mg and 176.9 mg, respectively; p = 0.058).Conclusion: The significantly higher prevalence of potential DDIs and potential cost impact found in pDPN duloxetine users, relative to pregabalin users, underscore the importance of considering DDIs when selecting a treatment.
SN  - 1472-6963
U2  - PMID: 25889173.
DO  - 10.1186/s12913-015-0829-9
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109732247&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106799614
T1  - Low incidence of nausea and vomiting with intravenous opiate analgesia in the ED.
AU  - Paoloni R
AU  - Talbot-Stern J
Y1  - 2002/11//2002 Nov
N1  - Accession Number: 106799614. Language: English. Entry Date: 20030124. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Nausea -- Chemically Induced
KW  - Vomiting -- Chemically Induced
KW  - Narcotics -- Adverse Effects
KW  - Prospective Studies
KW  - Convenience Sample
KW  - Wilcoxon Rank Sum Test
KW  - McNemar's Test
KW  - T-Tests
KW  - Descriptive Statistics
KW  - Chi Square Test
KW  - Emergency Service
KW  - Adolescence
KW  - Adult
KW  - Male
KW  - Female
KW  - Human
SP  - 604
EP  - 608
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 20
IS  - 7
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Two double-blind, placebo-controlled, prospective randomized trials in the emergency department (ED) setting have examined the use of metoclopramide for the prevention of opiate-induced nausea and vomiting. Both showed a low incidence of vomiting in the control group. This prospective observational study in 205 unselected ED patients with acute pain syndromes measured nausea and vomiting before intravenous opiate administration and 30 and 60 minutes posttreatment. Cumulative incidence of vomiting was 1.5% at 30 minutes and 2.4% at 60 minutes. Corresponding figures for nausea were 4.9% at 30 minutes and 9.3% at 60 minutes, with more than 75% of patients rating their nausea as mild. Prevalence of both nausea and vomiting were higher at baseline than after analgesia. These data support the findings of previous randomized trials that the incidence of nausea and vomiting after intravenous opiate analgesia in the ED is low and argues against routine use of prophylactic antiemetic administration in combination with opiate analgesia.
SN  - 0735-6757
AD  - Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown 2050, Sydney, Australia
U2  - PMID: 12442238.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106799614&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105381483
T1  - Evidence-based emergency medicine/rational clinical examination abstract. Do opioids affect the clinical evaluation of patients with acute abdominal pain?
AU  - Vadera R
AU  - Sherbino J
Y1  - 2009/07//
N1  - Accession Number: 105381483. Language: English. Entry Date: 20090807. Revision Date: 20150818. Publication Type: Journal Article; abstract; commentary. Original Study: Ranji SR, Goldman LE, Simel DL, Shojania KG, Rennie D, Ranji Sumant R, et al. Do opiates affect the clinical evaluation of patients with acute abdominal pain? (JAMA) 10/11/2006; 296 (14): 1764-1774. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care; Evidence-Based Practice; Pain and Pain Management. NLM UID: 8002646. 
KW  - Abdominal Pain -- Diagnosis
KW  - Narcotics -- Administration and Dosage
KW  - Abdominal Pain -- Surgery
KW  - Clinical Trials
KW  - Embase
KW  - Medline
KW  - Random Assignment
KW  - Systematic Review
SP  - 126
EP  - 127
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 54
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.
U2  - PMID: 18929432.
DO  - 10.1016/j.annemergmed.2008.08.028
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105381483&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107966847
T1  - Oxymorphone: Opioid Abuse Flying Under the Radar.
AU  - Roberts, James R.
Y1  - 2013/08//
N1  - Accession Number: 107966847. Language: English. Entry Date: 20130821. Revision Date: 20150712. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; USA. Special Interest: Emergency Care. NLM UID: 9000866. 
KW  - Substance Abuse -- Prevention and Control
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Medicine
KW  - News
KW  - Emergency Service
KW  - Medical Practice
KW  - Chronic Pain -- Therapy
KW  - Delayed-Action Preparations -- Administration and Dosage
KW  - Overdose -- Mortality
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Patient Care
SP  - 12
EP  - 14
JO  - Emergency Medicine News
JF  - Emergency Medicine News
JA  - EMERG MED NEWS
VL  - 35
IS  - 8
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 1054-0725
AD  - Chairman of emergency medicine, Mercy Catholic Medical Center, Philadelphia; Director, division of toxicology, Mercy Catholic Medical Center, Philadelphia; Professor of emergency medicine and toxicology, Drexel University College of Medicine, Philadelphia
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107966847&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106753873
T1  - The effect of race/ethnicity and desirable social characteristics on physicians' decisions to prescribe opioid analgesics.
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
Y1  - 2003/11//
N1  - Accession Number: 106753873. Language: English. Entry Date: 20040709. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: Agency for Healthcare Research and Quality Dissertation Grant R03 HS11948-01, the Center for Healthcare Research and Policy at MetroHealth Medical Center, and the Department of Epidemiology and Biostatistics at Case Western Reserve University. NLM UID: 9418450. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Decision Making, Clinical
KW  - Emergency Care
KW  - Ethnic Groups
KW  - Pain -- Drug Therapy
KW  - Physicians, Emergency
KW  - Prescriptions, Drug
KW  - Ankle Fractures
KW  - Bivariate Statistics
KW  - Blacks
KW  - Chi Square Test
KW  - Confidence Intervals
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Emergency Service
KW  - Female
KW  - Funding Source
KW  - Hispanics
KW  - Hospitals
KW  - Interviews
KW  - Low Back Pain
KW  - Male
KW  - Migraine
KW  - Multiple Logistic Regression
KW  - Odds Ratio
KW  - P-Value
KW  - Patient Discharge
KW  - Physician Attitudes
KW  - Physician-Patient Relations
KW  - Questionnaires
KW  - Race Factors
KW  - Random Assignment
KW  - Random Sample
KW  - Relative Risk
KW  - Sex Factors
KW  - Stereotyping
KW  - Surveys
KW  - United States
KW  - Vignettes
KW  - Whites
KW  - Human
SP  - 1239
EP  - 1248
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 10
IS  - 11
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
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.
SN  - 1069-6563
AD  - Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH; sarver@po.cwru.edu
U2  - PMID: 14597500.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106753873&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105660084
T1  - Poisoning necessitating pediatric ICU admissions: size of pupils does matter.
AU  - Hon KLE
AU  - Ho JK
AU  - Hung EC
AU  - Cheung K
AU  - Ng P
AU  - Hon, Kam-Lun Ellis
AU  - Ho, Jasperine Ka-Yee
AU  - Hung, Emily Chi-Wan
AU  - Cheung, Kam-Lau
AU  - Ng, Pak-Cheung
Y1  - 2008/08//2008 Aug
N1  - Accession Number: 105660084. Language: English. Entry Date: 20081003. Revision Date: 20151231. Publication Type: journal article; case study. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 7503090. 
KW  - Central Nervous System Depressants -- Poisoning
KW  - Methadone -- Poisoning
KW  - Neuromuscular Depolarizing Agents -- Poisoning
KW  - Phenobarbital -- Poisoning
KW  - Pupil -- Drug Effects
KW  - Child
KW  - Child, Preschool
KW  - Female
KW  - Infant
KW  - Infant, Newborn
KW  - Intensive Care Units, Pediatric
KW  - Male
KW  - Overdose -- Diagnosis
KW  - Patient Admission
SP  - 952
EP  - 956
JO  - Journal of the National Medical Association
JF  - Journal of the National Medical Association
JA  - J NATL MED ASSOC
VL  - 100
IS  - 8
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Introduction: Childhood poisonings are common, but usually trivial, and infrequently necessitate intensive care unit (ICU) admissions.Methods: A retrospective record review was conducted to analyze the pattern of severe poisoning-associated ICU admissions at a teaching hospital between May 2002 and December 2007.Results: Six cases (4 boys and 2 girls, aged 2 months to 11 years) of drug poisoning-associated ICU admissions were identified. Methadone was the culprit in 3 boys and 1 girl, resulting in respiratory failure, depressed conscious state and pinpoint pupils. As relevant exposure history was not immediately apparent, diagnosis at the emergency department was only made correctly in 2 patients. Phenobarbitone overdose occurred in 1 girl with past history of phenobarbitone overdose as a clue. She was also considered to have pinpoint pupils that were unresponsive to naloxone. Features consistent with cholinergic toxidrome, including small pupils, and increased secretion occurred in an infant fed with milk prepared with an herbal broth suspected to have been adulterated with a pesticide. Atropine as an antidote was used when the child was in the pediatric ICU. All children made an uneventful recovery following their short ICU stay.Conclusions: Life-threatening poisonings requiring ICU support can pose diagnostic difficulties and challenges to frontline medical officers at the emergency department. Children from all age groups can be affected. Prompt diagnosis is based on relevant history, careful clinical examination and a high index of suspicion in patients known to be at risk. The pupillary size and its reaction following treatment serves as an important diagnostic clue.
SN  - 0027-9684
AD  - Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, People's Republic of China
U2  - PMID: 18717147.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105660084&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105876732
T1  - Nurse initiated intravenous opioid administration: how a community ED helped change legislation in the state of Victoria, 2006...6th International Conference for Emergency Nurses: Future Directions, Future ChallengesEL Beyond Tomorrow, 11-13 October 2007, Melbourne, Victoria, Australia
AU  - Green D
AU  - Kelly A
Y1  - 2007/11//
N1  - Accession Number: 105876732. Language: English. Entry Date: 20080404. Revision Date: 20150711. Publication Type: Journal Article; abstract. Journal Subset: Australia & New Zealand; Core Nursing; Nursing; Peer Reviewed. 
KW  - Administration, Intravenous
KW  - Emergency Nursing
KW  - Narcotics -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Scope of Nursing Practice
KW  - Emergency Patients
KW  - Emergency Service
KW  - Nursing Practice, Evidence-Based
KW  - Registered Nurses
SP  - 203
EP  - 203
JO  - Australasian Emergency Nursing Journal
JF  - Australasian Emergency Nursing Journal
JA  - AUSTRALAS EMERG NURS J
VL  - 10
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 1574-6267
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105876732&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104887518
T1  - Procedural Sedation and Analgesia in the Emergency Department.
AU  - Baker, Stephanie N.
AU  - Weant, Kyle A.
Y1  - 2011/04//04/01/2011
N1  - Accession Number: 104887518. Language: English. Entry Date: 20110525. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8900945. 
KW  - Analgesia -- Methods
KW  - Pharmacists
KW  - Emergency Medicine -- Manpower
KW  - Sedation -- Methods
KW  - Emergency Service
KW  - Medication Errors -- Prevention and Control
KW  - Monitoring, Physiologic
KW  - Analgesics -- Therapeutic Use
KW  - Hypnotics and Sedatives -- Therapeutic Use
KW  - Analgesics -- Administration and Dosage
KW  - Hypnotics and Sedatives -- Administration and Dosage
KW  - Drug Therapy, Combination
KW  - Flumazenil
KW  - Naloxone
KW  - Pediatric Care
SP  - 189
EP  - 195
JO  - Journal of Pharmacy Practice
JF  - Journal of Pharmacy Practice
JA  - J PHARM PRACT
VL  - 24
IS  - 2
CY  - Thousand Oaks, California
PB  - Sage Publications Inc.
SN  - 0897-1900
AD  - University of Kentucky HealthCare Lexington, KY, USA stephnbaker@uky.edu
AD  - University of Kentucky HealthCare Lexington, KY, USA
U2  - PMID: 21712213.
DO  - 10.1177/0897190011400554
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106468255
T1  - Reduction in emergency presentations by adolescent poly-drug users: a case-series.
AU  - Tait RJ
AU  - Hulse GK
Y1  - 2005/06//
N1  - Accession Number: 106468255. Language: English. Entry Date: 20060707. Revision Date: 20150711. Publication Type: Journal Article; case study; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: Heathway, the Western Australian Health Promotion Foundation. NLM UID: 9439517. 
KW  - Emergency Service -- Utilization -- In Adolescence
KW  - Overdose -- Therapy -- In Adolescence
KW  - Substance Abuse -- Therapy -- In Adolescence
KW  - Aboriginal Australians
KW  - Adolescence
KW  - Case Management
KW  - Case Studies
KW  - Female
KW  - Male
KW  - Naltrexone -- Therapeutic Use
KW  - Record Review
KW  - Retrospective Design
KW  - Street Drugs
KW  - Substance Abuse -- Drug Therapy
KW  - Substance Abuse -- Legislation and Jurisprudence
KW  - Western Australia
KW  - Funding Source
KW  - Human
SP  - 41
EP  - 53
JO  - Journal of Child & Adolescent Substance Abuse
JF  - Journal of Child & Adolescent Substance Abuse
JA  - J CHILD ADOLESC SUBST ABUSE
VL  - 14
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - The objectives were, firstly, to describe the frequency and type of hospital emergency department (ED) admissions in a small number of alcohol and other drug (AOD) using adolescents who accounted for a high number of ED and other hospital presentations. Secondly, to identify interventions that impacted on these repeat ED presentations. An earlier 12-month review of hospital presentations identified a cohort of 55 AOD using adolescents with 236 repeat presentations. Six adolescents accounted for 47% (n = 112) of these presentations. A case review of these six adolescents was conducted over 24-months across the four major public hospitals in Perth. AODtreatment during this period was identified from hospital case notes and patient notes at the major opiate treatment service. There were 172 hospital presentations of which 98 were overdoses (ODs) (75% opiate). There were 24 other AOD related and 50 non-AOD presentations. ED treatment focused on acute care. Four adolescents were referred to an external treatment agency and two, a residential psychiatric hospital. Five of the six attended a specialist opiate treatment centre. Of these, one opted for unsupervised home detoxification and continued to represent to ED, primarily with opiate ODs. Four underwent rapid opiate detoxification (ROD), with three commencing oral naltrexone maintenance. Three cases with continuing ODs were further treated with slow-release naltrexone implants. In 91 weeks post implant follow-up (range 8-42) there were no opiate or non-opiate OD presentations compared with 14 in the corresponding pre-implant period. The sixth adolescent had representations primarily related to psychiatric problems. ED based interventions, including intensive case management had little impact on repeat ED presentation in these 'high-risk' adolescents. Preliminary results however, suggest that treatment with naltrexone implants dramatically reduces repeat OD presentations.
SN  - 1067-828X
AD  - School of Psychiatry and Clinical Neurosciences, QEII Medical Centre ('D' Block), Nedlands, WA, Australia; 6009; rjtait@cyllene.uwa.edu.au
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105705440
T1  - Review article: Lack of effect of opiates in the treatment of acute cardiogenic pulmonary oedema.
AU  - Sosnowski MA
Y1  - 2008/10//
N1  - Accession Number: 105705440. Language: English. Entry Date: 20081205. Revision Date: 20150711. Publication Type: Journal Article; research; systematic review; tables/charts. Journal Subset: Australia & New Zealand; Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Emergency Care; Evidence-Based Practice. NLM UID: 101199824. 
KW  - Emergency Care
KW  - Narcotics -- Therapeutic Use
KW  - Outcomes (Health Care)
KW  - Pulmonary Edema -- Drug Therapy
KW  - Cochrane Library
KW  - Dose-Response Relationship, Drug
KW  - Embase
KW  - Emergency Service
KW  - Heart Failure -- Drug Therapy
KW  - Hemodynamics -- Drug Effects
KW  - Medline
KW  - Morphine -- Administration and Dosage
KW  - Morphine -- Pharmacodynamics
KW  - Morphine -- Therapeutic Use
KW  - Nitroglycerin -- Therapeutic Use
KW  - Professional Practice, Evidence-Based
KW  - Pulmonary Edema -- Physiopathology
KW  - Receptors, Drug
KW  - Treatment Outcomes
KW  - Vasodilation
KW  - Human
SP  - 384
EP  - 390
JO  - Emergency Medicine Australasia
JF  - Emergency Medicine Australasia
JA  - EMERG MED AUSTRALAS
VL  - 20
IS  - 5
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1742-6731
AD  - Emergency Department, Wangani Hospital, Wanganui, New Zealand; marcins@ghw.co.nz
U2  - PMID: 18973635.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105705440&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 111054743
T1  - Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
AU  - Lavonas, Eric J.
AU  - Drennan, Ian R.
AU  - Gabrielli, Andrea
AU  - Heffner, Alan C.
AU  - Hoyte, Christopher O.
AU  - Orkin, Aaron M.
AU  - Sawyer, Kelly N.
AU  - Donnino, Michael W.
Y1  - 2015/11/04/10/3/2015 Supplement
N1  - Accession Number: 111054743. Language: English. Entry Date: 20160123. Revision Date: 20160901. Publication Type: journal article; practice guidelines; review. Supplement Title: 10/3/2015 Supplement. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0147763. 
KW  - Heart Arrest -- Therapy
KW  - Emergency Medical Services -- Standards
KW  - Resuscitation, Cardiopulmonary -- Standards
KW  - Near Drowning -- Complications
KW  - Anaphylaxis -- Therapy
KW  - Hypothermia -- Therapy
KW  - Hypothermia -- Complications
KW  - Heart Arrest -- Complications
KW  - Cardiovascular Care
KW  - Anaphylaxis -- Complications
KW  - Fluid-Electrolyte Imbalance -- Complications
KW  - Pulmonary Embolism -- Therapy
KW  - Pregnancy Complications, Cardiovascular -- Therapy
KW  - Cardiac Tamponade -- Therapy
KW  - Near Drowning -- Therapy
KW  - Fluid-Electrolyte Imbalance -- Therapy
KW  - Fat Emulsions, Intravenous -- Therapeutic Use
KW  - Wounds and Injuries -- Complications
KW  - Wounds and Injuries -- Therapy
KW  - Emergency Medical Services -- Methods
KW  - Pregnancy
KW  - Adult
KW  - Naloxone -- Therapeutic Use
KW  - Female
KW  - Pulmonary Embolism -- Complications
KW  - Heart Arrest -- Chemically Induced
KW  - Cardiac Tamponade -- Complications
KW  - Resuscitation, Cardiopulmonary -- Methods
SP  - S501
EP  - S518
JO  - Circulation
JF  - Circulation
JA  - CIRCULATION
VL  - 132
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - The article examines the recommended resuscitation management in several critical situations including cardiac arrest associated with pregnancy, pulmonary embolism, and opioid-associated resuscitative emergencies, with or without cardiac arrest. Information about the intravenous lipid emulsion (ILE) therapy for cardiac arrest due to drug intoxication, is given. Also highlighted is the use of standardized methodological approach in evaluation of evidence review process.
SN  - 0009-7322
U2  - PMID: 26472998.
DO  - 10.1161/CIR.0000000000000264
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106426019
T1  - Major increases in opioid analgesic abuse in the United States: concerns and strategies.
AU  - Compton WM
AU  - Volkow ND
Y1  - 2006/02//
N1  - Accession Number: 106426019. Language: English. Entry Date: 20060414. Revision Date: 20150711. Publication Type: Journal Article; statistics. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 7513587. 
KW  - Analgesics, Opioid
KW  - Substance Abuse -- Epidemiology -- United States
KW  - Substance Abuse -- Prevention and Control -- United States
KW  - Adolescence
KW  - Drugs, Prescription
KW  - Emergency Service
KW  - Substance Dependence
KW  - United States
SP  - 103
EP  - 107
JO  - Drug & Alcohol Dependence
JF  - Drug & Alcohol Dependence
JA  - DRUG ALCOHOL DEPENDENCE
VL  - 81
IS  - 2
PB  - Elsevier B.V.
AB  - The problem of abuse of and addiction to opioid analgesics has emerged as a major issue for the United States in the past decade and has worsened over the past few years. The increases in abuse of these opioids appear to reflect, in part, changes in medication prescribing practices, changes in drug formulations as well as relatively easy access via the internet. Though the use of opioid analgesics for the treatment of acute pain appears to be generally benign, long-term administration of opioids has been associated with clinically meaningful rates of abuse or addiction. Important areas of research to help with the problem of opioid analgesic abuse include the identification of clinical practices that minimize the risks of addiction, the development of guidelines for early detection and management of addiction, the development of opioid analgesics that minimize the risks for abuse, and the development of safe and effective non-opioid analgesics. With high rates of abuse of opiate analgesics among teenagers in the United States, a particularly urgent priority is the investigation of best practices for treating pain in adolescents as well as the development of prevention strategies to reduce diversion and abuse.
SN  - 0376-8716
AD  - National Institute on Drug Abuse, 6001 Executive Boulevard, MSC 9589, Bethesda, MD 20892-9589; wcompton@nida.nih.gov
U2  - PMID: 16023304.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103781559
T1  - Parenteral Midazolam Is Superior to Diazepam for Treatment of Prehospital Seizures.
AU  - Clemency, Brian M.
AU  - Ott, Jamie A.
AU  - Tanski, Christopher T.
AU  - Bart, Joseph A.
AU  - Lindstrom, Heather A.
Y1  - 2015/04/03/
N1  - Accession Number: 103781559. Language: English. Entry Date: 20150407. Revision Date: 20160926. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 9703530. 
KW  - Midazolam -- Administration and Dosage
KW  - Injections
KW  - Diazepam -- Administration and Dosage
KW  - Drug Evaluation
KW  - Seizures -- Therapy
KW  - Prehospital Care
KW  - Serial Publications
KW  - Human
KW  - Emergency Medicine
KW  - Emergency Medical Technicians
KW  - Administration, Intravenous
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Lorazepam -- Administration and Dosage
KW  - Data Analysis
KW  - Fisher's Exact Test
KW  - Male
KW  - Female
KW  - Middle Age
KW  - Alcohol Drinking
KW  - Trauma
KW  - Naloxone -- Administration and Dosage
SP  - 218
EP  - 223
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 19
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Introduction. Diazepam and midazolam are commonly used by paramedics to treat seizures. A period of drug scarcity was used as an opportunity to compare their effectiveness in treating prehospital seizures. Methods. A retrospective chart review of a single, large, commercial agency during a 29-month period was performed. The period included alternating shortages of both medications. Ambulances were stocked with either diazepam or midazolam based on availability of the drugs. Adult patients who received at least 1 parenteral dose of diazepam or midazolam for treatment of seizures were included. The regional prehospital protocol recommended 5 mg intravenous (IV) diazepam, 5 mg intramuscular (IM) diazepam, 5 mg IM midazolam, or 2.5 mg IV midazolam. Medication effectiveness was compared with respect to the primary end point: cessation of seizure without repeat seizure during the prehospital encounter. Results. A total of 440 study subjects received 577 administrations of diazepam or midazolam and met the study criteria. The subjects were 52% male, with a mean age of 48 (range 18-94) years. A total of 237 subjects received 329 doses of diazepam, 64 (27%) were treated with first-dose IM. A total of 203 subjects received 248 doses of midazolam; 71 (35%) were treated with first-dose IM. Seizure stopped and did not recur in 49% of subjects after parenteral diazepam and 65% of subjects after parenteral midazolam ( p = 0.002). Diazepam and midazolam exhibited similar first dose success for IV administration (58 vs. 62%; p = 0.294). Age, gender, seizure history, hypoglycemia, the presence of trauma, time to first administration, prehospital contact time, and frequency of IM administration were similar between groups. Conclusion. For parenteral administration, midazolam demonstrated superior first-dose seizure suppression. This study demonstrates how periods of drug scarcity can be utilized to study prehospital medication effectiveness.
SN  - 1090-3127
U2  - PMID: 25291522.
DO  - 10.3109/10903127.2014.959220
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105459900
T1  - Association between access block and time to parenteral opioid analgesia in renal colic: a pilot study.
AU  - Chu K
AU  - Brown A
Y1  - 2009/02//
N1  - Accession Number: 105459900. Language: English. Entry Date: 20090403. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Australia & New Zealand; Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Emergency Care. NLM UID: 101199824. 
KW  - Kidney Diseases -- Complications
KW  - Narcotics -- Therapeutic Use
KW  - Pain -- Drug Therapy
KW  - Treatment Delay
KW  - Waiting Lists
KW  - Adult
KW  - Confidence Intervals
KW  - Crowding
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Emergency Service
KW  - Female
KW  - Logistic Regression
KW  - Male
KW  - Middle Age
KW  - Nonexperimental Studies
KW  - Odds Ratio
KW  - Pilot Studies
KW  - Record Review
KW  - Retrospective Design
KW  - Human
SP  - 38
EP  - 42
JO  - Emergency Medicine Australasia
JF  - Emergency Medicine Australasia
JA  - EMERG MED AUSTRALAS
VL  - 21
IS  - 1
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1742-6731
AD  - Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld 4029, Australia; kevin_chu@health.qld.gov.au
U2  - PMID: 19254311.
DO  - 10.1111/j.1742-6723.2008.01146.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105428681
T1  - Comparison of selected sedation scales for reporting opioid-induced sedation assessment.
AU  - Nisbet AT
AU  - Mooney-Cotter F
Y1  - 2009/09//
N1  - Accession Number: 105428681. Language: English. Entry Date: 20091106. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Blind Peer Reviewed; Core Nursing; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Pain and Pain Management. Instrumentation: Richmond Agitation and Sedation Scale (RASS); Inova Sedation Scale (ISS); Pasero Opioid-Induced Sadation Scale (POSS). NLM UID: 100890606. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Instrument Validation
KW  - Medical-Surgical Nursing
KW  - Scales
KW  - Sedation -- Evaluation
KW  - Adult
KW  - Certification
KW  - Coefficient Alpha
KW  - Confidence Intervals
KW  - Content Validity
KW  - Convenience Sample
KW  - Descriptive Research
KW  - Descriptive Statistics
KW  - Middle Age
KW  - Nursing Assessment
KW  - Paired T-Tests
KW  - Random Sample
KW  - Trauma Centers
KW  - Two-Tailed Test
KW  - Validation Studies
KW  - Vignettes
KW  - Virginia
KW  - Human
SP  - 154
EP  - 164
JO  - Pain Management Nursing
JF  - Pain Management Nursing
JA  - PAIN MANAGE NURS
VL  - 10
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - W B Saunders
AB  - A descriptive survey-based study was undertaken to test the validity and reliability of three scales that are used to assess sedation during opioid administration for pain management: the Inova Health System Sedation Scale (ISS), the Richmond Agitation and Sedation Scale (RASS), and the Pasero Opioid-Induced Sedation Scale (POSS). The study was conducted in a large (830 beds) suburban level I trauma hospital with a random convenience sample of 96 medical-surgical nurses. The study reports: measures of reliability and validity of each scale and significant findings related to correct nursing score and selected actions; nurses' ratings of each scale in terms of combined ease of use; information provided by the scale to inform clinical decisions; and nursing confidence measures. Both the RASS and the POSS demonstrated adequate measures of reliability and validity for measurement of sedation during opioid administration for pain management. However, the POSS scored higher in combined measures of ease of use, nursing confidence, and usefulness of information provided to make clinical decisions. The POSS also yielded the highest percentage agreement with the correct score and correct nursing actions chosen by the nurse among the three scales tested. Study results have clinical significance for accuracy of clinical assessments and subsequent actions on behalf of patients experiencing advancing sedation during opioid analgesia. The POSS can be recommended as a superior sedation scale for the measurement of sedation during opioid administration for pain management. © 2009 by the American Society for Pain Management Nurses
SN  - 1524-9042
AD  - Inova Fairfax Hospital, Falls Church, VA 22042, USA. allison.nisbet@inova.org
U2  - PMID: 19706353.
DO  - 10.1016/j.pmn.2009.03.001
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107117150
T1  - Trends in medical use and abuse of opioid analgesics.
AU  - Joranson DE
AU  - Ryan KM
AU  - Gilson AM
AU  - Dahl JL
AU  - Joranson, D E
AU  - Ryan, K M
AU  - Gilson, A M
AU  - Dahl, J L
Y1  - 2000/04/05/
N1  - Accession Number: 107117150. Language: English. Entry Date: 20000701. Revision Date: 20161112. Publication Type: journal article; research; tables/charts. Commentary: Ball J, Korper S, Woodward A. Reporting drug abuse in the emergency department. (JAMA) 8/2/2000; 284 (5): 564-564. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: Grant 031461 from the Robert Wood Johnson Foundation. NLM UID: 7501160. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Substance Abuse -- Epidemiology
KW  - Retrospective Design
KW  - Funding Source
KW  - Human
SP  - 1710
EP  - 1714
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 283
IS  - 13
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - Context: Pain often is inadequately treated due in part to reluctance about using opioid analgesics and fear that they will be abused. Although international and national expert groups have determined that opioid analgesics are essential for the relief of pain, little information has been available about the health consequences of the abuse of these drugs.Objective: To evaluate the proportion of drug abuse related to opioid analgesics and the trends in medical use and abuse of 5 opioid analgesics used to treat severe pain: fentanyl, hydromorphone, meperidine, morphine, and oxycodone.Design and Setting: Retrospective survey of medical records from 1990 to 1996 stored in the databases of the Drug Abuse Warning Network (source of abuse data) and the Automation of Reports and Consolidated Orders System (source of medical use data).Patients: Nationally representative sample of hospital emergency department admissions resulting from drug abuse.Main Outcome Measures: Medical use in grams and grams per 100,000 population and mentions of drug abuse by number and percentage of the population.Results: From 1990 to 1996, there were increases in medical use of morphine (59%; 2.2 to 3.5 million g), fentanyl (1168%; 3263 to 41,371 g), oxycodone (23%; 1.6 to 2.0 million g), and hydromorphone (19%; 118,455 to 141,325 g), and a decrease in the medical use of meperidine (35%; 5.2 to 3.4 million g). During the same period, the total number of drug abuse mentions per year due to opioid analgesics increased from 32,430 to 34,563 (6.6%), although the proportion of mentions for opioid abuse relative to total drug abuse mentions decreased from 5.1% to 3.8%. Reports of abuse decreased for meperidine (39%; 1335 to 806), oxycodone (29%; 4526 to 3190), fentanyl (59%; 59 to 24), and hydromorphone (15%; 718 to 609), and increased for morphine (3%; 838 to 865).Conclusions: The trend of increasing medical use of opioid analgesics to treat pain does not appear to contribute to increases in the health consequences of opioid analgesic abuse.
SN  - 0098-7484
AD  - Pain and Policy Studies Group, Comprehensive Cancer Center, University of Wisconsin Medical School, Madison, USA
AD  - Pain and Policy Studies Group, University of Wisconsin Medical School, 1900 University Ave, Madison, WI 53705 (e-mail: joranson@facstaff.wisc.edu)
U2  - PMID: 10755497.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107082293
T1  - Patient and physician agreement on abdominal pain severity and need for opioid analgesia.
AU  - Thomas SH
AU  - Borczuk P
AU  - Shackleford J
AU  - Ostrander J
AU  - Silver D
AU  - Evans M
AU  - Stein J
AU  - Thomas, S H
AU  - Borczuk, P
AU  - Shackelford, J
AU  - Ostrander, J
AU  - Silver, D
AU  - Evans, M
AU  - Stein, J
Y1  - 1999/10//1999 Oct
N1  - Accession Number: 107082293. Language: English. Entry Date: 20000101. Revision Date: 20171128. Publication Type: journal article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Abdominal Pain -- Drug Therapy
KW  - Physician Attitudes
KW  - Patient Attitudes
KW  - Prospective Studies
KW  - Convenience Sample
KW  - Visual Analog Scaling
KW  - Data Analysis Software
KW  - Data Analysis, Statistical
KW  - Descriptive Statistics
KW  - Physician Attitudes -- Evaluation
KW  - Patient Attitudes -- Evaluation
KW  - Adult
KW  - Middle Age
KW  - Male
KW  - Female
KW  - Human
SP  - 586
EP  - 590
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 17
IS  - 6
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Whereas controversy surrounds emergency department (ED) analgesia administration to patients with undifferentiated abdominal pain, few studies have addressed the level of patient-physician agreement on abdominal pain severity and need for opioid analgesia. This prospective study was undertaken to assess concordance between emergency physicians and patients on abdominal pain severity. Study subjects were a convenience sample of 30 adults seen in an urban university-affiliated tertiary care ED (annual census 65,000) who had undifferentiated abdominal pain meeting an initial severity threshold of 5 on a 10 cm visual analog scale (VAS) marked by the patient. Patients' and physicians' VAS scores, obtained in blinded fashion at presentation (t0) and at one (t1) and two (t2) hours into the ED stay, were compared with t test (VAS scores) and sign-rank (percent change in VAS scores) analyses. In addition, patients and physicians were asked at each assessment time, in blinded fashion, "Is the pain severe enough to warrant morphine?" The kappa statistic was used to characterize the degree of agreement between physician and patient assessments as to whether opioids were indicated. At t0, t1, and t2, patients' mean VAS scores (7.5, 6.7, and 5.1) were significantly (P < .05) higher than the corresponding physicians' VAS scores (5.3, 4.7, and 3.9). Though VAS scores for physicians started lower than those of patients, the percentage changes in scores from one assessment to the next were similar by Wilcoxon sign-rank testing (P > .50 for time intervals t0 - t1 and t1 - t2). Overall, patients and physicians agreed on the question of whether pain was sufficient to warrant opioids in 71 of 90 (78.9%) assessments; the corresponding kappa statistic of .57 indicated moderate agreement (P < .0001). These results, indicating that patients and physicians usually agree on whether opioids are warranted for abdominal pain, have important implications for further research on ED analgesia in this population.
SN  - 0735-6757
AD  - Harvard Medical School, and the Department of Emergency Medicine, Massachusetts General Hospital, Boston 02114, USA
AD  - Department of Emergency Medicine, Massachusetts General Hospital, Clinics Building #115, 55 Fruit St, Boston, MA 02114
U2  - PMID: 10530541.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106394934
T1  - Effect of an opioid management system on opioid prescribing and unscheduled visits in a large primary care clinic.
AU  - Goldberg KC
AU  - Simel DL
AU  - Oddone EZ
Y1  - 2005/12//2005 Dec
N1  - Accession Number: 106394934. Language: English. Entry Date: 20060210. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. NLM UID: 9503754. 
KW  - Contracts -- Evaluation
KW  - Narcotics -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Primary Health Care -- Evaluation
KW  - Descriptive Statistics
KW  - Emergency Service -- Utilization
KW  - Female
KW  - Hospitals, Veterans -- Evaluation
KW  - Male
KW  - Middle Age
KW  - P-Value
KW  - Patient Selection
KW  - Prospective Studies
KW  - Retrospective Design
KW  - Human
SP  - 621
EP  - 628
JO  - Journal of Clinical Outcomes Management
JF  - Journal of Clinical Outcomes Management
JA  - JCOM
VL  - 12
IS  - 12
CY  - Wayne, Pennsylvania
PB  - Turner White Communications
AB  - Objective: To measure the effect of an explicit pain management program on unscheduled patient visits, prescribing behavior, and opioid use.Design: Retrospective cohort study.Setting: General medicine practice of a university-affiliated Veterans Affairs (VA) hospital.Participants: All patients who had a formal pain management contract and a matched comparison group of patients without evidence of such a con-tract were evaluated.Intervention: Establishment of a pain management contract, placement of the contract in the medical record, implementation of an opioid prescribing system, and focused attention to pain management by the primary care provider.Measurements: Visits to the emergency department (ED), number of providers of and prescriptions for opioids, consumption of oxycodone, and visits to other VA medical centers.Results: 91 patients with a pain management con-tract were identified. After implementation, visit frequency to the ED, the number of providers issuing prescriptions, the number of separate prescriptions for opioids, and the number of dispensed oxycodone tablets decreased significantly (P < 0.001 for each measure). Visits to other VA hospitals within the state did not increase. In a matched group of 224 patients receiving opioids, ED visit frequency de-creased during the observation period, but to a lesser degree. The number of separate providers issuing opioids to these patients and the number of unique prescriptions did not change over time, although the number of oxycodone tablets consumed increased steadily.Conclusions: A pain management program made explicit by a provider-patient contract can result in fewer unscheduled visits and a consolidation of opioid prescribing toward a single provider.
SN  - 1079-6533
AD  - Duke University Medical Center, Durham VA Medical Center, Durham, NC; kenneth.goldberg@duke.edu
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104808706
T1  - Long-term opioid treatment of nonmalignant pain.
AU  - Vijayaragjavan, Maya
Y1  - 2010/12//2010 Dec
N1  - Accession Number: 104808706. Language: English. Entry Date: 20110401. Revision Date: 20150711. Publication Type: Journal Article; abstract; commentary. Original Study: Braden JB, Russo J, Fan MY, Edlund MJ, Martin BC, DeVries A, et al. Emergency department visits among recipients of chronic opioid therapy. (ARCH INTERN MED) 9/13/2010; 170 (16): 1425-1432. Journal Subset: Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Special Interest: Pain and Pain Management; Quality Assurance. NLM UID: 9503754. 
KW  - Emergency Service -- Utilization
KW  - Narcotics -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Alcohol Drinking
KW  - Narcotics -- Adverse Effects
KW  - Substance Abuse -- Epidemiology
SP  - 538
EP  - 544
JO  - Journal of Clinical Outcomes Management
JF  - Journal of Clinical Outcomes Management
JA  - JCOM
VL  - 17
IS  - 12
CY  - Wayne, Pennsylvania
PB  - Turner White Communications
SN  - 1079-6533
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106414594
T1  - Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditions.
AU  - Kelly A
AU  - Brumby C
AU  - Barnes C
Y1  - 2005/05//
N1  - Accession Number: 106414594. Language: English. Entry Date: 20060324. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 100893237. 
KW  - Analgesia -- Methods
KW  - Emergency Service
KW  - Narcotics -- Therapeutic Use
KW  - Nursing Care
KW  - Pain -- Drug Therapy
KW  - Acute Disease
KW  - Adult
KW  - Colic
KW  - Data Analysis, Statistical
KW  - Descriptive Statistics
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Narcotics -- Administration and Dosage
KW  - Record Review
KW  - Retrospective Design
KW  - Time Factors
KW  - Victoria
KW  - Human
SP  - 149
EP  - 154
JO  - CJEM: Canadian Journal of Emergency Medicine
JF  - CJEM: Canadian Journal of Emergency Medicine
JA  - CAN J EMERG MED
VL  - 7
IS  - 3
PB  - Cambridge University Press
AB  - Objectives: Traditionally, patients have to wait until assessed by a physician for opioid analgesia to be administered, which contributes to delays to analgesia. Western Hospital developed a protocol enabling nurses to initiate opioid analgesia prior to medical assessment for selected conditions. The aim of this study was to determine the impact of this protocol on time to first opioid dose in patients presenting to the emergency department (ED) with renal or biliary colic.Methods: This was an explicit medical record review of all adult patients with an ED discharge diagnosis of renal or biliary colic presenting to a metropolitan teaching hospital ED. Patients were identified via the ED data management system. Data collected included demographics, condition, triage category, time of presentation, whether analgesia was nurse-initiated or not, and interval from arrival to first opioid analgesic dose. The narcotic drug register for the relevant period was also searched to cross-check whether opiates were doctor- or nurse-initiated.Results: There were 58 presentations in the nurse-initiated opioid analgesia group and 99 in the non-nurse-initiated analgesia group. Groups were reasonably well matched for gender, triage category and time of presentation, but there was a higher proportion of biliary colic in the non-nurse-initiated analgesia group. Median time to first analgesic dose was 31 minutes in the nurse-initiated group and 57 minutes in the non-nurse-initiated analgesia group (effect size, 26 minutes; 95% confidence interval 16-36 min; p < 0.0001]. There were no major adverse events in either group.Conclusion: A nurse-initiated opioid analgesia protocol reduces delays to opioid analgesia for patients with renal and biliary colic.
SN  - 1481-8035
AD  - Professor, Joseph Epstein Centre for Emergency Medicine Research, Western Hospital, Melbourne, Victoria, Australia
U2  - PMID: 17355670.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106704334
T1  - Emergency department presentations of naltrexone-accelerated detoxification.
AU  - Armstrong J
AU  - Little M
AU  - Murray L
Y1  - 2003/08//
N1  - Accession Number: 106704334. Language: English. Entry Date: 20040220. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Emergency Care
KW  - Naltrexone -- Adverse Effects
KW  - Naltrexone -- Therapeutic Use
KW  - Substance Dependence -- Drug Therapy
KW  - Substance Withdrawal Syndrome -- Therapy
KW  - Substance Withdrawal, Controlled -- Adverse Effects
KW  - Academic Medical Centers
KW  - Adolescence
KW  - Adult
KW  - Age Factors
KW  - Ambulatory Care Facilities
KW  - Antiemetics -- Therapeutic Use
KW  - Confidence Intervals
KW  - Data Analysis Software
KW  - Descriptive Statistics
KW  - Emergency Service
KW  - Female
KW  - Hypnotics and Sedatives -- Therapeutic Use
KW  - Intravenous Therapy
KW  - Intubation, Intratracheal
KW  - Length of Stay
KW  - Male
KW  - Middle Age
KW  - Monitoring, Physiologic
KW  - Mortality
KW  - Outpatients
KW  - Prospective Studies
KW  - Record Review
KW  - Retrospective Design
KW  - Sedation
KW  - Sex Factors
KW  - Western Australia
KW  - Human
SP  - 860
EP  - 866
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 10
IS  - 8
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - OBJECTIVES: To analyze emergency department (ED) presentations after naltrexone-accelerated detoxification. METHODS: This was a retrospective cohort analysis of patient presentations to Sir Charles Gairdner Hospital Emergency Department over a six-month period (November 2000 to April 2001). RESULTS: During the six-month study period, 42 patients presented to the ED after naltrexone-accelerated detoxification. This represented 7% of patients treated at a single clinic over the same period. Presentation occurred within 24 hours in 40% of cases and within 48 hours in 74%. Clinical features on presentation included gastrointestinal (GI) symptoms (vomiting, 60%; abdominal pain, 55%; diarrhea, 45%), central nervous system [CNS] symptoms (excessive drowsiness, 55%; agitation requiring sedation, 50%), and respiratory symptoms (tachypnea, 33%; respiratory difficulties, 19%). Gastrointestinal symptoms were managed adequately with supportive therapy in most cases (intravenous fluids; antiemetics). Agitation sometimes required large doses of intravenous benzodiazepines (up to 730 mg in 44 hours), one-to-one nursing, and security staff. Two of 14 patients presenting with predominantly CNS disturbance required intubation (14%). Mean in-hospital stay for all patients was 18 hours (range 1 to 92 hours). CONCLUSIONS: A few patients undergoing outpatient naltrexone-accelerated detoxification during a six-month period subsequently required ED management. The clinical features encountered in this group of patients can be subdivided into GI or CNS predominance, with different management strategies. Most presentations can be managed in the ED or an associated observation ward, but departmental resources must be available for one-to-one nursing and security personnel. Patients presenting with agitation should be sedated with benzodiazepines; large doses may be required. Close monitoring of respiratory function is mandatory, and advanced airway management may be required.
SN  - 1069-6563
AD  - Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
U2  - PMID: 12896887.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 110452889
T1  - Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
AU  - Travers, Andrew H.
AU  - Perkins, Gavin D.
AU  - Berg, Robert A.
AU  - Castren, Maaret
AU  - Considine, Julie
AU  - Escalante, Raffo
AU  - Gazmuri, Raul J.
AU  - Koster, Rudolph W.
AU  - Swee Han Lim
AU  - Nation, Kevin J.
AU  - Olasveengen, Theresa M.
AU  - Tetsuya Sakamoto
AU  - Sayre, Michael R.
AU  - Sierra, Alfredo
AU  - Smyth, Michael A.
AU  - Stanton, David
AU  - Vaillancourt, Christian
AU  - Lim, Swee Han
AU  - Sakamoto, Tetsuya
Y1  - 2015/10/21/10/20/2015 Supplement
N1  - Accession Number: 110452889. Corporate Author: Basic Life Support Chapter Collaborators. Language: English. Entry Date: 20160123. Revision Date: 20171115. Publication Type: journal article; practice guidelines; review; tables/charts. Supplement Title: 10/20/2015 Supplement. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: PDF-2014-07-061//Department of Health/United Kingdom. NLM UID: 0147763. 
KW  - Cardioversion -- Standards
KW  - Heart Arrest -- Therapy
KW  - Defibrillators
KW  - Emergency Medical Services -- Standards
KW  - Resuscitation, Cardiopulmonary -- Standards
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Heart Arrest -- Chemically Induced
KW  - Child
KW  - Resuscitation, Cardiopulmonary -- Methods
KW  - Ventricular Fibrillation -- Therapy
KW  - Heart Massage -- Standards
KW  - Health Education
KW  - Near Drowning -- Therapy
KW  - Adult
KW  - Emergency Medical Services -- Methods
KW  - Heart Massage -- Methods
KW  - Emergencies
KW  - Age Factors
KW  - Heart Arrest -- Drug Therapy
KW  - Cardioversion -- Methods
KW  - Naloxone -- Therapeutic Use
SP  - S51
EP  - S83
JO  - Circulation
JF  - Circulation
JA  - CIRCULATION
VL  - 132
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the “what” in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of resuscitation. We hope that resuscitation councils and other stakeholders will be able to translate this body of knowledge of international consensus statements to build their own effective resuscitation guidelines.
SN  - 0009-7322
U2  - PMID: 26472859.
DO  - 10.1161/CIR.0000000000000272
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104792230
T1  - After antagonization of acute opiate overdose: a survey at hospitals in Vienna.
AU  - Seidler, D
AU  - Stühlinger, G H
AU  - Fischer, G
AU  - Woisetschlaeger, C
AU  - Berzlanovich, A
AU  - Schmid, R
AU  - Hirschl, M M
AU  - Laggner, A N
Y1  - 1996/10//
N1  - Accession Number: 104792230. Language: English. Entry Date: 20110610. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Emergencies
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Substance Use Disorders -- Epidemiology
KW  - Overdose -- Epidemiology
KW  - Urban Population
KW  - Adolescence
KW  - Adult
KW  - Austria
KW  - Cross Sectional Studies
KW  - Female
KW  - Human
KW  - Incidence
KW  - Length of Stay -- Statistics and Numerical Data
KW  - Male
KW  - Substance Use Disorders -- Rehabilitation
KW  - Patient Attitudes
SP  - 1479
EP  - 1487
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 91
IS  - 10
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - This study describes the clinical management and characteristics of people who, following acute opioid overdose, are taken to hospital after efficient antagonization by the pre-hospital emergency service. In addition, it defines areas of interest for further research. Over a 4-month period (September-December 1993) we collected data by a structured protocol sheet on patients' characteristics, anamnestic data on abuse and emergencies, clinical presentation, treatment by specific antidote and routine laboratory investigations. Outcome was verified by retrospective review of prehospital and forensic data. We studied 77 subjects, predominantly young males, who were involved in 83 emergencies, mostly occurring at weekends. In more than 60% of cases a single administration of specific antidote sufficed to stabilize the patients; 64% of patients left hospital against medical advice after an average stay of less than 6 hours; 46% denied daily opioid abuse and half the subjects, especially younger drug-users, seemed interested in counselling. This hospital-based study did not provide reliable data on the epidemiology of opioid overdose. Clinical management is determined by experience, pragmatism and beliefs. Efforts towards secondary prevention of drug problems at emergency departments might be warranted, and further research on pattern and management of opioid overdose is needed.
SN  - 0965-2140
AD  - Department of Emergency Medicine, University of Vienna, Austria.
U2  - PMID: 8917916.
DO  - 10.1111/j.1360-0443.1996.tb02252.x
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105982557
T1  - Providing naloxone to substance users for secondary administration to reduce overdose mortality in New York City.
AU  - Heller DI
AU  - Stancliff S
Y1  - 2007/05//May/Jun2007
N1  - Accession Number: 105982557. Language: English. Entry Date: 20080215. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Peer Reviewed; Public Health; USA. NLM UID: 9716844. 
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Substance Use Disorders -- Prevention and Control
KW  - Emergency Care -- Methods
KW  - Health Education
KW  - Legislation, Drug -- Administration
KW  - New York
KW  - Overdose
KW  - Substance Use Disorders -- Mortality
SP  - 393
EP  - 397
JO  - Public Health Reports
JF  - Public Health Reports
JA  - PUBLIC HEALTH REP
VL  - 122
IS  - 3
PB  - Sage Publications Inc.
SN  - 0033-3549
AD  - New York City Department of Health and Mental Hygiene in New York, NY
U2  - PMID: 17518311.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105528337
T1  - Misconceptions about opioid dosing.
AU  - Norton VC
A2  - Todd K
Y1  - 2009/04//2009 Apr
N1  - Accession Number: 105528337. Language: English. Entry Date: 20090710. Revision Date: 20150820. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management. 
KW  - Emergency Service
KW  - Narcotics -- Administration and Dosage
KW  - Pain -- Drug Therapy
KW  - Patient Care
KW  - Drug Administration Schedule
KW  - Injections, Intravenous
KW  - Male
KW  - Middle Age
SP  - 12
EP  - 14
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 41
IS  - 4
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
T3  - Case Studies in Pain Management Series
AB  - A ranking physician stricken with a painful acute illness forces the emergency department staff to rethink their assumptions about morphine.
SN  - 0013-6654
AD  - Medical Director, Scripps Mercy Emergency Department, San Diego, CA
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106549644
T1  - Research review. [Commentary on] Neighbor ML, Honner S, Kohn MA, 2004. Factors affecting emergency department opioid administration to severely injured patients. Academic Emergency Medicine 11(12), 1290-1296.
AU  - McClelland HM
Y1  - 2005/04//
N1  - Accession Number: 106549644. Language: English. Entry Date: 20051209. Revision Date: 20150711. Publication Type: Journal Article; abstract; brief item; commentary. Original Study: Neighbor ML, Honner S, Kohn MA. Factors affecting emergency department opioid administration to severely injured patients. (ACAD EMERG MED) Dec2004; 11 (12): 1290-1296. Journal Subset: Core Nursing; Europe; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 9305090. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Care
KW  - Trauma
KW  - Emergency Service
SP  - 138
EP  - 138
JO  - Accident & Emergency Nursing
JF  - Accident & Emergency Nursing
JA  - ACCID EMERG NURS
VL  - 13
IS  - 2
PB  - Churchill Livingstone, Inc.
SN  - 0965-2302
AD  - Lecturer Practitioner, Leeds General Infirmary, Leeds Teaching Hospitals Trust, Emergency Care, St. George Street, Leeds, UK
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105764910
T1  - Alteration in prehospital drug concentration after thermal exposure.
AU  - Gammon DL
AU  - Su S
AU  - Jordan J
AU  - Patterson R
AU  - Finley PJ
AU  - Lowe C
AU  - Huckfeldt R
Y1  - 2008/06//
N1  - Accession Number: 105764910. Language: English. Entry Date: 20080711. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Drug Stability
KW  - Drugs
KW  - Emergency Medical Services
KW  - Heat -- Adverse Effects
KW  - Chromatography, High Pressure Liquid
KW  - Drug Storage
KW  - Spectrum Analysis
SP  - 566
EP  - 573
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 26
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - OBJECTIVE: The aim of the study was to determine the remaining concentration of 23 commonly carried emergency medical services medications used in the United States after they have experienced thermal extremes that have been documented in the prehospital environment for a period of 1 month. METHODS: Pharmaceuticals were thermally cycled (-6 degrees C and 54 degrees C) every 12 hours and then assayed by high-performance liquid chromatography. RESULTS: Eight (35%) of 23 prehospital pharmaceuticals revealed ending concentrations of less than 90% with strong correlation to thermal exposure time. These included lidocaine, diltiazem, dopamine, nitroglycerin, ipratropium, succinylcholine, haloperidol, and naloxone. CONCLUSION: A decrease in concentration was found to be statistically significant in 8 (35%) of 23 commonly carried emergency medical services pharmaceuticals. These results provide new information and perspective regarding stability of emergency drugs in the prehospital environment by evaluating a broad range of pharmaceuticals as well as by using thermal exposure points that have been documented in the United States. Copyright © 2008 by Elsevier Inc.
SN  - 0735-6757
AD  - St. John's Emergency Medical Services, Springfield, MO 65804, USA. dustin.gammon@mercy.net
U2  - PMID: 18534286.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 112032543
T1  - Using Alternatives to Opioids In an Acute Care Setting.
AU  - Faley, Brian
Y1  - 2015/12//
N1  - Accession Number: 112032543. Language: English. Entry Date: 20160324. Revision Date: 20160627. Publication Type: journal article. Journal Subset: Biomedical; Health Services Administration; USA. NLM UID: 9303583. 
KW  - Emergency Service
KW  - Adverse Drug Event -- Prevention and Control
KW  - Prescriptions, Drug
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - United States
KW  - Analgesics, Opioid -- Adverse Effects
SP  - 52
EP  - 52
JO  - Managed Care
JF  - Managed Care
JA  - MANAGE CARE
VL  - 24
IS  - 12
CY  - Yardley, Pennsylvania
PB  - MediMedia Managed Markets, an ICON Company
SN  - 1062-3388
AD  - Clinical pharmacist for the Emergency Trauma Department of Hackensack University Medical Center in Hackensack, N.J.
AD  - Clinical assistant professor in the Department of Pharmacy Practice and Administration of Rutgers University
U2  - PMID: 26803896.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112032543&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107847181
T1  - FDA Approves Naloxone.
Y1  - 2014/05//
N1  - Accession Number: 107847181. Language: English. Entry Date: 20140505. Revision Date: 20150712. Publication Type: Journal Article; brief item. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. 
KW  - First Aid
KW  - Prehospital Care
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Narcotics -- Poisoning
KW  - Drug Approval
KW  - United States Food and Drug Administration
KW  - Caregivers
KW  - Family
SP  - 5
EP  - 5
JO  - EMS Insider
JF  - EMS Insider
JA  - EMS INSIDER
VL  - 41
IS  - 5
CY  - , <Blank>
PB  - Elsevier Public Safety
SN  - 1081-4507
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104800101
T1  - Acute opiate overdose: characteristics of 190 consecutive cases.
AU  - Cook, S
AU  - Moeschler, O
AU  - Michaud, K
AU  - Yersin, B
Y1  - 1998/10//
N1  - Accession Number: 104800101. Language: English. Entry Date: 20110610. Revision Date: 20170831. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9304118. 
KW  - Narcotics -- Poisoning
KW  - Adolescence
KW  - Adult
KW  - Emergencies
KW  - Emergency Medical Services -- Utilization
KW  - Female
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Human
KW  - Male
KW  - Overdose -- Mortality
KW  - Overdose -- Therapy
KW  - Referral and Consultation
KW  - Switzerland
SP  - 1559
EP  - 1565
JO  - Addiction
JF  - Addiction
JA  - ADDICTION
VL  - 93
IS  - 10
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - To characterize the population of drug users consulting the Emergency Room (ER) of a university hospital with acute opiate overdose (AOO) and to assess rate of referral to specialized treatment programme. Survey of a 12-month sample of AOO patients. Medical and psychosocial features of the drug users, details of emergency treatment and referral by a mobile resuscitation team (SMUR) and the ER of our hospital (CHUV-Lausanne, Switzerland). In addition fatal AOO cases were collected by the Institute of Forensic Medicine (IFM) during the same period. One hundred and eighty-four cases of AOO (134 patients) were treated. The files of the IFM detailed six additional deceased cases. This population of drug users was characterized by an over-representation of men (73%), by young age (27.4 years), by a high rate of multi-drugs use (90%) and by a high rate of multiple previous overdoses (2.6). Average length of stay was 20.1 hours but 41% of cases stayed less than 8 hours. Only one patient was readmitted within an 8-hour period. When discharged, 78% returned home. Unexpectedly, 67% of patients were not referred to any therapeutic programme for drug addiction. This study shows the low mortality of AOO when treated but also demonstrates the need to improve psychosocial evaluation and referral of drug addicts admitted with AOO.
SN  - 0965-2140
AD  - University Hospital (CHUV), Lausanne, Switzerland.
U2  - PMID: 9926561.
DO  - 10.1046/j.1360-0443.1998.9310155913.x
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104800101&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107847394
T1  - INNOVATIONS in EMS 2014.
AU  - Goodloe, Jeffrey M.
Y1  - 2014/05//
N1  - Accession Number: 107847394. Language: English. Entry Date: 20140515. Revision Date: 20150712. Publication Type: Journal Article; questions and answers. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101466002. 
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Prehospital Care
KW  - Emergency Medical Services
KW  - Emergency Medical Technicians
KW  - Police
KW  - Drug Storage
KW  - Naloxone -- Adverse Effects
SP  - 51
EP  - 52
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 43
IS  - 5
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
SN  - 1946-9365
AD  - Medical director for the Medical Control Board, EMS system serving metropolitan Oklahoma City and Tulsa; EMS Section chief and director of the Oklahoma Center for Prehospital & Disaster Medicine, Department of Emergency Medicine, University of Oklahoma School of Community Medicine.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107847394&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 122331129
T1  - Drops, Ointments, Gels, and Patches The Dangers of Topical Medications.
AU  - Calleo, Vincent J.
AU  - Curtin, Patrick
AU  - Eggleston, William
AU  - Cantor, Richard
Y1  - 2017/04//
N1  - Accession Number: 122331129. Language: English. Entry Date: 20170410. Revision Date: 20170412. Publication Type: Article; pictorial; review; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Patient Safety; Pediatric Care. 
KW  - Drugs, Prescription -- Poisoning
KW  - Drugs, Non-Prescription -- Poisoning
KW  - Administration, Topical -- Adverse Effects
KW  - Overdose -- Diagnosis
KW  - Overdose -- Therapy
KW  - Dosage Forms -- Poisoning
KW  - Emergency Care
KW  - Ointments -- Poisoning
KW  - Gels -- Poisoning
KW  - Transdermal Patches, Drugs -- Poisoning
KW  - Ophthalmic Solutions -- Poisoning
KW  - Overdose -- Symptoms
KW  - Antidotes -- Therapeutic Use
KW  - Imidazoles -- Poisoning
KW  - Salicylates -- Poisoning
KW  - Nicotine -- Poisoning
KW  - Hemodialysis
KW  - Exchange Transfusion, Whole Blood
KW  - Airway Management
KW  - Fluid Resuscitation
KW  - Anesthetics, Local -- Poisoning
KW  - Methylene Blue -- Therapeutic Use
KW  - Methemoglobinemia -- Therapy
KW  - Methemoglobinemia -- Chemically Induced
KW  - Fentanyl -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Child
SP  - 152
EP  - 160
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 49
IS  - 4
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
AD  - Chief resident, department of emergency medicine, State University of New York Upstate Medical University, Syracuse
AD  - Second-year medical student, State University of New York Upstate Medical University, Syracuse
AD  - Assistant professor, State University of New York Upstate Medical University, department of emergency medicine, Syracuse
AD  - Clinical toxicologist, Upstate New York Poison Center, Syracuse
AD  - Professor, department of emergency medicine, at State University of New York Upstate Medical University, Syracuse
AD  - Professor of pediatrics, and director of emergency department pediatrics, at State University of New York Upstate Medical University, Syracuse
DO  - 10.12788/emed.2017.0022
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122331129&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106977854
T1  - Discharge of patients who have taken an overdose of opioids.
AU  - Clarke S
A2  - Dargan P
Y1  - 2002/05//
N1  - Accession Number: 106977854. Language: English. Entry Date: 20021115. Revision Date: 20150820. Publication Type: Journal Article; case study; tables/charts. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 100963089. 
KW  - Length of Stay
KW  - Patient Discharge
KW  - Substance Dependence -- Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Overdose
KW  - Female
KW  - Adult
KW  - Heroin
KW  - Medical Practice, Evidence-Based
KW  - Journal Clubs -- England
KW  - England
KW  - Emergency Care
KW  - Literature Review
KW  - Computerized Literature Searching
SP  - 250
EP  - 251
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
PB  - BMJ Publishing Group
AB  - A short cut review was carried out to establish whether patients with no recurrence of symptoms one hour after receiving naloxone for an opioid overdose can safely be discharged. Altogether 195 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
SN  - 1472-0205
AD  - Specialist Registrar, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
U2  - PMID: 11971844.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106977854&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104718667
T1  - A small area analysis estimating the prevalence of addiction to opioids in Barcelona, 1993.
AU  - Brugal, M T
AU  - Domingo-Salvany, A
AU  - Maguire, A
AU  - Caylà, J A
AU  - Villalbí, J R
AU  - Hartnoll, R
Y1  - 1999/08//
N1  - Accession Number: 104718667. Language: English. Entry Date: 20110610. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; Public Health; UK & Ireland. NLM UID: 7909766. 
KW  - Substance Use Disorders -- Epidemiology
KW  - Adolescence
KW  - Adult
KW  - Female
KW  - Human
KW  - Male
KW  - Prevalence
KW  - Regression
KW  - Cluster Analysis
KW  - Social Class
KW  - Spain
SP  - 488
EP  - 494
JO  - Journal of Epidemiology & Community Health
JF  - Journal of Epidemiology & Community Health
JA  - J EPIDEMIOL COMMUNITY HEALTH
PB  - BMJ Publishing Group
AB  - To determine the distribution of opioid use prevalence in small areas and its relation with socioeconomic indicators. Capture-recapture was applied using data from the Barcelona Drug Information System for 1993 (treatment demands, hospital emergency room visits, deaths from heroin acute adverse reaction and pre-trial prison admissions). To avoid dependence between sources, a log-linear regression model with interactions was fitted. For small neighbourhoods, where capture-recapture estimates were not obtainable, the Heroin Problem Index (HPI) was used to predict prevalence rates from a regression model. The correlation between estimated opioid use prevalence by neighbourhoods and their socioeconomic level was computed. The city's estimated prevalence was 12.9 opioid addicts per 1000 inhabitants aged 15 to 44 years (95% CI: 10.1, 17.2), which represents 9176 persons. The highest rate was found in the inner city neighbourhood. Comparing rates obtained for each neighbourhood with their unemployment rates, a high correlation coefficient was obtained (r = 0.80, p < 0.001). The main contribution of this study is that of combining capture-recapture with the HPI to produce small area prevalence estimates, which would not have been possible using only one method. Areas with higher socioeconomic status showed proportionally low addiction prevalences, but in depressed areas, prevalences varied widely.
SN  - 0143-005X
AD  - Servei d'Epidemiologia, Institut Municipal de Salut Pública de Barcelona, Spain.
U2  - PMID: 10562867.
DO  - 10.1136/jech.53.8.488
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106755216
T1  - Intranasal drug delivery: an alternative to intravenous administration in selected emergency cases.
AU  - Wolfe TR
AU  - Bernstone T
Y1  - 2004/04//2004 Apr
N1  - Accession Number: 106755216. Language: English. Entry Date: 20040716. Revision Date: 20150818. Publication Type: Journal Article; CEU; exam questions; pictorial; tables/charts. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. NLM UID: 7605913. 
KW  - Administration, Intranasal
KW  - Emergency Nursing
KW  - Absorption
KW  - Administration, Intranasal -- Methods
KW  - Administration, Intranasal -- Utilization
KW  - Conscious Sedation
KW  - Education, Continuing (Credit)
KW  - Emergency Service
KW  - Epistaxis -- Drug Therapy
KW  - Intubation, Gastrointestinal
KW  - Naloxone -- Administration and Dosage
KW  - Naloxone -- Therapeutic Use
KW  - Overdose -- Drug Therapy
KW  - Pain -- Drug Therapy
KW  - Seizures -- Drug Therapy
SP  - 141
EP  - 198
JO  - JEN: Journal of Emergency Nursing
JF  - JEN: Journal of Emergency Nursing
JA  - J EMERG NURS
VL  - 30
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - The intranasal drug route delivers medications to the blood stream almost as rapidly as if they were administered intravenously, particularly valuable in situations where establishing an IV line might be both difficult and risky, for example, with an IV drug abuser requiring naloxone, or when the pain of an injection might cause significant emotional turmoil, as with pediatric sedation or pain control. The intranasal route seems to be safe and effective.
SN  - 0099-1767
AD  - Associate Professor, Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah; wolfeman@csolutions.net
U2  - PMID: 15039670.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106755216&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105774798
T1  - Pediatric toxicology: part 3.
AU  - Vroman R
Y1  - 2008/06//
N1  - Accession Number: 105774798. Language: English. Entry Date: 20080801. Revision Date: 20150711. Publication Type: Journal Article; pictorial; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 101466002. 
KW  - Emergency Medical Services
KW  - Poisoning -- Diagnosis -- In Infancy and Childhood
KW  - Poisoning -- Therapy -- In Infancy and Childhood
KW  - Prehospital Care -- In Infancy and Childhood
KW  - Toxicology -- In Infancy and Childhood
KW  - Adolescence
KW  - Adult
KW  - Airway Management
KW  - Atropine -- Poisoning
KW  - Camphor -- Poisoning
KW  - Charcoal -- Therapeutic Use
KW  - Child
KW  - Child, Preschool
KW  - Diphenoxylate -- Poisoning
KW  - Drug Combinations
KW  - Drug Monitoring
KW  - Emergency Patients
KW  - Glucagon -- Therapeutic Use
KW  - Hypoglycemic Agents -- Poisoning
KW  - Infant
KW  - Intravenous Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Naloxone -- Therapeutic Use
KW  - Narcotics -- Poisoning
KW  - Outpatients
KW  - Salicylates -- Poisoning
KW  - Symptoms
SP  - 61
EP  - 68
JO  - EMS Magazine
JF  - EMS Magazine
JA  - EMS MAG
VL  - 37
IS  - 6
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
AB  - As discussed in Parts 1 and 2 in the April and May issues, most toxic exposures in children under 6 years old are secondary to exploration rather than intentional attempts to harm and therefore do not involve enough substance to cause signifi cant toxicity. It is not until the teen years that toxic exposures with intent to cause personal harm begin to occur. There are several substances, however, that can result in signifi cant toxicity, even when taken at low doses. These are referred to as 'one-pill' or 'one-dose' killers. Although it may take more than one pill or dose for death to occur, this is a good tenet to remember, as low doses of these substances can indeed cause signifi cant toxicity or death. Therefore, it is imperative that prehospital providers be familiar with both the generic and trade names of these medications so exposure can be recognized and appropriate treatment initiated.
SN  - 1946-4967
AD  - Paramedic Education Program Faculty, HealthONE EMS in Englewood, CO.
U2  - PMID: 18810958.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105774798&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105735079
T1  - Pediatric toxicology: part 2.
AU  - Vroman R
Y1  - 2008/05//
N1  - Accession Number: 105735079. Language: English. Entry Date: 20080606. Revision Date: 20150711. Publication Type: Journal Article; pictorial; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 101466002. 
KW  - Antidepressive Agents -- Poisoning -- In Infancy and Childhood
KW  - Calcium Channel Blockers -- Poisoning -- In Infancy and Childhood
KW  - Clonidine -- Poisoning -- In Infancy and Childhood
KW  - Poisoning -- Diagnosis -- In Infancy and Childhood
KW  - Poisoning -- Therapy -- In Infancy and Childhood
KW  - Prehospital Care -- In Infancy and Childhood
KW  - Toxicology -- In Infancy and Childhood
KW  - Adolescence
KW  - Airway Management
KW  - Antidepressive Agents -- Adverse Effects
KW  - Antidepressive Agents -- Pharmacodynamics
KW  - Antidotes -- Administration and Dosage
KW  - Atropine -- Administration and Dosage
KW  - Calcium Channel Blockers -- Adverse Effects
KW  - Calcium Channel Blockers -- Pharmacodynamics
KW  - Calcium Chloride -- Administration and Dosage
KW  - Cardiovascular System -- Drug Effects
KW  - Central Nervous System -- Drug Effects
KW  - Charcoal -- Administration and Dosage
KW  - Child
KW  - Child, Preschool
KW  - Clonidine -- Adverse Effects
KW  - Clonidine -- Pharmacodynamics
KW  - Diazepam -- Administration and Dosage
KW  - Dopamine -- Administration and Dosage
KW  - Drug Monitoring
KW  - Electrocardiography
KW  - Emergency Medical Services
KW  - Emergency Patients
KW  - Gastric Lavage
KW  - Glucagon -- Administration and Dosage
KW  - Glucose -- Administration and Dosage
KW  - Infant
KW  - Intravenous Therapy
KW  - Lidocaine -- Administration and Dosage
KW  - Midazolam -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Oxygen Therapy
KW  - Patient Assessment
KW  - Physical Examination
KW  - Poisoning -- Symptoms
KW  - Treatment Outcomes
SP  - 88
EP  - 92
JO  - EMS Magazine
JF  - EMS Magazine
JA  - EMS MAG
VL  - 37
IS  - 5
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 1946-4967
U2  - PMID: 18814676.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105735079&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107945733
T1  - Guidelines for opioid prescription: the devil is in the details.
AU  - Rosenau, Alex M
Y1  - 2013/06/04/
N1  - Accession Number: 107945733. Language: English. Entry Date: 20130816. Revision Date: 20150712. Publication Type: Journal Article. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. NLM UID: 0372351. 
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Prescriptions, Drug
KW  - Emergency Service
KW  - Practice Guidelines
KW  - Chronic Pain -- Drug Therapy
KW  - Medical Practice, Evidence-Based
KW  - New York
KW  - Substance Use Disorders
KW  - Patient Discharge
KW  - United States
SP  - 843
EP  - 844
JO  - Annals of Internal Medicine
JF  - Annals of Internal Medicine
JA  - ANN INTERN MED
VL  - 158
IS  - 11
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
SN  - 0003-4819
AD  - Lehigh Valley Health Network, Allentown, PA 18103, USA. alex.rosenau@gmail.com
U2  - PMID: 23567867.
DO  - 10.7326/0003-4819-158-11-201306040-00632
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107945733&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104541621
T1  - Pain and Palliative Care Pharmacotherapy Literature Summaries and Analyses.
AU  - Abernethy, Amy P.
AU  - Zhukovsky, Donna
Y1  - 2012/03//
N1  - Accession Number: 104541621. Language: English. Entry Date: 20120727. Revision Date: 20150711. Publication Type: Journal Article; abstract. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management; Palliative Care/Hospice. NLM UID: 101125608. 
KW  - Buprenorphine -- Adverse Effects
KW  - Naltrexone -- Administration and Dosage
KW  - Drug Therapy, Combination
KW  - Treatment Outcomes
KW  - Dementia -- Psychosocial Factors
KW  - Life Purpose
KW  - Carcinoma, Non-Small-Cell Lung -- Prognosis
KW  - Terminally Ill Patients -- Psychosocial Factors
KW  - Emergency Service -- Utilization
KW  - Cancer Patients
SP  - 51
EP  - 54
JO  - Journal of Pain & Palliative Care Pharmacotherapy
JF  - Journal of Pain & Palliative Care Pharmacotherapy
JA  - J PAIN PALLIAT CARE PHARMACOTHER
VL  - 26
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
AB  - Timely and important studies are reviewed and commentaries provided by leading palliative care clinicians. Symptoms, interventions, and treatment-related adverse events addressed in this issue are optimizing buprenorphine antinociception with the addition of naltrexone; reliably assessing the internal state of persons with cognitive impairment, for the purpose of measuring perception of their sense of purpose; improving understanding of prognosis over time by means of early palliative care intervention in patients with non-small cell lung cancer (NSCLC); and examining reasons for cancer patients' emergency department (ED) visits and outcomes of the visits.
SN  - 1536-0288
DO  - 10.3109/15360288.2011.650355
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104541621&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107027004
T1  - Journal scan. Discharge after opioid overdose...commentary on Christenson J et al (2000) Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule. ACADEMIC EMERGENCY MEDICINE. 7, 10, 1110-1118
AU  - Holt L
Y1  - 2000/12//2000Dec/2001Jan
N1  - Accession Number: 107027004. Language: English. Entry Date: 20010601. Revision Date: 20150711. Publication Type: Journal Article; abstract; commentary. Supplement Title: 2000Dec/2001Jan. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Europe; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 9208913. 
KW  - Narcotics
KW  - Patient Discharge
KW  - Naloxone
SP  - 4
EP  - 4
JO  - Emergency Nurse
JF  - Emergency Nurse
JA  - EMERG NURSE
VL  - 8
IS  - 8
PB  - RCNi
SN  - 1354-5752
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107027004&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106114571
T1  - Emergency naloxone for heroin overdose: should it be available over the counter?
AU  - Strang J
AU  - Kelleher M
AU  - Best D
AU  - Mayet S
AU  - Manning V
Y1  - 2006/09/23/
N1  - Accession Number: 106114571. Language: English. Entry Date: 20070706. Revision Date: 20150711. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101090866. 
KW  - Heroin -- Poisoning
KW  - Naloxone -- Legislation and Jurisprudence
KW  - Narcotic Antagonists -- Legislation and Jurisprudence
KW  - Drugs, Non-Prescription -- Legislation and Jurisprudence
KW  - Emergencies
KW  - Emergency Care
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Overdose -- Drug Therapy
SP  - 614
EP  - 615
JO  - BMJ: British Medical Journal (International Edition)
JF  - BMJ: British Medical Journal (International Edition)
JA  - BMJ
VL  - 333
IS  - 7569
PB  - BMJ Publishing Group
SN  - 0959-8146
AD  - Director, National Addiction Centre (Institute of Psychiatry/The Maudsley), London SE5 8AF; j.strang@iop.kcl.ac.uk
U2  - PMID: 16990298.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106114571&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105363891
T1  - Emergency department overcrowding: time for a quantitive measure...Chu K, Brown A. Association between access block and time to parenteral opioid analgesia in renal colic: a pilot study. Emerg Med Australas. 2009;21:38-42
AU  - O'Connor AE
Y1  - 2009/06//
N1  - Accession Number: 105363891. Language: English. Entry Date: 20090724. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter. Journal Subset: Australia & New Zealand; Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Emergency Care. NLM UID: 101199824. 
KW  - Crowding -- Evaluation
KW  - Emergency Service
KW  - Patient Admission
KW  - Waiting Lists
SP  - 240
EP  - 240
JO  - Emergency Medicine Australasia
JF  - Emergency Medicine Australasia
JA  - EMERG MED AUSTRALAS
VL  - 21
IS  - 3
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1742-6731
U2  - PMID: 19527286.
DO  - 10.1111/j.1742-6723.2009.01189.x
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105363891&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106031437
T1  - Opioids.
AU  - Tepper SJ
Y1  - 2004/11//Nov/Dec2004
N1  - Accession Number: 106031437. Language: English. Entry Date: 20070101. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 2985091R. 
SP  - 1061
EP  - 1063
JO  - Headache: The Journal of Head & Face Pain
JF  - Headache: The Journal of Head & Face Pain
JA  - HEADACHE
VL  - 44
IS  - 10
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
AB  - Saper JR, Lake AE, Hamel RL, Lutz TE, Branca B, Sims DB, Kroll MM. Daily scheduled opioids for intractable head pain: long-term observations of a treatment program.Neurology. 2004;62:1687-1694.Background:Daily scheduled opioids (DSO) have been employed in some instances to remediate intractable headache. However, long-term studies of effectiveness, sequelae over several years, predictors of long-term benefit, comparisons of pain-related outcome measures, and prevalence of problematic drug behavior are not available.Methods:The authors evaluated the results of a treatment program at their institution designed to treat and monitor intractable headache patients administered DSO. Of 160 sequential patients participating in the program, 70 who remained on DSO for at least 3 years qualified for inclusion in an efficacy analysis. Patients completed structured questionnaires at each medical visit as part of routine clinical care. The authors assessed medical records during treatment, and during the 2 years before starting DSO. The primary clinical efficacy variable was percentage improvement in the severe headache index (frequencyx severity of severe headaches/week).Results:Analysis of the medical records found 41 (26%) of the original 160 patients with>50% improvement. Patients reported larger improvements on a visual analog scale (mean improvement= 70%) than shown by the medical record (mean improvement= 46%),P<.00001. Problem drug behavior (dose violations, lost prescriptions, multisourcing) occurred in 50% of patients, usually involving dose violations.Conclusions:For a select group of intractable headache patients, DSO can offer significant benefit. However, 74% of those treated either failed to show significant improvement or were discontinued from the program for clinical reasons. The relatively low percentage of patients with demonstrated efficacy and unexpectedly high prevalence of misuse have clinical relevance. Colman I, Rothney A, Wright SC, Zilkalns B, Rowe BH. Use of narcotic analgesics in the emergency department treatment of migraine headache.Neurology. 2004;62: 1695-1700.Objective:Treatment of acute migraine headache with narcotics is potentially ineffective and may lead to abuse. The authors examined the treatment practice variation across five linked EDs in one Canadian center, focusing on the use of narcotic analgesics and factors associated with their use.Methods:Five hundred acute migraine headache patient charts were randomly selected from five Canadian EDs. Charts underwent a structured review to determine medication use. Data were analyzed, comparing those who received narcotics as first-line treatment with those who did not, using[chi]2 andt-tests and logistic regression.Results:The majority of patients (59.6%) received narcotics as first-line treatment. Numerous factors were associated with first-line narcotic treatment. Having taken antiheadache medications prior to ED presentation (odds ratio[OR]: 2.63; 95%CI: 1.53, 4.51) and hospital of presentation being other than Hospital A (eg, Hospital D; OR: 6.32; 95%CI: 2.76, 14.46) increased the odds of receiving first-line narcotics. Having received a more urgent triage score (OR: 0.4; 95%CI: 0.24, 0.65) or having a longer duration of headache (OR: 0.994; 95%CI: 0.99, 0.99) decreased the odds of receiving first-line narcotics.Conclusions:Acute migraine management in these EDs does not meet current consensus guidelines. Factors associated with narcotic use are predictable, and a concerted effort to replace narcotics with more evidence-based first-line treatments is needed. Plus an Editorial:Lipton RB, Bigal ME. Opioid therapy and headache: a cause and a cure.Neurology. 2004;62:1662-1663.The role of opioids in the management of chronic benign pain remains controversial. Beyond the usual assessment of risks and benefits, clinical decision making regarding opioids is often colored by fears of addiction and diversion. As a consequence, patients in pain who would genuinely benefit from opioids may not receive them.For patients with headache, the role of opioids is made more complex because of the closely related issues of medication-overuse headache and transformed migraine. The medications used to manage headache can become a cause of headache if overused. The available evidence suggests that opioids are a risk factor for medication-overuse headache and transformed migraine, that vulnerability to medication-overuse headache is increased in persons with migraine, and that patients who overuse opioids have high headache relapse rates after initially successful withdrawal.Against this backdrop, the current issue ofNeurologyprovides data from two studies assessing two different arenas of headache therapy. Colman et al examine patterns of opioid use in the emergency department (ED) for short-term management of migraine. Saper et al provide results from a study of long-term open-label use of daily opioids as a preventive therapy for intractable headache. Together, the studies support a diminished role for opioids as a short-term therapy for migraine and cautious expansion of their use for the long-term preventive therapy of otherwise intractable headache.Colman et al begin with the well-supported assumption that opioids are usually not the optimal short-term therapy for migraine in the ED. According to the US Headache Consortium Guidelines, several nonopioid parenteral medications are as effective as parenteral opioids; meperidine, the most widely used parenteral opioid in the ED, was ranked as a category 2 drug, indicating scientific support for its efficacy is only moderate. Although the risk of opioid overuse is minimal in the ED, dosing is often difficult, and sedation may delay discharge. Given the availability of better treatment options, it is surprising that nearly 60% of migraine sufferers evaluated at EDs of five Canadian hospitals received narcotics as their first treatment. Parenteral formulations of triptans, dihydroergotamine, neuroleptics, or nonsteroidal anti-inflammatory agents, absent contraindications, are preferable to opioids for the short-term management of clear-cut migraine in the ED.Saper et al assessed the outcomes associated with daily opioid treatment in carefully selected patients with intractable headache. From an inception cohort of 160 subjects, 70 (43.7%) were still using opioids daily at a 3-year follow-up evaluation. Forty-one (26%) had an improvement of>=50% on a composite measure of frequency and duration. Dose violations occurred at the relatively high rate of 16.5% per year despite meticulous efforts to minimize misuse. The authors conclude that opioid therapy may provide significant long-term relief to selected patients, although most subjects with refractory headache syndromes did not do well. Nonetheless, for 25% of the initially treated sample, results were excellent. Given the refractory nature of their patients, these findings suggest that in expert hands daily opioids provide an important option for the treatment of some individuals with intractable headache. It would be difficult, if not impossible, to conduct this study with blinding and a placebo control group. The authors appropriately caution the readers about the limitations their design imposes on causal inferences about the benefits of opioids.These findings do not mitigate concerns about opioids as a causal factor in medication-overuse headache and transformed migraine. For the typical patient with episodic migraine, opioids should be used as rescue therapy if triptans or other first-line therapies fail or are contraindicated. Short-term therapy should be used 2 or, at most, 3 days per week to avoid the risk of medication-overuse headache. For patients with frequent and disabling headaches that fail to respond to other therapies, daily opioids may help a significant minority but also have the potential to cause harm. Clinicians who recommend daily opioids for intractable headache must balance the risk and benefits for individual patients and carefully monitor treated patients.Comment: The Saper et al study is the most important study ever completed on the use of opioids in the treatment of refractory chronic daily headache (CDH). Some interesting facts that have been presented from this study: (1) Dr. Saper's clinic, the Michigan Headpain and Neurologic Institute used opioid contracts with teeth, with significant consequences if the contract was violated. Despite this, a higher than expected number of patients violated their contractual agreements (16.5%), and'at least one incident of problem drug behavior was observed in 50% of those patients who remained on opioids for at least 3 years or longer.' Patients used medications inappropriately, received them from more than one physician, tried to fill prescriptions early, or claimed to lose them and requested more. (2) Many patients who reported significant improvement in pain control did not return to work or demonstrate improvement in objective measures of disability.'Fewer than one out of five patients was employed full time.' (3) The majority of patients who reported significant improvement with narcotics were not able to give up other medications and rely primarily on opioids. (4) More than 50% required escalating doses during the 5 years. (5) Dr. Saper has commented publicly that the patients who were most likely to respond were those most severely affected, ie, those who were bedridden. Patients with moderate-to-severe CDH, bedridden only several days per week were often not bad enough. (6) There was no demonstrable benefit to long-acting versus short-acting opioids.'One out of four patients (26%) relied on frequent scheduling of short-acting opioids.' It was scheduling the opioids rather than making them prn that helped. (7) Usually, the 3 to 5 year prognosis could be set at 1 month ('a strong but not absolute factor in predicting long-term improvement'). If the patient was not doing well by 2 months, the narcotic trial was usually a failure.It is worth remembering that about three-quarters of trials of opioids for CDH at one of the pre-emininent headache centers of the world failed, and that the US Headache Consortium Guidelines state, with respect to acute attacks of migraine that'The oral opiate analgesics reviewed were associated with a higher rate of adverse events than placebo... The most commonly reported... included dizziness, fatigue, and drowsiness... Until further data are available, these drugs may be better reserved for use when other medications cannot be used, when sedation effects are not a concern, or the risk of abuse has been addressed' (Silberstein SD. Neurology. 2000;55:754-762; Snow V, Weiss K, Wall EM, Mottur-Pilson C. American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 2002 Nov 19;137(10):840-849).- Stewart J. Tepper
SN  - 0017-8748
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105705438
T1  - Opiates and acute pulmonary oedema: addicted to the wrong therapy.
AU  - Hermann L
AU  - Jagoda A
Y1  - 2008/10//
N1  - Accession Number: 105705438. Language: English. Entry Date: 20081205. Revision Date: 20150711. Publication Type: Journal Article; editorial. Journal Subset: Australia & New Zealand; Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Emergency Care. NLM UID: 101199824. 
KW  - Emergency Care
KW  - Narcotics -- Therapeutic Use
KW  - Pulmonary Edema -- Drug Therapy
KW  - Anxiety
KW  - Dose-Response Relationship, Drug
KW  - Heart Failure -- Drug Therapy
KW  - Hemodynamics
KW  - Vasodilation
SP  - 379
EP  - 381
JO  - Emergency Medicine Australasia
JF  - Emergency Medicine Australasia
JA  - EMERG MED AUSTRALAS
VL  - 20
IS  - 5
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1742-6731
U2  - PMID: 18973633.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107354123
T1  - Health professional perceptions of opioid dependence among patients with pain.
AU  - Waldrop RD
AU  - Mandry C
Y1  - 1995/09//1995 Sep
N1  - Accession Number: 107354123. Language: English. Entry Date: 19971201. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Anemia, Sickle Cell -- Drug Therapy
KW  - Substance Dependence
KW  - Pain -- Drug Therapy
KW  - Narcotics
KW  - Health Personnel
KW  - Attitude of Health Personnel
KW  - Surveys
KW  - Hospitals, Urban
KW  - Emergency Service
KW  - Mail
KW  - One-Way Analysis of Variance
KW  - Human
SP  - 529
EP  - 531
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 13
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - The purpose of this study was to determine the percentage of patients perceived by health professionals to be opioid dependent among all patients presenting with pain and specifically among sickle cell patients with pain. Surveys were completed by all staff, residents, and nurses at an urban teaching hospital with an emergency department population consisting primarily of lower socioeconomic patients of African-American origin. The surveys requested a percentage estimate of all pain patients and sickle cell patients with pain presenting to this hospital who they perceived to be opioid dependent. The estimated percentage of opioid dependent patients presenting to the emergency department with pain was 4% for staff (P < .05, n = 14), 9% for residents (n = 31), and 7% for nurses (n = 41), and the estimates for sickle cell patients presenting with pain only were 8%, 17%, and 13% respectively (P < .05). All health professional groups surveyed estimated opioid dependence in patients with pain far in excess of that shown in previous studies. It is unknown whether pain medication are withheld inappropriately by physicians who perceived patients with pain to be opioid dependent, and that this deserved further study especially among sickle cell patients. Copyright (C) 1995 W.B. Saunders Company
SN  - 0735-6757
AD  - Earl K. Long Medical Center, Department of Emergency Medicine, 5825 Airline Highway, Baton Rouge, LA 70805
U2  - PMID: 7662056.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107868167
T1  - VERMONT TAKES ACTION TO EXPAND NALOXONE DELIVERY.
AU  - Bell, Chris
Y1  - 2014/08//
N1  - Accession Number: 107868167. Language: English. Entry Date: 20140805. Revision Date: 20150712. Publication Type: Journal Article; brief item. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Prehospital Care -- Legislation and Jurisprudence -- Vermont
KW  - Emergency Medical Services
KW  - Health Policy
KW  - Protocols
KW  - Administration, Intranasal
KW  - Rural Areas
KW  - Vermont
KW  - Health Services Accessibility
SP  - 19
EP  - 19
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 39
IS  - 8
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Director, Office of Public Health Preparedness, EMS and Injury Prevention, Vermont Department of Public Health.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104122403
T1  - Fatal heat stroke associated with topiramate therapy.
AU  - Borron, Stephen W
AU  - Woolard, Robert
AU  - Watts, Susan
Y1  - 2013/12//
N1  - Accession Number: 104122403. Language: English. Entry Date: 20140214. Revision Date: 20150710. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Anticonvulsants -- Adverse Effects
KW  - Epilepsy -- Drug Therapy
KW  - Fructose
KW  - Heat Stroke
KW  - Adult
KW  - Fatal Outcome
KW  - Fructose -- Adverse Effects
KW  - Male
SP  - 1720.e5
EP  - 6
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 31
IS  - 12
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - A 40-year-old man with diabetes and seizure disorder was found at home unresponsive and 'very hot to touch' by his father 40 minutes before emergency medical services arrival. His usual medications included topiramate, divalproex sodium, and rosiglitazone/metformin. Paramedics administered oxygen, intravenous fluids, and naloxone. They did not witness or report seizure activity. Upon emergency department arrival, the patient was unresponsive (Glasgow Coma Scale 3), hypotensive (94/50 mm Hg), and tachypneic (32 breaths per minute), with a heart rate of 60 beats per minute and elevated rectal temperature peaking at 43.2°C. His skin was hot and dry, without rash; physical examination was otherwise normal. Laboratory studies revealed severe metabolic acidosis with acute renal failure and rhabdomyolysis. In spite of sedation, intubation, and aggressive cooling measures, the patient had cardiac arrest and died approximately 2 hours after arrival. Serum topiramate and valproate concentrations were within therapeutic ranges at 8.8 [mu]g/mL (therapeutic 2-12) and 97 [mu]g/mL (therapeutic 50-100), respectively.
SN  - 0735-6757
AD  - Division of Medical Toxicology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso TX 79905, USA; Department of Emergency Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso TX 79905, USA.
U2  - PMID: 23993866.
DO  - 10.1016/j.ajem.2013.07.013
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105438156
T1  - Case 42: an elderly patient with opioid-induced constipation.
AU  - Hume A
AU  - Davis C
Y1  - 2009/01//2009 Jan
N1  - Accession Number: 105438156. Language: English. Entry Date: 20091002. Revision Date: 20150711. Publication Type: Journal Article; case study; pictorial. Journal Subset: Editorial Board Reviewed; Europe; Expert Peer Reviewed; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Gerontologic Care; Oncologic Care; Palliative Care/Hospice. NLM UID: 9434451. 
KW  - Cancer Patients -- Psychosocial Factors -- In Old Age
KW  - Constipation -- Diagnosis
KW  - Constipation -- Drug Therapy -- In Old Age
KW  - Professional-Patient Relations
KW  - Aged
KW  - Constipation -- Chemically Induced
KW  - Female
KW  - Patient Centered Care
SP  - 19
EP  - 20
JO  - European Journal of Palliative Care
JF  - European Journal of Palliative Care
JA  - EUR J PALLIAT CARE
VL  - 16
IS  - 1
PB  - Hayward Medical Communications
AB  - Jean Tremlett was admitted to the palliative care unit as an emergency. She is 79 years old and, 18 months ago, was diagnosed with lung cancer, which was treated with palliative radiotherapy. She has mild-to-moderate dementia and lives in an elderly mentally infirm (EMI) registered home. She has been getting a lot of back pain and is known to have bone metastases in her ribs and thoracic spine. These were diagnosed on a radio-isotopic bone scan. She refused any further anticancer treatment and is not being followed up by the oncologists.
SN  - 1352-2779
AD  - Staff Grade Doctor in Palliative Medicine, Specialist Palliative Care Unit, Countess Mountbatten House
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 107772296
T1  - High-dose opioids mainly prescribed in offices, not the ED.
AU  - Jo Dales, Mary
Y1  - 2015/01//
N1  - Accession Number: 107772296. Language: English. Entry Date: 20150218. Revision Date: 20150712. Publication Type: Journal Article; brief item; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pain and Pain Management. 
KW  - Narcotics
KW  - Prescribing Patterns
KW  - Emergency Care
KW  - Pain -- Drug Therapy
KW  - Emergency Service
KW  - Physicians
KW  - Illinois
KW  - Drugs, Prescription
SP  - 9
EP  - 9
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 47
IS  - 1
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106747637
T1  - Safe and efficacious use of procedural sedation and analgesia by nonanesthesiologists in a pediatric emergency department.
AU  - Pitetti RD
AU  - Singh S
AU  - Pierce MC
Y1  - 2003/11//
N1  - Accession Number: 106747637. Language: English. Entry Date: 20040618. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 9422751. 
KW  - Analgesics -- Adverse Effects -- In Infancy and Childhood
KW  - Anoxia -- Chemically Induced
KW  - Emergency Medical Services
KW  - Hypnotics and Sedatives -- Adverse Effects
KW  - Vomiting -- Chemically Induced
KW  - Adult
KW  - Chi Square Test
KW  - Child
KW  - Child, Preschool
KW  - Descriptive Research
KW  - Descriptive Statistics
KW  - Female
KW  - Fisher's Exact Test
KW  - Infant
KW  - Male
KW  - Mann-Whitney U Test
KW  - Naloxone -- Therapeutic Use
KW  - Prospective Studies
KW  - Record Review
KW  - Yates' Continuity Correction
KW  - Human
SP  - 1090
EP  - 1096
JO  - Archives of Pediatrics & Adolescent Medicine
JF  - Archives of Pediatrics & Adolescent Medicine
JA  - ARCH PEDIATR ADOLESC MED
VL  - 157
IS  - 11
CY  - Chicago, Illinois
PB  - American Medical Association
SN  - 1072-4710
AD  - Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213; piterd@chp.edu
U2  - PMID: 14609900.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107992475
T1  - Improving opioid prescribing: the New York City recommendations.
AU  - Juurlink, David N
AU  - Dhalla, Irfan A
AU  - Nelson, Lewis S
Y1  - 2013/03/06/
N1  - Accession Number: 107992475. Language: English. Entry Date: 20130322. Revision Date: 20161112. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Standards
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Practice Guidelines
KW  - Analgesics, Opioid -- Poisoning
KW  - Drug Therapy
KW  - New York
KW  - Substance Use Disorders -- Prevention and Control
KW  - Pain -- Drug Therapy
KW  - Patient Satisfaction
SP  - 879
EP  - 880
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 309
IS  - 9
CY  - Chicago, Illinois
PB  - American Medical Association
SN  - 0098-7484
AD  - Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. david.juurlink@ices.on.ca
U2  - PMID: 23462783.
DO  - 10.1001/jama.2013.1139
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104360767
T1  - Estimating the prevalence of illicit opioid use in New York City using multiple data sources.
AU  - McNeely, Jennifer
AU  - Gourevitch, Marc N
AU  - Paone, Denise
AU  - Shah, Sharmila
AU  - Wright, Shana
AU  - Heller, Daliah
Y1  - 2012/01//
N1  - Accession Number: 104360767. Language: English. Entry Date: 20140718. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Public Health; UK & Ireland. Special Interest: Public Health. Grant Information: KL2RR029891/RR/NCRR NIH HHS/United States. NLM UID: 100968562. 
KW  - Resource Databases
KW  - Substance Use Disorders -- Epidemiology
KW  - Drugs, Prescription
KW  - Street Drugs
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Emergency Service -- Utilization
KW  - Female
KW  - Hospitalization -- Statistics and Numerical Data
KW  - Male
KW  - Middle Age
KW  - New York
KW  - Substance Use Disorders -- Therapy
KW  - Prevalence
KW  - Substance Use Rehabilitation Programs -- Utilization
KW  - Young Adult
SP  - 443
EP  - 443
JO  - BMC Public Health
JF  - BMC Public Health
JA  - BMC PUBLIC HEALTH
VL  - 12
IS  - 1
PB  - BioMed Central
AB  - Background: Despite concerns about its health and social consequences, little is known about the prevalence of illicit opioid use in New York City. Individuals who misuse heroin and prescription opioids are known to bear a disproportionate burden of morbidity and mortality. Service providers and public health authorities are challenged to provide appropriate interventions in the absence of basic knowledge about the size and characteristics of this population. While illicit drug users are underrepresented in population-based surveys, they may be identified in multiple administrative data sources.Methods: We analyzed large datasets tracking hospital inpatient and emergency room admissions as well as drug treatment and detoxification services utilization. These were applied in combination with findings from a large general population survey and administrative records tracking prescriptions, drug overdose deaths, and correctional health services, to estimate the prevalence of heroin and non-medical prescription opioid use among New York City residents in 2006. These data were further applied to a descriptive analysis of opioid users entering drug treatment and hospital-based medical care.Results: These data sources identified 126,681 cases of opioid use among New York City residents in 2006. After applying adjustment scenarios to account for potential overlap between data sources, we estimated over 92,000 individual opioid users. By contrast, just 21,600 opioid users initiated drug treatment in 2006. Opioid users represented 4 % of all individuals hospitalized, and over 44,000 hospitalizations during the calendar year.Conclusions: Our findings suggest that innovative approaches are needed to provide adequate services to this sizeable population of opioid users. Given the observed high rates of hospital services utilization, greater integration of drug services into medical settings could be one component of an effective approach to expanding both the scope and reach of health interventions for this population.
SN  - 1471-2458
AD  - Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA. jennifer.mcneely@nyumc.org.
U2  - PMID: 22713674.
DO  - 10.1186/1471-2458-12-443
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107013101
T1  - Peer-initiated overdose resuscitation: fellow drug users could be mobilised to implement resuscitation.
AU  - Strang J
AU  - Best D
AU  - Man L
AU  - Noble A
AU  - Gossop M
Y1  - 2000/12//2000 Dec
N1  - Accession Number: 107013101. Language: English. Entry Date: 20010406. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: Charity Action on Addiction. NLM UID: 9014759. 
KW  - Overdose
KW  - Substance Abusers
KW  - Peer Group
KW  - Resuscitation
KW  - Narcotics -- Poisoning
KW  - England
KW  - Descriptive Statistics
KW  - Overdose -- Mortality
KW  - Naloxone -- Therapeutic Use
KW  - Intravenous Drug Users
KW  - Structured Interview
KW  - Male
KW  - Female
KW  - Adult
KW  - First Aid
KW  - Funding Source
KW  - Human
SP  - 437
EP  - 445
JO  - International Journal of Drug Policy
JF  - International Journal of Drug Policy
JA  - INT J DRUG POLICY
VL  - 11
IS  - 6
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Research interviews about overdose experiences were conducted with 115 patients attending a methadone maintenance clinic in south London, UK. While almost half (49.6%) reported having experienced overdose personally (on an average of four occasions each), almost all (97.4%) reported that they had witnessed overdoses (on an average of six occasions each). This represents a total of 706 overdoses witnessed, of which 106 had resulted in fatalities. The vast majority of patients (86/97) reported that they had taken actions when they had witnessed overdoses with those acting taking an average of nearly threee different actions on the last occasion on which they had seen someone overdosing. Most respondents reported that they would be willing to act, even if they did not know the overdose victim personally and that they had not been deterred from acting by the previous response from the emergency services. Fear of punishment was not a strong deterrent from acting certainly not for this sample, with many participants also expressing an interest in expanding their repertoire of overdose interventions, for example through training in resuscitation techniques and by keeping naloxone at home for use in overdose emergency.
SN  - 0955-3959
AD  - National Addiction Centre, Institute of Psychiatry The Maudsley, Denmark Hill, London SE5 8AF, UK
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104412298
T1  - Redesigning Delivery of Opioids to Optimize Pain Management, Improve Outcomes, and Contain Costs.
AU  - Cahana, Alex
AU  - Dansie, Elizabeth J.
AU  - Theodore, Brian R.
AU  - Wilson, Hilary D.
AU  - Turk, Dennis C.
Y1  - 2013/01//
N1  - Accession Number: 104412298. Language: English. Entry Date: 20130125. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. NLM UID: 100894201. 
KW  - Chronic Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Patient Care -- Methods
KW  - Models, Theoretical
KW  - Pain Measurement
KW  - Collaboration
KW  - Telemedicine -- Methods
KW  - Emergency Service
KW  - Washington
SP  - 36
EP  - 42
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 14
IS  - 1
PB  - Oxford University Press / USA
SN  - 1526-2375
AD  - Department of Anesthesiology and Pain Medicine, University of Washington
U2  - PMID: 23279325.
DO  - 10.1111/pme.12013
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105345024
T1  - Gender bias in opiate administration for acute abdominal pain...2007 Society for Academic Emergency Medicine Annual Meeting
AU  - Mills A
AU  - Hollander J
AU  - Shofer F
AU  - Robey J
AU  - Baxt W
AU  - Chen E
Y1  - 2007/05/02/May2007 Supplement 1
N1  - Accession Number: 105345024. Language: English. Entry Date: 20091211. Revision Date: 20150711. Publication Type: Journal Article; abstract; research. Supplement Title: May2007 Supplement 1. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Abdominal Pain -- Drug Therapy
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Emergency Patients
KW  - Gender Bias
KW  - Adult
KW  - Descriptive Statistics
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Pain Measurement
KW  - Prospective Studies
KW  - Human
SP  - S59
EP  - S59
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 14
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105345024&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106901252
T1  - Epidemic increases in cocaine and opiate use by trauma center patients: documentation with a large clinical toxicology database.
AU  - Soderstrom CA
AU  - Dischinger PC
AU  - Kerns TJ
AU  - Kufera JA
AU  - Mitchell KA
AU  - Scalea TM
Y1  - 2001/09//2001 Sep
N1  - Accession Number: 106901252. Language: English. Entry Date: 20020215. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: Supported in part by a National Institute on Alcohol Abuse and Alcoholism grant AA-09050-04A2. NLM UID: 0376373. 
KW  - Cocaine
KW  - Substance Abuse
KW  - Narcotics
KW  - Trauma Centers
KW  - Trauma
KW  - Databases, Health
KW  - Chi Square Test
KW  - Descriptive Statistics
KW  - Retrospective Design
KW  - Record Review
KW  - Convenience Sample
KW  - Adolescence
KW  - Adult
KW  - Middle Age
KW  - Male
KW  - Female
KW  - Funding Source
KW  - Human
SP  - 557
EP  - 564
JO  - Journal of Trauma
JF  - Journal of Trauma
JA  - J TRAUMA
VL  - 51
IS  - 3
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - BACKGROUND: Although reports have documented alcohol and other drug use by trauma patients, no studies of long-term trends have been published. We assessed substance use trends in a large cohort of patients admitted to a regional Level I adult trauma center between July 1984 and June 2000. METHODS: Positive toxicology results, collected via retrospective database review, were analyzed for patients admitted directly to the center. Data were abstracted from a clinical toxicology database for 53,338 patients. Results were analyzed for alcohol, cocaine, and opiates relative to sex, age (< 40/> or = 40 years), and injury type (nonviolence/violence). Positive toxicology test result trends were assessed for the 3 years at the beginning and end of the period (chi2). Testing biases were assessed for sex, race, and injury type. RESULTS: The patient profile was as follows: men, 72%; age < 40 years, 69%; nonviolence victims, 77%. Alcohol-positive results decreased 37%, but cocaine-positive and opiate-positive results increased 212% and 543%, respectively (all p < 0.001). Cocaine-positive/opiate-positive results increased 152%/640% for nonviolence and 226%/258% for violence victims, respectively (all p < 0.001). In fiscal year 2000, cocaine-positive and opiate-positive results were highest among violence victims (27.4% for both drugs). Cocaine-positive and opiate-positive results among nonviolence victims were 9.4% and 17.6%, respectively. Patients who were minorities or victims of violence were not tested more frequently than other patients. CONCLUSION: Epidemic increases in cocaine and opiate use were documented in all groups of trauma patients, with the greatest increases being in violence victims. Alcohol use decreased for all groups.
SN  - 0022-5282
AD  - R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201. E-mail: csoderstrom@umm.edu
U2  - PMID: 11535910.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105345077
T1  - Impact of an electronic prescription writer on emergency department opioid prescribing practice...2007 Society for Academic Emergency Medicine Annual Meeting
AU  - Grafstein E
AU  - Stenstrom R
AU  - Harris D
AU  - Hunte G
AU  - Innes G
Y1  - 2007/05/02/May2007 Supplement 1
N1  - Accession Number: 105345077. Language: English. Entry Date: 20091211. Revision Date: 20150711. Publication Type: Journal Article; abstract; research. Supplement Title: May2007 Supplement 1. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Analgesics, Opioid
KW  - Automation -- Utilization
KW  - Physicians, Emergency
KW  - Prescribing Patterns -- Trends
KW  - Prescriptions, Drug -- Methods
KW  - Academic Medical Centers
KW  - Analysis of Covariance
KW  - British Columbia
KW  - Descriptive Statistics
KW  - Pretest-Posttest Design
KW  - Repeated Measures
KW  - Human
SP  - S74
EP  - S74
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 14
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105859738
T1  - Characteristics of patients transported by an aeromedical service for acute toxicologic emergencies: a 5-year experience.
AU  - Maloney GE Jr
AU  - Pakiela JA
Y1  - 2008/01//
N1  - Accession Number: 105859738. Language: English. Entry Date: 20080314. Revision Date: 20150820. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 9312325. 
KW  - Aeromedical Transport
KW  - Hazardous Materials -- Poisoning
KW  - Transportation of Patients
KW  - Acute Disease
KW  - Adolescence
KW  - Adult
KW  - Aged
KW  - Aged, 80 and Over
KW  - Audit
KW  - Child
KW  - Child, Preschool
KW  - Female
KW  - Infant
KW  - Male
KW  - Middle Age
KW  - Ohio
KW  - Retrospective Design
KW  - Human
SP  - 48
EP  - 50
JO  - Air Medical Journal
JF  - Air Medical Journal
JA  - AIR MED J
VL  - 27
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
AB  - INTRODUCTION: Aeromedical services are used routinely in the prehospital and interhospital transfer of patients with trauma, neurosurgical, cardiac, and other conditions requiring specialized care. The use of aeromedical transport in patients with acute toxicologic emergencies is not well described. We sought to investigate and describe the characteristics of patients transported by our aeromedical service. SETTING: The study was performed at an urban critical care transport service operating both ground and aeromedical units and transporting an average of 3,362 patients per year during the study period. METHODS: Charts from the 5-year period of 2000 to 2004 for which a toxicologic emergency was coded as the primary diagnosis were identified and reviewed by the authors. Data abstracted included age, sex, toxin(s) involved, treatment rendered at the scene/bedside and en route by the transport team, and additional data (electrocardiogram [ECG] findings, serum levels) when appropriate. RESULTS: One hundred thirty-three patients were transported (for a total of 135 transports). Most (82%) were transported by air. Carbon monoxide was the most common toxic exposure, accounting for 16% of all transports. Fifty-seven percent of the patients were intubated, with 11% intubated by the flight crew. Antidotes were administered in 40 patients, with naloxone and bicarbonate being the most common. CONCLUSION: Acute toxicologic emergencies accounted for a small percentage of total transports. The most common additional intervention by flight crews was endotracheal intubation. Identification of common poisonings encountered by flight crews may assist services in developing education and quality assurance programs.
SN  - 1067-991X
AD  - Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109, USA. gmaloney@metrohealth.org
U2  - PMID: 18191089.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107847392
T1  - HOW WE GOT HERE.
AU  - Busch, Jason
Y1  - 2014/05//
N1  - Accession Number: 107847392. Language: English. Entry Date: 20140515. Revision Date: 20150712. Publication Type: Journal Article; brief item. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 101466002. 
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Prehospital Care
KW  - Drug Approval
KW  - United States
KW  - Injections, Intramuscular
KW  - Syringes
SP  - 51
EP  - 51
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 43
IS  - 5
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
SN  - 1946-9365
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105335663
T1  - 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.
AU  - Chang AK
AU  - Bijur PE
AU  - Davitt M
AU  - Gallagher EJ
Y1  - 2009/10//
N1  - Accession Number: 105335663. Language: English. Entry Date: 20091106. Revision Date: 20150818. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Critical Path
KW  - Dihydromorphinone -- Administration and Dosage
KW  - Emergency Service
KW  - Pain -- Drug Therapy
KW  - Patient-Controlled Analgesia
KW  - Adult
KW  - Randomized Controlled Trials
KW  - Drug Administration Schedule
KW  - Female
KW  - Infusions, Intravenous
KW  - Male
KW  - Middle Age
KW  - New York
KW  - Pain Measurement
KW  - Patient Satisfaction
KW  - Human
SP  - 561
EP  - 567.e2
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 54
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
AB  - STUDY OBJECTIVE: We 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. METHODS: This 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. RESULTS: The 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. CONCLUSION: The 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.
SN  - 0196-0644
AD  - Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. achang@montefiore.org
U2  - PMID: 19560838.
DO  - 10.1016/j.annemergmed.2009.05.003
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105345022
T1  - Randomized clinical trial of procedural sedation using propofol with and without the ultra-short acting opioid alfentamil...2007 Society for Academic Emergency Medicine Annual Meeting
AU  - Miner J
AU  - Stephens D
AU  - Plummer D
AU  - Gray R
Y1  - 2007/05/02/May2007 Supplement 1
N1  - Accession Number: 105345022. Language: English. Entry Date: 20091211. Revision Date: 20150711. Publication Type: Journal Article; abstract; research. Supplement Title: May2007 Supplement 1. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Alfentanil -- Administration and Dosage
KW  - Conscious Sedation -- Methods
KW  - Propofol -- Administration and Dosage
KW  - Chi Square Test
KW  - Clinical Trials
KW  - Confidence Intervals
KW  - Descriptive Statistics
KW  - Oxygen Saturation
KW  - Human
SP  - S58
EP  - S58
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 14
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105345022&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106868162
T1  - Neonatal emergencies: a case-based approach to treating medical emergencies of newborns from birth to 28 days old.
AU  - Maloney G
Y1  - 2003/07//2003 Jul
N1  - Accession Number: 106868162. Language: English. Entry Date: 20030919. Revision Date: 20150820. Publication Type: Journal Article; case study; CEU; exam questions; glossary; pictorial; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Emergencies -- In Infancy and Childhood
KW  - Pediatric Care
KW  - Prehospital Care -- In Infancy and Childhood
KW  - Education, Continuing (Credit)
KW  - Infant Physiology
KW  - Cardiovascular System Physiology -- In Infancy and Childhood
KW  - Neonatal Assessment
KW  - Patient History Taking
KW  - Physical Examination
KW  - Vital Signs -- In Infancy and Childhood
KW  - Clinical Assessment Tools
KW  - Fever -- In Infancy and Childhood
KW  - Neonatal Sepsis
KW  - Meningitis, Bacterial -- In Infancy and Childhood
KW  - Cyanosis -- In Infancy and Childhood
KW  - Heart Defects, Congenital
KW  - Seizures -- In Infancy and Childhood
KW  - Jaundice -- In Infancy and Childhood
KW  - Epinephrine -- Administration and Dosage -- In Infancy and Childhood
KW  - Sodium Bicarbonate -- Administration and Dosage -- In Infancy and Childhood
KW  - Naloxone -- Administration and Dosage -- In Infancy and Childhood
KW  - Phenobarbital -- Administration and Dosage -- In Infancy and Childhood
KW  - Glucose -- Administration and Dosage -- In Infancy and Childhood
KW  - Normal Saline -- Administration and Dosage -- In Infancy and Childhood
KW  - Resuscitation -- In Infancy and Childhood
KW  - Resuscitation -- Equipment and Supplies -- In Infancy and Childhood
KW  - Oxygen Therapy
KW  - Intravenous Therapy
KW  - Male
KW  - Female
KW  - Fetus
KW  - Infant, Newborn
KW  - Outpatients
SP  - 64
EP  - 78
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 28
IS  - 7
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Chief Resident in Emergency Medicine, Doctors Hospital, Columbus, OH
U2  - PMID: 12872073.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106005513
T1  - Safety and efficacy of hydromorphone as an analgesic alternative to morphine in acute pain: a randomized clinical trial.
AU  - Chang AK
AU  - Bijur PE
AU  - Meyer RH
AU  - Kenny MK
AU  - Solorzano C
AU  - Gallagher EJ
Y1  - 2006/08//
N1  - Accession Number: 106005513. Language: English. Entry Date: 20080229. Revision Date: 20150711. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Dihydromorphinone -- Therapeutic Use
KW  - Pain -- Prevention and Control
KW  - Adult
KW  - Aged
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Antiemetics -- Therapeutic Use
KW  - Dihydromorphinone -- Administration and Dosage
KW  - Double-Blind Studies
KW  - Emergency Service
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Morphine -- Therapeutic Use
KW  - Pain Measurement
KW  - Prospective Studies
KW  - Treatment Outcomes
KW  - Human
SP  - 164
EP  - 172
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 48
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - STUDY OBJECTIVE: We compare a standard weight-based dose of intravenous hydromorphone (Dilaudid) to a standard weight-based dose of intravenous morphine in adults presenting to the ED with acute severe pain. METHODS: This was a prospective, randomized, double-blind, clinical trial conducted in an academic medical center. Of the 198 adult patients presenting to the ED with acute severe pain who were randomized to receive either intravenous hydromorphone at 0.015 mg/kg or intravenous morphine at 0.1 mg/kg, 191 patients had sufficient data for analysis. The main outcome measure was the difference between the 2 groups in pain reduction at 30 minutes as measured on a validated numeric rating scale. Adverse effects, pain reduction at 5 minutes and 2 hours postbaseline, and additional analgesics and antiemetics were tracked as secondary outcome measures. RESULTS: The mean change of pain from baseline to 30 minutes postbaseline in patients allocated to intravenous hydromorphone was -5.5 numeric rating scale units versus -4.1 in patients allocated to intravenous morphine (difference -1.3; 95% confidence interval -2.2 to -0.5). Adverse effects were similar in both groups, with the exception of pruritus, which did not occur in patients receiving hydromorphone (0% versus 6% [difference -6%; 95% confidence interval -11% to -1%]). No patient required naloxone. CONCLUSION: For the treatment of acute, severe pain in the emergency department, intravenous hydromorphone at 0.015 mg/kg represents a feasible alternative to intravenous morphine at 0.1 mg/kg.
SN  - 0196-0644
U2  - PMID: 16857467.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106005511
T1  - Randomized clinical trial of morphine in acute abdominal pain.
AU  - Gallagher EJ
AU  - Esses D
AU  - Lee C
AU  - Lahn M
AU  - Bijur PE
Y1  - 2006/08//
N1  - Accession Number: 106005511. Language: English. Entry Date: 20080229. Revision Date: 20150711. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Abdomen, Acute -- Diagnosis
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Morphine -- Therapeutic Use
KW  - Abdomen, Acute -- Etiology
KW  - Abdomen, Acute -- Prevention and Control
KW  - Adult
KW  - Double-Blind Studies
KW  - Emergency Service
KW  - Female
KW  - Logistic Regression
KW  - Male
KW  - Middle Age
KW  - Pain Measurement
KW  - Prospective Studies
KW  - Human
SP  - 150
EP  - 160
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 48
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - STUDY OBJECTIVE: Administration 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. METHODS: Pain 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. RESULTS: We 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. CONCLUSION: Although 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.
SN  - 0196-0644
U2  - PMID: 16953529.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108217999
T1  - Clear the fog: the challenges of altered mental status in children.
AU  - Meredith, Mark
AU  - Blair, Lee
AU  - Claus, Eric
Y1  - 2012/01//2012 Jan
N1  - Accession Number: 108217999. Language: English. Entry Date: 20120217. Revision Date: 20150820. Publication Type: Journal Article; case study; exam questions; glossary; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 8102138. 
KW  - Emergency Medical Services
KW  - Mental Status -- In Infancy and Childhood
KW  - Physical Examination -- Methods -- In Infancy and Childhood
KW  - Prehospital Care -- In Infancy and Childhood
KW  - Child
KW  - Child, Preschool
KW  - Diagnosis, Differential
KW  - Emergency Patients
KW  - Glucose -- Administration and Dosage
KW  - Head Injuries
KW  - Hyperglycemia
KW  - Hypoglycemia
KW  - Infant
KW  - Intussusception
KW  - Meningitis
KW  - Naloxone -- Administration and Dosage
KW  - Neurologic Examination -- Methods
KW  - Outpatients
KW  - Overdose
KW  - Patient History Taking
KW  - Pulse Oximetry
KW  - Seizures
KW  - Stroke
KW  - Vital Signs
SP  - 56
EP  - 61
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 37
IS  - 1
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
U2  - PMID: 22269695.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108217999&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105473578
T1  - Doctors' knowledge of the appropriate use and route of administration of antidotes in the management of recreational drug toxicity.
AU  - Lidder S
AU  - Ovaska H
AU  - Archer JR
AU  - Greene SL
AU  - Jones AL
AU  - Dargan PI
AU  - Wood DM
Y1  - 2008/12//
N1  - Accession Number: 105473578. Language: English. Entry Date: 20090320. Revision Date: 20150820. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Emergency Care. NLM UID: 100963089. 
KW  - Antidotes -- Administration and Dosage
KW  - Clinical Competence -- Standards
KW  - Medical Staff, Hospital -- Standards
KW  - Street Drugs -- Adverse Effects
KW  - Substance Use Disorders -- Drug Therapy
KW  - Adolescence
KW  - Adult
KW  - Drug Administration Routes
KW  - Emergency Service
KW  - Female
KW  - Male
KW  - Middle Age
KW  - Questionnaires
KW  - Surveys
KW  - Human
SP  - 820
EP  - 823
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
VL  - 25
IS  - 12
PB  - BMJ Publishing Group
AB  - BACKGROUND: Specific antidotes (eg, naloxone, flumazenil, cyproheptadine and benzodiazepines) are available for the management of certain recreational drug-induced toxicities. Some controversies surround the use of some of these antidotes, especially flumazenil in benzodiazepine toxicity. There are no previously published data on doctors' knowledge of the use of these specific antidotes. METHODS: A questionnaire survey was designed to determine internal/emergency medicine doctors' knowledge of the appropriate use of antidotes in the management of clinical scenarios of acutely poisoned patients. For nine simulated clinical scenarios of acute toxicity from recreational drugs (benzodiazepines, cocaine, N-methyl-L-(3,4-methylene-dioxyphenyl)-2-aminopropane (MDMA)-induced serotonin toxicity and opioids), they were asked to indicate whether the suggested antidote and route of administration were correct. RESULTS: 42 physicians of all grades completed the questionnaire. The mean correct score was 5.4 (SD 1.1) (median 6, interquartile range 5-7). The percentages correct for the various clinical scenarios were 68.3% for opioid toxicity, 81% for benzodiazepine toxicity, 28.6% for MDMA-induced serotonin toxicity and 70.2% for cocaine toxicity. Doctors were more likely to record an answer of 'unsure' for the use of cyproheptadine in ST serotonin toxicity (28.6%) compared with the use of the other antidotes (1.4%; p<0.001). CONCLUSION: Knowledge of the appropriate use of antidotes in recreational drug toxicity is not consistent, with poorer knowledge on the use of newer antidotes such as cyproheptadine in serotonin toxicity. Education is required both to increase overall knowledge on the use of specific antidotes in the management of recreational drug-induced toxicity, as well as focusing on newer antidotes such as cyproheptadine.
SN  - 1472-0205
U2  - PMID: 19033500.
DO  - 10.1136/emj.2007.054890
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106121960
T1  - Emergency naloxone for heroin overdose: beware of naloxone's other characteristics...Strang J, Kelleher M, Best D, Mayet S, Manning V. Emergency naloxone for heroin overdose. BMJ 2006;333:614-5. (23 September.)
AU  - Ashworth AJ
Y1  - 2006/10/07/
N1  - Accession Number: 106121960. Language: English. Entry Date: 20070720. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; pictorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101090866. 
KW  - Drugs, Non-Prescription -- Adverse Effects
KW  - Heroin -- Poisoning
KW  - Naloxone -- Adverse Effects
KW  - Narcotic Antagonists -- Adverse Effects
KW  - Overdose -- Drug Therapy
SP  - 754
EP  - 754
JO  - BMJ: British Medical Journal (International Edition)
JF  - BMJ: British Medical Journal (International Edition)
JA  - BMJ
VL  - 333
IS  - 7571
PB  - BMJ Publishing Group
SN  - 0959-8146
U2  - PMID: 17023478.
DO  - 10.1136/bmj.333.7571.754-a
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106121960&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106121959
T1  - Emergency naloxone for heroin overdose: over the counter availability needs careful consideration...Strang J, Kelleher M, Best D, Mayet S, Manning V. Emergency naloxone for heroin overdose. BMJ 2006;333:614-5. (23 September.)
AU  - Byrne A
Y1  - 2006/10/07/
N1  - Accession Number: 106121959. Language: English. Entry Date: 20070720. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; pictorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101090866. 
KW  - Drugs, Non-Prescription
KW  - Heroin -- Poisoning
KW  - Naloxone
KW  - Narcotic Antagonists
KW  - Overdose -- Drug Therapy
SP  - 754
EP  - 754
JO  - BMJ: British Medical Journal (International Edition)
JF  - BMJ: British Medical Journal (International Edition)
JA  - BMJ
VL  - 333
IS  - 7571
PB  - BMJ Publishing Group
SN  - 0959-8146
U2  - PMID: 17023479.
DO  - 10.1136/bmj.333.7571.754
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106121959&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106663714
T1  - Emergency physicians vary widely in their prescribing of opioid analgesics for common, painful conditions.
Y1  - 2004/06//2004 Jun
N1  - Accession Number: 106663714. Language: English. Entry Date: 20041119. Revision Date: 20150711. Publication Type: Journal Article; brief item. Journal Subset: Biomedical; USA. NLM UID: 9102229. 
KW  - Narcotics -- Administration and Dosage
KW  - Physicians, Emergency -- Psychosocial Factors
KW  - Prescriptions, Drug
SP  - 12
EP  - 13
JO  - AHRQ Research Activities
JF  - AHRQ Research Activities
JA  - RES ACTIVITIES
IS  - 286
CY  - Rockville, Maryland
PB  - Agency for Healthcare Research & Quality
SN  - 1537-0224
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106663714&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105554674
T1  - Opioids dominate pain relief prescribing in emergency departments.
AU  - Pinn S
Y1  - 2008/09//
N1  - Accession Number: 105554674. Language: English. Entry Date: 20090102. Revision Date: 20150711. Publication Type: Journal Article; brief item. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101257109. 
KW  - Emergency Service -- Northern Ireland
KW  - Narcotics -- Therapeutic Use
KW  - Pain -- Drug Therapy
KW  - Northern Ireland
SP  - 498
EP  - 498
JO  - British Journal of Hospital Medicine (17508460)
JF  - British Journal of Hospital Medicine (17508460)
JA  - BR J HOSP MED (LOND)
VL  - 69
IS  - 9
PB  - Mark Allen Holdings Limited
SN  - 1750-8460
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105554674&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104411981
T1  - Legal substances and their abuse: Legal highs.
AU  - Ratnapalan, Savithiri
Y1  - 2013/01//
N1  - Accession Number: 104411981. Language: English. Entry Date: 20130120. Revision Date: 20150819. Publication Type: Journal Article; review; tables/charts. Journal Subset: Allied Health; Europe; UK & Ireland. Special Interest: Emergency Care. 
KW  - Drugs, Prescription -- Adverse Effects
KW  - Drugs, Non-Prescription -- Adverse Effects
KW  - Designer Drugs -- Adverse Effects
KW  - Dietary Supplements -- Adverse Effects
KW  - Psychotropic Drugs -- Adverse Effects
KW  - Sympathomimetics -- Adverse Effects
KW  - Substance Abuse -- Diagnosis
KW  - Substance Abuse -- Therapy
KW  - Prehospital Care
KW  - Emergency Medical Services
KW  - United Kingdom
KW  - Substance Abusers
KW  - Histamine H1 Antagonists -- Adverse Effects
KW  - Antidotes -- Administration and Dosage
KW  - Caffeine -- Adverse Effects
KW  - Energy Drinks -- Adverse Effects
KW  - Dextromethorphan -- Adverse Effects
KW  - Cannabis -- Adverse Effects
KW  - Plants, Medicinal -- Adverse Effects
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Drug Monitoring
KW  - Child
KW  - Adult
KW  - Electrocardiography
KW  - Physical Examination
KW  - Anticonvulsants -- Therapeutic Use
KW  - Hyponatremia -- Therapy
KW  - Seizures -- Drug Therapy
KW  - Fever -- Therapy
KW  - Cryotherapy
KW  - Fluid Therapy
KW  - Sedation
KW  - Naloxone -- Therapeutic Use
SP  - 40
EP  - 51
JO  - Journal of Paramedic Practice
JF  - Journal of Paramedic Practice
JA  - J PARAMEDIC PRACT
VL  - 5
IS  - 1
PB  - Mark Allen Holdings Limited
SN  - 1759-1376
AD  - Associate Professor, Departments of Paediatrics and Dalla Lana School of Public Health, University of Toronto Divisions of Emergency Medicine, Clinical Pharmacology and Toxicology, The Hospital for Sick Children,555 University Avenue, Toronto
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104793181
T1  - Titrated intravenous opioids from the same syringe: an infection risk?
AU  - Taylor, M
AU  - Bourke, J
AU  - Anderson, M
AU  - Davey, R
AU  - Kelly, A M
AU  - Guthrie, B
Y1  - 1997/01//
N1  - Accession Number: 104793181. Language: English. Entry Date: 20110610. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research. Journal Subset: Allied Health; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9433751. 
KW  - Analgesia -- Methods
KW  - Drug Contamination
KW  - Equipment Reuse
KW  - Narcotics -- Administration and Dosage
KW  - Syringes
KW  - Australia
KW  - Confidence Intervals
KW  - Emergency Service
KW  - Equipment Contamination
KW  - Human
KW  - Infection Control
KW  - Pharmacy Service
KW  - Prospective Studies
KW  - Quality Control (Technology)
KW  - Clinical Trials
SP  - 33
EP  - 35
JO  - Journal of Accident & Emergency Medicine
JF  - Journal of Accident & Emergency Medicine
JA  - J ACCID EMERG MED
VL  - 14
IS  - 1
PB  - BMJ Publishing Group
AB  - (1) To compare the rate of contamination of syringes prepared under laminar flow conditions in pharmacy with those prepared by nurses in the emergency department; (2) to determine whether the time elapsed since preparation or number of doses given affected the contamination rate; (3) to determine whether any adverse effects resulted from bacterially contaminated drugs. Prospective, blinded trial exploring the effect of method of preparation, time since preparation, and number of doses given on contamination rates and infective adverse events associated with bacterially contaminated specimens. The rate of bacterial contamination was 12% (95% confidence interval 6% to 18%). There was no difference in contamination rate in respect of method of preparation, number of doses given, or time since preparation. No infective complications were identified. Abandonment of titrated intravenous opioids is not justified by the results. However, there is concern about the use of this technique of pain control for immunocompromised patients and those with prosthetic heart valves.
SN  - 1351-0622
AD  - Department of Emergency Medicine, Western Hospital, Footscray, Australia.
U2  - PMID: 9023621.
DO  - 10.1136/emj.14.1.33
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104303835
T1  - Use of intranasal drug administration in the pre-hospital setting.
AU  - Creed, Chloe
Y1  - 2012/12//
N1  - Accession Number: 104303835. Language: English. Entry Date: 20130201. Revision Date: 20150819. Publication Type: Journal Article; pictorial; review; tables/charts. Journal Subset: Allied Health; Europe; UK & Ireland. Special Interest: Emergency Care; Evidence-Based Practice. 
KW  - Administration, Intranasal
KW  - Prehospital Care
KW  - Professional Practice, Evidence-Based
KW  - Emergency Medical Technicians
KW  - Emergency Medical Services
KW  - Emergency Patients
KW  - United Kingdom
KW  - Nasal Cavity -- Drug Effects
KW  - Pharmacokinetics
KW  - Administration, Intranasal -- Economics
KW  - Injections, Intramuscular -- Economics
KW  - Overdose -- Drug Therapy
KW  - Narcotics -- Poisoning
KW  - Naloxone -- Administration and Dosage
KW  - Child
KW  - Adult
KW  - Midazolam -- Administration and Dosage
KW  - Seizures -- Drug Therapy
KW  - Needlestick Injuries -- Prevention and Control
SP  - 699
EP  - 704
JO  - Journal of Paramedic Practice
JF  - Journal of Paramedic Practice
JA  - J PARAMEDIC PRACT
VL  - 4
IS  - 12
PB  - Mark Allen Holdings Limited
SN  - 1759-1376
AD  - Paramedic, West Midlands Ambulance Service NHS Trust
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104303835&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108101765
T1  - FROM CLASSROOM TO STREET. Fatal Mistakes in Prehospital Medicine: The laryngoscope, the syringe and the ink pen can all cause great harm.
AU  - Grayson, Kelly
AU  - Gandy, William E. Gene
Y1  - 2012/10//
N1  - Accession Number: 108101765. Language: English. Entry Date: 20121008. Revision Date: 20150819. Publication Type: Journal Article; review. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Patient Safety. NLM UID: 101466002. 
KW  - Patient Safety
KW  - Prehospital Care
KW  - Emergency Medical Services
KW  - Treatment Refusal
KW  - Intubation, Intratracheal -- Adverse Effects
KW  - Medication Errors
KW  - Professional Practice
KW  - Decision Making, Clinical
KW  - Patient Assessment
KW  - Mental Status -- Evaluation
KW  - Neurologic Examination
KW  - Liability, Legal
KW  - Cognition
KW  - Consent
KW  - Orientation
KW  - Tube Placement Determination
KW  - Endotracheal Tubes -- Adverse Effects
KW  - Hyperoxygenation
KW  - Oxygen Saturation
KW  - Tachycardia, Supraventricular -- Drug Therapy
KW  - Adenosine -- Administration and Dosage
KW  - Adenosine -- Adverse Effects
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Adverse Effects
KW  - Emergency Patients
KW  - Emergency Medical Technicians
KW  - Outpatients
SP  - 28
EP  - 34
JO  - EMS World
JF  - EMS World
JA  - EMS WORLD
VL  - 41
IS  - 10
CY  - Nashville, Tennessee
PB  - SouthComm Inc.
SN  - 1946-9365
AD  - Critical care paramedic for Acadian Ambulance, Louisiana
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107411172
T1  - The hidden perils of naloxone.
AU  - LeDuc TJ
AU  - Bourn S
Y1  - 1994/11//1994 Nov
N1  - Accession Number: 107411172. Language: English. Entry Date: 19950701. Revision Date: 20150820. Publication Type: Journal Article; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Prehospital Care
KW  - Naloxone -- Adverse Effects
KW  - Unconsciousness -- Drug Therapy
KW  - Narcotics
KW  - Coma -- Etiology
KW  - Outpatients
SP  - 63
EP  - 68
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 19
IS  - 11
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Broward County (Fla) Fire Rescue
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105425519
T1  - The case study masterclass. Case 42 answers: An elderly patient with opioid-induced constipation.
AU  - Hume A
AU  - Davis C
Y1  - 2009/03//2009 Mar-Apr
N1  - Accession Number: 105425519. Language: English. Entry Date: 20091016. Revision Date: 20150820. Publication Type: Journal Article; case study; questions and answers. Journal Subset: Editorial Board Reviewed; Europe; Expert Peer Reviewed; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Palliative Care/Hospice. NLM UID: 9434451. 
KW  - Antiinflammatory Agents, Non-Steroidal -- Adverse Effects
KW  - Constipation -- Chemically Induced
KW  - Constipation -- Drug Therapy
KW  - Palliative Care
KW  - Abdominal Pain
KW  - Aged
KW  - Bone Neoplasms
KW  - Cancer Pain -- Drug Therapy
KW  - Constipation -- Etiology
KW  - Decision Making, Patient
KW  - Diagnosis, Differential
KW  - Female
SP  - 71
EP  - 71
JO  - European Journal of Palliative Care
JF  - European Journal of Palliative Care
JA  - EUR J PALLIAT CARE
VL  - 16
IS  - 2
PB  - Hayward Medical Communications
AB  - Jean Tremlett was admitted to the palliative care unit as an emergency. She is 79 years old and, 18 months ago, was diagnosed with lung cancer, which was treated with palliative radiotherapy. She has mild-to-moderate dementia and lives in an elderly mentally infirm (EMI) registered home. She has been getting a lot of back pain and is known to have bone metastases in her ribs and thoracic spine. These were diagnosed on a radio-isotopic bone scan. She refused any further anticancer treatment and is not being followed up by the oncologists.
SN  - 1352-2779
AD  - Staff Grade Doctor in Palliative Medicine, Specialist Palliative Care Unit, Countess Mountbatten House
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107236930
T1  - Cocaine balloon aspiration: successful removal with bronchoscopy.
AU  - Cobaugh DJ
AU  - Schneider SM
AU  - Benitez JG
AU  - Donahoe MP
AU  - Cobaugh, D J
AU  - Schneider, S M
AU  - Benitez, J G
AU  - Donahoe, M P
Y1  - 1997/09//1997 Sep
N1  - Accession Number: 107236930. Language: English. Entry Date: 19980101. Revision Date: 20171128. Publication Type: journal article; case study. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Foreign Bodies
KW  - Aspiration -- Therapy
KW  - Bronchoscopy
KW  - Cocaine
KW  - Public Offenders
KW  - Adult
KW  - Male
SP  - 544
EP  - 546
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 15
IS  - 5
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Ingestion of balloons containing illicit substances along with the potential toxic sequelae associated with these ingestions have been described in the literature. This report describes the successful bronchoscopic retrieval of a cocaine balloon after aspiration. A 39-year-old man was witnessed swallowing several balloons that were thought to contain heroin. Shortly after ingestion, the patient became unconscious and required nasotracheal intubation. Before intubation, several balloons were removed from the oropharynx. Naloxone 4 mg was administered en route to the emergency department (ED). Following naloxone, the patient awoke and became agitated and combative. On arrival in the ED, midazolam, succinylcholine, and vecuronium were required to manage his combativeness. Vital signs were: heart rate, 130 beats/min; blood pressure, 128/86 mm Hg; respirations, 12 breaths/min; temperature, 96.5 degrees F. A balloon and balloon tip were removed during lavage. Whole bowel irrigation with a polyethylene glycol electrolyte solution was initiated. A right upper lobe infiltrate was identified on chest X-ray and aspiration of a balloon was suspected. At bronchoscopy, a small yellow, intact balloon visualized in the basilar segment of the right lower lobe was removed. Toxicologic analysis of the balloon contents found cocaine. The rest of the patient's hospital course was unremarkable and he was discharged 5 days after admission. This case brings to light the potential concerns, such as respiratory compromise, associated with aspiration of small balloons in the body stuffer. Additionally, the potential for the development of toxicity if the balloon ruptures and toxin absorption occurs through through the lungs should be considered. Emergency physicians and toxicologists should be aware of this significant complication of packet ingestion in the body packer or stuffer and be prepared to intervene early during the course of the patient's treatment.
SN  - 0735-6757
AD  - Finger Lakes Regional Poison Center, University of Rochester Medical Center, NY 14642, USA
AD  - Finger Lakes Regional Poison Center, University of Rochester Medical Center, 601 Elmwood Ave., Box 321, Rochester, NY 14642
U2  - PMID: 9270402.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107236930&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107347574
T1  - Clonidine poisoning in Jefferson County, Alabama... presented at the American Academy of Pediatrics Emergency Medicine Section, Washington DC, October 1993.
AU  - Nichols MH
AU  - King WD
AU  - James LP
Y1  - 1997/04//1997 Apr
N1  - Accession Number: 107347574. Language: English. Entry Date: 19971201. Revision Date: 20150818. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Clonidine -- Poisoning -- In Infancy and Childhood
KW  - Poisoning -- Epidemiology -- In Infancy and Childhood
KW  - Poisoning -- Drug Therapy -- In Infancy and Childhood
KW  - Naloxone -- Therapeutic Use
KW  - Hospitalization
KW  - Retrospective Design
KW  - Emergency Service
KW  - Race Factors
KW  - Time Factors
KW  - Alabama
KW  - Record Review
KW  - Descriptive Statistics
KW  - Data Analysis Software
KW  - Chi Square Test
KW  - T-Tests
KW  - Odds Ratio
KW  - Confidence Intervals
KW  - Poisoning -- Symptoms
KW  - Infant
KW  - Child, Preschool
KW  - Child
KW  - Male
KW  - Female
KW  - Human
SP  - 511
EP  - 517
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 29
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - Pediatric Emergency Medicine, The Children's Hospital of Alabama, 1600 Seventh Ave South, Birmingham, Alabama 35233
U2  - PMID: 9095013.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107347574&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107464206
T1  - Handling an opioid overdose.
AU  - Delaney K
Y1  - 1993/01//1993 Jan
N1  - Accession Number: 107464206. Language: English. Entry Date: 19930501. Revision Date: 20150712. Publication Type: Journal Article. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. 
KW  - Overdose -- Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Narcotics -- Antagonists and Inhibitors
KW  - Emergency Care
SP  - 127
EP  - 136
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 25
IS  - 1
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106676409
T1  - Metoclopramide versus placebo with opioid.
AU  - Alsalim W
A2  - Leung WC
A2  - Butler J
Y1  - 2004/05//
N1  - Accession Number: 106676409. Language: English. Entry Date: 20041210. Revision Date: 20150820. Publication Type: Journal Article; brief item; case study; tables/charts. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 100963089. 
KW  - Metoclopramide -- Therapeutic Use
KW  - Nausea and Vomiting -- Drug Therapy
KW  - Nausea and Vomiting -- Prevention and Control
KW  - Pain -- Drug Therapy
KW  - Computerized Literature Searching
KW  - Drug Therapy, Combination
KW  - Emergency Care
KW  - England
KW  - Fractures
KW  - Journal Clubs
KW  - Male
KW  - Medical Practice, Research-Based
KW  - Medline
KW  - Middle Age
SP  - 334
EP  - 335
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
PB  - BMJ Publishing Group
SN  - 1472-0205
AD  - Specialist Registrar, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
U2  - PMID: 15107376.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108011745
T1  - Opioid prescribing webinars set for April.
Y1  - 2013/03/18/2013 Mar 18
N1  - Accession Number: 108011745. Language: English. Entry Date: 20130621. Revision Date: 20150712. Publication Type: Journal Article. Journal Subset: Biomedical; USA. Special Interest: Dental Care. NLM UID: 8701683. 
KW  - Dental Care
KW  - Emergency Care
KW  - Internet
KW  - Narcotics -- Therapeutic Use
KW  - Seminars and Workshops
KW  - Government Agencies -- United States
KW  - Grants
KW  - Pain -- Drug Therapy
KW  - Substance Use Disorders
KW  - United States
SP  - 31
EP  - 31
JO  - American Dental Association News
JF  - American Dental Association News
JA  - ADA NEWS
VL  - 44
IS  - 6
CY  - Chicago, Illinois
PB  - American Dental Association
SN  - 0895-2930
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107476248
T1  - ExacTech blood glucose meter clinical trial.
AU  - Bartkus EA
AU  - Daya M
AU  - Hedges JR
AU  - Jui J
Y1  - 1993/09//09/01/1993
N1  - Accession Number: 107476248. Language: English. Entry Date: 19961001. Revision Date: 20150712. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health; USA. NLM UID: 8918173. 
KW  - Product Evaluation
KW  - Blood Glucose Meters -- Evaluation
KW  - Clinical Trials
KW  - Prospective Studies
KW  - Convenience Sample
KW  - Data Analysis Software
KW  - Chi Square Test
KW  - Pearson's Correlation Coefficient
KW  - Adolescence
KW  - Adult
KW  - Middle Age
KW  - Aged
KW  - Aged, 80 and Over
KW  - Male
KW  - Female
KW  - Human
SP  - 217
EP  - 227
JO  - Prehospital & Disaster Medicine
JF  - Prehospital & Disaster Medicine
JA  - PREHOSPITAL DISASTER MED
VL  - 8
IS  - 3
PB  - Cambridge University Press
AB  - Introduction: Current prehospital protocols for the management of patients with altered mental status include the empiric administration of hypertonic glucose, naloxone, and thiamine. The injudicious use of 50% dextrose (D50W) may result in hyperosmolarity, a worsening of hypokalemia, and unwarranted additional health-care costs for the patient. The administration of D50W also may worsen the neurological outcome of patients with local or generalized ischemia. Objective: To evaluate the ExacTech blood glucose meter's ability to estimate blood glucose levels accurately and rapidly. Methods: Emergency medical technicians (EMTs) from selected advanced life support (ALS) units in the Portland, Ore., metropolitan area participated in a prospective clinical trial of the ExacTech blood glucose meter. A convenience sample was drawn from emergency medical services (EMS) patients with suspected diabetic emergencies, altered mental status, and other neurological deficits. Venous blood samples were drawn from these populations at the same time as the ExacTech readings were obtained. The venous blood was submitted to the receiving hospitals for laboratory analysis of blood glucose levels, and a comparison was made between the results of the two methods. Results: A total of 80 matched sets of data were obtained from 1 April 1990 through 6 May 1991. The hospital blood glucose values ranged from 8 to 1233 mg/dl. Sixteen (20%) of the patients were hypoglycemic (< 60 mg/dl) and 23 (28.8%) were hyperglycemic (> 180 mg/dl). the ExacTech device sensitivity and specificity for hypoglycemia using venous samples were 94.6% and 89.2%, respectively. For hyperglycemia, these same parameters were 87.5% and 97.1%. Pearson's r over the range of the instrument (40-450 mg/dl) was 0.8656 (p < .001). If the prehospital 'definition' of hypoglycemia (for threshold-to-treat) is raised to 65 mg/dl, the device has 100% sensitivity in the sample population. Conclusion: The device functioned accurately and consistently in the prehospital environment over a wide range of temperatures, and in the hands of many different individuals.
SN  - 1049-023X
AD  - Dept Emergency Med, UHN-52, Oregon Health Sci Univ, 3181 SW Sam Jackson Park Rd, Portland, OR 97201-3098
U2  - PMID: 10146302.
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 105505551
T1  - Pediatric ziprasidone overdose.
AU  - Fasano CJ
AU  - O'Malley GF
AU  - Lares C
AU  - Rowden AK
Y1  - 2009/04//2009 Apr
N1  - Accession Number: 105505551. Language: English. Entry Date: 20090731. Revision Date: 20150711. Publication Type: Journal Article; case study. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Pediatric Care. NLM UID: 8507560. 
KW  - Coma -- Chemically Induced
KW  - Overdose
KW  - Ziprasidone -- Poisoning
KW  - Antidotes -- Therapeutic Use
KW  - Charcoal -- Therapeutic Use
KW  - Child, Preschool
KW  - Drug Resistance
KW  - Emergencies
KW  - Eye Diseases -- Chemically Induced
KW  - Eye Diseases -- Physiopathology
KW  - Female
KW  - Hypotension, Orthostatic -- Chemically Induced
KW  - Intubation, Intratracheal
KW  - Naloxone -- Therapeutic Use
KW  - Receptors, Cell Surface -- Antagonists and Inhibitors
KW  - Tachycardia -- Chemically Induced
KW  - Ziprasidone -- Administration and Dosage
KW  - Ziprasidone -- Pharmacokinetics
SP  - 258
EP  - 259
JO  - Pediatric Emergency Care
JF  - Pediatric Emergency Care
JA  - PEDIATR EMERG CARE
VL  - 25
IS  - 4
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - We describe the first ziprasidone overdose with quantitative serum levels of a pediatric patient in coma and with pinpoint pupils. This case is an important contribution to the pediatric ziprasidone literature because it illustrates that ingestion of just 1 pill may result to profound mental status and respiratory depression in a child. H.C., a 30-month-old girl, presented to the emergency department approximately 30 minutes after an accidental ingestion of an adult family member's medication. The child was found on the floor surrounded by numerous pills and was witnessed to have ingested at least 1 tablet by a caregiver. After finding the child with the pills, the family observed the child for a brief period but transported her to the hospital after she became lethargic and unresponsive. The child received 2 doses of 0.4 mg of intravenous naloxone without change in her neurologic status. The child then underwent a rapid sequence intubation for airway protection and subsequently received gastrointestinal decontamination with 15 g of activated charcoal via the orogastric tube. Ziprasidone is an atypical antipsychotic drug that was approved by the Food and Drug Administration in February 2001 for the general treatment of schizophrenia in adults. Previously reported pediatric ziprasidone overdoses describe a syndrome of sedation, tachycardia, hypotonia, and coma consistent with that of the patient described in this paper. In pediatric ziprasidone overdose, QTc prolongation and hypotension have also been illustrated, but seizures have not been reported. An interesting aspect of this case is the development of pinpoint pupils unresponsive to naloxone. This phenomenon has been reported before with overdose of olanzapine, a similar atypical antipsychotic. The mechanism of miosis associated with overdose of atypical antipsychotics is unclear but is likely related to interference with central innervation of the pupil. Pupil size is maintained by a balance between sympathetic and parasympathetic neurohumeral tones. We propose that an overdose of an alpha-1 receptor blocking agent, such as ziprasidone, results in unopposed parasympathetic stimulation resulting in miosis.
SN  - 0749-5161
AD  - Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA. pasanoc@einstein.edu
U2  - PMID: 19369840.
DO  - 10.1097/PEC.0b013e31819e3775
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106848763
T1  - Seizures with intravenous codeine phosphate.
AU  - Zolezzi M
AU  - Al Mohaimeed SA
AU  - Zolezzi, M
AU  - Al Mohaimeed, S A
Y1  - 2001/10//2001 Oct
N1  - Accession Number: 106848763. Language: English. Entry Date: 20030711. Revision Date: 20170224. Publication Type: journal article; case study; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 9203131. 
KW  - Codeine -- Adverse Effects -- In Infancy and Childhood
KW  - Seizures -- Chemically Induced -- In Infancy and Childhood
KW  - Administration, Intravenous
KW  - Anemia, Sickle Cell -- Drug Therapy
KW  - Child
KW  - Codeine -- Administration and Dosage
KW  - Male
KW  - Practice Guidelines
KW  - Scales
SP  - 1211
EP  - 1213
JO  - Annals of Pharmacotherapy
JF  - Annals of Pharmacotherapy
JA  - ANN PHARMACOTHER
VL  - 35
IS  - 10
CY  - Thousand Oaks, California
PB  - Sage Publications Inc.
AB  - Objective: To describe an adverse effect with intravenous codeine in a chid diagnosed with sickle cell anemia.Case Summary: A seven-year-old boy with sickle cell anemia was admitted to the emergency department with severe pain unresponsive to high doses of oral acetaminophen; subsequently, intravenous codeine phosphate was administered. The patient immediately developed a tonic-clonic seizure, which was treated with intravenous diazepam and naloxone.Discussion: Seizures associated with the intravenous administration of codeine phosphate have not been extensively reported in the literature, and special precautions for using the parenteral route for this drug have been vague and limited. Because of the frequent need for acute pain control in children with sicke cell crisis, they may be exposed to this type of reaction when intravenous narcotics are administered. The need for clear guidelines regarding the drug's appropriate parenteral dosing and administration is essential.Conclusions: Codeine phosphate-induced seizures are not common. The need for special instructions for its intravenous administration may prevent this type of reaction, especially in patients in need of acute pain control requiring intravenous narcotics.
SN  - 1060-0280
AD  - Department of Pharmaceutical Services, Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia
AD  - Clinical Pharmacist, Coordinator, ADR Program, Dept of Pharmaceutical Services, Riyadh Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia
U2  - PMID: 11675848.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107268821
T1  - Insufficient stocking of poisoning antidotes in hospital pharmacies.
AU  - Dart RC
AU  - Stark Y
AU  - Fulton B
AU  - Koziol-McLain J
AU  - Lowenstein SR
AU  - Dart, R C
AU  - Stark, Y
AU  - Fulton, B
AU  - Koziol-McLain, J
AU  - Lowenstein, S R
Y1  - 1996/11/20/
N1  - Accession Number: 107268821. Language: English. Entry Date: 19980701. Revision Date: 20161112. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Antidotes
KW  - Pharmacy Service
KW  - Emergency Service
KW  - Poisoning -- Drug Therapy
KW  - Questionnaires
KW  - Surveys
KW  - Colorado
KW  - Nevada
KW  - Montana
KW  - Multiple Regression
KW  - Human
SP  - 1508
EP  - 1510
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 276
IS  - 19
CY  - Chicago, Illinois
PB  - American Medical Association
AB  - Objective: To determine whether antidotes for poisoning and overdose are available in hospitals that provide emergency department care.Design: Written survey of hospital pharmacy directors, each of whom reported the amount currently in stock of 8 different antidotes: antivenin (Crotalidae) polyvalent, cyanide kit, deferoxamine mesylate, digoxin immune Fab, ethanol, naloxone hydrochloride, pralidoxime chloride, and pyridoxine hydrochloride.Participants: Pharmacy directors of all hospitals with emergency departments in Colorado, Montana, and Nevada.Main Outcome Measures: Proportions of hospitals with insufficient stocking of each antidote, defined as complete lack of the antidote or an amount inadequate to initiate treatment of 1 seriously poisoned 70-kg patient.Results: Questionnaires were mailed to 137 hospital pharmacy directors and 108 (79%) responded. Only 1 (0.9%) of the 108 hospitals stocked all 8 antidotes in adequate amounts. The rate of insufficient stocking for individual antidotes ranged from 2% (for naloxone) to 98% (for digoxin immune Fab). In a multiple regression analysis, smaller hospital size and lack of a formal review of antidote stocking were independent predictors of the number of antidotes stocked insufficiently.Conclusions: Insufficient stocking of antidotes is a widespread problem in Colorado, Montana, and Nevada. Although these states are served by a certified regional poison center, potentially lifesaving antidotes are frequently not available when and where they might be needed to treat a single poisoned patient.
SN  - 0098-7484
AD  - Rocky Mountain Poison and Drug Center, Denver Department of Health and Hospitals, Denver, CO 80220, USA
AD  - Rocky Mountain Poison and Drug Center, 8802 E Ninth Ave, Denver, CO 80220
U2  - PMID: 8903263.
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 105882376
T1  - Use of remifentanil in general anesthesia for emergency cesarean section in a patient with severe valvular heart disease and pulmonary hypertension.
AU  - Wong AYC
Y1  - 2008/01/09/
N1  - Accession Number: 105882376. Language: English. Entry Date: 20080411. Revision Date: 20150820. Publication Type: Journal Article; case study. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100888356. 
KW  - Anesthesia, General
KW  - Anesthetics, Intravenous -- Adverse Effects -- In Pregnancy
KW  - Aortic Valve Stenosis -- Complications -- In Pregnancy
KW  - Cesarean Section
KW  - Fentanyl -- Analogs and Derivatives
KW  - Hypertension, Pulmonary -- Complications -- In Pregnancy
KW  - Mitral Valve Stenosis -- Complications -- In Pregnancy
KW  - Adult
KW  - Apgar Score
KW  - Female
KW  - Infant, Newborn
KW  - Male
KW  - Mitral Valve Stenosis -- Surgery
KW  - Naloxone -- Administration and Dosage -- In Infancy and Childhood
KW  - Pregnancy
KW  - Pregnancy Outcomes
KW  - RH Isoimmunization
SP  - 6p
EP  - 6p
JO  - Internet Journal of Anesthesiology
JF  - Internet Journal of Anesthesiology
JA  - INTERNET J ANESTHESIOL
VL  - 15
IS  - 2
CY  - Sugar Land, Texas
PB  - Internet Scientific Publications LLC
AB  - A 23 year-old, 160 cm, 50 kg, gravida 2, para 1 Pakistani parturient who had severe mitral stenosis (mitral valve area 0.82 cm2, pressure gradient [peak/mean] 40/26 mmHg) and pulmonary hypertension (right ventricular systolic pressure of 87 mm Hg) and moderate aortic stenosis (aortic valve area 1.2 cm2, pressure gradient [peak/mean] 58/30 mmHg) from chronic rheumatic heart disease, had her pregnancy complicated by Rhesus iso-immunization. A transvenous mitral commissurotomy was performed percutaneously under local anesthesia. An emergency cesarean delivery for fetal distress was performed under general anaesthesia with sevoflurane and remifentanil. A live 1.73 kg flaccid male baby was delivered with a heart rate of 60 beats/min and treated with naloxone. The Apgar scores for the baby were 3 and 10 at 1 and 5 minutes respectively. Umbilical cord blood at delivery revealed venous and arterial pH of 7.36 (base excess +1) and 7.31 (base excess -2) respectively. The mother maintained stable haemodynamics and was extubated at the end of surgery. Both mother and baby were discharged from hospital on postoperative day 5. The use of remifentanil in cesarean section in patients with severe valvular heart disease is reviewed and discussed.
SN  - 1092-406X
AD  - Honorary Clinical Assistant Professor, Department of Anaesthesiology, Queen Mary Hospital, University of Hong Kong, Hong Kong
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 107005330
T1  - Toxic alcohol poisoning: 5 steps to successful treatment.
AU  - Erickson T
Y1  - 2000/11//
N1  - Accession Number: 107005330. Language: English. Entry Date: 20010309. Revision Date: 20150711. Publication Type: Journal Article; case study; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 750110. 
KW  - Ethanol -- Poisoning
KW  - Poisoning -- Therapy
KW  - Alcohol Drinking
KW  - Ethanol -- Administration and Dosage
KW  - Hemodialysis
KW  - Acid-Base Equilibrium
KW  - Adult
KW  - Male
KW  - Emergency Care
SP  - 2194
EP  - 2198
JO  - Consultant (00107069)
JF  - Consultant (00107069)
JA  - CONSULTANT
VL  - 40
IS  - 13
CY  - Malvern, Pennsylvania
PB  - HMP Communications
AB  - In a patient with suspected toxic alcohol poisoning, the first priority is to ensure that the airway is patent and protected, ventilation is adequate, and systemic perfusion is maintained. If the patient has altered mental status, administer the following intravenously: naloxone, 2 mg; thiamine, 100 mg; and glucose (0.5 to 1 g/kg). Rapid reversal of metabolic acidosis is a key supportive measure. Administer sodium bicarbonate intravenously to maintain a blood pH that is higher than 7.35. The mainstay of therapy for toxic alcohol ingestion is ethanol (with a goal blood ethanol level between 100 mg/dL and 150 mg/dL) or the recently approved antidote, fomepizole (4-methylpyrazole). Indications for hemodialysis include renal failure, significant metabolic acidosis, worsening acidosis despite treatment, and a blood level of either ethylene glycol or methanol greater than 50 mg/dL.
SN  - 0010-7069
AD  - Associate Professor of Emergency Medicine and Director, Division of Toxicology, University of Illinois College of Medicine, Chicago, IL
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DB  - ccm
ER  - 

TY  - JOUR
ID  - 107158516
T1  - Anticholinergic syndrome precipitated by opioid reversal.
AU  - Hicks SD
AU  - Wolfson AB
AU  - Asplin BR
AU  - Lipinski CA
AU  - Callaway CW
Y1  - 1998/01/04/
N1  - Accession Number: 107158516. Language: English. Entry Date: 19990101. Revision Date: 20150820. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9703530. 
KW  - Naloxone -- Diagnostic Use
KW  - Heroin
KW  - Cholinergic Antagonists -- Poisoning
KW  - Prehospital Care
KW  - Adult
KW  - Middle Age
KW  - Male
KW  - Female
SP  - 328
EP  - 329
JO  - Prehospital Emergency Care
JF  - Prehospital Emergency Care
JA  - PREHOSPITAL EMERG CARE
VL  - 2
IS  - 4
CY  - Philadelphia, Pennsylvania
PB  - Taylor & Francis Ltd
SN  - 1090-3127
AD  - Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
U2  - PMID: 9799024.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106780827
T1  - Buprenorphine: a primer for emergency physicians.
AU  - Sporer KA
Y1  - 2004/05//2004 May
N1  - Accession Number: 106780827. Language: English. Entry Date: 20041001. Revision Date: 20150818. Publication Type: Journal Article; review. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Buprenorphine -- Therapeutic Use
KW  - Substance Dependence -- Drug Therapy
KW  - Substance Withdrawal, Controlled -- Methods
KW  - Narcotics -- Adverse Effects
KW  - Overdose
KW  - Buprenorphine -- Pharmacodynamics
SP  - 580
EP  - 584
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 43
IS  - 5
CY  - New York, New York
PB  - Elsevier B.V.
AB  - The recent approval of office-based treatment for opioid addiction and US Food and Drug Administration approval of buprenorphine will expand treatment options for opioid addiction. Buprenorphine is classified as a partial micro opioid agonist and a weak kappa antagonist. It has a high affinity for the micro receptor, with slow dissociation resulting in a long duration of action and an analgesic potency 25 to 40 times more potent than morphine. At higher doses, its agonist effects plateau and it begins to behave more like an antagonist, limiting the maximal analgesic effect and respiratory depression. This 'ceiling effect' confers a high safety profile clinically, a low level of physical dependence, and only mild withdrawal symptoms on cessation after prolonged administration. Suboxone contains a mixture of buprenorphine and naloxone. The naloxone is poorly absorbed sublingually and is designed to discourage intravenous use. Subutex, buprenorphine only, will also be available primarily as an initial test dose. Clinicians will be using this drug for detoxification or for maintenance of opioid addiction. Patients with recent illicit opioid use may develop a mild precipitated withdrawal syndrome with the induction of buprenorphine. Acute buprenorphine intoxication may present with some diffuse mild mental status changes, mild to minimal respiratory depression, small but not pinpoint pupils, and relatively normal vital signs. Naloxone may improve respiratory depression but will have limited effect on other symptoms. Patients with significant symptoms related to buprenorphine should be admitted to the hospital for observation because symptoms will persist for 12 to 24 hours.
SN  - 0196-0644
AD  - Dept of Emergency Services, Room 1E21, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110; ksporer@itsa.ucsf.edu
U2  - PMID: 15111917.
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107252633
T1  - Prehospital treatment of patients with IV heroin overdose: what are we treating?
AU  - Pedersen CB
AU  - Steentoft A
AU  - Worm K
AU  - Sprehn M
AU  - Mogensen T
AU  - Sorensen MB
Y1  - 1997/06//06/01/1997
N1  - Accession Number: 107252633. Language: English. Entry Date: 19980401. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health; USA. NLM UID: 8918173. 
KW  - Prehospital Care
KW  - Heroin -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Morphine
KW  - Denmark
KW  - Descriptive Statistics
KW  - Overdose -- Diagnosis
KW  - Flumazenil
KW  - Substance Abuse
KW  - Outcomes (Health Care)
KW  - Adult
KW  - Male
KW  - Female
KW  - Human
SP  - 92
EP  - 95
JO  - Prehospital & Disaster Medicine
JF  - Prehospital & Disaster Medicine
JA  - PREHOSPITAL DISASTER MED
VL  - 12
IS  - 2
PB  - Cambridge University Press
AB  - Objective: To measure blood levels of morphine and additional drugs in patients suspected of intravenous (IV) heroin abuse and to evaluate the effects of antidote treatment. Design: Prehospital blood sampling in 52 patients. Results. Forty-five patients were blood positive for heroin, eight of whom were hospitalized. Forty-one patients also had abused additional drugs: minor tranquilizers, ethanol amphetamine, cocaine, and/or carbamazepine. Seven Patients had taken either only methadone or ketobemidione: one was admitted. Treatment with increasing doses of naloxone indicated a necessity for hospitalization. Six of 14 patients treated with naloxone (1.8 mg were hospitalized. Seven patients had an extremely high blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in moderate doses. Conclusion: This study indicates that under prehospital conditions, it is difficult to identify a patient intoxicated only with intravenous heroin. Nearly all patients treated were cases of multiple drug/alcohol overdoses. Even the symptoms associated with extremely high blood levels of morphine could be reversed with naloxone in moderate doses.
SN  - 1049-023X
AD  - Mobile Intensive Care Unit of Copenhagen, Osterfarigmagsgade 5, Villa 1, 1399 Copenhagen K., Denmark
U2  - PMID: 10187003.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107252633&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104976883
T1  - A believer in opioids loses his faith.
Y1  - 2011/01//2011 Jan
N1  - Accession Number: 104976883. Language: English. Entry Date: 20110204. Revision Date: 20150711. Publication Type: Journal Article; brief item. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Pain and Pain Management; Physical Therapy. NLM UID: 9884284. 
KW  - Chronic Pain -- Drug Therapy
KW  - Emergency Care
KW  - Narcotics -- Administration and Dosage
KW  - Emergency Service
SP  - 7
EP  - 7
JO  - Back Letter
JF  - Back Letter
JA  - BACKLETTER
VL  - 26
IS  - 1
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
SN  - 0894-7376
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104976883&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105685369
T1  - Somatic health among heroin addicts before and during opioid maintenance treatment: a retrospective cohort study.
AU  - Skeie I
AU  - Brekke M
AU  - Lindbaek M
AU  - Waal H
Y1  - 2008/01//
N1  - Accession Number: 105685369. Language: English. Entry Date: 20110610. Revision Date: 20171129. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Public Health; UK & Ireland. NLM UID: 100968562. 
KW  - Acute Disease -- Epidemiology
KW  - Chronic Disease -- Epidemiology
KW  - Health Services -- Utilization
KW  - Methadone -- Therapeutic Use
KW  - Narcotics -- Therapeutic Use
KW  - Substance Abuse, Intravenous -- Rehabilitation
KW  - Substance Use Disorders -- Rehabilitation
KW  - Adult
KW  - Ambulatory Care -- Utilization
KW  - Female
KW  - Hospitals -- Utilization
KW  - Incidence
KW  - Male
KW  - Middle Age
KW  - Norway
KW  - Overdose -- Epidemiology
KW  - Overdose -- Prevention and Control
KW  - Prospective Studies
KW  - Substance Abuse, Intravenous -- Complications
KW  - Substance Abuse, Intravenous -- Drug Therapy
KW  - Substance Use Disorders -- Complications
KW  - Substance Use Disorders -- Drug Therapy
KW  - Human
SP  - 43
EP  - 43
JO  - BMC Public Health
JF  - BMC Public Health
JA  - BMC PUBLIC HEALTH
VL  - 8
IS  - 1
PB  - BioMed Central
AB  - Background: The long-term impact of opioid maintenance treatment (OMT) on morbidity and health care utilization among heroin addicts has been insufficiently studied. The objective of this study was to investigate whether health care utilization due to somatic disease decreased during OMT, and if so, whether the reduction included all kinds of diseases and whether a reduction was related to abstinence from drug use. Methods: Cohort study with retrospective registration of somatic disease incidents (health problems, acute or sub-acute, or acute problems related to chronic disease, resulting in a health care contact). Medical record data were collected from hospitals, Outpatients' Departments, emergency wards and from general practitioners (GPs) and prospective data on substance use during OMT were available from 2001 onwards. The observation period was five years before and up to five years during OMT. The cohort consisted of 35 out of 40 patients who received OMT between April 1999 and January 2005 in a Norwegian district town. Statistical significance concerning changes in number of incidents and inpatient and outpatient days during OMT compared with the pre OMT period was calculated according to Wilcoxon signed rank test. Significance concerning pre/during OMT changes in disease incidents by relation to the type of health service contacts, as well as the impact of ongoing substance use during OMT on the volume of contacts, was calculated according to Pearson chi-square and Fisher's exact tests. Results: 278 disease incidents were registered. There was a reduction in all incidents by 35% (p = 0.004), in substance-related incidents by 62% (p < 0.001) and in injection-related incidents by 70% (p < 0.001). There was an insignificant reduction in non-fatal overdose incidents by 44% (p = 0.127) and an insignificant increase in nonsubstance-related incidents by 13% (p = 0.741). Inpatient and outpatient days were reduced by 76% (p = 0.003) and 46% (p = 0.060), respectively. The disease incidents were less often drug-related during OMT (p < 0.001). Patients experienced a reduction in substance-related disease incidents regardless of ongoing substance use, however there was a trend towards greater reductions in those without ongoing abuse. Conclusion: Although as few as 35 patients were included, this study demonstrates a significant reduction in health care utilization due to somatic disease incidents during OMT. The reduction was most pronounced for incidents related to substance use and injection. Inpatient and outpatient days were reduced. Most probably these findings reflect somatic health improvement among heroin addicts during OMT.
SN  - 1471-2458
AD  - Aker University Hospital, Oslo, Norway. ivskeie@online.no
U2  - PMID: 18237421.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105685369&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105265205
T1  - Spotlight on research.
AU  - Willimas J
Y1  - 2009/11//2009 Nov
N1  - Accession Number: 105265205. Language: English. Entry Date: 20100122. Revision Date: 20150711. Publication Type: Journal Article; abstract. Journal Subset: Allied Health; Europe; UK & Ireland. Special Interest: Emergency Care. 
KW  - Administration, Intranasal
KW  - Emergency Medical Service Communication Systems
KW  - Naloxone -- Administration and Dosage
KW  - Narcotic Antagonists -- Administration and Dosage
KW  - Transfer, Discharge
KW  - Emergency Medical Technicians
KW  - Prehospital Care
KW  - Time Factors
SP  - 599
EP  - 600
JO  - Journal of Paramedic Practice
JF  - Journal of Paramedic Practice
JA  - J PARAMEDIC PRACT
VL  - 1
IS  - 14
PB  - Mark Allen Holdings Limited
SN  - 1759-1376
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105265205&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106203290
T1  - The toxic emergency. Antidote worse than the poison?
AU  - Nelson L
Y1  - 2006/06//2006 Jun
N1  - Accession Number: 106203290. Language: English. Entry Date: 20070105. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. 
KW  - Antidotes
KW  - Naloxone -- Administration and Dosage
KW  - Poisoning -- Drug Therapy
KW  - Administration, Intravenous
KW  - Diagnosis, Differential
KW  - Injections, Subcutaneous
KW  - Male
KW  - Middle Age
KW  - Naloxone -- Adverse Effects
SP  - 31
EP  - 34
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 38
IS  - 6
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
AD  - Director, Medical Toxicology Fellowship and Associate Director, New York City Poison Control Center
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106168070
T1  - Why won't he wake up? Altered LOC, decreased respirations & pinpoint pupils provide clues to a medication mishap.
AU  - Augustine JJ
Y1  - 2007/09//
N1  - Accession Number: 106168070. Language: English. Entry Date: 20071012. Revision Date: 20150711. Publication Type: Journal Article; case study; questions and answers; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101466002. 
KW  - Emergency Medical Services
KW  - Medication Errors
KW  - Morphine -- Poisoning
KW  - Overdose -- Diagnosis
KW  - Overdose -- Therapy
KW  - Prehospital Care
KW  - Adult
KW  - Airway Management
KW  - Emergency Patients
KW  - Guest Relations
KW  - Male
KW  - Naloxone -- Administration and Dosage
KW  - Outpatients
KW  - Physical Examination
KW  - Residential Facilities
SP  - 25
EP  - 27
JO  - EMS Magazine
JF  - EMS Magazine
JA  - EMS MAG
VL  - 36
IS  - 9
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 1946-4967
AD  - Clinical Faculty, Department of Emergency Medicine, Emory University, Atlanta, GA; jaugustine@emp.com
U2  - PMID: 17910238.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106168070&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107922918
T1  - WHY SO 'LOW'?
AU  - Nevin, Jon
Y1  - 2013/11//
N1  - Accession Number: 107922918. Language: English. Entry Date: 20131230. Revision Date: 20150712. Publication Type: Journal Article; case study; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Gerontologic Care; Patient Safety. NLM UID: 8102138. 
KW  - Insulin -- Administration and Dosage -- In Old Age
KW  - Hypoglycemia -- Chemically Induced -- In Old Age
KW  - Narcotics -- Poisoning -- In Old Age
KW  - Overdose -- Etiology -- In Old Age
KW  - Medication Errors -- Etiology -- In Old Age
KW  - Self Administration -- Adverse Effects -- In Old Age
KW  - Prehospital Care -- In Old Age
KW  - Emergency Medical Services
KW  - Recurrence
KW  - Geriatric Assessment
KW  - Patient History Taking
KW  - Physical Examination
KW  - Mental Status
KW  - Intravenous Therapy
KW  - Oxygen Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Administration, Intravenous
KW  - Injections, Subcutaneous -- Adverse Effects
KW  - Insertion Sites -- Adverse Effects
KW  - Insulin -- Pharmacokinetics
KW  - Drug Interactions
KW  - Zolpidem -- Adverse Effects
KW  - Oxycodone -- Adverse Effects
KW  - Hypoglycemia -- Symptoms
KW  - Overdose -- Symptoms
KW  - Family Role
KW  - Diabetes Education
KW  - Inpatients
KW  - Female
KW  - Aged
KW  - Emergency Patients
KW  - Diabetic Patients
SP  - 24
EP  - 25
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 38
IS  - 11
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Firefighter/paramedic, with Heartland Fire & Rescue, San Diego
U2  - PMID: 24475614.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107922918&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106542209
T1  - IN vs. IM naloxone.
AU  - Salvucci A Jr.
Y1  - 2005/08//2005 Aug
N1  - Accession Number: 106542209. Language: English. Entry Date: 20051125. Revision Date: 20150711. Publication Type: Journal Article; abstract; commentary. Original Study: Kelly AM, Kerr D, Dietze P et al. Randomized trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose. MED J AUSTRALIA 2005; 182(1): 24-7. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Administration, Intranasal
KW  - Injections, Intramuscular
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Prehospital Care
KW  - Clinical Trials
KW  - Comparative Studies
KW  - Emergency Patients
KW  - Outpatients
KW  - Prospective Studies
KW  - Respiratory Rate -- Drug Effects
KW  - Treatment Outcomes
KW  - Victoria
SP  - 64
EP  - 66
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 34
IS  - 8
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106542209&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107088789
T1  - The unconscious patient: evaluation and first-line interventions.
AU  - Chuidian FX
Y1  - 2000/01//2000 Jan
N1  - Accession Number: 107088789. Language: English. Entry Date: 20000201. Revision Date: 20150711. Publication Type: Journal Article; algorithm; diagnostic images; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8608118. 
KW  - Unconsciousness -- Diagnosis
KW  - Unconsciousness -- Therapy
KW  - Physical Examination
KW  - Emergency Care
KW  - Airway Management
KW  - Resuscitation
KW  - Intravenous Therapy
SP  - 14
EP  - 20
JO  - Journal of Critical Illness
JF  - Journal of Critical Illness
JA  - J CRIT ILLN
VL  - 15
IS  - 1
CY  - Greenwich, Connecticut
PB  - Cliggott Publishing Company
AB  - Unconscious patients are at high risk for acute, irreversible deterioration, and resuscitative therapy often must begin without a definite diagnosis. The essential first steps are to secure the patient's airway, breathing, and circulation and to begin treating imminently life-threatening conditions. Rapid-sequence orotracheal intubation is often required to protect the airway. Hyperthermia or hypothermia should be recognized promptly and corrected at once. Administration of appropriate intravenous agents can be started early: dextrose if the patient is hypoglycemic; isotonic fluids and insulin for hyperglycemia; empiric antibiotics when an infectious process is suspected; naloxone when there are signs of opioid overdose; thiamine when there is evidence of alcoholism or malnutrition. Abdominal ultrasonography and cerebral CT scanning are often indicated for patients who have suffered trauma.
SN  - 1040-0257
AD  - Assistant Professor of Emergency Medicine, Medical College of Virginia Hospitals-Virginia Commonwealth University, Richmond
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107098366
T1  - Ultrarapid opiate detoxification.
AU  - Bulthius D
AU  - Díaz JE
Y1  - 2000/01//2000 Jan
N1  - Accession Number: 107098366. Language: English. Entry Date: 20000401. Revision Date: 20150818. Publication Type: Journal Article; case study; letter. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Substance Dependence -- Drug Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Substance Withdrawal Syndrome -- Drug Therapy
KW  - Emergency Care -- Methods
KW  - Heroin
KW  - Time Factors
KW  - Treatment Outcomes
KW  - Adult
KW  - Male
SP  - 100
EP  - 101
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 35
IS  - 1
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
U2  - PMID: 10613955.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107098366&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106130581
T1  - A sticky situation: toxicity of clonidine and fentanyl transdermal patches in pediatrics.
AU  - Behrman A
AU  - Goertemoeller S
A2  - Muller AA
Y1  - 2007/06//
N1  - Accession Number: 106130581. Language: English. Entry Date: 20070810. Revision Date: 20150818. Publication Type: Journal Article; case study; CEU; exam questions; tables/charts. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. NLM UID: 7605913. 
KW  - Clonidine -- Adverse Effects -- In Infancy and Childhood
KW  - Emergency Care -- In Infancy and Childhood
KW  - Fentanyl -- Adverse Effects -- In Infancy and Childhood
KW  - Overdose -- In Infancy and Childhood
KW  - Transdermal Patches, Drugs -- Adverse Effects -- In Infancy and Childhood
KW  - Clonidine -- Administration and Dosage
KW  - Education, Continuing (Credit)
KW  - Fentanyl -- Administration and Dosage
KW  - Infant
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Overdose -- Etiology
KW  - Overdose -- Prevention and Control
KW  - Overdose -- Symptoms
SP  - 290
EP  - 293
JO  - JEN: Journal of Emergency Nursing
JF  - JEN: Journal of Emergency Nursing
JA  - J EMERG NURS
VL  - 33
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0099-1767
AD  - Senior Drug and Poison Information Specialist, Cincinnati Drug and Poison Information Center, Cincinnati, OH; Alysha.Behrman@cchmc.org
U2  - PMID: 17517283.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106130581&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105859941
T1  - Should naloxone be prescribed in the ED management of patients with cardiac arrest? A case report and review of literature.
AU  - Martins HS
AU  - Silva RV
AU  - Bugano D
AU  - Santana AN
AU  - Brandao-Neto RA
AU  - Giannini FP
AU  - Scalabrini-Neto A
AU  - Velasco IT
Y1  - 2008/01//
N1  - Accession Number: 105859941. Language: English. Entry Date: 20080314. Revision Date: 20150711. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309942. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Heart Arrest -- Chemically Induced
KW  - Methadone -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - Emergency Service
KW  - Female
KW  - Middle Age
SP  - 113.e5
EP  - 8
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 26
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
SN  - 0735-6757
AD  - Department of Emergency Medicine, School of Medicine of the University of Sao Paulo, Hospital das Clinicas, 05.403-900 Sao Paulo, Brazil.
U2  - PMID: 18082805.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105859941&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105353321
T1  - Two milligrams i.v. hydromorphone is efficacious for treating pain but is associated with oxygen desaturation.
AU  - Chang AK
AU  - Bijur PE
AU  - Napolitano A
AU  - Lupow J
AU  - Gallagher EJ
Y1  - 2009/03//2009 Mar-Apr
N1  - Accession Number: 105353321. Language: English. Entry Date: 20090717. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101234523. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Dihydromorphinone -- Administration and Dosage
KW  - Oxygen -- Blood
KW  - Pain -- Drug Therapy
KW  - Acute Disease
KW  - Adult
KW  - Analgesics, Opioid -- Adverse Effects
KW  - Antiemetics -- Therapeutic Use
KW  - Clinical Trials
KW  - Dihydromorphinone -- Adverse Effects
KW  - Emergency Service
KW  - Female
KW  - Infusions, Intravenous
KW  - Male
KW  - Middle Age
KW  - Naloxone -- Therapeutic Use
KW  - Narcotic Antagonists -- Therapeutic Use
KW  - New York
KW  - Pain Measurement
KW  - Pilot Studies
KW  - Prospective Studies
KW  - Severity of Illness Indices
KW  - Treatment Outcomes
KW  - Human
SP  - 75
EP  - 80
JO  - Journal of Opioid Management
JF  - Journal of Opioid Management
JA  - J OPIOID MANAGE
VL  - 5
IS  - 2
CY  - Weston, Massachusetts
PB  - Weston Medical Publishing, LLC
SN  - 1551-7489
AD  - Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
U2  - PMID: 19507803.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105353321&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105693107
T1  - Serotonin syndrome triggered by a single dose of suboxone.
AU  - Isenberg D
AU  - Wong SC
AU  - Curtis JA
Y1  - 2008/09//
N1  - Accession Number: 105693107. Language: English. Entry Date: 20081121. Revision Date: 20150711. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8309942. 
KW  - Naloxone -- Therapeutic Use
KW  - Serotonin Syndrome -- Prevention and Control
KW  - Administration, Oral
KW  - Emergency Medicine
KW  - Male
KW  - Middle Age
KW  - Opioid Peptides -- Adverse Effects
SP  - 840.e3
EP  - 5
JO  - American Journal of Emergency Medicine
JF  - American Journal of Emergency Medicine
JA  - AM J EMERG MED
VL  - 26
IS  - 7
CY  - Philadelphia, Pennsylvania
PB  - Elsevier B.V.
AB  - Suboxone (buprenorphine/naloxone) is an oral medication used for the treatment of opiate dependence. Because of its mixed properties at the opiate receptors, buprenorphine has a ceiling on its euphoric effects. We report the first case of serotonin syndrome caused by buprenorphine and review other medications implicated in serotonin syndrome. A 54-year-old man on tricyclic antidepressants took an unprescribed dose of buprenorphine/naloxone. He presented to the emergency department with signs and symptoms of severe serotonin syndrome including clonus, agitation, and altered mental status. His agitation was not controlled with benzodiazepines and was electively intubated. At the recommendation of the toxicology service, cyproheptadine, a serotonin receptor antagonist, was administered with improvement in the patient's symptoms. Emergency physicians should be aware of the potential of buprenorphine/naloxone to trigger serotonin syndrome. © 2008 Elsevier Inc. All rights reserved.
SN  - 0735-6757
AD  - Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA. disenber@drexelmed.edu
U2  - PMID: 18774063.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105693107&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 105905827
T1  - Demographic characteristics and opioid prescribing...JAMA. 2008 Jan 2;299(1):70-8
AU  - Maserejian NN
AU  - McKinlay JB
AU  - Maserejian, Nancy N
AU  - McKinlay, John B
Y1  - 2008/04/16/
N1  - Accession Number: 105905827. Language: English. Entry Date: 20080502. Revision Date: 20161112. Publication Type: commentary; commentary; letter; response. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Health Services Accessibility -- Statistics and Numerical Data
KW  - Pain -- Drug Therapy
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Drug Utilization -- Statistics and Numerical Data
KW  - Ethnic Groups
KW  - Female
KW  - Male
KW  - Pain -- Ethnology
KW  - Socioeconomic Factors
KW  - United States
SP  - 1773
EP  - 1774
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 299
IS  - 15
CY  - Chicago, Illinois
PB  - American Medical Association
SN  - 0098-7484
U2  - PMID: 18413872.
DO  - 10.1001/jama.299.15.1773-a
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105905827&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - GEN
ID  - 105905826
T1  - Demographic characteristics and opioid prescribing...JAMA. 2008 Jan 2;299(1):70-8
AU  - Berger JT
AU  - Berger, Jeffrey T
Y1  - 2008/04/16/
N1  - Accession Number: 105905826. Language: English. Entry Date: 20080502. Revision Date: 20161112. Publication Type: commentary; commentary; letter; response. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. 
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Emergency Service -- Statistics and Numerical Data
KW  - Health Services Accessibility -- Statistics and Numerical Data
KW  - Pain -- Drug Therapy
KW  - Practice Patterns -- Statistics and Numerical Data
KW  - Drug Utilization -- Statistics and Numerical Data
KW  - Ethnic Groups
KW  - Female
KW  - Male
KW  - Pain -- Ethnology
SP  - 1773
EP  - 1774
JO  - JAMA: Journal of the American Medical Association
JF  - JAMA: Journal of the American Medical Association
JA  - JAMA
VL  - 299
IS  - 15
CY  - Chicago, Illinois
PB  - American Medical Association
SN  - 0098-7484
U2  - PMID: 18413871.
DO  - 10.1001/jama.299.15.1773-b
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105905826&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107379299
T1  - Safety of fentanyl for analgesia in adults undergoing air medical transport from trauma scenes... this paper was presented at the Eleventh Annual Conference and Scientific Assembly of the National Association of EMS Physicians, San Diego Calif, July 31, 1995, and at the 1995 Air Medical Transport Conference, Long Beach Calif, October 17, 1995.
AU  - Thomas SH
AU  - Benevelli W
AU  - Brown DFM
AU  - Wedel SK
Y1  - 1996/04//1996 Apr-Jun
N1  - Accession Number: 107379299. Language: English. Entry Date: 19960801. Revision Date: 20150820. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 9312325. 
KW  - Fentanyl -- Therapeutic Use
KW  - Aeromedical Transport
KW  - Retrospective Design
KW  - Record Review
KW  - T-Tests
KW  - Adult
KW  - Human
SP  - 57
EP  - 59
JO  - Air Medical Journal
JF  - Air Medical Journal
JA  - AIR MED J
VL  - 15
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
AB  - Introduction: Although proper analgesia provision for patients in the inhospital acute setting has received recent attention, little discussion has been done of prehospital pain relief. This study was conducted to evaluate the safety of fentanyl administration during air medical transport of adult trauma patients. Setting: Urban air medical transport program using a flight nurse/paramedic crew operating with patient care protocols and off-line medical control. Methods: Flight records for trauma patients transported directly from the scene receiving fentanyl were analyzed retrospectively. Study parameters were obtained for the times just preceding and after fentanyl administration. A t test (alpha = 0.05) comparison between before and after fentanyl administration was performed for the following study parameters: systolic blood pressure, heart rate, oxygen saturation, respiratory rate, and Glasgow coma score in nonintubated patients. Flight records were also reviewed for any administration of naloxone or subjective notation of complications possibly attributable to fentanyl. Results: Fentanyl was administered 154 times to 99 patients. No patient received inflight naloxone, and no fentanyl-related complications were noted on flight record review. Conclusion: Administration of fentanyl for inflight trauma analgesia in adults seems safe. Further study should investigate efficacy of inflight fentanyl administration and determine whether prehospital opiate administration impairs emergency department evaluation of trauma patients.
SN  - 1067-991X
AD  - Boston MedFlight, 31 Fargo St, Boston MA 02210-1995
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107379299&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106778056
T1  - Leaving against medical advice after out-of-hospital naloxone: a closer look is needed...Vilke GM, Sloane C, Smith AM et al. Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. Acad Emerg Med. 2003;10:893-6
AU  - Perez A
AU  - Kamin R
AU  - McKay CA
AU  - Vilke GM
AU  - Smith AM
AU  - Chan TC
Y1  - 2004/03//
N1  - Accession Number: 106778056. Language: English. Entry Date: 20040917. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. 
KW  - Emergency Patients
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Patient Discharge
KW  - Prehospital Care
KW  - Treatment Refusal
KW  - Dose-Response Relationship, Drug
KW  - Drug Monitoring
KW  - Intubation, Intratracheal
KW  - Overdose -- Mortality
KW  - Protocols
SP  - 323
EP  - 324
JO  - Academic Emergency Medicine
JF  - Academic Emergency Medicine
JA  - ACAD EMERG MED
VL  - 11
IS  - 3
CY  - Malden, Massachusetts
PB  - Wiley-Blackwell
SN  - 1069-6563
U2  - PMID: 15001421.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106778056&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

ID  - 28130024
T1  - Acute respiratory distress syndrome induced by oral methadone managed with non-invasive ventilation.
AU  - Ridgway, Z. A.
AU  - Pountney, A. J.
Y1  - 2007/09//
N1  - Accession Number: 28130024. Language: English. Entry Date: 20080229. Revision Date: 20150604. Publication Type: Case Study. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 100963089. 
SP  - 681
EP  - 681
JO  - Emergency Medicine Journal
JF  - Emergency Medicine Journal
JA  - EMERG MED J
VL  - 24
IS  - 9
PB  - BMJ Publishing Group
AB  - The article describes the case of a 54-year old man who presented to the emergency department with acute respiratory distress syndrome induced by oral methadone managed with non-invasive ventilation. Upon presentation to the ED, the patient's arterial blood gas, arterial carbon dioxide pressure and arterial oxygen pressure were obtained. He had a portable chest x-ray and electrocardiogram, was given intravenous dose of naloxone, furosemide and a glyceryl trinitrate infusion and was commenced on bi-level positive airway pressure non-invasive ventilation.
SN  - 1472-0205
AD  - Department of Anaesthesia, Leeds General Infirmary, Leeds, UK
AD  - Emergency Department, St. James's University Hospital, Leeds, UK
DO  - 10.1136/emj.2007.048991
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106125635
T1  - Beyond the basics: street drugs.
AU  - Limmer DD
AU  - Mistovich JJ
AU  - Krost WS
Y1  - 2007/05//
N1  - Accession Number: 106125635. Language: English. Entry Date: 20070727. Revision Date: 20150711. Publication Type: Journal Article; CEU; exam questions; pictorial. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101466002. 
KW  - Emergency Medical Services
KW  - Prehospital Care
KW  - Street Drugs
KW  - Substance Abuse
KW  - Cocaine
KW  - Education, Continuing (Credit)
KW  - Heroin
KW  - Lysergic Acid Diethylamide
KW  - Methamphetamine
KW  - Methylenedioxymethamphetamine
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics
KW  - Niacin -- Poisoning
KW  - Outpatients
KW  - Overdose -- Drug Therapy
KW  - Sodium Oxybate
KW  - Substance Abuse -- Physiopathology
KW  - Substance Abuse -- Symptoms
KW  - Substance Abuse -- Therapy
KW  - Substance Withdrawal Syndrome
SP  - 75
EP  - 81
JO  - EMS Magazine
JF  - EMS Magazine
JA  - EMS MAG
VL  - 36
IS  - 5
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 1946-4967
AD  - Kennebunk Fire-Rescue, Kennebunk, ME
U2  - PMID: 17536597.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106125635&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107226613
T1  - Naloxone in the reversal of coma induced by sodium valproate.
AU  - Montero FJ
Y1  - 1999/03//1999 Mar
N1  - Accession Number: 107226613. Language: English. Entry Date: 19991201. Revision Date: 20150818. Publication Type: Journal Article; letter. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Naloxone -- Therapeutic Use
KW  - Valproic Acid -- Poisoning
KW  - Coma -- Drug Therapy
KW  - Overdose
KW  - Coma -- Chemically Induced
KW  - Suicide, Attempted
KW  - Emergency Care
KW  - Adult
KW  - Female
SP  - 357
EP  - 358
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 33
IS  - 3
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
U2  - PMID: 10036355.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107226613&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107478039
T1  - Heroin overdose... a little naloxone goes a long way.
AU  - Schoen ST
Y1  - 1993/11//1993 Nov
N1  - Accession Number: 107478039. Language: English. Entry Date: 19931201. Revision Date: 20150712. Publication Type: Journal Article; case study; CEU; exam questions. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Heroin -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Prehospital Care
KW  - Emergency Medical Technicians
KW  - Education, Continuing (Credit)
KW  - Adult
KW  - Outpatients
KW  - Male
SP  - 53
EP  - 54
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 22
IS  - 11
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
AD  - New York Hosp Cornell Med Ctr, New York City NY
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107478039&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105722796
T1  - Pediatric toxicology: part 1.
AU  - Vroman R
Y1  - 2008/04//
N1  - Accession Number: 105722796. Language: English. Entry Date: 20080523. Revision Date: 20150711. Publication Type: Journal Article; pictorial; review; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101466002. 
KW  - Emergency Medical Services
KW  - Poisoning -- Diagnosis -- In Infancy and Childhood
KW  - Poisoning -- Therapy -- In Infancy and Childhood
KW  - Prehospital Care -- In Infancy and Childhood
KW  - Toxicology -- In Infancy and Childhood
KW  - Adolescence
KW  - Adult
KW  - Antidotes -- Therapeutic Use
KW  - Atropine -- Administration and Dosage
KW  - Calcium Chloride -- Administration and Dosage
KW  - Charcoal -- Administration and Dosage
KW  - Child
KW  - Child, Preschool
KW  - Diazepam -- Administration and Dosage
KW  - Dopamine -- Administration and Dosage
KW  - Drugs -- Poisoning
KW  - Emergency Patients
KW  - Environmental Exposure
KW  - Female
KW  - Gastric Lavage -- Methods
KW  - Glucagon -- Administration and Dosage
KW  - Glucose -- Administration and Dosage
KW  - Infant
KW  - Ipecac -- Therapeutic Use
KW  - Lidocaine -- Administration and Dosage
KW  - Male
KW  - Midazolam -- Administration and Dosage
KW  - Monitoring, Physiologic
KW  - Naloxone -- Administration and Dosage
KW  - Outpatients
KW  - Patient Assessment
KW  - Patient History Taking
KW  - Poisoning -- Drug Therapy
KW  - Poisoning -- Epidemiology -- United States
KW  - Poisoning -- Symptoms
KW  - Sodium Bicarbonate -- Administration and Dosage
KW  - Sorbitol -- Therapeutic Use
KW  - United States
SP  - 72
EP  - 84
JO  - EMS Magazine
JF  - EMS Magazine
JA  - EMS MAG
VL  - 37
IS  - 4
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
AB  - The perils of toxic exposures in the pediatric population.
SN  - 1946-4967
AD  - Member of Paramedic Education Program faculty, HealthONE EMS, Englewood, CO
U2  - PMID: 18811073.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105722796&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103917734
T1  - IN BRIEF.
Y1  - 2014/11/29/
N1  - Accession Number: 103917734. Language: English. Entry Date: 20141212. Revision Date: 20150710. Publication Type: Journal Article; pictorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. 
KW  - Naloxone -- Analysis
KW  - Drug Evaluation
KW  - Medicine
KW  - Serial Publications
KW  - Patient Safety
KW  - Naloxone -- Therapeutic Use
KW  - Palliative Care
KW  - Naloxone -- Administration and Dosage
KW  - Hospitals
KW  - Emergency Service -- Evaluation
KW  - Suicide -- Prevention and Control
KW  - Counseling -- Methods
KW  - Quality of Health Care
KW  - Medical Organizations
KW  - Communication
KW  - Technology
KW  - Contracts
KW  - Health Care Costs -- Evaluation
KW  - Personnel Staffing and Scheduling
SP  - g7236
EP  - g7236
JO  - BMJ: British Medical Journal
JF  - BMJ: British Medical Journal
JA  - BMJ BR MED J
VL  - 349
IS  - 7895
PB  - BMJ Publishing Group
SN  - 1756-1833
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103917734&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105459103
T1  - How to guide the alcohol-dependent patient toward recovery.
AU  - Newberry M
Y1  - 2009/02//2009 Feb
N1  - Accession Number: 105459103. Language: English. Entry Date: 20090410. Revision Date: 20150711. Publication Type: Journal Article; pictorial; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. 
KW  - Alcohol Abuse -- Drug Therapy
KW  - Alcohol Abuse -- Prevention and Control
KW  - Alcohol Rehabilitation Programs
KW  - Alcoholism -- Prevention and Control
KW  - Alcoholism -- Psychosocial Factors
KW  - Emergency Service
KW  - Naltrexone -- Administration and Dosage
KW  - Naltrexone -- Therapeutic Use
KW  - Psychotherapy
KW  - Risk Taking Behavior
SP  - 32
EP  - 38
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 41
IS  - 2
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
AB  - Conventional wisdom has it that heavy drinkers aren't interested in getting help. But in fact, many are -- and there are simple, focused steps you can follow to keep them motivated.
SN  - 0013-6654
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105459103&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108174589
T1  - Clinical implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children.
AU  - Sahyoun, Cyril
AU  - Krauss, Baruch
Y1  - 2012/04//2012 Apr
N1  - Accession Number: 108174589. Language: English. Entry Date: 20120427. Revision Date: 20150712. Publication Type: Journal Article; review; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pediatric Care. NLM UID: 9000850. 
KW  - Hypnotics and Sedatives -- Pharmacodynamics
KW  - Hypnotics and Sedatives -- Pharmacokinetics
KW  - Sedation
KW  - Airway Management
KW  - Anoxia -- Risk Factors
KW  - Child
KW  - Chloral Hydrate -- Pharmacodynamics
KW  - Chloral Hydrate -- Pharmacokinetics
KW  - Fentanyl -- Adverse Effects
KW  - Fentanyl -- Pharmacodynamics
KW  - Fentanyl -- Pharmacokinetics
KW  - Flumazenil -- Administration and Dosage
KW  - Flumazenil -- Pharmacodynamics
KW  - Flumazenil -- Pharmacokinetics
KW  - Glomerular Filtration Rate -- Evaluation
KW  - Hypersensitivity -- Diagnosis
KW  - Hypersensitivity -- Prevention and Control
KW  - Midazolam -- Administration and Dosage
KW  - Midazolam -- Adverse Effects
KW  - Midazolam -- Pharmacodynamics
KW  - Midazolam -- Pharmacokinetics
KW  - Morphine -- Administration and Dosage
KW  - Morphine -- Adverse Effects
KW  - Morphine -- Pharmacodynamics
KW  - Morphine -- Pharmacokinetics
KW  - Naloxone -- Administration and Dosage
KW  - Naloxone -- Adverse Effects
KW  - Naloxone -- Pharmacodynamics
KW  - Naloxone -- Pharmacokinetics
KW  - Nitrous Oxide -- Administration and Dosage
KW  - Nitrous Oxide -- Adverse Effects
KW  - Nitrous Oxide -- Pharmacodynamics
KW  - Nitrous Oxide -- Pharmacokinetics
KW  - Pediatrics
KW  - Pentobarbital -- Administration and Dosage
KW  - Pentobarbital -- Pharmacodynamics
KW  - Pentobarbital -- Pharmacokinetics
KW  - Propofol -- Administration and Dosage
KW  - Propofol -- Adverse Effects
KW  - Propofol -- Pharmacodynamics
KW  - Propofol -- Pharmacokinetics
KW  - Pulse Oximetry
KW  - Respiration Disorders -- Risk Factors
KW  - Safety
KW  - Seizures
KW  - Substance Withdrawal Syndrome -- Risk Factors
KW  - Vomiting -- Diagnosis
SP  - 225
EP  - 232
JO  - Current Opinion in Pediatrics
JF  - Current Opinion in Pediatrics
JA  - CURR OPIN PEDIATR
VL  - 24
IS  - 2
CY  - Baltimore, Maryland
PB  - Lippincott Williams & Wilkins
AB  - PURPOSE OF REVIEW: Procedural sedation has become the standard of care for managing pain and anxiety in children in the emergency department. RECENT FINDINGS: Numerous articles have been published on pediatric procedural sedation with, however, little in-depth discussion of the pharmacodynamics and pharmacokinetics of the sedation agents utilized. SUMMARY: We review the pharmacokinetics and pharmacodynamics of the pediatric procedural sedation pharmacopeia from a clinical perspective with emphasis on the practical implications for drug titration and dosing.
SN  - 1040-8703
AD  - Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA.
U2  - PMID: 22245909.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108174589&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 103881575
T1  - Research Roundup. Hospital costs decline dramatically with naltrexone implant for alcohol use.
Y1  - 2014/09//
N1  - Accession Number: 103881575. Language: English. Entry Date: 20140825. Revision Date: 20150710. Publication Type: Journal Article; brief item. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Psychiatry/Psychology. 
KW  - Research
KW  - Naltrexone -- Therapeutic Use
KW  - Drug Implants
KW  - Alcoholism -- Drug Therapy
KW  - Hospitalization
KW  - Emergency Care
KW  - Health Care Costs
SP  - 7
EP  - 7
JO  - Brown University Psychopharmacology Update
JF  - Brown University Psychopharmacology Update
JA  - BROWN UNIV PSYCHOPHARMACOL UPDATE
VL  - 25
IS  - 9
CY  - Hoboken, New Jersey
PB  - John Wiley & Sons, Inc.
SN  - 1068-5308
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103881575&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106872277
T1  - Delayed poisoning emergencies.
AU  - Gahagan LD
AU  - Hatlestad D
Y1  - 2003/08//2003 Aug
N1  - Accession Number: 106872277. Language: English. Entry Date: 20031003. Revision Date: 20150819. Publication Type: Journal Article; CEU; exam questions; pictorial; review. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Poisoning -- Diagnosis -- In Infancy and Childhood
KW  - Poisoning -- Therapy -- In Infancy and Childhood
KW  - Drugs -- Poisoning -- In Infancy and Childhood
KW  - Delayed Onset
KW  - Prehospital Care
KW  - Emergency Medical Services
KW  - Education, Continuing (Credit)
KW  - Dosage Forms
KW  - Drugs -- Pharmacokinetics
KW  - Poisoning -- Etiology -- In Infancy and Childhood
KW  - Poisoning -- Symptoms -- In Infancy and Childhood
KW  - Poisoning -- Drug Therapy -- In Infancy and Childhood
KW  - Street Drugs -- Poisoning
KW  - Cocaine -- Poisoning
KW  - Overdose -- Therapy
KW  - Ferric Compounds -- Poisoning
KW  - Acetaminophen -- Poisoning
KW  - Liver Failure -- Chemically Induced
KW  - Hepatotoxicity
KW  - Hypoglycemic Agents -- Poisoning
KW  - Hypoglycemia -- Chemically Induced
KW  - Hypoglycemia -- Drug Therapy
KW  - Glucose -- Administration and Dosage
KW  - Monoamine Oxidase Inhibitors -- Poisoning
KW  - Antidepressive Agents, Tricyclic -- Poisoning
KW  - Tachycardia -- Chemically Induced
KW  - Lead Poisoning -- In Infancy and Childhood
KW  - Hazardous Materials -- Poisoning
KW  - Hydrofluoric Acid -- Poisoning
KW  - Cyanides -- Poisoning
KW  - Environmental Exposure
KW  - Naloxone -- Therapeutic Use
KW  - Charcoal -- Therapeutic Use
KW  - Electrocardiography
KW  - Oxygen Therapy
KW  - Intravenous Therapy
KW  - Decontamination, Hazardous Materials
KW  - Information Resources
KW  - Infant, Newborn
KW  - Infant
KW  - Child, Preschool
KW  - Outpatients
SP  - 80
EP  - 87
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 32
IS  - 8
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
U2  - PMID: 12942915.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106872277&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106106543
T1  - Review: opiate administration may alter physical examination findings but does not increase management errors in acute abdominal pain.
AU  - Edmonds M
Y1  - 2007/02//
N1  - Accession Number: 106106543. Language: English. Entry Date: 20070622. Revision Date: 20150711. Publication Type: Journal Article; abstract; commentary; tables/charts. Original Study: Ranji SR, Goldman LE, Simel DL, Shojania KG, Rennie D, Ranji Sumant R, et al. Do opiates affect the clinical evaluation of patients with acute abdominal pain? (JAMA) 10/11/2006; 296 (14): 1764-1774. Journal Subset: Biomedical; USA. NLM UID: 9608386. 
KW  - Abdomen, Acute -- Drug Therapy
KW  - Abdomen, Acute -- Therapy
KW  - Analgesics, Opioid -- Therapeutic Use
KW  - Physical Examination
KW  - Clinical Trials
KW  - Emergency Service
KW  - Systematic Review
KW  - Treatment Errors
KW  - Treatment Outcomes
SP  - 23
EP  - 23
JO  - Evidence Based Medicine
JF  - Evidence Based Medicine
JA  - EVID BASED MED
VL  - 12
IS  - 1
PB  - BMJ Publishing Group
SN  - 1356-5524
AD  - University of Western Ontario, London, Ontario, Canada.
U2  - PMID: 17264271.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106106543&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 108094565
T1  - A notable contrast: studies compare IN vs. IV administration.
AU  - Page, David
Y1  - 2012/12//2012 Dec
N1  - Accession Number: 108094565. Language: English. Entry Date: 20130215. Revision Date: 20150712. Publication Type: Journal Article; abstract; commentary; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Administration, Intranasal
KW  - Administration, Intravenous
KW  - Emergency Medical Services
KW  - Prehospital Care
KW  - Transportation of Patients
KW  - Trauma -- Mortality
KW  - Automobiles
KW  - Body Temperature Determination
KW  - Emergency Patients
KW  - Fever -- Diagnosis
KW  - Ireland
KW  - Lactates -- Blood
KW  - Naloxone -- Administration and Dosage
KW  - Nebulizers and Vaporizers
KW  - Overdose -- Drug Therapy
KW  - Pennsylvania
KW  - Prospective Studies
KW  - Randomized Controlled Trials
KW  - Record Review
KW  - Retrospective Design
KW  - Sepsis -- Diagnosis
KW  - Temporal Arteries
KW  - Trauma Centers
SP  - 28
EP  - 29
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 37
IS  - 12
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108094565&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107858613
T1  - HEROIN IN VERMONT...Last Word section of April JEMS
AU  - Bell, Chris
Y1  - 2014/06//
N1  - Accession Number: 107858613. Language: English. Entry Date: 20140620. Revision Date: 20150712. Publication Type: Journal Article; commentary; letter. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - First Aid
KW  - Prehospital Care
KW  - Administration, Intranasal
KW  - Vermont
SP  - 18
EP  - 18
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 39
IS  - 6
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Director, Office of Public Health Preparedness and EMS, Vermont Department of Health
U2  - PMID: 25109141.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107858613&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107065730
T1  - Bystanders give Narcan.
Y1  - 2001/10//2001 Oct
N1  - Accession Number: 107065730. Language: English. Entry Date: 20011109. Revision Date: 20150711. Publication Type: Journal Article; brief item. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. 
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Heroin -- Poisoning
KW  - Prehospital Care -- Education
KW  - Police -- Education
KW  - Family -- Education
KW  - Health Education
KW  - Substance Abusers
KW  - Injections
KW  - New Mexico
SP  - 6
EP  - 6
JO  - EMS Insider
JF  - EMS Insider
JA  - EMS INSIDER
VL  - 28
IS  - 10
CY  - , <Blank>
PB  - Elsevier Public Safety
SN  - 1081-4507
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107065730&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104133592
T1  - P69 How to stop drug users dying from an overdose: a systematic review of treatment and prevention interventions in the community.
AU  - Evans, A
AU  - Snooks, H
AU  - Russell, D
AU  - Brown, C
AU  - Nair, A
AU  - Moore, C
AU  - Lewis, A
Y1  - 2010/09/02/Sep2010 Supp
N1  - Accession Number: 104133592. Language: English. Entry Date: 20140108. Revision Date: 20150710. Publication Type: Journal Article; abstract; research; systematic review. Supplement Title: Sep2010 Supp. Journal Subset: Biomedical; Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; Public Health; UK & Ireland. Special Interest: Emergency Care; Evidence-Based Practice; Public Health. NLM UID: 7909766. 
KW  - Substance Abusers
KW  - Overdose -- Prevention and Control
KW  - Prehospital Care
KW  - Emergency Care
KW  - Human
KW  - Systematic Review
KW  - United Kingdom
SP  - A60
EP  - A60
JO  - Journal of Epidemiology & Community Health
JF  - Journal of Epidemiology & Community Health
JA  - J EPIDEMIOL COMMUNITY HEALTH
VL  - 64
PB  - BMJ Publishing Group
AB  - Objective To describe interventions to prevent and treat overdoses in the pre-hospital setting and review their effectiveness. Design This review was undertaken in three stages: 1: systematic overview—systematic literature search for all reports of interventions to treat and prevent overdose in the pre-hospital setting; 2: systematic review—we selected comparative studies from the overview results and undertook qualitative synthesis; 3: we identified studies suitable for meta-analysis. Setting We looked for interventions providing overdose reversal and/or prevention treatment in the prehospital emergency setting. UK opiate overdoses are amongst the highest in Europe. People who suffer a non-fatal poisoning are at high risk of death within the following year. For every death there are approximately 7 “near misses”. Naloxone is administered to reverse overdose. Participants Drug users who overdose or are at risk of further overdose. Main Outcome Measure Prevention of fatal overdose. Results (1) Systematic overview—39 references described interventions in six categories: 1. take-home naloxone administered by peers to an overdose patient, following training; 2. CPR training for bystanders witnessing an overdose; 3. alternative routes of naloxone administration by health professionals(intranasal, subcutaneous, intramuscular, intravenous); 4. police attendance protocols to encourage 999 calls by peers witnessing overdose; 5. supervised injection facilities; 6. psychosocial/educational interventions. (2) Systematic review—15 studies were included. Populations, interventions, methods and outcome were heterogeneous but 10/15 contained at least one comparative result. Quality assessment scores identified 3/15 reasonable quality studies (1 RCT) but most were poor quality. Evidence of effectiveness was weak but suggested death rates may be reduced by: take-home naloxone; bystander CPR; treatment for addiction; naloxone implants. Inter-study results were not comparable. (3) Meta-analysis—we could not identify comparable results across such diverse studies. Meta-analysis of effectiveness was therefore not possible. Conclusion There is little evidence of effectiveness for interventions identified in this review, including alternative pathways for naloxone administration, although naloxone is an effective treatment to reverse opiate overdose. Rigorous evaluation is needed to assess clinical and cost effectiveness, adverse event rates and effects on drug-taking behaviour of such approaches.
SN  - 0143-005X
AD  - School of Medicine, Swansea University, Swansea, UK
AD  - ABM University NHS Trust, UK
AD  - Welsh Ambulance Service Trust, UK
AD  - Welsh Assembly Government, UK
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104133592&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106805287
T1  - No more coma cocktails: using science to dispel myths & improve patient care.
AU  - Bledsoe BE
Y1  - 2002/11//2002 Nov
N1  - Accession Number: 106805287. Language: English. Entry Date: 20030214. Revision Date: 20150820. Publication Type: Journal Article; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Coma -- Drug Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Adverse Effects
KW  - Thiamine -- Therapeutic Use
KW  - Thiamine -- Adverse Effects
KW  - Glucose -- Therapeutic Use
KW  - Glucose -- Adverse Effects
KW  - Prehospital Care
KW  - Professional Practice, Evidence-Based
KW  - Comatose Patients
KW  - Coma -- Etiology
KW  - Coma -- Diagnosis
KW  - Patient Assessment
KW  - Hypoglycemia -- Drug Therapy
KW  - Cerebral Ischemia -- Physiopathology
KW  - Overdose -- Drug Therapy
KW  - Narcotics -- Poisoning
KW  - Antianxiety Agents, Benzodiazepine -- Poisoning
KW  - Wernicke's Encephalopathy -- Drug Therapy
KW  - Hypertonic Solutions -- Administration and Dosage
KW  - Glucose -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Thiamine -- Administration and Dosage
KW  - Flumazenil -- Adverse Effects
KW  - Flumazenil -- Contraindications
KW  - Administration, Intravenous
KW  - Outpatients
SP  - 54
EP  - 60
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 27
IS  - 11
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
U2  - PMID: 12483195.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106805287&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105912392
T1  - Toxicity of buprenorphine overdoses in children.
AU  - Hayes BD
AU  - Klein-Schwartz W
AU  - Doyon S
Y1  - 2008/04//
N1  - Accession Number: 105912392. Language: English. Entry Date: 20080516. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0376422. 
KW  - Analgesics, Opioid -- Poisoning
KW  - Buprenorphine -- Poisoning
KW  - Respiratory Failure -- Chemically Induced
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Buprenorphine -- Administration and Dosage
KW  - Child
KW  - Child, Preschool
KW  - Dose-Response Relationship, Drug
KW  - Female
KW  - Incidence
KW  - Infant
KW  - Male
KW  - Overdose
KW  - Poisoning -- Epidemiology
KW  - Prospective Studies
KW  - Retrospective Design
KW  - Risk Assessment
KW  - Human
SP  - e782
EP  - 6
JO  - Pediatrics
JF  - Pediatrics
JA  - PEDIATRICS
VL  - 121
IS  - 4
CY  - Chicago, Illinois
PB  - American Academy of Pediatrics
AB  - OBJECTIVE: There are few reports in children of overdoses of buprenorphine, a partial opioid agonist used in the treatment of opioid dependence and pain. The purpose of this study was to analyze buprenorphine overdoses in young children reported by US poison centers to the Researched Abuse, Diversion, and Addiction-Related Surveillance System. METHODS: A retrospective review of buprenorphine overdoses in children < 6 years of age reported to the Researched Abuse, Diversion, and Addiction-Related Surveillance System from November 2002 through December 2005 was performed. Patients lost to follow-up and those ingesting multiple substances were excluded. RESULTS: Eighty-six cases met inclusion criteria. In the 54 children who developed toxicity, the clinical effects included drowsiness or lethargy (55%), vomiting (21%), miosis (21%), respiratory depression (7%), agitation or irritability (5%), pallor (3%), and coma (2%). There were no fatalities. The mean time to onset of effects was 64.2 minutes, with a range of 20 minutes to 3 hours. Duration of clinical effects was under 2 hours in 11%, 2 to 8 hours in 59%, 8 to 24 hours in 26%, and > 24 hours in 4%. Children who ingested > or = 2 mg of buprenorphine were more likely to experience clinical effects, and all of the children who ingested > 4 mg experienced some effect. No child ingesting < 4 mg experienced a severe effect. Of the 22 children administered naloxone, 67% had at least a partial response. CONCLUSIONS: Buprenorphine overdoses are generally well tolerated in children, with significant central nervous system and respiratory depression occurring in only 7%. Any child ingesting > 2 mg and children < 2 years of age ingesting more than a lick or taste should be referred to the emergency department for a minimum of 6 hours of observation. Naloxone can be used to reverse respiratory depression.
SN  - 0031-4005
AD  - PharmD, Maryland Poison Center, University of Maryland School of Pharmacy, 220 Arch St, Office Level 1, Baltimore, MD 21201, USA. bryan_d_hayes@yahoo.com
U2  - PMID: 18381506.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105912392&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106916085
T1  - Antidotes.
AU  - Dines A
Y1  - 2001/11//2001 Nov
N1  - Accession Number: 106916085. Language: English. Entry Date: 20020419. Revision Date: 20150820. Publication Type: Journal Article; bibliography; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Europe; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 9208913. 
KW  - Antidotes
KW  - Naloxone -- Administration and Dosage
KW  - Acetylcysteine -- Administration and Dosage
KW  - Flumazenil
KW  - Emergency Service
SP  - 23
EP  - 28
JO  - Emergency Nurse
JF  - Emergency Nurse
JA  - EMERG NURSE
VL  - 9
IS  - 7
PB  - RCNi
AB  - Alison Dines discusses the practical considerations of the stocking and use of antidotes in the A&E department.
SN  - 1354-5752
AD  - Information Specialist, National Poisons Information Service (London)
U2  - PMID: 11935887.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106916085&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107051892
T1  - Management of heroin overdose in the emergency department.
AU  - Rodden P
Y1  - 1997/04//1997 Apr
N1  - Accession Number: 107051892. Language: English. Entry Date: 20010914. Revision Date: 20150820. Publication Type: Journal Article; review. Journal Subset: Australia & New Zealand; Core Nursing; Nursing; Peer Reviewed. 
KW  - Heroin -- Poisoning
KW  - Overdose
KW  - Emergency Care
KW  - Substance Abuse, Intravenous
KW  - Overdose -- Epidemiology
KW  - Overdose -- Symptoms
KW  - Overdose -- Drug Therapy
KW  - Overdose -- Complications
KW  - Patient Assessment
KW  - Airway Management
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Administration and Dosage
KW  - Injections, Intramuscular
KW  - Administration, Intravenous
KW  - Male
KW  - Female
KW  - Adult
KW  - Australia
SP  - 54
EP  - 58
JO  - Australian Emergency Nursing Journal
JF  - Australian Emergency Nursing Journal
JA  - AUST EMERG NURS J
VL  - 1
IS  - 2
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 1328-2743
AD  - Emergency Dept, St Vincents Hospital
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106288593
T1  - Naxolone should be administered...'Naloxone and EMT-Bs' a complex issue'
AU  - Pickett J
AU  - Werfel P
Y1  - 2007/02//2007 Feb
N1  - Accession Number: 106288593. Language: English. Entry Date: 20070525. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Emergency Medical Technicians
KW  - Naloxone -- Administration and Dosage
KW  - Naloxone -- Adverse Effects
KW  - Prehospital Care
SP  - 16
EP  - 16
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 32
IS  - 2
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106288593&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106112719
T1  - Review: opiate administration may alter physical examination findings, but does not increase management errors in acute abdominal pain.
AU  - Edmonds M
Y1  - 2007/01//Jan/Feb2007
N1  - Accession Number: 106112719. Language: English. Entry Date: 20070706. Revision Date: 20150711. Publication Type: Journal Article; abstract; commentary; tables/charts. Original Study: Ranji SR, Goldman LE, Simel DL, Shojania KG, Rennie D, Ranji Sumant R, et al. Do opiates affect the clinical evaluation of patients with acute abdominal pain? (JAMA) 10/11/2006; 296 (14): 1764-1774. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9104824. 
KW  - Abdominal Pain -- Diagnosis
KW  - Abdominal Pain -- Drug Therapy
KW  - Emergency Care
KW  - Narcotics -- Therapeutic Use
KW  - Physical Examination
KW  - Adult
KW  - Child
KW  - Clinical Trials
KW  - Confidence Intervals
KW  - Embase
KW  - Medline
KW  - Meta Analysis
KW  - Systematic Review
SP  - 21
EP  - 21
JO  - ACP Journal Club
JF  - ACP Journal Club
JA  - ACP J CLUB
VL  - 146
IS  - 1
CY  - Philadelphia, Pennsylvania
PB  - American College of Physicians
SN  - 1056-8751
AD  - University of Western Ontario, London, Ontario, Canada.
U2  - PMID: 17203941.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106112719&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106641994
T1  - DAWN report finds increase in opioid pain-medication ER visits.
Y1  - 2004/08/09/
N1  - Accession Number: 106641994. Language: English. Entry Date: 20050603. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Editorial Board Reviewed; Health Services Administration; Peer Reviewed; USA. NLM UID: 9000784. 
KW  - Emergency Care
KW  - Emergency Service
KW  - Overdose
KW  - Oxycodone -- Adverse Effects
KW  - Polypharmacy -- Adverse Effects
KW  - United States
SP  - 3
EP  - 4
JO  - Alcoholism & Drug Abuse Weekly
JF  - Alcoholism & Drug Abuse Weekly
JA  - ALCOHOL DRUG ABUSE WKLY
VL  - 16
IS  - 30
CY  - Hoboken, New Jersey
PB  - John Wiley & Sons, Inc.
SN  - 1042-1394
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106641994&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107193661
T1  - Meningitis: signs, symptoms & treatment options.
AU  - Murphy P
AU  - Alfaro S
Y1  - 1999/05//1999 May
N1  - Accession Number: 107193661. Language: English. Entry Date: 19990601. Revision Date: 20150820. Publication Type: Journal Article; CEU; exam questions; glossary; pictorial; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Meningitis -- Diagnosis
KW  - Meningitis -- Therapy
KW  - Prehospital Care
KW  - Education, Continuing (Credit)
KW  - Brain -- Anatomy and Histology
KW  - Meningitis -- Microbiology
KW  - Meningitis -- Physiopathology
KW  - Meningitis -- Symptoms
KW  - Meningitis -- Drug Therapy
KW  - Cerebrospinal Fluid
KW  - Risk Factors
KW  - Patient Assessment
KW  - Patient History Taking
KW  - Physical Examination
KW  - Glucose -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Thiamine -- Administration and Dosage
KW  - Diazepam -- Administration and Dosage
KW  - Occupational Exposure -- Prevention and Control
KW  - Outpatients
SP  - 74
EP  - 89
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 24
IS  - 5
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Denver Paramedics
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107271035
T1  - How to treat the poisoned patient.
AU  - Erickson TB
AU  - Goldfrank LR
AU  - Kulig K
Y1  - 1997/08/15/
N1  - Accession Number: 107271035. Language: English. Entry Date: 19980701. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0246161. 
KW  - Poisoning -- Diagnosis
KW  - Poisoning -- Therapy
KW  - Emergency Care
KW  - Poisoning -- Drug Therapy
KW  - Diagnosis, Differential
KW  - Patient History Taking
KW  - Physical Examination
KW  - Diagnosis, Laboratory
KW  - Glucose -- Administration and Dosage
KW  - Thiamine -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Flumazenil -- Administration and Dosage
KW  - Charcoal -- Therapeutic Use
KW  - Ipecac -- Therapeutic Use
KW  - Antidotes -- Therapeutic Use
KW  - Gastric Lavage
KW  - Sorption Detoxification
KW  - Child
KW  - Adolescence
KW  - Adult
KW  - Middle Age
SP  - 90
EP  - 96
JO  - Patient Care
JF  - Patient Care
JA  - PATIENT CARE
VL  - 31
IS  - 13
CY  - North Olmsted, Ohio
PB  - Advanstar Communications Inc.
AB  - Poisonings require a quick response. In fact, treatment often begins before you can identify the accountable toxin. Fortunately, you can usually save lives just by providing supportive care and general decontamination.
SN  - 0031-305X
AD  - Director, Division of Toxicology, University of Illinois College of Medicine, Chicago
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107271035&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107860486
T1  - 'Pre' Prehospital Care.
AU  - Flomenbaum, Neal
Y1  - 2014/05//
N1  - Accession Number: 107860486. Language: English. Entry Date: 20140625. Revision Date: 20150712. Publication Type: Journal Article; editorial; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. 
KW  - Prehospital Care
KW  - Patient Education
KW  - Health Policy
KW  - Legislation
KW  - History of Medicine
KW  - Defibrillators, Automated External -- Utilization
KW  - Epinephrine -- Therapeutic Use
KW  - United States Food and Drug Administration
KW  - Naloxone -- Therapeutic Use
SP  - 196
EP  - 196
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 46
IS  - 5
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
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DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106493905
T1  - Cochrane corner. Prophylactic metoclopramide for opioid induced nausea and vomiting following treatment of acute pain in the prehospital setting.
AU  - Smith E
AU  - Wasiak J
AU  - Boyle M
Y1  - 2004/03//
N1  - Accession Number: 106493905. Language: English. Entry Date: 20050805. Revision Date: 20150818. Publication Type: Journal Article. Journal Subset: Allied Health; Australia & New Zealand; Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 101262249. 
KW  - Metoclopramide -- Therapeutic Use
KW  - Narcotics -- Adverse Effects
KW  - Nausea and Vomiting -- Prevention and Control
KW  - Pain -- Drug Therapy
KW  - Prehospital Care
KW  - Chemoprevention
KW  - Nausea and Vomiting -- Chemically Induced
SP  - 2p
EP  - 2p
JO  - Journal of Emergency Primary Health Care
JF  - Journal of Emergency Primary Health Care
JA  - J EMERG PRIM HEALTH CARE
VL  - 2
IS  - 1-2
PB  - Monash University, Department of Community Emergency Health & Paramedic Practice
SN  - 1447-4999
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106493905&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106983279
T1  - Newborn resuscitation.
AU  - Rahm SJ
Y1  - 2002/07//2002 Jul
N1  - Accession Number: 106983279. Language: English. Entry Date: 20021129. Revision Date: 20150711. Publication Type: Journal Article; pictorial. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Resuscitation, Cardiopulmonary -- In Infancy and Childhood
KW  - Prehospital Care -- In Infancy and Childhood
KW  - Patient Assessment
KW  - Physical Examination
KW  - Heart Rate -- In Infancy and Childhood
KW  - Delivery, Obstetric
KW  - Meconium Aspiration -- Prevention and Control
KW  - Suctioning, Endotracheal
KW  - Fluid Therapy
KW  - Epinephrine -- Administration and Dosage -- In Infancy and Childhood
KW  - Sodium Bicarbonate -- Administration and Dosage -- In Infancy and Childhood
KW  - Naloxone -- Administration and Dosage -- In Infancy and Childhood
KW  - Fetus
KW  - Infant, Newborn
KW  - Outpatients
SP  - 61
EP  - 65
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 31
IS  - 7
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
AD  - EMT Program Coordinator, Department of Combat Medic Training, Fort Sam Houston, San Antonio, TX
U2  - PMID: 12154680.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106983279&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107069359
T1  - Pain management in the field.
AU  - Hatlestad D
Y1  - 2001///2001 Oct Special EMS Magazine Memorial Section
N1  - Accession Number: 107069359. Language: English. Entry Date: 20011123. Revision Date: 20150819. Publication Type: Journal Article; CEU; exam questions; pictorial; tables/charts. Supplement Title: 2001 Oct Special EMS Magazine Memorial Section. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Pain -- Drug Therapy
KW  - Sedation
KW  - Narcotics -- Therapeutic Use
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Prehospital Care
KW  - Education, Continuing (Credit)
KW  - Anxiety -- Drug Therapy
KW  - Patient Assessment
KW  - Respiration -- Evaluation
KW  - Drug Monitoring -- Methods
KW  - Antianxiety Agents, Benzodiazepine -- Administration and Dosage
KW  - Antianxiety Agents, Benzodiazepine -- Adverse Effects
KW  - Narcotics -- Administration and Dosage
KW  - Narcotics -- Adverse Effects
KW  - Flumazenil -- Therapeutic Use
KW  - Naloxone -- Therapeutic Use
KW  - Respiration Disorders -- Chemically Induced
SP  - 64
EP  - 86
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 30
IS  - 10
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
AD  - Captain, Inter-Canyon Fire Department, Morrison, CO. E-mail: priorityone@rmi.net
U2  - PMID: 11680220.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107069359&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107494244
T1  - Pharmacotherapeutics of hemorrhagic shock.
AU  - Ackerman GS
AU  - Fallon WF Jr.
Y1  - 1992/07//1992 Jul
N1  - Accession Number: 107494244. Language: English. Entry Date: 19921101. Revision Date: 20150712. Publication Type: Journal Article. Journal Subset: Allied Health; Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 8504537. 
KW  - Shock, Hemorrhagic -- Drug Therapy
KW  - Emergency Care
KW  - Pentoxifylline -- Therapeutic Use
KW  - Plasma Substitutes -- Therapeutic Use
KW  - Crystalloid Solutions -- Therapeutic Use
KW  - Colloids -- Therapeutic Use
KW  - Blood Transfusion
KW  - Bicarbonates -- Therapeutic Use
KW  - Calcium -- Therapeutic Use
KW  - Magnesium -- Therapeutic Use
KW  - Naloxone -- Therapeutic Use
KW  - Erythropoietin -- Therapeutic Use
KW  - Interferons -- Therapeutic Use
SP  - 54
EP  - 61
JO  - Trauma Quarterly
JF  - Trauma Quarterly
JA  - TRAUMA Q
VL  - 8
IS  - 4
PB  - VSP International Science Publishers
SN  - 0743-6637
AD  - Chief Resident, Dept Surg Univ Florida Health Sci Ctr, Jacksonville, FL
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107494244&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107037483
T1  - Pediatric pharmacology: what you need to know for the next pediatric call.
AU  - Carey K
AU  - Fuchs S
Y1  - 2001/06//2001 Jun
N1  - Accession Number: 107037483. Language: English. Entry Date: 20010713. Revision Date: 20150711. Publication Type: Journal Article; CEU; exam questions; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Drugs -- In Infancy and Childhood
KW  - Drug Therapy -- In Infancy and Childhood
KW  - Drug Administration -- In Infancy and Childhood
KW  - Prehospital Care -- In Infancy and Childhood
KW  - Pediatric Care
KW  - Education, Continuing (Credit)
KW  - Dosage Calculation -- In Infancy and Childhood
KW  - Body Weight
KW  - Anaphylaxis -- Drug Therapy -- In Infancy and Childhood
KW  - Epinephrine -- Administration and Dosage -- In Infancy and Childhood
KW  - Diphenhydramine -- Administration and Dosage -- In Infancy and Childhood
KW  - Seizures -- Drug Therapy -- In Infancy and Childhood
KW  - Diazepam -- Administration and Dosage -- In Infancy and Childhood
KW  - Midazolam -- Administration and Dosage -- In Infancy and Childhood
KW  - Resuscitation, Cardiopulmonary -- In Infancy and Childhood
KW  - Adenosine -- Administration and Dosage -- In Infancy and Childhood
KW  - Amiodarone -- Administration and Dosage -- In Infancy and Childhood
KW  - Atropine -- Administration and Dosage -- In Infancy and Childhood
KW  - Lidocaine -- Administration and Dosage -- In Infancy and Childhood
KW  - Sodium Bicarbonate -- Administration and Dosage -- In Infancy and Childhood
KW  - Intubation, Intratracheal -- In Infancy and Childhood
KW  - Ketamine -- Administration and Dosage -- In Infancy and Childhood
KW  - Succinylcholine -- Administration and Dosage -- In Infancy and Childhood
KW  - Thiopental -- Administration and Dosage -- In Infancy and Childhood
KW  - Vecuronium Bromide -- Administration and Dosage -- In Infancy and Childhood
KW  - Pain -- Drug Therapy -- In Infancy and Childhood
KW  - Morphine -- Administration and Dosage -- In Infancy and Childhood
KW  - Naloxone -- Administration and Dosage -- In Infancy and Childhood
KW  - Glucose -- Administration and Dosage -- In Infancy and Childhood
KW  - Infant, Newborn
KW  - Infant
KW  - Child, Preschool
KW  - Child
KW  - Adolescence
KW  - Outpatients
SP  - 27
EP  - 34
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 30
IS  - 6
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
AD  - Resident, University Hospitals of Pittsburgh Affiliated Emergency Medicine Program, Pittsburgh, PA
U2  - PMID: 11417085.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107037483&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107109816
T1  - Emergency tips from the literature. Heroin redux...Source article: Sporer KA: Acute heroin overdose. Ann Intern Med 130:584, 1999
AU  - Roberts J
Y1  - 2000/03//2000 Mar
N1  - Accession Number: 107109816. Language: English. Entry Date: 20000501. Revision Date: 20150711. Publication Type: Journal Article; commentary. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. 
KW  - Heroin -- Poisoning
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Overdose -- Diagnosis
SP  - 12
EP  - 13
JO  - Emergency Medicine (00136654)
JF  - Emergency Medicine (00136654)
JA  - EMERG MED
VL  - 32
IS  - 3
CY  - Parsippany, New Jersey
PB  - Frontline Medical Communications
SN  - 0013-6654
AD  - Professor of Emergency Medicine, Medical College of Pennsylvania
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107109816&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107194219
T1  - Prehospital newborn resuscitation.
AU  - Hamilton SA
Y1  - 1999/05//1999 May
N1  - Accession Number: 107194219. Language: English. Entry Date: 19990601. Revision Date: 20150711. Publication Type: Journal Article; algorithm; pictorial; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Resuscitation -- In Infancy and Childhood
KW  - Delivery, Obstetric
KW  - Prehospital Care -- In Infancy and Childhood
KW  - Emergency Medical Services
KW  - Resuscitation -- Equipment and Supplies
KW  - Neonatal Assessment
KW  - Meconium
KW  - Apnea -- In Infancy and Childhood
KW  - Heat Loss -- Prevention and Control -- In Infancy and Childhood
KW  - Warming Techniques
KW  - Patient Positioning
KW  - Airway Management
KW  - Suction
KW  - Oxygen Therapy
KW  - Ventilation, Manual
KW  - Intravenous Therapy
KW  - Epinephrine -- Administration and Dosage -- In Infancy and Childhood
KW  - Naloxone -- Administration and Dosage -- In Infancy and Childhood
KW  - Respiratory Rate -- In Infancy and Childhood
KW  - Heart Rate -- In Infancy and Childhood
KW  - Infant, Premature
KW  - Infant, Newborn
KW  - Outpatients
SP  - 39
EP  - 44
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 28
IS  - 5
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
AD  - Clinical Instructor of Pediatric Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107194219&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107158424
T1  - Snortin', smokin' and shootin' up...managing the overdose patient
AU  - Murphy P
AU  - Meade D
Y1  - 1998/09//1998 Sep
N1  - Accession Number: 107158424. Language: English. Entry Date: 19990101. Revision Date: 20150819. Publication Type: Journal Article; CEU; exam questions; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Substance Abuse
KW  - Street Drugs -- Poisoning
KW  - Overdose -- Therapy
KW  - Prehospital Care
KW  - Education, Continuing (Credit)
KW  - Street Drugs -- Classification
KW  - Hallucinogens
KW  - Cocaine
KW  - Amphetamines
KW  - Narcotics
KW  - Barbiturates
KW  - Antianxiety Agents, Benzodiazepine
KW  - Antidepressive Agents, Tricyclic
KW  - Antidotes -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Thiamine -- Administration and Dosage
KW  - Glucose -- Administration and Dosage
KW  - Glucagon -- Administration and Dosage
KW  - Sodium Bicarbonate -- Administration and Dosage
KW  - Diazepam -- Administration and Dosage
SP  - 57
EP  - 64
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 27
IS  - 9
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
AD  - Instructor, Rocky Mountain Training Institute, Littleton, CO
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107158424&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107033132
T1  - TOX-ACLS: toxicologic-oriented advanced cardiac life support...Proceedings of the International Guidelines 2000 Conference for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
AU  - Albertson TE
AU  - Dawson A
AU  - de Latorre F
AU  - Hoffman RS
AU  - Hollander JE
AU  - Jaeger A
AU  - Kerns W II
AU  - Martin TG
AU  - Ross MP
Y1  - 2001/04/02/2001 Apr Suppl
N1  - Accession Number: 107033132. Language: English. Entry Date: 20010629. Revision Date: 20150818. Publication Type: Journal Article; practice guidelines. Supplement Title: 2001 Apr Suppl. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 8002646. 
KW  - Advanced Cardiac Life Support -- Methods
KW  - Heart Diseases -- Chemically Induced
KW  - Heart Diseases -- Therapy
KW  - Advanced Cardiac Life Support -- Standards
KW  - Cocaine -- Poisoning
KW  - Professional Practice, Evidence-Based
KW  - Naloxone -- Therapeutic Use
KW  - Overdose -- Therapy
KW  - Adrenergic Antagonists -- Therapeutic Use
KW  - Antiarrhythmia Agents -- Therapeutic Use
KW  - Calcium Channel Blockers -- Poisoning
KW  - Cocaine -- Adverse Effects
KW  - Heart Assist Devices
SP  - S78
EP  - 90
JO  - Annals of Emergency Medicine
JF  - Annals of Emergency Medicine
JA  - ANN EMERG MED
VL  - 37
IS  - 4
CY  - New York, New York
PB  - Elsevier B.V.
SN  - 0196-0644
AD  - University of California Davis Medical Center, Sacramento, CA
U2  - PMID: 11290973.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107033132&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107396674
T1  - The treatment of poisonings.
AU  - Corey EC
Y1  - 1994/02//1994 Feb
N1  - Accession Number: 107396674. Language: English. Entry Date: 19950101. Revision Date: 20150818. Publication Type: Journal Article; tables/charts. Journal Subset: Allied Health; Peer Reviewed; USA. NLM UID: 7910894. 
KW  - Prehospital Care
KW  - Emergency Care
KW  - Poisoning
KW  - Antidotes -- Therapeutic Use
KW  - Antidotes -- Administration and Dosage
KW  - Airway Management
KW  - Patient Assessment -- Methods
KW  - Glucose
KW  - Naloxone
KW  - Charcoal
KW  - Flumazenil
KW  - Ipecac
KW  - Adult
KW  - Male
SP  - 20
EP  - 26
JO  - Emergency (01625942)
JF  - Emergency (01625942)
JA  - EMERGENCY (01625942)
VL  - 26
IS  - 2
CY  - Torrance, California
PB  - Bobit Publishing
SN  - 0162-5942
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107396674&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 104887519
T1  - Toxicology Today: What You Need to Know Now.
AU  - Lam, Simon W.
AU  - Engebretsen, Kristin M.
AU  - Bauer, Seth R.
Y1  - 2011/04//04/01/2011
N1  - Accession Number: 104887519. Language: English. Entry Date: 20110525. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8900945. 
KW  - Drug Toxicity
KW  - Overdose -- Epidemiology -- United States
KW  - Overdose -- Therapy
KW  - Antidotes -- Therapeutic Use
KW  - Emergency Service
KW  - Toxicology
KW  - United States
KW  - Overdose -- Diagnosis
KW  - Resuscitation -- Methods
KW  - Intestinal Absorption
KW  - Gastric Lavage
KW  - Charcoal -- Therapeutic Use
KW  - Cathartics -- Therapeutic Use
KW  - Diuresis
KW  - Acetaminophen -- Poisoning
KW  - Acetylcysteine -- Therapeutic Use
KW  - Acetylcysteine -- Administration and Dosage
KW  - Alcoholic Intoxication
KW  - Antidepressive Agents, Tricyclic -- Poisoning
KW  - Sodium Bicarbonate -- Therapeutic Use
KW  - Calcium Channel Blockers -- Poisoning
KW  - Adrenergic Beta-Antagonists -- Poisoning
KW  - Glucagon -- Therapeutic Use
KW  - Narcotics -- Poisoning
KW  - Antianxiety Agents, Benzodiazepine -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Serotonin Syndrome
KW  - Salicylates -- Poisoning
SP  - 174
EP  - 188
JO  - Journal of Pharmacy Practice
JF  - Journal of Pharmacy Practice
JA  - J PHARM PRACT
VL  - 24
IS  - 2
CY  - Thousand Oaks, California
PB  - Sage Publications Inc.
SN  - 0897-1900
AD  - Cleveland Clinic, Department of Pharmacy, Cleveland, OH, USA lams@ccf.org
AD  - Regions Hospital, Emergency Medicine Department, St. Paul, MN, USA
AD  - Cleveland Clinic, Department of Pharmacy, Cleveland, OH, USA
U2  - PMID: 21712212.
DO  - 10.1177/0897190011400552
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104887519&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106363253
T1  - Antidote use in the critically ill poisoned patient.
AU  - Betten DP
AU  - Vohra RB
AU  - Cook MD
AU  - Matteucci MJ
AU  - Clark RF
Y1  - 2006/09//Sep/Oct2006
N1  - Accession Number: 106363253. Language: English. Entry Date: 20061117. Revision Date: 20150711. Publication Type: Journal Article; equations & formulas; review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8610344. 
KW  - Antidotes -- Therapeutic Use
KW  - Critical Care
KW  - Poisoning -- Drug Therapy
KW  - Acetaminophen -- Poisoning
KW  - Acetylcysteine -- Administration and Dosage
KW  - Acetylcysteine -- Pharmacodynamics
KW  - Acetylcysteine -- Therapeutic Use
KW  - Adrenergic Beta-Antagonists -- Administration and Dosage
KW  - Adrenergic Beta-Antagonists -- Pharmacodynamics
KW  - Adrenergic Beta-Antagonists -- Therapeutic Use
KW  - Alcohol Dehydrogenase -- Metabolism
KW  - Ethanol -- Administration and Dosage
KW  - Ethanol -- Pharmacodynamics
KW  - Ethanol -- Therapeutic Use
KW  - Methanol -- Poisoning
KW  - Antianxiety Agents, Benzodiazepine -- Poisoning
KW  - Anticoagulants -- Poisoning
KW  - Antitoxins -- Therapeutic Use
KW  - Antivenins -- Administration and Dosage
KW  - Antivenins -- Pharmacodynamics
KW  - Antivenins -- Therapeutic Use
KW  - Atropine -- Administration and Dosage
KW  - Atropine -- Pharmacodynamics
KW  - Atropine -- Therapeutic Use
KW  - Bites and Stings
KW  - Botulism -- Drug Therapy
KW  - Botulism -- Physiopathology
KW  - Calcium Channel Blockers -- Poisoning
KW  - Calcium -- Administration and Dosage
KW  - Calcium -- Pharmacodynamics
KW  - Calcium -- Therapeutic Use
KW  - Cardiac Glycosides -- Poisoning
KW  - Cholinergic Agents -- Poisoning
KW  - Cholinergic Antagonists -- Poisoning
KW  - Critically Ill Patients
KW  - Cyanides -- Poisoning
KW  - Deferoxamine -- Administration and Dosage
KW  - Deferoxamine -- Pharmacodynamics
KW  - Deferoxamine -- Therapeutic Use
KW  - Emergency Care
KW  - Ethylene Glycols -- Poisoning
KW  - Flumazenil -- Administration and Dosage
KW  - Flumazenil -- Pharmacodynamics
KW  - Flumazenil -- Therapeutic Use
KW  - GABA Antagonists -- Therapeutic Use
KW  - Glucagon -- Administration and Dosage
KW  - Glucagon -- Pharmacodynamics
KW  - Glucagon -- Therapeutic Use
KW  - Glucose -- Therapeutic Use
KW  - Hyperbaric Oxygenation
KW  - Hyperinsulinemia -- Therapy
KW  - Hypoglycemia -- Drug Therapy
KW  - Hypoglycemic Agents -- Poisoning
KW  - Immunoglobulins, Fab -- Administration and Dosage
KW  - Immunoglobulins, Fab -- Pharmacodynamics
KW  - Immunoglobulins, Fab -- Therapeutic Use
KW  - Intensive Care Units
KW  - Iron -- Poisoning
KW  - Isoniazid -- Poisoning
KW  - Methemoglobinemia -- Physiopathology
KW  - Methemoglobinemia -- Therapy
KW  - Methylene Blue -- Administration and Dosage
KW  - Methylene Blue -- Pharmacodynamics
KW  - Methylene Blue -- Therapeutic Use
KW  - Naloxone -- Administration and Dosage
KW  - Naloxone -- Pharmacodynamics
KW  - Naloxone -- Therapeutic Use
KW  - Narcotics -- Poisoning
KW  - Octreotide Acetate -- Administration and Dosage
KW  - Octreotide Acetate -- Pharmacodynamics
KW  - Octreotide Acetate -- Therapeutic Use
KW  - Overdose
KW  - Physostigmine -- Administration and Dosage
KW  - Physostigmine -- Pharmacodynamics
KW  - Physostigmine -- Therapeutic Use
KW  - Poisoning -- Complications
KW  - Poisoning -- Physiopathology
KW  - Poisoning -- Prevention and Control
KW  - Pyridoxine -- Administration and Dosage
KW  - Pyridoxine -- Pharmacodynamics
KW  - Pyridoxine -- Therapeutic Use
KW  - QRS Complex
KW  - Receptors, Cell Surface
KW  - Reptiles
KW  - Sodium Bicarbonate -- Administration and Dosage
KW  - Sodium Bicarbonate -- Pharmacodynamics
KW  - Sodium Bicarbonate -- Therapeutic Use
KW  - Vitamin K -- Administration and Dosage
KW  - Vitamin K -- Pharmacodynamics
KW  - Vitamin K -- Therapeutic Use
SP  - 255
EP  - 277
JO  - Journal of Intensive Care Medicine (Sage Publications Inc.)
JF  - Journal of Intensive Care Medicine (Sage Publications Inc.)
JA  - J INTENSIVE CARE MED
VL  - 21
IS  - 5
CY  - Thousand Oaks, California
PB  - Sage Publications Inc.
AB  - The proper use of antidotes in the intensive care setting when combined with appropriate general supportive care may reduce the morbidity and mortality associated with severe poisonings. The more commonly used antidotes that may be encountered in the intensive care unit (N-acetylcysteine, ethanol, fomepizole, physostigmine, naloxone, flumazenil, sodium bicarbonate, octreotide, pyridoxine, cyanide antidote kit, pralidoxime, atropine, digoxin immune Fab, glucagon, calcium gluconate and chloride, deferoxamine, phytonadione, botulism antitoxin, methylene blue, and Crotaline snake antivenom) are reviewed. Proper indications for their use and knowledge of the possible adverse effects accompanying antidotal therapy will allow the physician to appropriately manage the severely poisoned patient.
SN  - 0885-0666
AD  - Department of Emergency Medicine, Sparrow Health System, Michigan State University College of Human Medicine, Lansing, Michigan. peckb73@hotmail.com.
U2  - PMID: 16946442.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106363253&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105632479
T1  - Summary of 12-lead ECG, CPAP, adult IO, therapeutic hypothermia, & intranasal & acute cardiogenic pulmonary edema medication use.
AU  - Heightman AJ
Y1  - 2009/01/02/2009 Jan State of the Science 2009
N1  - Accession Number: 105632479. Language: English. Entry Date: 20090220. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Supplement Title: 2009 Jan State of the Science 2009. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Administration, Intranasal
KW  - Continuous Positive Airway Pressure
KW  - Electrocardiography
KW  - Emergency Medical Services
KW  - Hypothermia, Induced
KW  - Infusions, Intraosseous
KW  - Prehospital Care
KW  - Pulmonary Edema, Acute Cardiogenic -- Drug Therapy
KW  - Adult
KW  - Descriptive Statistics
KW  - Emergency Medical Technicians
KW  - Fentanyl -- Administration and Dosage
KW  - Furosemide -- Administration and Dosage
KW  - Human
KW  - Midazolam -- Administration and Dosage
KW  - Morphine -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Nitroglycerin -- Administration and Dosage
KW  - Oxygen Therapy
KW  - Surveys
KW  - United States
SP  - 30
EP  - 31
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 34
IS  - 1
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105632479&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106780924
T1  - Painkiller overdoses are rising dramatically.
Y1  - 2003/06//2003 Jun
N1  - Accession Number: 106780924. Language: English. Entry Date: 20041001. Revision Date: 20150818. Publication Type: Journal Article. Journal Subset: Nursing; USA. NLM UID: 9891961. 
KW  - Acetaminophen -- Poisoning
KW  - Analgesics, Opioid -- Poisoning
KW  - Emergency Nursing
KW  - Nursing Assessment
KW  - Substance Abuse Detection
KW  - Substance Abuse -- Nursing
KW  - Emergency Care
KW  - Information Resources
KW  - Middle Age
KW  - Naloxone -- Administration and Dosage
KW  - Outpatients
KW  - Poison Control Centers
KW  - Substance Abuse -- Trends
KW  - World Wide Web
SP  - 93
EP  - 94
JO  - ED Nursing
JF  - ED Nursing
JA  - ED NURS
VL  - 6
IS  - 8
CY  - Atlanta, Georgia
PB  - AHC Media LLC
AB  - ED visits related to narcotic analgesic overdoses have risen dramatically in recent years, according to a report from the Drug Abuse Warning Network.* Ask patients about over-the-counter drugs.* Acetaminophen levels are more useful for acute rather than chronic ingestions.* When administering the antidote naloxone, start with the lowest initial dose.
SN  - 1096-4304
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106780924&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105030853
T1  - Research review.
AU  - Criss EA
Y1  - 2010/06//2010 Jun
N1  - Accession Number: 105030853. Language: English. Entry Date: 20100806. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Emergency Medical Services
KW  - Prehospital Care
KW  - Administration, Intranasal
KW  - Aged
KW  - Aged, 80 and Over
KW  - Blast Injuries -- Etiology
KW  - Coma -- Therapy
KW  - Hazardous Materials
KW  - Hypothermia, Induced
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Poisoning
KW  - Overdose -- Drug Therapy
KW  - Trauma -- Mortality
KW  - Trauma -- Therapy -- In Old Age
SP  - 42
EP  - 42
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 35
IS  - 6
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
U2  - PMID: 20569863.
DO  - 10.1016/S0197-2510(10)70145-5
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105030853&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106278309
T1  - Clinical alert. The new high: EMS crews confronted with heroin-fentanyl ODs.
AU  - Perrone J
AU  - DeRoos F
Y1  - 2007/01//2007 Jan
N1  - Accession Number: 106278309. Language: English. Entry Date: 20070504. Revision Date: 20150711. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Fentanyl -- Poisoning
KW  - Heroin -- Poisoning
KW  - Overdose -- Diagnosis
KW  - Overdose -- Therapy
KW  - Prehospital Care
KW  - Substance Abuse
KW  - Adult
KW  - Emergency Medical Services
KW  - Emergency Patients
KW  - Male
KW  - Naloxone -- Administration and Dosage
KW  - Outpatients
KW  - Oxygen Therapy
KW  - Physical Examination
KW  - Substance Abusers
SP  - 28
EP  - 29
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 32
IS  - 1
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Associate Professor, School of Medicine, University of Pennsylvania; jeanmari@mail.med.upenn.edu
U2  - PMID: 17210370.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106278309&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105423646
T1  - The burden of the nonmedical use of prescription opioid analgesics.
AU  - Gilson AM
AU  - Kreis PG
Y1  - 2009/07/02/Jul2009 Supplement 2
N1  - Accession Number: 105423646. Language: English. Entry Date: 20091030. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Supplement Title: Jul2009 Supplement 2. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Pain and Pain Management. Grant Information: Unrestricted grant from King Pharmaceuticals®, Inc.. NLM UID: 100894201. 
KW  - Analgesics, Opioid -- Administration and Dosage
KW  - Drugs, Prescription
KW  - Substance Abuse -- Prevention and Control
KW  - Behavior, Addictive -- Prevention and Control
KW  - Emergency Service
KW  - Funding Source
KW  - Pain -- Physiopathology
KW  - Pharmacy and Pharmacology -- Economics
KW  - Professional Organizations
KW  - Surveys
SP  - S89
EP  - 100
JO  - Pain Medicine
JF  - Pain Medicine
JA  - PAIN MED
VL  - 10
PB  - Oxford University Press / USA
SN  - 1526-2375
AD  - U.S. Program at the Pain and Policy Studies Group/WHO Collaborating Center for Policy and Communications in Cancer Care, Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
U2  - PMID: 19691688.
DO  - 10.1111/j.1526-4637.2009.00668.x
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105423646&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105665937
T1  - Critical care toxicology.
AU  - Holstege CP
AU  - Dobmeier SG
AU  - Bechtel LK
Y1  - 2008/08//2008 Aug
N1  - Accession Number: 105665937. Language: English. Entry Date: 20081017. Revision Date: 20150711. Publication Type: Journal Article; diagnostic images; equations & formulas; review; tables/charts; tracings. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8219565. 
KW  - Critical Care -- Methods
KW  - Toxicology
KW  - Acid-Base Equilibrium -- Physiology
KW  - Atropine -- Therapeutic Use
KW  - Digoxin -- Adverse Effects
KW  - Electrocardiography -- Methods
KW  - Emergency Service
KW  - Flumazenil -- Therapeutic Use
KW  - Naloxone -- Therapeutic Use
KW  - Overdose -- Diagnosis
KW  - Poisons
KW  - Pyridoxine -- Therapeutic Use
KW  - Substance Abuse Detection -- Methods
KW  - Tachycardia -- Diagnosis
SP  - 715
EP  - 739
JO  - Emergency Medicine Clinics of North America
JF  - Emergency Medicine Clinics of North America
JA  - EMERG MED CLIN NORTH AM
VL  - 26
IS  - 3
CY  - Philadelphia, Pennsylvania
PB  - W B Saunders
AB  - Emergency physicians are regularly called on to care for critically poisoned patients. This article reviews the general approach and management of the critically poisoned patient. Specific clinical characteristics are identified that may clue the clinician into a specific toxin class as a diagnosis. Appropriate testing in the poisoned patient is reviewed. Complications of poisoning that may bring a rapid demise of the critically ill poisoned patient are highlighted and the management of those complications is discussed. Copyright © 2008 by Elsevier Inc.
SN  - 0733-8627
AD  - Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, PO Box 800774, 1222 Jefferson Park Avenue, 4th Floor, Charlottesville, VA 22908-0774, USA; ch2xf@virginia.edu
U2  - PMID: 18655942.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105665937&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105806787
T1  - Provocative protocols.
AU  - Rubin M
Y1  - 2008/07//2008 Jul
N1  - Accession Number: 105806787. Language: English. Entry Date: 20080905. Revision Date: 20150820. Publication Type: Journal Article; pictorial; review. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care; Evidence-Based Practice. NLM UID: 8102138. 
KW  - Asthma -- Drug Therapy
KW  - Emergency Medical Services
KW  - Hypoglycemia -- Drug Therapy
KW  - Overdose -- Drug Therapy
KW  - Prehospital Care
KW  - Protocols
KW  - Pulmonary Edema -- Drug Therapy
KW  - Tachycardia, Ventricular -- Drug Therapy
KW  - Adenosine -- Administration and Dosage
KW  - Adult
KW  - Albuterol -- Administration and Dosage
KW  - Bronchodilator Agents -- Administration and Dosage
KW  - Defibrillation
KW  - Furosemide -- Administration and Dosage
KW  - Glucagon -- Administration and Dosage
KW  - Glucose -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - New York
KW  - Nitroglycerin -- Administration and Dosage
KW  - Normal Saline -- Administration and Dosage
KW  - Professional Practice, Evidence-Based
KW  - Resuscitation, Cardiopulmonary
SP  - 94
EP  - 100
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 33
IS  - 7
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
U2  - PMID: 18602594.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105806787&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105745887
T1  - In a delirium: patient in a post-excited state takes EMS by surprise.
AU  - Maggiore WA
Y1  - 2008/05//2008 May
N1  - Accession Number: 105745887. Language: English. Entry Date: 20080620. Revision Date: 20150711. Publication Type: Journal Article; case study; pictorial. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Delirium -- Diagnosis
KW  - Delirium -- Therapy
KW  - Emergency Medical Services
KW  - Prehospital Care
KW  - Adult
KW  - Male
KW  - Naloxone -- Administration and Dosage
KW  - Patient Assessment
KW  - Physical Examination
SP  - 44
EP  - 44
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 33
IS  - 5
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
U2  - PMID: 18482649.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105745887&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 105136965
T1  - Letters: in your words. Wake-up call...'The truth about IN Naxolone,' JEMS.com
AU  - Dymes M
Y1  - 2010/02//2010 Feb
N1  - Accession Number: 105136965. Language: English. Entry Date: 20100409. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. NLM UID: 8102138. 
KW  - Naloxone -- Adverse Effects
KW  - Naloxone -- Therapeutic Use
KW  - Prehospital Care
SP  - 16
EP  - 16
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 35
IS  - 2
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
U2  - PMID: 20219502.
DO  - 10.1016/S0197-2510(10)70031-0
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105136965&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106878197
T1  - When empiric drug use goes wrong...'Diagnostic discovery' (Case of the month, July JEMS)
AU  - Bledsoe B
Y1  - 2003/09//2003 Sep
N1  - Accession Number: 106878197. Language: English. Entry Date: 20031024. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Stroke
KW  - Cerebral Hemorrhage -- Chemically Induced
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Adverse Effects
KW  - Substance Abusers
KW  - Prehospital Care
KW  - Male
KW  - Adult
KW  - Outpatients
SP  - 14
EP  - 16
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 28
IS  - 9
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
U2  - PMID: 14506779.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106878197&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106116685
T1  - A milestone change in practice: a call for widespread application of intranasal medication delivery in the prehospital environment.
AU  - Curran R
Y1  - 2007/04//2007 Apr
N1  - Accession Number: 106116685. Language: English. Entry Date: 20070713. Revision Date: 20150819. Publication Type: Journal Article; case study; pictorial; review. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Administration, Intranasal -- Equipment and Supplies
KW  - Administration, Intranasal -- Methods
KW  - Prehospital Care
KW  - Antianxiety Agents, Benzodiazepine -- Administration and Dosage
KW  - Cardiovascular Agents -- Administration and Dosage
KW  - Child
KW  - Glucagon -- Administration and Dosage
KW  - Heart Arrest -- Drug Therapy
KW  - Hypoglycemia -- Drug Therapy
KW  - Male
KW  - Meclizine -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Administration and Dosage
KW  - Occupational Safety
KW  - Outpatients
KW  - Overdose -- Drug Therapy
KW  - Pain -- Drug Therapy
KW  - Pharmacokinetics
KW  - Seizures -- Drug Therapy
SP  - 40
EP  - 49
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 36
IS  - 4
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
AD  - State University of New York, Downstate Medical Center, USA. RPBDA@YAHOO.COM
U2  - PMID: 17461379.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106116685&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106151446
T1  - Medical management of adolescent drug overdoses.
AU  - Haynes JF Jr.
Y1  - 2006/06//2006 Jun
N1  - Accession Number: 106151446. Language: English. Entry Date: 20070914. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 101196463. 
KW  - Overdose -- Drug Therapy -- In Adolescence
KW  - Overdose -- Therapy -- In Adolescence
KW  - Substance Abuse -- Complications
KW  - Adolescence
KW  - Adrenergic Agents -- Adverse Effects
KW  - Age Factors
KW  - Airway Management
KW  - Antianxiety Agents, Benzodiazepine -- Therapeutic Use
KW  - Antidotes -- Therapeutic Use
KW  - Charcoal -- Therapeutic Use
KW  - Cholinergic Agents -- Adverse Effects
KW  - Cholinergic Antagonists -- Adverse Effects
KW  - Cocaine -- Adverse Effects
KW  - Drug Toxicity -- Diagnosis
KW  - Emergency Service
KW  - Enema -- Methods
KW  - Fluid Therapy
KW  - Gastric Lavage -- Methods
KW  - Hypnotics and Sedatives -- Adverse Effects
KW  - Inhalant Abuse
KW  - Naloxone -- Therapeutic Use
KW  - Narcotics -- Adverse Effects
KW  - Plants, Toxic -- Adverse Effects
KW  - Risk Taking Behavior
KW  - Substance Abuse -- Epidemiology
KW  - Substance Withdrawal Syndrome
SP  - 353
EP  - 379
JO  - Adolescent Medicine Clinics
JF  - Adolescent Medicine Clinics
JA  - ADOLESC MED CLIN
VL  - 17
IS  - 2
CY  - Philadelphia, Pennsylvania
PB  - W B Saunders
SN  - 1547-3368
AD  - Department of Emergency Medicine, Medical Toxicology, Texas Tech University, 4800 Alberta Avenue, El Paso, 79905, USA. john.haynes@ttuhsc.edu
U2  - PMID: 16814698.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106151446&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106197088
T1  - Nasal medications: a delivery method long overdue.
AU  - Fowler RL
AU  - Wesley K
Y1  - 2007/10/02/2007 Oct State of the Science
N1  - Accession Number: 106197088. Language: English. Entry Date: 20071123. Revision Date: 20150820. Publication Type: Journal Article. Supplement Title: 2007 Oct State of the Science. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Administration, Intranasal
KW  - Emergency Medical Services
KW  - Prehospital Care
KW  - Cost Savings
KW  - Fentanyl -- Administration and Dosage
KW  - Midazolam -- Administration and Dosage
KW  - Naloxone -- Administration and Dosage
KW  - Nasal Mucosa
KW  - Needlestick Injuries -- Prevention and Control
SP  - 33
EP  - 33
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 32
IS  - 10
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Chief of EMS Operations, University of Texas Southwestern Medical Center, Dallas, TX
U2  - PMID: 17982795.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106197088&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106706232
T1  - Nasal drug delivery in EMS: reducing needlestick risk.
AU  - Wolfe T
AU  - Barton E
Y1  - 2003/12//2003 Dec
N1  - Accession Number: 106706232. Language: English. Entry Date: 20040227. Revision Date: 20150820. Publication Type: Journal Article; case study; pictorial; review; tables/charts. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Administration, Intranasal -- Methods
KW  - Prehospital Care
KW  - Adult
KW  - Biological Availability
KW  - Child
KW  - Clinical Trials
KW  - Emergency Medical Services
KW  - Glucagon -- Administration and Dosage
KW  - Midazolam -- Administration and Dosage
KW  - Midazolam -- Pharmacokinetics
KW  - Naloxone -- Administration and Dosage
KW  - Narcotics -- Administration and Dosage
KW  - Nasal Mucosa
KW  - Needlestick Injuries -- Prevention and Control
KW  - Nose -- Anatomy and Histology
KW  - Occupational Safety
KW  - Pharmacokinetics
KW  - Seizures -- Drug Therapy
SP  - 52
EP  - 63
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 28
IS  - 12
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Associate Professor, Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT; wolfeman@csolutions.net
U2  - PMID: 14699348.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106706232&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 106964292
T1  - Poison control: patient assessment and management.
AU  - Coughlin C
Y1  - 2002/04//2002 Apr
N1  - Accession Number: 106964292. Language: English. Entry Date: 20021004. Revision Date: 20150819. Publication Type: Journal Article; CEU; exam questions; pictorial; review. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0431735. 
KW  - Poisoning -- Diagnosis
KW  - Poisoning -- Drug Therapy
KW  - Antidotes -- Therapeutic Use
KW  - Prehospital Care
KW  - Education, Continuing (Credit)
KW  - Patient Assessment
KW  - Narcotics -- Poisoning
KW  - Aspirin -- Poisoning
KW  - Acetaminophen -- Poisoning
KW  - Antianxiety Agents, Benzodiazepine -- Poisoning
KW  - Cardiovascular Agents -- Poisoning
KW  - Naloxone -- Therapeutic Use
KW  - Alcohols -- Poisoning
KW  - Methylenedioxymethamphetamine -- Poisoning
KW  - Child
KW  - Adult
KW  - Outpatients
SP  - 66
EP  - 91
JO  - Emergency Medical Services
JF  - Emergency Medical Services
JA  - EMERG MED SERV
VL  - 31
IS  - 4
CY  - Fort Atkinson, Wisconsin
PB  - Cygnus Business Media
SN  - 0094-6575
AD  - Resident Faculty, Glendale Community College, Glendale, AZ; chris.coughlin@gcmail.maricopa.edu
U2  - PMID: 11963611.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106964292&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107006320
T1  - Case of the month. The masquerade.
AU  - Werfel P
Y1  - 2000/12//2000 Dec
N1  - Accession Number: 107006320. Language: English. Entry Date: 20010316. Revision Date: 20150711. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Overdose
KW  - Patient Assessment
KW  - Decision Making, Clinical
KW  - Prehospital Care
KW  - Cerebral Hemorrhage
KW  - Substance Abusers
KW  - Naloxone -- Therapeutic Use
KW  - Treatment Errors
KW  - Male
KW  - Outpatients
SP  - 20
EP  - 20
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 25
IS  - 12
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - Paramedic Program Director, University Medical Center at State University of New York, Stony Brook. E-mail: pwerfel@epo.hsc.sunysb.edu
U2  - PMID: 11138378.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107006320&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107179293
T1  - Case of the month. When good isn't enough.
AU  - Werfel P
Y1  - 1999/02//1999 Feb
N1  - Accession Number: 107179293. Language: English. Entry Date: 19990401. Revision Date: 20150711. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Decision Making, Clinical
KW  - Prehospital Care
KW  - Emergency Medical Technicians
KW  - Adult
KW  - Male
KW  - Outpatients
SP  - 26
EP  - 26
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 24
IS  - 2
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - University Medical Center at State University of New York, Stony Brook. E-mail: pwerfel@epo.hsc.sunysb.edu
U2  - PMID: 10346332.
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107179293&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107254070
T1  - Case of the month. The most important piece of PPE... personal protective equipment... common sense.
AU  - Werfel PA
Y1  - 1997/12/15/1997 Dec
N1  - Accession Number: 107254070. Language: English. Entry Date: 19980401. Revision Date: 20150711. Publication Type: Journal Article; case study. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Prehospital Care
KW  - Occupational Safety
KW  - Emergency Medical Technicians
KW  - Overdose -- Drug Therapy
KW  - Naloxone -- Administration and Dosage
KW  - Needlestick Injuries
KW  - Judgment
KW  - Adult
KW  - Male
KW  - Outpatients
SP  - 33
EP  - 33
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 22
IS  - 12
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
AD  - University Medical Center, State University of New York at Stony Brook
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107254070&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107494246
T1  - Hemorrhagic shock: contemporary and future therapy.
AU  - Bonilla J
AU  - Farkas L
AU  - Martin M
Y1  - 1992/07//1992 Jul
N1  - Accession Number: 107494246. Language: English. Entry Date: 19921101. Revision Date: 20150712. Publication Type: Journal Article; review. Journal Subset: Allied Health; Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 8504537. 
KW  - Shock, Hemorrhagic -- Therapy
KW  - Emergency Care
KW  - Shock, Hemorrhagic -- Classification
KW  - Fluid Resuscitation
KW  - Prehospital Care
KW  - Pentoxifylline -- Therapeutic Use
KW  - Lactated Ringer's Solution -- Therapeutic Use
KW  - Hydroxyethyl Starch -- Therapeutic Use
KW  - Saline Solution, Hypertonic -- Therapeutic Use
KW  - Blood Cells -- Physiopathology
KW  - Free Radicals
KW  - Free Radical Scavengers
KW  - Hormone Therapy
KW  - Naloxone -- Therapeutic Use
KW  - Shock, Hemorrhagic -- Drug Therapy
SP  - 38
EP  - 53
JO  - Trauma Quarterly
JF  - Trauma Quarterly
JA  - TRAUMA Q
VL  - 8
IS  - 4
PB  - VSP International Science Publishers
SN  - 0743-6637
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107494246&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  - 

TY  - JOUR
ID  - 107418595
T1  - Drug wars... 'Heroin: Treating a Deadly Habit'.
AU  - Blenko JW
AU  - Murphy P
AU  - Tkach T
Y1  - 1995/02//1995 Feb
N1  - Accession Number: 107418595. Language: English. Entry Date: 19950901. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8102138. 
KW  - Emergency Care
KW  - Naloxone -- Therapeutic Use
KW  - Naloxone -- Administration and Dosage
KW  - Overdose -- Drug Therapy
KW  - Heroin -- Adverse Effects
KW  - Outpatients
SP  - 11
EP  - 11
JO  - JEMS: Journal of Emergency Medical Services
JF  - JEMS: Journal of Emergency Medical Services
JA  - JEMS
VL  - 20
IS  - 2
CY  - Tulsa, Oklahoma
PB  - PennWell Corporation
SN  - 0197-2510
UR  - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107418595&site=ehost-live&scope=site
DP  - EBSCOhost
DB  - ccm
ER  -