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Pharmacoepidemiology
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Pharmacoepidemiology and Addiction
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Pharmacoepidemiology and Addiction

A special issue of Pharmacoepidemiology (ISSN 2813-0618).

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 17460

Special Issue Editor

Dr. Matthew Ellis

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Guest Editor
Department of Psychiatry, Washington University in St. Louis, School of Medicine, St.Louis, MO, USA
Interests: addiction medicine; psychiatric epidemiology; substance use
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Substance use remains a significant public health concern worldwide. Pharmacoepidemiologic studies are a critical component in mitigating adverse outcomes across the addiction spectrum. Understanding trends in drug use, particularly the detection of novel psychoactive substances, provides opportunities for prevention and intervention. As the landscape of substance use changes, there is a need to develop pharmacologic treatments that not only treat withdrawals, craving and addiction to specific drugs, but address the use of multiple classes of substances, known as polysubstance use. The widespread prevalence of comorbid conditions among those with substance use disorders, such as chronic pain and mental health disorders, are often associated with substandard treatment outcomes such as retention and relapse. As such, it is crucial to develop models of multidisciplinary addiction medicine and understand the role that pharmacology may play in addressing comorbid conditions alongside substance use disorders. Finally, pharmacologic interventions can play an important role in mitigating serious adverse events, including overdose fatalities.

This Special Issue on aims to keep up to date on current or shifting trends in substance use, the identification of novel psychoactive substances, the development of novel pharmacologic treatments for mono- or polysubstance use, outcome research for currently established pharmacologic treatments of addiction, the integration of pharmacologic treatments for comorbid conditions into addiction medicine, and the development of pharmacologic interventions for drug overdose or other adverse outcomes. This issue will accept original research articles, review articles, commentaries, letters or other materials facilitating an understanding of addiction through pharmacoepidemiology.

Dr. Matthew Ellis
Guest Editor

Manuscript Submission Information

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Related Special Issue

Published Papers (7 papers)

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Research

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9 pages, 1033 KiB  
Article
Opioid Prescribing for Noncancer Patients—Issues of Drug Therapy Safety: Results from a German Study Based on Routine Data
by Veronika Lappe, Daniel Grandt, Ursula Marschall and Ingrid Schubert
Pharmacoepidemiology 2024, 3(1), 94-102; https://doi.org/10.3390/pharma3010007 - 22 Feb 2024
Viewed by 1153
Abstract
Opioids are highly effective drugs but need close monitoring to avoid harm to patients. The aim of this study was to analyze how guideline recommendations are met for (i) the avoidance of the concomitant use of anxiolytics, hypnotics, or sedatives; (ii) the prescribing [...] Read more.
Opioids are highly effective drugs but need close monitoring to avoid harm to patients. The aim of this study was to analyze how guideline recommendations are met for (i) the avoidance of the concomitant use of anxiolytics, hypnotics, or sedatives; (ii) the prescribing of laxatives in long-term opioid treatment; (iii) the co-prescribing of drugs to control the emetic effect of opioids; (iv) pretreatment with non-opioids; and (v) screening for depression when initiating opioids. The results are based on a routine data analysis of a large German health insurance fund. Different study populations of noncancer patients (18+ years old) treated with opioids were analyzed: 10.4% of the opioid recipients in 2021 received at least one concomitant prescription with anxiolytics, hypnotics, or sedatives; 69.3% of those with long-term opioid treatment received at least one laxative prescription. Of those with first-time opioid prescriptions, 4.8% received an antiemetic drug; 47.3% of those with a newly initiated opioid therapy received a non-opioid prescription within three months before the start of the opioid therapy; and 22.0% of patients with incident opioid prescription had at least one documentation of a depression diagnosis within three months of the first prescription. There is an urgent need to improve opioid prescribing to avoid risky combinations and adverse effects. Full article
(This article belongs to the Special Issue Pharmacoepidemiology and Addiction)
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12 pages, 539 KiB  
Article
“My Addiction Doesn’t Define Me”—Experiences of Stigma among Mothers with Opioid Use Disorder
by Christine Bakos-Block, Andrea Yatsco, A. Sarah Cohen, Francine Vega and Tiffany Champagne-Langabeer
Pharmacoepidemiology 2024, 3(1), 57-68; https://doi.org/10.3390/pharma3010004 - 29 Jan 2024
Viewed by 1888
Abstract
Opioid use in women has increased by 300% since 1999, and opioid use disorder among pregnant women has quadrupled. The stigma of substance use disorder is a significant barrier to treatment, especially among women. The purpose of this study was to explore the [...] Read more.
Opioid use in women has increased by 300% since 1999, and opioid use disorder among pregnant women has quadrupled. The stigma of substance use disorder is a significant barrier to treatment, especially among women. The purpose of this study was to explore the experiences and perceptions of stigma among mothers and the underlying themes. (1) Background: To understand the stigmatization of women with substance use disorders, we interviewed mothers in recovery from opioid use disorder. (2) Methods: Qualitative methods and descriptive analysis was used to extrapolate themes related to the experienced stigma. (3) Results: A total of 20 mothers in recovery from opioid use disorder were interviewed and three main themes emerged from the data: internal stigma, external stigma, and healing from stigma. (4) Conclusion: The examination of stigma is important in reducing its effect on all individuals with substance use disorders, and it is important to understand gender inequities. Full article
(This article belongs to the Special Issue Pharmacoepidemiology and Addiction)
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8 pages, 911 KiB  
Article
Analyzing Black Market Sales of the Second-Line ADHD Medication Atomoxetine
by Sophie A. Roe, Dayna S. DeSalve and Brian J. Piper
Pharmacoepidemiology 2023, 2(4), 320-327; https://doi.org/10.3390/pharma2040027 - 7 Nov 2023
Viewed by 2768
Abstract
Research Question and Objective: While the number of pharmacoepidemiological studies on stimulant-based ADHD medications has expanded rapidly in recent years, likely due to the stimulant shortage, few studies have analyzed non-stimulant ADHD medications from a pharmacoepidemiological perspective. Such research is important because a [...] Read more.
Research Question and Objective: While the number of pharmacoepidemiological studies on stimulant-based ADHD medications has expanded rapidly in recent years, likely due to the stimulant shortage, few studies have analyzed non-stimulant ADHD medications from a pharmacoepidemiological perspective. Such research is important because a significant number of individuals with ADHD have medical or psychiatric conditions that preclude stimulant use. Furthermore, no studies, to our knowledge, have analyzed atomoxetine exchanges on the black market. In this report, we seek to fill both these gaps in the research by analyzing black market diversions of atomoxetine, a non-stimulant medication for ADHD. As ADHD medication diversion is a growing issue, we also hypothesize the pharmacoepidemiologic contributors to and implications of such diversion. Method: This study analyzed black market atomoxetine purchases entered on the web-based platform StreetRx between January 2015 and July 2019. Data included the generic drug name, dosage, purchase price, date, and location in the United States. The mean price per milligram was determined and a heatmap was generated. Results: The average price per milligram of 113 diverted atomoxetine submissions was USD 1.35 (±USD 2.76 SD) (Median = USD 0.05, Min = USD 0.01, Max = USD 20.00). The states with the most submissions included Michigan (11), Pennsylvania (9), Indiana (8), and Ohio (8). Conclusion: The cost per milligram of atomoxetine on the black market is over 50 times the cost per milligram of the generic prescribed form. Future qualitative studies should investigate reasons why individuals are motivated to purchase atomoxetine, a non-stimulant medication, on the black market (recreational vs. nootropic vs. other clinical uses). Full article
(This article belongs to the Special Issue Pharmacoepidemiology and Addiction)
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12 pages, 3556 KiB  
Article
Identifying Surgical and Trauma Patients in New Zealand for Opioid-Related Pharmacoepidemiological Research: A Descriptive Study
by Jiayi Gong, Amy Hai Yan Chan, Kebede Beyene, Alan Forbes Merry, Andrew Tomlin and Peter Jones
Pharmacoepidemiology 2023, 2(1), 1-12; https://doi.org/10.3390/pharma2010001 - 27 Dec 2022
Cited by 3 | Viewed by 2419
Abstract
Unique aspects of New Zealand’s (NZ) health system allow for a novel pharmacoepidemiologic approach to conducting population-based clinical research. A defined cohort of surgical and trauma patients would facilitate future studies into opioid utilisation, outcomes, and other questions related to surgery and trauma. [...] Read more.
Unique aspects of New Zealand’s (NZ) health system allow for a novel pharmacoepidemiologic approach to conducting population-based clinical research. A defined cohort of surgical and trauma patients would facilitate future studies into opioid utilisation, outcomes, and other questions related to surgery and trauma. We aimed to describe all patients admitted to a NZ hospital with trauma or to undergo surgery between 1 January 2007 to 31 December 2019. This was a retrospective population-based study involving all hospital centres in NZ. We excluded patients with hospitalisation episodes for surgery or trauma one year before the event. We identified 1.78 million surgical only patients, 633,386 trauma only, and 250,800 trauma with surgery patients. Trauma only patients had the highest prevalence of death within one year of event (17.8%), history of opioid dispensing (18.3%), mental health disorders (17.0%) and chronic pain (2.3%). Moreover, trauma patients also had the highest prevalence of those with higher comorbidity burden. We plan to use this dataset for future research into the prevalence and outcomes of persistent opioid use, and to make our dataset available to other researchers upon request. Our findings of significant differences between cohorts suggest studies should treat surgical and trauma patients separately. Full article
(This article belongs to the Special Issue Pharmacoepidemiology and Addiction)
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12 pages, 560 KiB  
Article
Evaluation of the Effectiveness of Buprenorphine-Naloxone on Opioid Overdose and Death among Insured Patients with Opioid Use Disorder in the United States
by Tianyu Sun, Natallia Katenka, Stephen Kogut, Jeffrey Bratberg, Josiah Rich and Ashley Buchanan
Pharmacoepidemiology 2022, 1(3), 101-112; https://doi.org/10.3390/pharma1030010 - 24 Nov 2022
Cited by 4 | Viewed by 3470
Abstract
Opioid use disorder (OUD) is a chronic disease requiring long-term treatment and is associated with opioid overdose and increased risk of mortality. However, existing randomized clinical trials focused on short-term treatment engagement and detoxification rather than overdose or mortality risk due to limited [...] Read more.
Opioid use disorder (OUD) is a chronic disease requiring long-term treatment and is associated with opioid overdose and increased risk of mortality. However, existing randomized clinical trials focused on short-term treatment engagement and detoxification rather than overdose or mortality risk due to limited follow-up time and ethical considerations. We used a hypothetical trial framework to conduct a retrospective cohort study to assess the effectiveness of time-varying buprenorphine-naloxone on opioid overdose and death. We identified 58,835 insured adult patients with OUD diagnosis in the US, 2010–2017. We fit a marginal structural model using inverse probability weighting methods to account for measured baseline and time-varying confounders, as well as selection bias due to possibly differential loss-to-follow-up. We found that receipt of buprenorphine-naloxone was associated with reduced risk of opioid overdose (hazard ratio (HR) = 0.66, 95% confidence interval (CI): 0.49, 0.91), death (HR = 0.24, 95% CI: 0.08, 0.75), and overdose or death (HR = 0.58, 95% CI: 0.40, 0.84). The E-value for death was 7.8, which was larger than the upper 95% CI of the association between each measured baseline variable and all-cause death, which implies that the unmeasured confounding itself may not explain away the estimated effect of treatment on the endpoint of all-cause mortality. Full article
(This article belongs to the Special Issue Pharmacoepidemiology and Addiction)
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Review

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15 pages, 957 KiB  
Review
The Complexity in the Diagnosis and Treatment of Symptoms in Electronic Cigarette Users during the COVID-19 Pandemic
by Ayesha Rahman Ahmed and Mahiba Ahmed
Pharmacoepidemiology 2022, 1(2), 49-63; https://doi.org/10.3390/pharma1020006 - 12 Jul 2022
Viewed by 2118
Abstract
The issue with the overlapping clinical symptoms from an electronic cigarette (e-cigarette) or vaping product use-associated lung injury (EVALI) and coronavirus disease 2019 (COVID-19) sometimes leads to incorrect diagnosis and, consequently, wrong treatment regimen. The purpose of this review is to study the [...] Read more.
The issue with the overlapping clinical symptoms from an electronic cigarette (e-cigarette) or vaping product use-associated lung injury (EVALI) and coronavirus disease 2019 (COVID-19) sometimes leads to incorrect diagnosis and, consequently, wrong treatment regimen. The purpose of this review is to study the burden of vaping-associated health consequences on the diagnosis and treatment of COVID-19 in young adults and adolescents with a misconception of e-cigarettes as a safer alternative to smoking. The online reference databases, including PubMed, Google Scholar, Web of Science, Medline, and Centers for Disease Control and Prevention (CDC), were used in the literature search, as we analyzed the complexity of timely diagnosis and treatment in the current COVID-19 era with the use of e-cigarettes. This study briefly describes the dysbiosis of the oral microbiome in e-cigarette users that could potentially aggravate the COVID-19 symptoms and lead to the complexity of timely diagnosis and treatment. Additionally, the patient case reports with a history of vaping and symptoms similar to COVID-19 disease are reviewed. Full article
(This article belongs to the Special Issue Pharmacoepidemiology and Addiction)
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Other

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16 pages, 550 KiB  
Systematic Review
Helpful, Unnecessary, or Harmful: A Systematic Review of the Effects of Prescription Drug Monitoring Program Use on Opioid Prescriptions
by Nina Z. Y. Smith, J. Douglas Thornton, Susan H. Fenton, Debora Simmons and Tiffany Champagne-Langabeer
Pharmacoepidemiology 2023, 2(4), 350-365; https://doi.org/10.3390/pharma2040030 - 15 Dec 2023
Viewed by 2345
Abstract
Prescription drug misuse is a global problem, especially in the United States (US). Clinician involvement is necessary in this crisis, and prescription drug monitoring programs (PDMPs) are a recommended tool for the prevention, recognition, and management of prescription opioid misuse. However, because of [...] Read more.
Prescription drug misuse is a global problem, especially in the United States (US). Clinician involvement is necessary in this crisis, and prescription drug monitoring programs (PDMPs) are a recommended tool for the prevention, recognition, and management of prescription opioid misuse. However, because of the plethora of differences between different PDMPs, research on their effects is mixed. Yet, despite varied evidence, policy on PDMP use is trending stricter and more comprehensive. We aimed to identify patterns in the research to inform clinicians and policy. Through a systematic review of four literature databases (CINAHL, Cochrane Database, Embase, and Medline/OVID), we found 56 experimental and quasi-experimental studies published between 2016 and 2023 evaluating PDMP effects on clinician behavior. To address study heterogeneity, we categorized studies by type of intervention and study outcome. The review suggests that more comprehensive PDMP legislation is associated with decreases in the number of opioid prescriptions overall and the number of risky prescriptions prescribed or dispensed. However, this review shows that much is still unknown, encourages improvements to PDMPs and policies, and suggests further research. Full article
(This article belongs to the Special Issue Pharmacoepidemiology and Addiction)
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