Rheumatology News

Vol. 4 • No. 1 • 2016 • R heumatology N ews 13 PAIN

91% who overdose on opioids continue to receive opioid prescriptions

Rheumatology Conference 2016

MARCH 4–8 March | San Francisco, USA 2016 Annual Meeting – The American Academy of Dermatology www.aad.org/ meetings/2016-annual-meeting 31 March – 3 April | Amsterdam, The Netherlands OsteoArthritis Research Society

12–15 May | Florida, USA Congress of Clinical Rheumatology ccrheumatology.com

or more morphine-equivalent dosage per day), with hazard ratios of 1.13 for patients taking low doses of opioids, 1.89 for those taking mid-range doses, and 2.57 for those taking high doses. “We could not determine the reason for the treatment patterns after the overdose; how- ever, some prescribers may have been una- ware that the opioid overdose had occurred” because there are no procedures in place to ensure provider notification in such cases. Newly introduced prescription monitoring programs may facilitate such communication, but a more rigorous approach would mandate that all overdoses be reported to public health departments, which would then notify pro- viders and pharmacies, and perhaps secure patient referral to substance abuse treatment programs, the investigators said ( Ann Intern Med 2015 Dec 28. doi: 10.7326/M15-0038). It is possible that some overdoses stemmed from therapeutic error rather than opioid mis- use, and that providers felt the risk-benefit ratio justified continued opioid treatment. But it also is likely that many providers simply did not have the knowledge and skills to identify and treat opioid misuse, they added. “Simply eliminating opioid prescribing for patients who had an overdose is not suffi- cient. … because some [patients] may turn to diverted or illicit opioids. Rather, efforts to identify and treat substance use disorders in these patients are needed,” Dr Larochelle and his associates said. Overall, the study findings indicate that nonfatal overdoses provide a meaningful op- portunity to improve the safety of opioid pre- scribing, but that most prescribers at present are missing this opportunity.

BY MARY ANN MOON Frontline Medical News From Annals of Internal Medicine

A lmost all patients who had nonfatal over- doses while taking long-term opioids for noncancer pain continued to receive opi- oid prescriptions, usually from the same physi- cians, in a nationwide cohort study published online Dec. 28 in Annals of Internal Medicine. Clinical guidelines specify that adverse events related to the misuse of opioids are clear indications to discontinue long-term opioid therapy. But patterns of prescribing after opioid overdoses are not monitored. To examine prescribing trends following nonfatal opioid overdoses, researchers analysed infor- mation in a database of inpatient, outpatient, and pharmacy claims from a large US health insurer covering all 50 states. They focused on 2848 insured adults en- rolled in 2000–2012 who received hospital or ED treatment for a prescription opioid overdose and were followed in the database for a median of 15 months. The prescribed drugs included codeine, dihydrocodeine, me- peridine, morphine, oxycodone, hydrocodone, hydromorphone, fentanyl, oxymorphone, propoxyphene, methadone, tramadol, and levorphanol, said Dr Marc R. Larochelle of Boston Medical Centre and his associates. A total of 2597 of these patients (91%) continued to receive opioid prescriptions after their overdose. The primary prescriber was the same person before and after the overdose in 1198 cases (61%). Two hundred twelve of these patients (7%) had another opioid over- dose during follow-up. The likelihood of a second overdose was much higher for patients taking the highest doses of opioids (100 mg

14–17 May | Perth, Australia 49th Australasian College of

Dermatologists Annual Scientific Meeting www.dermcoll.edu.au/college-events JUNE 1–3 June | Geneva, Switzerland 17th EFORT Congress: Infection www.efort.org/geneva2016

International (OARSI): World Congress on Osteoarthritis oarsi.org/events/ oarsi-2016-world-congress APRIL 9–10 April | Chicago, USA

State-of-the-Art Clinical Symposium: American College of Rheumatology www.rheumatology.org/Education/ Profmeetingcourses/SOTA/ State-of-the-Art_Clinical_Symposium

13–16 April | Dubai, UAE World Forum for Spine Research: Global Spine Congress 2016 www.gsc2016.org 14–17 April | Malaga, Spain World Congress On Osteoporosis, Osteoarthritis And

8–11 June | London, England EULAR 2016 Annual European Congress of Rheumatology www.congress.eular.org JULY 5–7 July | Birmingham, UK 96th Annual Meeting of the British Association of Dermatologists www.bad.org.uk/events/annualmeeting AUGUST 25– 8 August | Napier, New Zealand New Zealand Rheumatology Association with New Zealand Health

Musculoskeletal Diseases www.wco-iof-esceo.org

New resource centre offers best available evidence on Zika virus

Professionals in Rheumatology Annual Scientific Meeting 2016 www.eenz.com/nzra16 21–26 August | Melbourne, Australia ICI 2016 : International Conference of Immunology ici2016.org

In view of the global concern over the outbreak of the Zika virus, both Elsevier and The Lancet have created a Zika Virus Resource Center on Elsevier Connect with the latest updates, research, reviews, editorials, corre- spondence and commentary to help healthcare profession- als, medical researchers and the public understand the outbreak. Both info centres are advised by clinicians and professional editors, and will be updated with the most current research and evidence-based informa- tion available.

26–28 April | Glasgow, UK Rheumatology 2016 eiseverywhere.com/ehome/121743 30 April – 4 May | Darwin, Australia 57th Annual Scientific Meeting of the Australian Rheumatology Association www.araconference.com

NOVEMBER 1–4 November | Hobart, Australia Joint ANZBMS, MEPSA and MBSANZ Annual Scientific Meeting www.anzbmsconference.com/ 6–11 November | San Francisco, USA The American College of Rheumatology/

“With our virus resource centre on The Lancet , and with one on Elsevier Connect, we strive to bring together the best available evidence on Zika to assist researchers, policy makers and health workers in understanding the effects of the outbreak and how best to respond,” said Richard Horton, Editor-in-Chief of The Lancet. “Decisions affecting the public’s health should be supported by the best available evidence, and our resource centre will aim to keep policy makers and others updated with the latest research and analysis as developments unfold.”

MAY 11– 4 May | Austin, USA American Pain Society: 35th Annual Scientific Meeting http://americanpainsociety.org/ annual-meeting/2016/overview

American Rheumatology Health Professionals Annual Meeting www.acrannualmeeting.org

Both resource centres can be accessed through elsevier.com/connect/zika-virus-resource-center