1. Coprescribing naloxone with opioids is feasible and may reduce opioid-related ER visits
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2771
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M16-1348
URL goes live when the embargo lifts
Naloxone, a fast-acting medication used to block the effects of opioids, can be successfully coprescribed to patients receiving opioid analgesics for chronic pain in primary care. Naloxone coprescribing was associated with reduced opioid-related emergency room visits, suggesting that adopting this practice could reduce opioid-related adverse events. The findings are published in Annals of Internal Medicine.
Unintentional opioid overdose is a leading cause of injury-related death in the United States. Many interventions to curb opioid-related morbidity and mortality have not proven effective, but targeted distribution of naloxone to those likely to witness or experience an opioid overdose, mainly illicit drug users, has been associated with substantial reductions in opioid overdose mortality in communities where this practice is implemented. In San Francisco, implementation and expansion of a targeted naloxone distribution program was associated with a temporary decline in heroin-related deaths. However, the number of deaths attributed to opioid analgesics taken for chronic pain continued to climb. Limited research suggests that prescribing naloxone to these patients when they receive their opioid prescriptions could decrease overdose.
Researchers developed a standardized naloxone coprescribing program (Naloxone for Opioid Safety Evaluation, or NOSE) at primary care clinics in a safety net system in San Francisco to assess the feasibility of introducing and scaling up naloxone coprescribing. They also conducted analyses to assess the association of naloxone coprescribing with emergency room utilization and prescribed opioid dose. They found that more than one third of patients were prescribed naloxone, with the most going to patients who had previous opioid-related emergency room visits and those on higher opioid doses. Compared to patients not prescribed naloxone, patients prescribed naloxone had substantially fewer opioid-related emergency room visits even when there was no net change in opioid dose.
Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the lead author, Dr. Phillip Coffin, please contact Rachael Kagen at rachael.kagan@sfdph.org. The editorialist can be reached through Jenny Eriksen Leary at jenny.eriksen@bmc.org or 617-638-6841.
2. Numerous therapies assessed for curbing binge-eating disorder
Cognitive behavior therapy, antidepressants, and CNS stimulant seem to help reduce binge eating episodes
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2455
URL goes live when the embargo lifts
Evidence suggests that talk therapy, second-generation antidepressants, and a CNS stimulant used for ADHD are all safe and effective treatments for adults with binge-eating disorder. The systematic evidence review and meta-analysis is published in Annals of Internal Medicine.
Binge-eating disorder is the most common eating disorder, affecting about 3 percent of the U.S. population. Binge-eating disorder is characterized by recurrent, brief, psychologically distressing episodes of out-of-control eating. During a binge-eating episode, patients eat larger amounts of food than most people would consume under similar circumstances. Binge-eating disorder is associated with poorer psychological and physical well-being and may result in chronic health conditions. Treatment for binge-eating disorder aims to reduce binge frequency and disordered eating-related conditions, improve metabolic health and weight, and regulate mood. Treatment approaches include psychological and behavioral treatments, pharmacologic treatments, and combinations of the two, but the best treatment options are unclear.
Researchers reviewed published evidence to summarize evidence about the benefits and harms of psychological and pharmacologic therapies for adults with binge-eating disorder. They found strong evidence that therapist-led cognitive behavior therapy, second generation antidepressants, and lisdexamfetamine (a CNS stimulant commonly used for ADHD) all reduced the frequency of binge eating, increased the likelihood of achieving abstinence from binge-eating, and improved other eating-related psychological outcomes. There was less compelling evidence for other forms of cognitive behavior therapy and topiramate (an anticonvulsant commonly used to treat seizure disorder). This evidence will help to inform recommendations for treating adults with binge-eating disorder.
Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Dr. Kimberly Brownley, please contact Tom Hughes at Tom.Hughes@unchealth.unc.edu or 984-974-1151.
3. No danger of contracting dementia through blood transfusions
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2421
URL goes live when the embargo lifts
A large study of Scandinavian blood donors and transfusion recipients showed no evidence that dementia-type disorders are transmitted through blood transfusion. The findings are published in Annals of Internal Medicine.
Several neurodegenerative disorders, including Alzheimer and Parkinson disease, are characterized by an aggregation of misfolded proteins in the brain. This protein aberration can be passed from humans to healthy laboratory animals through the injection of diseased brain tissue from human sufferers, prompting fears that the diseases could also be passed from human to human through blood transfusion.
Researchers studied nationwide registers of blood transfusions in Sweden and Denmark between 1968 and 2012 to investigate possible transmission of dementia disorders. They identified more than 40,000 patients who had been given blood from donors diagnosed with one of the studied dementia diseases within 20 years of having given blood. After a maximum follow up of 44 years, the researchers compared those patients with the 1.4 million patients who had not received blood from donors with a subsequent diagnosis of one of the dementia diseases. The patients in both groups had exactly the same likelihood of contracting one of these diseases, which clearly showed that neurodegenerative disorders cannot be transmitted through blood transfusion.
Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the lead author, Dr. Gustaf Edgren, please contact Helene Almqvist at helene.almqvist@ki.se or +46 8 524 868 50.
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Journal
Annals of Internal Medicine