The diagnosis, treatment, and management of chronic pain is complex, nuanced, and challenging in primary care settings. These challenges often give rise to internal provider conflicts around approp...

https://journals.sagepub.com/doi/pdf/10.1177/21501327211008055

Diagnosing and Treating Chronic Pain: Are We Doing This Right?

Opioids: A ‘crisis’ of too much or not enough – or simply how rich you are and where you live?

The relationship between drug use and traumatic injury is well documented, yet only a small proportion of patients are biochemically tested for cannabis and other substances. The study objective was to determine whether patient self-report can be used as a proxy for biochemical drug testing following traumatic injury.This study was a secondary analysis that included 320 patients admitted to four level I trauma centers in Colorado and Texas, primarily involved in motor vehicle crash (89%). If performed, biochemical testing was collected via urine toxicology screen ("tox screen") for cannabis, amphetamines, barbiturates, cocaine, opiates, PCP, and benzodiazepines. All patients were screened for self-reported current drug use, which was evaluated for any drug and specifically for cannabis use. Analyses used to compare results of self-reported drug use and tox screen included sensitivity, specificity, positive, and negative predictive values, and percent agreement.Among 320 patients, 23% (n = 75) self-reported drug use; cannabis was the most frequently reported drug (n = 63). A tox screen was performed in 59% of patients (n = 190); the proportion of patients who had a tox screen was similar for those self-reporting drug use (60.0%) to those who denied using drugs (59.2%), p = 0.90. Among patients who had a tox screen performed, 18% (n = 35) tested positive for any drug, 12% (n = 22) tested positive for THC, and 7% (n = 13) tested positive for opiates. The percent agreement was 80% for any drug and 81% for cannabis. The specificity was 84-85%, indicating a high likelihood that a patient will not have a positive tox screen if they do not report using drugs. Negative predictive values were 90-95%, indicating a negative self-report correctly identified nearly all patients testing negative on tox screen. Sensitivity was only 60% and positive predictive values were 30-47% for cannabis and drugs, respectively.These findings may negate the need for biochemical drug testing in this population, particularly as a "rule out" based on self-reporting. Future studies are needed to confirm these findings and should address risk of selection bias. 

/pdf/validity-between-self-report-and-biochemical-testing-of-2cbstwjc.pdf

Validity between self-report and biochemical testing of cannabis and drugs among patients with traumatic injury: brief report

Background: There is a growing number of opioid use disorders (OUDs) and overdose deaths in older adults. In addition, older adults with OUD routinely receive lower-quality preventive and chronic care that result in poorer overall health. Purpose: The purpose of this study was to identify older patients with OUD at the study site and determine the prevalence of medical and psychiatric comorbidities. Methodology: This retrospective study used a computer algorithm employed by a network of Federally Qualified Health Center primary care clinics in lower New York state. With the approval from institutional review board, the IT department of the organization captured data about older adults with an OUD diagnosis. The IT department identified 664 patients and provided anonymized demographic and medical history data of these patients for analysis. Results: Patients with OUD had 2–3 times more medical and psychiatric co-occurring conditions than national sample of older adults with no OUD of similar age and income. The most frequent co-occurring medical conditions in the patients were heart or circulatory disorders, movement disorders, respiratory disorders, pain disorders, nutritional disorders, and metabolic disorders. The most common co-occurring psychiatric conditions were anxiety disorders, major depressive disorder, post-traumatic stress disorder (PTSD), and bipolar disorder. Conclusions: Older adults with OUD often have complex health care needs that often include one or more chronic medical and psychiatric conditions. Implications: Providers should be aware of the multiple needs of older adults with OUD so that appropriate and comprehensive care can be offered to the patients.

Linda Lindsay

Papers

NP Safe Prescribing Of Controlled Substances While Avoiding Drug Diversion