Jeff Schein

Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents

Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain.

Estimated costs of prescription opioid analgesic abuse in the United States in 2001: a societal perspective.

ObjectivesThis study estimates the costs to society of prescription opioid analgesic (RxO) abuse in the United States. MethodsCosts associated with RxO abuse were grouped into healthcare, criminal justice, and workplace categories. Costs were estimated by either (1) a quantity method that multiplies the number of RxO abusers derived from various national surveys by the estimated per abuser cost, or (2) an apportionment method that starts with overall (ie, prescription and nonprescription) drug abuse costs for a cost component (eg, police protection) and apportions the share of costs based on the prevalence of RxO abuse relative to overall drug abuse. Medical costs in excess of those for otherwise similar nonabusers were based on an analysis of a large administrative claims database for an employed population using multivariate regression methods. ResultsA lower bound estimate of the costs of RxO abuse in the United States was

Neuropsychological effects of long-term opioid use in chronic pain patients

8.6 billion in 2001 (or

Direct and Indirect Costs of Pain Therapy for Osteoarthritis in an Insured Population in the United States

9.5 billion in 2005 dollars). Of this amount,

Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed

2.6 billion were healthcare costs,

COMPARISON OF RIVAROXABAN OR WARFARIN USE FOR VENOUS THROMBOEMBOLISM ON INPATIENT LENGTH OF STAY

1.4 billion were criminal justice costs, and

Direct costs of opioid abuse in an insured population in the United States.

4.6 billion were workplace costs. ConclusionsThe costs of RxO abuse represent a substantial economic burden. Rising trends of RxO abuse suggest an escalating economic and public health burden in coming years in the United States, and potentially, elsewhere.

Long-Term Effects of Analgesics in a Population of Elderly Nursing Home Residents With Persistent Nonmalignant Pain

Opioids are thought to worsen the performance of psychomotor tasks due to their sedating and mental-clouding effects. As a result, some safety regulations currently restrict the use of opioids when driving or using heavy equipment. We investigated the psychomotor effects of long-term opioid use in 144 patients with low back pain. All subjects were administered two neuropsychological tests (Digit Symbol and Trail Making Test-B) before being prescribed opioids for pain; tests were re-administered at 90- and 180-day intervals. Test scores significantly improved while subjects were taking opioids for pain, which suggests that long-term use of oxycodone with acetaminophen or transdermal fentanyl does not significantly impair cognitive ability or psychomotor function.

Patient-Reported Utilization Patterns of Fentanyl Transdermal System and Oxycodone Hydrochloride Controlled-Release Among Patients With Chronic Nonmalignant Pain

Objective: To assess the health care utilization and cost of illness for osteoarthritis (OA) patients taking pain medications. Specifically, the goals were to estimate the direct health care and indirect costs of OA. Methods: A claims database of privately insured patients was used to identify OA patients. Prescription drug pain treatments included tramadol, cyclooxygenase-II inhibitors, and nonsteroidal anti-inflammatory drugs. Mean annual per patient costs were calculated from an employer’s perspective. Results: OA patients were prescribed multiple drugs simultaneously and/or sequentially to manage pain. OA patients had a number of prevalent comorbid conditions. Average annual direct medical, drug, and indirect work loss costs were

One-year adherence to warfarin treatment for venous thromboembolism in high-risk patients and its association with long-term risk of recurrent events.

8601,