This study used nationally representative survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder, such as depression or anxiety, was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other factors.
April 3, 2017
The current opiate epidemic has spurred long-overdue scrutiny on the pharmaceutical production and distribution of opiate medication, but it also raises questions of public policy and law regarding the regulation of medical access to and use of opiate medications with high potential for addiction. Expert panelists will address the challenges that arise from efforts to balance restrictions on access to opiates to limit addiction while also preserving sufficient access for legitimate medical management of pain.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/opiate-regulation-policies
April 3, 2017
The current opiate epidemic has spurred long-overdue scrutiny on the pharmaceutical production and distribution of opiate medication, but it also raises questions of public policy and law regarding the regulation of medical access to and use of opiate medications with high potential for addiction. Expert panelists will address the challenges that arise from efforts to balance restrictions on access to opiates to limit addiction while also preserving sufficient access for legitimate medical management of pain.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/opiate-regulation-policies
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
April 3, 2017
The current opiate epidemic has spurred long-overdue scrutiny on the pharmaceutical production and distribution of opiate medication, but it also raises questions of public policy and law regarding the regulation of medical access to and use of opiate medications with high potential for addiction. Expert panelists will address the challenges that arise from efforts to balance restrictions on access to opiates to limit addiction while also preserving sufficient access for legitimate medical management of pain.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/opiate-regulation-policies
April 3, 2017
The current opiate epidemic has spurred long-overdue scrutiny on the pharmaceutical production and distribution of opiate medication, but it also raises questions of public policy and law regarding the regulation of medical access to and use of opiate medications with high potential for addiction. Expert panelists will address the challenges that arise from efforts to balance restrictions on access to opiates to limit addiction while also preserving sufficient access for legitimate medical management of pain.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/opiate-regulation-policies
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
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https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
April 3, 2017
The current opiate epidemic has spurred long-overdue scrutiny on the pharmaceutical production and distribution of opiate medication, but it also raises questions of public policy and law regarding the regulation of medical access to and use of opiate medications with high potential for addiction. Expert panelists will address the challenges that arise from efforts to balance restrictions on access to opiates to limit addiction while also preserving sufficient access for legitimate medical management of pain.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/opiate-regulation-policies
A new study adds further evidence to suggest that opioid prescribing in the U.S. is skewed and concentrated among a few providers. Researchers looked at prescribing patterns in data from an unspecified national private insurer between 2003-2017.
Around 670,000 providers prescribed more than 8 million standard doses of opioid prescriptions — but more than a quarter of these prescriptions were written by only 1% of physicians. And in 2017, these physicians prescribed nearly half of all the dispensed opioids. This small group of doctors also prescribed higher doses than recommended, and for longer durations than guidelines allow.
What’s encouraging, the authors suggest, is that the vast majority of physicians do seem to follow guidelines. Some caveats: The study was based on one company’s data, and didn’t look at medical reasons behind prescriptions.
This is the summary text of a presentation at the Vatican addressing: "The Question of the Use of Pharmaceuticals in Pediatrics." This presentation covers the clinical trial evidence and offers prescription guidelines
A Tool to Engage the Patient in Web-based Coordinated Treatment of Opioid Add...Clinical Tools, Inc
Tanner B, Metcalf F. A Tool to Engage the Patient in Web-based Coordinated Treatment of Opioid Addiction with Buprenorphine. Poster presented at the 2015 IPS: The Mental Health Services Conference, October 10, 2015, New York, NY.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
Trends in Psychotropic Medication Costsfor Children and Adol.docxwillcoxjanay
Trends in Psychotropic Medication Costs
for Children and Adolescents, 1997-2000
Andrés Martin, MD, MPH; Douglas Leslie, PhD
Objective: To examine trends in psychotropic medi-
cation utilization and costs for children and adolescents
between January 1, 1997, and December 31, 2000.
Methods: Pharmacy claims were analyzed for mental
health users 17 years and younger (N = 83 039) from a
national database covering 1.74 million privately in-
sured youths. Utilization rates and costs for dispensed
medications were compared across psychotropic drug cat-
egories and individual agents over time.
Results: Overall use of psychotropic drugs increased from
59.5% of mental health outpatients in 1997 (a 1-year
prevalence of 28.7 per 1000) to 62.3% in 2000 (33.7 per
1000), a 4.7% increase. The largest changes in utiliza-
tion were seen for atypical antipsychotics (138.4%), atypi-
cal antidepressants (42.8%), and selective serotonin re-
uptake inhibitors (18.8%). The average prescription price
increased by 17.6% ($7.90 per prescription), a change
in turn attributed to a shift toward costlier medications
within the same category (55.1% of the increase, or $4.35)
and to pure inflation (44.9% of the increase, or $3.55;
P for trend �.001 for all comparisons). Almost half
(46.7%) of the $2.7 million gross sales differential was
accounted for by only 3 of the 39 drugs identified (am-
phetamine compound, risperidone, and sertraline), and
75% was accounted for by 7 drugs (the previous 3 and
bupropion, paroxetine, venlafaxine, and citalopram).
Conclusions: Psychotropic drug expenditure increases
during the late 1990s resulted from more youths being
prescribed drugs, a preference for newer and costlier medi-
cations, and the net effects of inflation. The impact of man-
aged care and pharmaceutical marketing effects on these
trends warrants further study.
Arch Pediatr Adolesc Med. 2003;157:997-1004
T
HE USE of psychotropic
medications in children has
become a highly visible is-
sue, receiving regular at-
tention from academics (for
a recent summary, see Jensen et al1), poli-
cymakers,2,3 and the lay press alike.4-6 In
contrast to the controversial and at times
charged reactions that the topic can en-
gender, reliable national estimates of the
extent of pediatric use of psychotropic
drugs have only recently started to be-
come available.7-9 Previous studies10,11 have
documented that most psychotropic medi-
cations are not prescribed by mental health
specialists but rather by general practi-
tioners, a pattern that is certainly appli-
cable to stimulants, the most widely used
psychotropic drug class for children: in
1995, pediatricians prescribed 50% of
stimulants, family practitioners 20%, and
psychiatrists only 13%.8
The financial implications of pediat-
ric pharmacotherapy have gone largely un-
examined, an important shortcoming given
that in the US expenditures for prescrip-
tion drugs have continued to be the fastest
growing component of health care across
a ...
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. ColTawnaDelatorrejs
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. Colpe
Prevalence, Treatment, And Unmet
Treatment Needs Of US Adults
With Mental Health And
Substance Use Disorders
ABSTRACT We examined prevalence, treatment patterns, trends, and
correlates of mental health and substance use treatments among adults
with co-occurring disorders. Our data were from the 325,800 adults who
participated in the National Survey on Drug Use and Health in the period
2008–14. Approximately 3.3 percent of the US adult population, or
7.7 million adults, had co-occurring disorders during the twelve months
before the survey interview. Among them, 52.5 percent received neither
mental health care nor substance use treatment in the prior year. The
9.1 percent who received both types of care tended to have more serious
psychiatric problems and physical comorbidities and to be involved with
the criminal justice system. Rates of receiving care only for mental
health, receiving treatment only for substance use, and receiving both
types of care among adults with co-occurring disorders remained
unchanged during the study period. Low perceived need and barriers to
care access for both disorders likely contribute to low treatment rates of
co-occurring disorders. Future studies are needed to improve treatment
rates among this population.
S
ubstance use disorders and mental
disorders influence each other, and
their combined presentation (here-
after referred to as co-occurring
disorders) results in more profound
functional impairment; worse treatment out-
comes; higher morbidity and mortality; in-
creased treatment costs; and higher risk for
homelessness, incarceration, and suicide than
each of the individual disorders.1–4 Current treat-
ment guidelines recommend that people with co-
occurring disorders receive treatments for both
disorders.5–7 However, little is known about the
twelve-month prevalence, service use patterns,
correlates of mental health and substance use
treatments, and unmet treatment need among
US adults with co-occurring disorders.
Recent studies indicate that the prevalence of
opioid use disorders and marijuana use among
adults has increased in recent years.8,9 It is im-
portant to determine whether these specific in-
creases led to greater overall prevalence of co-
occurring disorders, because adults with opioid
or marijuana use disorders are likely to have co-
occurring mental illness.8,9 Also, two recent stud-
ies reported that between 2005–07 and 2014 and
between 2004 and 2013, respectively, among the
overall US adult population, receipt of mental
health care increased (primarily as a result of
increasing use of psychiatric medications), and
receipt of substance use treatment remained
stable.10,11 However, it is unknown whether there
have been similar changes in patterns of care for
adults with co-occurring disorders.
The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008
required insurance coverage of mental he ...
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
April 3, 2017
The current opiate epidemic has spurred long-overdue scrutiny on the pharmaceutical production and distribution of opiate medication, but it also raises questions of public policy and law regarding the regulation of medical access to and use of opiate medications with high potential for addiction. Expert panelists will address the challenges that arise from efforts to balance restrictions on access to opiates to limit addiction while also preserving sufficient access for legitimate medical management of pain.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/opiate-regulation-policies
A new study adds further evidence to suggest that opioid prescribing in the U.S. is skewed and concentrated among a few providers. Researchers looked at prescribing patterns in data from an unspecified national private insurer between 2003-2017.
Around 670,000 providers prescribed more than 8 million standard doses of opioid prescriptions — but more than a quarter of these prescriptions were written by only 1% of physicians. And in 2017, these physicians prescribed nearly half of all the dispensed opioids. This small group of doctors also prescribed higher doses than recommended, and for longer durations than guidelines allow.
What’s encouraging, the authors suggest, is that the vast majority of physicians do seem to follow guidelines. Some caveats: The study was based on one company’s data, and didn’t look at medical reasons behind prescriptions.
This is the summary text of a presentation at the Vatican addressing: "The Question of the Use of Pharmaceuticals in Pediatrics." This presentation covers the clinical trial evidence and offers prescription guidelines
A Tool to Engage the Patient in Web-based Coordinated Treatment of Opioid Add...Clinical Tools, Inc
Tanner B, Metcalf F. A Tool to Engage the Patient in Web-based Coordinated Treatment of Opioid Addiction with Buprenorphine. Poster presented at the 2015 IPS: The Mental Health Services Conference, October 10, 2015, New York, NY.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
Trends in Psychotropic Medication Costsfor Children and Adol.docxwillcoxjanay
Trends in Psychotropic Medication Costs
for Children and Adolescents, 1997-2000
Andrés Martin, MD, MPH; Douglas Leslie, PhD
Objective: To examine trends in psychotropic medi-
cation utilization and costs for children and adolescents
between January 1, 1997, and December 31, 2000.
Methods: Pharmacy claims were analyzed for mental
health users 17 years and younger (N = 83 039) from a
national database covering 1.74 million privately in-
sured youths. Utilization rates and costs for dispensed
medications were compared across psychotropic drug cat-
egories and individual agents over time.
Results: Overall use of psychotropic drugs increased from
59.5% of mental health outpatients in 1997 (a 1-year
prevalence of 28.7 per 1000) to 62.3% in 2000 (33.7 per
1000), a 4.7% increase. The largest changes in utiliza-
tion were seen for atypical antipsychotics (138.4%), atypi-
cal antidepressants (42.8%), and selective serotonin re-
uptake inhibitors (18.8%). The average prescription price
increased by 17.6% ($7.90 per prescription), a change
in turn attributed to a shift toward costlier medications
within the same category (55.1% of the increase, or $4.35)
and to pure inflation (44.9% of the increase, or $3.55;
P for trend �.001 for all comparisons). Almost half
(46.7%) of the $2.7 million gross sales differential was
accounted for by only 3 of the 39 drugs identified (am-
phetamine compound, risperidone, and sertraline), and
75% was accounted for by 7 drugs (the previous 3 and
bupropion, paroxetine, venlafaxine, and citalopram).
Conclusions: Psychotropic drug expenditure increases
during the late 1990s resulted from more youths being
prescribed drugs, a preference for newer and costlier medi-
cations, and the net effects of inflation. The impact of man-
aged care and pharmaceutical marketing effects on these
trends warrants further study.
Arch Pediatr Adolesc Med. 2003;157:997-1004
T
HE USE of psychotropic
medications in children has
become a highly visible is-
sue, receiving regular at-
tention from academics (for
a recent summary, see Jensen et al1), poli-
cymakers,2,3 and the lay press alike.4-6 In
contrast to the controversial and at times
charged reactions that the topic can en-
gender, reliable national estimates of the
extent of pediatric use of psychotropic
drugs have only recently started to be-
come available.7-9 Previous studies10,11 have
documented that most psychotropic medi-
cations are not prescribed by mental health
specialists but rather by general practi-
tioners, a pattern that is certainly appli-
cable to stimulants, the most widely used
psychotropic drug class for children: in
1995, pediatricians prescribed 50% of
stimulants, family practitioners 20%, and
psychiatrists only 13%.8
The financial implications of pediat-
ric pharmacotherapy have gone largely un-
examined, an important shortcoming given
that in the US expenditures for prescrip-
tion drugs have continued to be the fastest
growing component of health care across
a ...
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. ColTawnaDelatorrejs
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. Colpe
Prevalence, Treatment, And Unmet
Treatment Needs Of US Adults
With Mental Health And
Substance Use Disorders
ABSTRACT We examined prevalence, treatment patterns, trends, and
correlates of mental health and substance use treatments among adults
with co-occurring disorders. Our data were from the 325,800 adults who
participated in the National Survey on Drug Use and Health in the period
2008–14. Approximately 3.3 percent of the US adult population, or
7.7 million adults, had co-occurring disorders during the twelve months
before the survey interview. Among them, 52.5 percent received neither
mental health care nor substance use treatment in the prior year. The
9.1 percent who received both types of care tended to have more serious
psychiatric problems and physical comorbidities and to be involved with
the criminal justice system. Rates of receiving care only for mental
health, receiving treatment only for substance use, and receiving both
types of care among adults with co-occurring disorders remained
unchanged during the study period. Low perceived need and barriers to
care access for both disorders likely contribute to low treatment rates of
co-occurring disorders. Future studies are needed to improve treatment
rates among this population.
S
ubstance use disorders and mental
disorders influence each other, and
their combined presentation (here-
after referred to as co-occurring
disorders) results in more profound
functional impairment; worse treatment out-
comes; higher morbidity and mortality; in-
creased treatment costs; and higher risk for
homelessness, incarceration, and suicide than
each of the individual disorders.1–4 Current treat-
ment guidelines recommend that people with co-
occurring disorders receive treatments for both
disorders.5–7 However, little is known about the
twelve-month prevalence, service use patterns,
correlates of mental health and substance use
treatments, and unmet treatment need among
US adults with co-occurring disorders.
Recent studies indicate that the prevalence of
opioid use disorders and marijuana use among
adults has increased in recent years.8,9 It is im-
portant to determine whether these specific in-
creases led to greater overall prevalence of co-
occurring disorders, because adults with opioid
or marijuana use disorders are likely to have co-
occurring mental illness.8,9 Also, two recent stud-
ies reported that between 2005–07 and 2014 and
between 2004 and 2013, respectively, among the
overall US adult population, receipt of mental
health care increased (primarily as a result of
increasing use of psychiatric medications), and
receipt of substance use treatment remained
stable.10,11 However, it is unknown whether there
have been similar changes in patterns of care for
adults with co-occurring disorders.
The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008
required insurance coverage of mental he ...
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
Intro to Prevention: Psychopharmacology Guest LectureJulie Hynes
Current A&D Conditions in lane County: And why we need prevention. Guest lecturer: Julie Hynes, MA, RD, CPS - PreventionLane at Lane County Public Health
10 Strategic Points
My Degree: Ph.D.
Program Emphasis: Industrial & Organizational Psychology
Ten Strategic Points
Comments or Feedback
Broad Topic Area Final Topic
Factors Affecting Utilization of Mental Health in Southern Texas
Factors Influencing Individuals' Decision to Utilize Mental Health in South Texas
Lit Review
(Theoretical Framework (Theory)
Gaps
Themes
All Citations
Gaps
A. De Luca, Blosnich, Hentschel, King, & Amen (2016). The authors indicate that mental health has emerged as one of the critical areas of focus in recent times, and for a long time, it had been sidelined. However, with the realization that most health conditions are related in one way or another to a mental disorder, this area is now been studied extensively, and more attention has been given to patients.
B. Mental health professionals point to insufficient mental healthcare resources in the United States as one of the major factors contributing to the rising suicide rate in the country. Nevertheless, these professionals noted that emergency providers paly major role at forefront of the problem and may also play significant role in its prevention. The experts reiterated the necessity for providers to possess the skills required for managing patients at lower suicide risk levels, especially in settings in which such patients do not enough access to behavioral healthcare providers and that the providers need to be accustomed to suicide risk, especially when there are widely publicized high-profile instances of suicide.
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131266532&site=eds-live&scope=site.
C. According to Kohn, et. al, (2018), emphasize the gap in mental health treatment in the American Region when examined through the prevalence of mental health disorders, use of mental health services, and the global burden of disease. Statistical data from community-based surveys of mental disorders in the various countries in America including Argentina, Brazil, Canada, Chile, and the United States etc. were utilized. The World Mental Health Survey published data were used in estimating professional the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas (Kohn, Ali, Puac-Polanco, Figueroa, López-Soto, Morgan, & Vicente, 2018).
D. Wang, & Xie, (2019) Emphasizes the need to eliminate the prevalence of mental health service utilization among many adults in the United States. The authors exam ...
Hospital Care for Mental Health and Substance Abuse ConditionsLizbethQuinonez813
Hospital Care for Mental Health and Substance Abuse Conditions in
Parkinson’s Disease
Allison. W. Willis, MD, MSCI,1,2,3,4* Dylan P. Thibault, MS,1 Peter N. Schmidt, PhD,5 E. Ray Dorsey, MD, MBA,6 and
Daniel Weintraub, MD1,7,8
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
2
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5
National Parkinson’s Foundation, Miami, Florida, USA
6Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
7
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
8
Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia,
Pennsylvania, USA
A B S T R A C T : O b j e c t i v e : The objective of this
study was to examine mental health conditions among
hospitalized individuals with Parkinson’s disease in the
United States.
M e t h o d s : This was a serial cross-sectional study of
hospitalizations of individuals aged �60 identified in the
Nationwide Inpatient Sample dataset from 2000 to
2010. We identified all hospitalizations with a diagnosis
of PD, alcohol abuse, anxiety, bipolar disorder, depres-
sion, impulse control disorders, mania, psychosis, sub-
stance abuse, and attempted suicide/suicidal ideation.
National estimates of each mental health condition
were compared between hospitalized individuals with
and without PD. Hierarchical logistic regression models
determined which inpatient mental health diagnoses
were associated with PD, adjusting for demographic,
payer, geographic, and hospital characteristics.
R e s u l t s : We identified 3,918,703 mental health and sub-
stance abuse hospitalizations. Of these, 2.8% (n 5 104,
437) involved a person also diagnosed with PD. The major-
ity of mental health and substance abuse patients were
white (86.9% of PD vs 83.3% of non-PD). Women were
more common than men in both groups (male:female
prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-
0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34),
psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar
disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse
control disorders (adjusted odds ratio 1.51, 1.31-1.75),
and mania (adjusted odds ratio 1.43, 1.18-1.74) were more
likely among PD patients, alcohol abuse was less likely
(adjusted odds ratio 0.26, 0.25-0.27). We found no PD-
associated difference in suicide-related care.
C o n c l u s i o n s : PD patients have unique patterns of
acute care for mental health and substance abuse.
Research is needed to guide PD treatment in individuals
with ...
Running head OPIOID CRISIS PUBLIC POLICY PAPER .docxglendar3
Running head: OPIOID CRISIS PUBLIC POLICY PAPER 1
OPIOID CRISIS PUBLIC POLICY PAPER 7
Opioid Crisis Public Policy Paper
Anniesha Overton
Strayer Umiversity
Summary of the policy
The opioid crisis has been a significant public health concern in the United States since the late 1990s. The inability to develop strategic legislation and regulation to control the use of opioid has been critical to the development of the opioid crisis. The opioid crisis involves the use of both prescription and non-prescription opioid drugs. According to the Center for Disease control and prevention, the rate of opioid addiction has been significantly increasing over the years. From 1999 to 2016, at least 350,000 individuals have died from related opioid addiction, which includes prescription and illicit opioids.
Unlicensed pharmacies and overdependence on these drugs in pain management have been major concepts, which have created a challenging setting where the abuse of prescription drugs can be controlled. The underlying basis of this problem is the current assumption in the United States that medical practitioners can cure almost everything. Even though it is essential to understand that prescription drugs are effective in pain management, the drugs are required to be offered based on the prescriptions issued (McDonald & Lambert, 2016). It is also noted that they should not be used regularly since they created a very detrimental habit to patient wellbeing because they have addictive properties, which make it dangerous when consumed in large portions.
Confronting opioid addiction requires significant efforts by all stakeholders in healthcare in ensuring that there is a common objective in providing that there is a crucial focus in integrating quality focus in preventing opioid addiction. Considering the fact that a prescribed drug mainly propagates opioid addiction. It is essential to ensure that they are issued through consideration of critical healthcare knowledge regarding the admissibility of opioid drugs (Bihel, 2016). Nurses have a significant role to play regarding the overall development of the opioid addiction crisis. Critical issues that have been identified in opioid drug abuse include improper use, lack of the required knowledge and related interpretation in the use of opioid prescribed drugs and decreased regulation and legislation from the government regarding the existing concern on the increasing addiction levels across the country.
Players
The increase in opioid crisis has had a direct and indirect influence on different stakeholders. Therefore developing a strong focus on essential strategies that can help limit the overall impact of the opioid crisis on the lives of an individual is critical. The national institute on drug abuse reported that in 2015, 33,091 deaths were reported be.
Running head OPIOID CRISIS PUBLIC POLICY PAPER .docxtodd581
Running head: OPIOID CRISIS PUBLIC POLICY PAPER 1
OPIOID CRISIS PUBLIC POLICY PAPER 7
Opioid Crisis Public Policy Paper
Anniesha Overton
Strayer Umiversity
Summary of the policy
The opioid crisis has been a significant public health concern in the United States since the late 1990s. The inability to develop strategic legislation and regulation to control the use of opioid has been critical to the development of the opioid crisis. The opioid crisis involves the use of both prescription and non-prescription opioid drugs. According to the Center for Disease control and prevention, the rate of opioid addiction has been significantly increasing over the years. From 1999 to 2016, at least 350,000 individuals have died from related opioid addiction, which includes prescription and illicit opioids.
Unlicensed pharmacies and overdependence on these drugs in pain management have been major concepts, which have created a challenging setting where the abuse of prescription drugs can be controlled. The underlying basis of this problem is the current assumption in the United States that medical practitioners can cure almost everything. Even though it is essential to understand that prescription drugs are effective in pain management, the drugs are required to be offered based on the prescriptions issued (McDonald & Lambert, 2016). It is also noted that they should not be used regularly since they created a very detrimental habit to patient wellbeing because they have addictive properties, which make it dangerous when consumed in large portions.
Confronting opioid addiction requires significant efforts by all stakeholders in healthcare in ensuring that there is a common objective in providing that there is a crucial focus in integrating quality focus in preventing opioid addiction. Considering the fact that a prescribed drug mainly propagates opioid addiction. It is essential to ensure that they are issued through consideration of critical healthcare knowledge regarding the admissibility of opioid drugs (Bihel, 2016). Nurses have a significant role to play regarding the overall development of the opioid addiction crisis. Critical issues that have been identified in opioid drug abuse include improper use, lack of the required knowledge and related interpretation in the use of opioid prescribed drugs and decreased regulation and legislation from the government regarding the existing concern on the increasing addiction levels across the country.
Players
The increase in opioid crisis has had a direct and indirect influence on different stakeholders. Therefore developing a strong focus on essential strategies that can help limit the overall impact of the opioid crisis on the lives of an individual is critical. The national institute on drug abuse reported that in 2015, 33,091 deaths were reported be.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdf
Prescription Opioid Use Among Adults with Mental Health Disorders in the US
1. ORIGINAL RESEARCH
Prescription Opioid Use among Adults with Mental
Health Disorders in the United States
Matthew A. Davis, MPH, PhD, Lewei A. Lin, MD, Haiyin Liu, MA, and
Brian D. Sites, MD, MS
Background: The extent to which adults with mental health disorders in the United States receive opi-
oids has not been adequately reported.
Methods: We performed a cross-sectional study of a nationally representative sample of the noninsti-
tutionalized U.S. adult population from the Medical Expenditure Panel Survey. We examined the rela-
tionship between mental health (mood and anxiety) disorders and prescription opioid use (defined as
receiving at least 2 prescriptions in a calendar year).
Results: We estimate that among the 38.6 million Americans with mental health disorders, 18.7%
(7.2 million of 38.6 million) use prescription opioids. Adults with mental health conditions receive
51.4% (60 million of 115 million prescriptions) of the total opioid prescriptions distributed in the
United States each year. Compared with adults without mental health disorders, adults with mental
health disorders were significantly more likely to use opioids (18.7% vs 5.0%; P < .001). In adjusted
analyses, having a mental health disorder was associated with prescription opioid use overall (odds
ratio, 2.08; 95% confidence interval, 1.83–2.35).
Conclusions: The 16% of Americans who have mental health disorders receive over half of all opi-
oids prescribed in the United States. Improving pain management among this population is critical to
reduce national dependency on opioids. (J Am Board Fam Med 2017;30:000–000.)
Keywords: Analgesics, Opioid, Anxiety Disorders, Cross-sectional Studies, Mental Health, Opioid-Related Disor-
ders, Pain Management, Prescriptions, Surveys and Questionnaires
The United States is in the midst of an epidemic of
morbidity and mortality due to prescription opioid
use.1
Over the past 15 years the number of pre-
scription opioid analgesic medications sold in the
United States has quadrupled, yet the amount of
pain or disability that Americans experience has
remained unchanged.2
The Centers for Disease
Control and Prevention reports that from 2000 to
2014, more than 165,000 people have died from
overdoses related to prescription opioid use.2
The
identification of specific populations that rely heav-
ily on opioids is of strategic importance for risk
mitigation efforts. For instance, attention has fo-
cused on patients recovering from trauma and sur-
gery, among whom poor coping strategies were
associated with long-term reliance on opioids.3,4
Previous studies suggest that adults with mental
health disorders (ie, mood and anxiety disorders)
are more likely to be prescribed opioids and remain
taking them long-term.5–8
For example, adults with
mood disorders are nearly twice as likely to use
opioids long-term for pain.8
In fact, pain is very
common among adults with mental health disor-
ders,9,10
and the relationship between mental ill-
ness and opioid use is complex. However, some
suggest that mental illness may be a moderator in
the relationship between pain and opioid use.5
De-
spite the increase in the prevalence of mental health
disorders11
and the importance of tracking use of
prescription opioids nationally, the extent to which
This article was externally peer reviewed.
Submitted 2 March 2017; revised 6 March 2017; accepted
10 March 2017.
From the Institute for Healthcare Policy and Innovation
(MAD), the School of Nursing (MAD, HL), the Institute for
Social Research (MAD), and the Addiction Center, Depart-
ment of Psychiatry (LAL), University of Michigan, Ann
Arbor; and the Department of Anesthesiology, Geisel
School of Medicine at Dartmouth College, Hanover, NH
(BDS).
Funding: none.
Conflict of interest: none declared.
Corresponding author: Matthew A. Davis, MPH, PhD,
University of Michigan, 400 North Ingalls, Room 4347, Ann
Arbor, MI 48109 ͑E-mail: mattadav@umich.edu).
doi: 10.3122/jabfm.2017.04.170112 Prescription Opioid Use and Mental Health 1
PLEASE NOTE: Embargo deadline: Monday, June 26, 2017
2. U.S. adults with mental health disorders use pre-
scription opioids has not been thoroughly exam-
ined. Furthermore, identification of the specific
factors that may underpin the association would
help clarify the complex relationship between men-
tal health and pain.
Therefore, we used the nationally representative
Medical Expenditure Panel Survey (MEPS) to ex-
amine the relationship between mental health dis-
orders and prescription opioid use. Because anxiety
and depression are the predominate mental health
disorders among adults in the United States,11
we
focused our attention on these 2 conditions. Our
objective was to derive national estimates of opioid
use among Americans with mental health disorders
and to examine factors associated with such use.
Methods
We performed a cross-sectional study using nation-
ally representative data from the MEPS, a survey of
the U.S. noninstitutionalized population that is
conducted by the Agency for Healthcare Research
and Quality that gathers extensive information on
health care utilization (including prescription med-
ications), expenditures, and health status.12
The
survey uses an overlapping panel design consisting
of a household component, a medical provider
component, and an insurance provider component.
To avoid potential recall bias, participants are sur-
veyed about past health and health care use at
6-month intervals. Personal and family-level data
obtained from the household, medical provider,
and insurance provider components are aggregated
by the MEPS study team. For this study we used
data from the MEPS household component files,
including the full-year consolidated, medical con-
dition, and prescription medication files. Because
our study used only publically available and deiden-
tified data, it was granted an exemption from insti-
tutional board review.
Study Sample
To increase the sample size in order to generate
more stable national estimates for subgroups, we
appended 2011 and 2013 MEPS data. These survey
years were chosen because they were the most re-
cently available at the time of analysis and ensured
an adequate sample size. We excluded 2012 data
because of duplication of participants due to the
overlapping panel design (ie, aggregation of MEPS
surveys in adjacent years would result in noninde-
pendence of study participants). A total of 52,000
adults (aged Ն18 years) participated in MEPS in
these 2 years (25,465 in 2011 and 26,535 in 2013).
After ineligible respondents were removed, such as
those who were institutionalized for a period of
time during the study, our final analytic sample
consisted of 51,891 adults.
Measures
Identification of Adults with Mental Health Disorders
Each MEPS participant is asked to identify any
health conditions in 6-month time periods. For
those who have a self-reported health condition,
trained MEPS staff code conditions using the In-
ternational Classification of Diseases, Ninth Revi-
sion, Clinical Modification (ICD-9-CM) codes. A
special feature of the MEPS is that the health care
providers and facilities provide data on MEPS par-
ticipants’ health care use; such data are then cross-
referenced with survey responses from the partici-
pant. Thus, if a person with a mental health
disorder did not self-report having the condition,
they would still be identified if they had a clinical
diagnosis.
Based on the combination of self-report and
administrative clinical data, we identified partici-
pants who had a mental health disorder. To do so
we used ICD-9-CM codes truncated to the first 3
digits, including 300 (Anxiety, dissociative and so-
matoform disorders), 311 (Depressive disorder),
and 296 (Episodic mood disorders), to identify
adult MEPS participants with mental health disor-
ders13
(Appendix Table 1).
Prescription Opioid Use
The MEPS collects detailed data on prescription
medications using a unique combination of partic-
ipant self-report and administrative data obtained
from pharmacies. MEPS participants are asked to
supply the name of any prescribed medications and
the name and location of the pharmacy where they
obtained the prescription. Participants provide
written permission for the release of pharmacy re-
cords. Pharmacies are contacted to obtain records,
which detail the date filled, the National Drug
Code, medication name, strength of the medication
(amount and unit), quantity (package size), and pay-
ments by source. To identify meaningful classes of
drugs, National Drug Codes are merged to the
comprehensive Multum Lexicon crosswalk.14
We
2 JABFM July–August 2017 Vol. 30 No. 4 http://www.jabfm.org
3. used the Multum drug classes for oral “Narcotic
analgesics” and “Narcotic analgesics combinations”
in order to identify oral prescription opioid medi-
cations. In the MEPS prescription medication data,
the most common oral opioid prescriptions—
which account for approximately 65% of all opioid
prescriptions—include hydrocodone with acet-
aminophen, tramadol, hydrocodone with acetamin-
ophen, and hydrocodone. Our study was focused
on examining the likelihood of receiving prescrip-
tion opioid medications rather than chronic use;
thus we operationally defined an opioid user as an
adult who filled Ն2 prescription medications in the
calendar year.
To explore the clinical diagnoses associated with
prescription opioids, we also examined the top 10
clinical diagnoses for which opioids were pre-
scribed. To collapse ICD-9-CM codes into rele-
vant clinical disorders, the MEPS uses the Clinical
Classification Software developed by the Health-
care Cost and Utilization Project.15
Covariates
We extracted a variety of health measures to be
used as covariates (Appendix Table 2). The MEPS
administers the 12-Item Short Form Survey (SF-
12) to participants.16
From these data, we calcu-
lated the mean physical component summary
(PCS) and mental component summary (MCS)
scores of the SF-12 (PCS and MCS scores range
from 0 to 100, with 100 indicating the highest level
of health). We examined several items of the SF-12
separately as well. We collapsed self-reported
health status17
into “excellent, very good, or good”
versus “fair or poor.” Because pain is the primary
driver of prescription opioid use, we examined the
SF-12 item on pain. The item inquires, “During
the past 4 weeks, how much did pain interfere with
your normal work (including work outside the
home and housework)?” We collapsed the response
set into none or little (“not at all” or “a little bit”),
moderate (“moderately”) or severe (“quite a bit” or
“extremely”). Based on a combination of measures
of both physical and cognitive limitations, we also
calculated the percentage of participants with “any
functional limitation,” “physical limitation,” “social
limitation,” and “cognitive limitation.” We also
identified those who were smokers (current vs
never or former). Last, based on all medical condi-
tions (ICD-9-CM diagnosis codes reported in the
medical condition files) we generated a comorbid-
ity score. To do so, we applied a modified version
of the Charlson Comorbidity Index18
developed by
D’Hoore et al.19
We used ICD-9-CM diagnosis codes 303 (Alco-
hol dependence syndrome), 304 (Drug depen-
dence), and 305 (Nondependent abuse of drugs) to
identify study participants with substance abuse
disorders. The MEPS inquires about cancer diag-
noses; we used these items to identify participants
who had cancer. We also identified participants
with musculoskeletal conditions using a previously
applied approach.20
From the MEPS annual consolidated files, we ex-
tracted sociodemographic data for participants in our
study, including age, sex, race/ethnicity, marital sta-
tus, level of education, and health insurance coverage.
Age was collapsed into relevant age categories, in-
cluding young adult (18–44 years), middle-aged adult
(45–64 years), and older adult (Ն65 years). We also
identified those adults who underwent an outpatient
surgery, underwent surgery during an inpatient ad-
mission, or visited an emergency department specifi-
cally related to a physical injury.
Statistical Analyses
Our primary analyses examined the relationship
between having a mental health disorder and the
likelihood of prescription opioid use. We used sim-
ple descriptive measures to examine differences be-
tween adults with mental health disorders and
those without, restricted to those with specific
characteristics (eg, a cancer diagnosis, those self-
reporting having severe pain, etc.). The 2
test was
used to compare proportions and an independent t
test was used to compare means. A 2-sided P value
Ͻ.05 was considered statistically significant.
We used logit models to examine the relation-
ship while adjusting for differences, and coefficients
from our models were exponentiated to express
associations in the form of odds ratios. Covariates
in our model included age (continuous), sex, race/
ethnicity (non-Hispanic white, non-Hispanic black,
Hispanic, other), health insurance coverage (pri-
vate, public, uninsured), having a usual source of
care, self-reported limitation due to pain (little/
none, moderate, severe), PCS score (continuous),
physical limitation, substance use disorder diagno-
sis, outpatient surgery use, and inpatient surgery
use. Because our operational definition of an opioid
user was based on receiving 2 or more prescriptions
in the calendar year, we also performed a sensitivity
doi: 10.3122/jabfm.2017.04.170112 Prescription Opioid Use and Mental Health 3
4. analysis in which we varied our definition to in-
clude between 1 and 5 prescriptions and then re-
examined associations.
For all analyses we used complex survey design
methods to make national estimates, which account
for a participant’s probability of selection and sam-
pling methodology. Because our study aggregated
2011 and 2013 MEPS data, survey weights were
adjusted so that the data represented a single cal-
endar year. Analyses were based on complete case
analysis, and we assumed any missing values to be
missing completely at random. Analyses were con-
ducted using Stata MP, version 14.0 (StataCorp,
College Station, TX).
Results
Among the 239.4 million U.S. adults, we estimate
that 38.6 million had a mental health disorder (Ta-
ble 1 and Figure 1). Of the adults with mental
health disorders, 18.7% were opioid users, com-
pared with only 5.0% among those without mental
health disorders (P Ͻ.001) (Figure 2). We estimate
that approximately 115 million opioid prescriptions
are distributed each year in the United States,
51.4% (60 million prescriptions) of which are re-
ceived by adults who have a mental health disorder.
Characteristics of Adults with a Mental Health
Disorder Who Use Opioids
Among adults with mental health disorders, opioid
users differed in several ways. Opioid users were
older (nearly 75% of opioid users were aged Ն45
years compared with 60% among nonopioid users),
more likely to be non-Hispanic white, and com-
pleted less educational (P Ͻ .001 for all) (Table 1).
Comparing opioid users with and without a mental
health disorder, those with a mental health disorder
were more likely to be middle-aged, female, non-
Hispanic white, and divorced, separated, or wid-
owed.
Among adults with mental health disorders, opi-
oid users were considerably less healthy than non-
opioid users (Table 1 and Appendix Table 2). The
mean PCS score was 33.5 (standard error, 0.50)
among opioid users versus 47.7 (standard error,
0.20) among nonopioid users (P Ͻ .001). Likewise,
among adults with mental health disorders, opioid
users had considerably more comorbidities; for in-
stance, 18.1% of opioid users had Ն3 comorbidi-
ties, compared with just 6.3% among nonopioid
users. Adults with mental health disorders who use
opioids also had much higher self-reported pain
levels (eg, 60.0% of opioid users reported severe
pain compared with only 16.2% among nonopioid
users). Among opioid users, those with mental
health disorders were less healthy than those with-
out mental health disorders, but the differences
were less pronounced.
Opioid Use Among Adults with Mental Health
Disorders
Among specific subpopulations based on the level
of self-reported pain, cancer diagnosis, and muscu-
loskeletal conditions, the higher percentage of opi-
oid users persisted among adults with mental health
conditions compared with those without (P Ͻ .001
for all) (Figure 2). Most notable was nearly twice
the percentage of opioid users among adults with
severe pain (45.3% of adults with mental health
disorders were opioid users compared with 24.1%
among those without mental health disorders).
The top 10 clinical diagnoses associated with
prescription opioids for Americans with mental
health disorders included musculoskeletal disor-
ders, poorly defined conditions, or an otherwise
missing diagnosis (Figure 3). The top 10 clinical
diagnoses we identified among adults with mental
health disorders account for 54.0% of the total
opioids prescribed to this population, suggesting
considerable variation in clinical diagnosis.
Association Between Mental Health Disorders and
Opioid Use
In unadjusted analyses the odds of opioid use was
Ͼ4 times higher among adults with mental health
disorders than among those without (odds ratio
[OR], 4.34; 95% confidence interval [CI], 3.93–
4.77) (Table 2). After adjusting for sociodemo-
graphic characteristics, health status, and use of
selected health services, although attenuated, the
association persisted: adults with mental health dis-
orders had more than twice the odds of being an
opioid user (OR, 2.08; 95% CI, 1.83–2.35). Other
notable factors in the fully adjusted model associ-
ated with opioid use included having a usual source
of care (OR, 1.67), having moderate or severe self-
reported pain (ORs , 2.15 and 3.15, respectively),
reporting a physical limitation (OR, 1.84), having
had surgery (ORs, 2.73 and 3.58 for outpatient and
inpatient surgery, respectively), and having a sub-
stance abuse diagnosis (OR, 2.42).
4 JABFM July–August 2017 Vol. 30 No. 4 http://www.jabfm.org
5. In our sensitivity analyses, all associations persisted
when varying our opioid user definition (from 1 to 5
prescriptions/year), and were more pronounced with
more stringent definitions of opioid use.
Discussion
Although, previous reports have documented the
association between having a mental health disor-
der and opioid use in specific populations, our
Table 1. Sociodemographic Characteristics and Health Status of U.S. Adults According to Mental Health Disorder
Status and Opioid Use
No Mental Health Disorder Mental Health Disorder
P Value* P Value†
Non–Opioid User
(n ϭ 42,908)
Opioid User
(n ϭ 1,983)
Non–Opioid User
(n ϭ 5,690)
Opioid User
(n ϭ 1,310)
No. of U.S. adults, millions 190.7 10.1 31.4 7.2
Sociodemographic characteristics
Age, years Ͻ.001 Ͻ.001
18–44 49.4 29.7 40.0 25.1
45–64 32.7 42.0 39.8 51.9
Ն65 17.9 28.3 20.3 22.9
Sex .14 Ͻ.001
Male 51.2 45.8 34.8 32.2
Female 48.8 54.2 65.2 67.8
Race/ethnicity .03 Ͻ.001
Non-Hispanic white 62.8 74.1 79.3 80.6
Non-Hispanic black 12.2 13.5 7.1 8.2
Hispanic 16.5 8.7 9.4 6.8
Other or multiple races 8.4 3.7 4.1 4.5
Marital status Ͻ.001 Ͻ.001
Married 53.4 55.1 46.8 44.9
Divorced, separated, or
widowed
17.9 28.4 27.6 40.3
Never married 28.7 16.5 25.5 14.9
Education Ͻ.001 .06
High school or less 56.3 63.5 53.9 67.9
Some college or bachelor’s
degree
27.5 25.8 28.2 24.5
Advanced degree 16.2 10.7 17.9 7.6
Health insurance Ͻ.001 Ͻ.001
Private 67.9 60.5 65.8 47.1
Public 15.8 30.7 23.4 45.7
Uninsured 16.3 8.7 10.8 7.2
Health status
SF-12, mean (SE)
PCS score 50.9 (0.08) 37.8 (0.47) 47.7 (0.20) 33.5 (0.50) Ͻ.001 Ͻ.001
MCS score 53.1 (0.06) 49.6 (0.32) 43.9 (0.20) 40.6 (0.40) Ͻ.001 Ͻ.001
Fair or poor overall health 8.8 32.2 21.0 54.3 Ͻ.001 Ͻ.001
Number of comorbidities Ͻ.001 Ͻ.001
0 89.0 72.8 78.3 58.2
1–2 7.9 15.9 15.4 23.7
Ն3 3.1 11.3 6.3 18.1
Data are percentages unless otherwise indicated. All estimates are weighted to represent the U.S. noninstitutionalized population. The
2
test was used to compare proportions.
*P value compares nonopioid users with opioid users among adults with mental health disorders.
†
P value compares adult opioid users with versus those without mental health disorders.
MCS, mental component summary; PCS, physical component summary; SE, standard error; SF-12, 12-item Short Form.
doi: 10.3122/jabfm.2017.04.170112 Prescription Opioid Use and Mental Health 5
6. study offers several contributions. First, we found
that the population of adults with mental health
disorders receive more than half of the total opioid
prescriptions in the United States. Second, among
the nearly 40 million Americans who have a mental
health condition, approximately 19% use prescrip-
tion opioids. Last, higher opioid use among those
with mental health disorders persists across key
characteristics, including cancer status and various
levels of self-reported pain.
Although evidence-based prescribing guidelines
are emerging,21,22
there exists a complex interac-
tion of factors related to the patient, provider, and
medical and social conditions that ultimately results
in the decision to prescribe an opioid.23
Our find-
ings that patients with mental illness are more
likely to receive opioid prescriptions across all dif-
ferent levels of pain suggests that there may be
additional patient- and provider-related factors
specific to those with mental illness that increase
the likelihood of receiving prescription opioids.
Such a relationship is particularly concerning be-
cause mental illness is also a prominent risk factor
for overdose and other adverse opioid-related out-
comes.24,25
Thus, the expectation would be that
physicians would be more conservative with their
prescribing behaviors in the setting of mental ill-
ness and favor nonopioid alternatives. The ability
Figure 1. Estimated number of adults with mental health disorders who use prescription opioids in the United
States. All estimates are weighted to represent the U.S. noninstitutionalized population.
Figure 2. Estimated percentages of U.S. adults with and without mental health disorders who use prescription
opioids, according to selected characteristics. All estimates are weighted to represent the U.S. noninstitutionalized
population. Error bars represent 95% confidence intervals. Musculoskeletal conditions include all forms of
arthritis, and other pain-related conditions.
6 JABFM July–August 2017 Vol. 30 No. 4 http://www.jabfm.org
7. to identify populations that may use prescription
opioids independent of pain would be of strategic
importance for mitigating potential risk at a popu-
lation health level.
The challenge with pain management is that
there is no biological measure of pain or objective
assessment of efficacy of treatment. The Interna-
tional Association for the Study of Pain adopted a
definition of pain that is widely accepted.26
The
definition states that pain is “an unpleasant sensory
and emotional experience, associated with actual or
threatened tissue damage, or described in terms of
such.” The definition thus relies on physician in-
terpretation and the subjective experience of the
patient. Thus, one could hypothesize that increased
opioid use in patients with mental health disorders
may be related to a variety of psychological factors
that may contribute to an increased subjective ex-
perience of pain or to increased likelihood of using
opioids irrespective of pain level.5
Our finding that approximately 19% of adults
with mental health disorders use prescription opi-
oids aligns with what is to our knowledge the only
other article that used nationally representative
data to examine this relationship. Halbert and col-
leagues8
examined patients with pain-related con-
ditions and found those who had mood disorders
were more likely to initiate opioid use than those
without mood disorders: 19.3% of patients with
pain and mood disorders initiated opioid use, com-
pared with 17.2% of patients with pain without
mood disorders. Evidence indicating an increased
risk of depressive symptoms in patients receiving
chronic opioids may raise concerns regarding re-
verse causality.27
The relationship between mental
health disorders and pain is also likely bidirectional,
with improvements in pain leading to improve-
ments in mental health symptoms and vice versa.28
Furthermore, some evidence indicates that opti-
mizing depression and pain treatment can improve
outcomes in both areas for patients seen in primary
care.29
Although the relationship between mental
health disorders, pain, and opioid use is complex,
we found that having a mental health disorder is
associated with increased opioid use even after con-
trolling for a wide array of other demographic and
clinical risk factors, including substance abuse. The
high prevalence of mental health disorders cou-
pled with prescription opioid use suggests that
this population is critical to consider when ad-
dressing the issue of opioid use from a health
system or policy perspective. Although a number
of important steps are already underway to ad-
dress opioid use in this country, such as the
Figure 3. Top 10 clinical diagnoses for prescription opioids among U.S. adults who have a mental health disorder.
All estimates are weighted to represent the number of prescriptions among the U.S. noninstitutionalized
population. The 2
test was used to compare proportions.
doi: 10.3122/jabfm.2017.04.170112 Prescription Opioid Use and Mental Health 7
8. recent Centers for Disease Control and Preven-
tion opioid prescribing guidelines,22
improving
treatment of comorbid mental health disorders
and pain will be an important focus when trying
to reduce the overall negative impacts of opioid
use on patients and communities.
Study Limitations
Our study has several limitations that must be
acknowledged. First, our study used a cross-sec-
tional, observational design and therefore is not
intended to demonstrate a cause–effect relation-
ship between having a mental health disorder and
using opioids. Thus we cannot rule out the ef-
fects of residual confounding nor potential re-
verse causality. However, with regard to the lat-
ter, recent evidence from longitudinal analyses
suggests opioid-naïve patients with mood disor-
ders are in fact more likely to initiate prescription
opioids and to transition to longer-term opioid
use than those without a mood disorder.8
Second,
because we focused on determining whether clin-
ical treatment varies by mental health disorder
status, our study only examined prescription opi-
oid use and therefore neglects any concurrent
illicit medication use. Third, we investigated the
association between mental health disorders and
opioid use among noninstitutionalized U.S. adult
citizens. Therefore, findings among children or
institutionalized adults may differ. Last, the
MEPS data on health care utilization and expen-
ditures are self-reported by patients, potentially
causing inaccuracies; however, the MEPS at-
tempts to correct self-reported errors by verify-
Table 2. Odds Ratios For the Association Between Independent Factors and Prescription Opioid Use
Independent Variables
Odds Ratio (95% CI)
Unadjusted Adjusted*
Any mental health disorder 4.34 (3.93–4.77) 2.08 (1.83–2.35)
Age, years 1.02 (1.02–1.02) 0.99 (0.98–1.00)
Sex
Male 1.00 (Reference) 1.00 (Reference)
Female 1.42 (1.31–1.55) 1.07 (0.96–0.99)
Race/ethnicity
Non-Hispanic white 1.00 (Reference) 1.00 (Reference)
Non-Hispanic black 0.83 (0.74–0.93) 0.80 (0.70–0.91)
Hispanic or Latino 0.43 (0.38–0.49) 0.58 (0.49–0.67)
Other 0.44 (0.35–0.56) 0.55 (0.42–0.72)
Health insurance coverage
Private 1.00 (Reference) 1.00 (Reference)
Public 2.70 (2.44–3.00) 1.23 (1.06–1.42)
Uninsured 0.64 (0.54–0.76) 0.86 (0.70–1.06)
Has usual source of care 2.91 (2.49–3.39) 1.67 (1.39–2.02)
PCS score 0.91 (0.91–0.91) 0.96 (0.95–0.97)
Self-reported overall health status
Excellent to good 1.00 (Reference) 1.00 (Reference)
Fair or poor 6.02 (5.38–6.74) 1.29 (1.11–1.48)
Self-reported limitation due to pain
None or little 1.00 (Reference) 1.00 (Reference)
Moderate 5.25 (4.50–6.13) 2.15 (1.78–2.59)
Severe 15.24 (13.41–17.31) 3.15 (2.58–3.85)
Physical limitation 8.25 (7.40–9.20) 1.84 (1.56–2.17)
Has substance abuse diagnosis 4.29 (2.88–6.40) 2.42 (1.19–4.96)
Had outpatient surgery 4.62 (3.98–5.36) 2.73 (2.22–3.36)
Had inpatient surgery 7.02 (6.13–8.05) 3.58 (2.92–4.38)
All estimates are weighted to represent the U.S. noninstitutionalized population.
*Adjusted for all other factors in the table.
PCS, physical component summary.
8 JABFM July–August 2017 Vol. 30 No. 4 http://www.jabfm.org
9. ing response data with the participant’s health
care and insurance providers.
Despite these inherent limitations, our study of-
fers valuable insights regarding opioid use among
Americans with mental health disorders. Although
the relationship between mental health and pain
management is complex, we find that as a popula-
tion, adults with mental health disorders receive
more than half of all opioid prescriptions distrib-
uted each year in the United States. This finding
warrants more research to understand further the
association between mental health disorders and
prescription opioid use, and to promote safer opi-
oid use among this population.
To see this article online, please go to: http://jabfm.org/content/
30/4/000.full.
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10 JABFM July–August 2017 Vol. 30 No. 4 http://www.jabfm.org
11. Appendix
Appendix Table 1. Medical Expenditure Panel Survey Participants with Mental Health Disorders According to
International Classification of Diseases, Ninth Revision, Clinical Modification Diagnosis Codes
ICD-9-CM Code Description Participants with Code, n (% among adults)
296 Episodic mood disorders 671 (1.3)
300 Anxiety, dissociative, and somatoform disorders 3,644 (7.0)
311 Depressive disorder 4,362 (8.4)
ICD-9-CM, International Classification of Disease, Ninth Revision, Clinical Modification.
Appendix Table 2. Health Status of U.S. Adults According to Mental Health Disorder Status and Opioid Use
No Mental Health Disorder Mental Health Disorder
P Value* P Value†
Non–Opioid User
(n ϭ 42,908)
Opioid User
(n ϭ 1,983)
Non–Opioid User
(n ϭ 5,690)
Opioid User
(n ϭ 1,310)
Health status
SF-12, mean (SE)
PCS score 50.9 (0.08) 37.8 (0.47) 47.7 (0.20) 33.5 (0.50) Ͻ.001 Ͻ.001
MCS score 53.1 (0.06) 49.6 (0.32) 43.9 (0.20) 40.6 (0.40) Ͻ.001 Ͻ.001
Fair or poor overall health 8.8 32.2 21.0 54.3 Ͻ.001 Ͻ.001
Self-reported limitation due to pain Ͻ.001 Ͻ.001
None or little 84.6 40.2 69.4 21.2
Moderate 8.6 19.6 14.4 18.9
Severe 6.8 40.2 16.2 60.0
Smoker 15.2 24.9 22.4 36.7 Ͻ.001 Ͻ.001
Number of comorbidities Ͻ.001 Ͻ.001
0 89.0 72.8 78.3 58.2
1–2 7.9 15.9 15.4 23.7
Ն3 3.1 11.3 6.3 18.1
Self-reported limitation
Any self-reported limitation 19.6 61.2 42.7 81.2 Ͻ.001 Ͻ.001
Physical limitation 8.3 40.1 21.0 59.3 Ͻ.001 Ͻ.001
Social limitation 2.8 18.7 11.7 36.0 Ͻ.001 Ͻ.001
Cognitive limitation 2.7 11.3 13.6 30.9 Ͻ.001 Ͻ.001
Healthcare use
Has usual source of care 71.0 86.8 85.0 91.3 Ͻ.001 Ͻ.01
Had inpatient surgery 2.9 18.2 4.2 18.0 Ͻ.001 .93
Had outpatient surgery 3.6 17.5 6.1 13.7 Ͻ.001 .04
Had at least one ED visit for injury 15.3 41.5 25.1 43.5 Ͻ.001 .38
Data are percentages unless otherwise indicated. All estimates are weighted to represent the U.S. noninstitutionalized population. The
t test was used to compare means, and the 2
test was used to compare proportions.
*P value compares non–opioid users with opioid users among adults with mental health disorders.
†
P value compares adult opioid users with versus those without mental health disorders.
ED, emergency department; MCS, mental component summary; PCS, physical component summary; SE, standard error; SF-12,
12-item Short Form.
doi: 10.3122/jabfm.2017.04.170112 Prescription Opioid Use and Mental Health 11