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An Examination of Chronic Pain and Opioid Use Among Veterans with and without Alcohol Use Disorder

Description
Chronic pain is devastating and highly prevalent among Veterans in the United States (Johnson, Levesque, Broderick, Bailey & Kerns, 2017). While there are various treatment options for chronic pain, opioids remain high in popularity. Although opioids are fast-acting and effective, potential consequences range from unpleasant side effects to dependence and…

Chronic pain is devastating and highly prevalent among Veterans in the United States (Johnson, Levesque, Broderick, Bailey & Kerns, 2017). While there are various treatment options for chronic pain, opioids remain high in popularity. Although opioids are fast-acting and effective, potential consequences range from unpleasant side effects to dependence and fatal overdose (Baldini, Korff & Lin, 2012; Park et al., 2015; Kaur, 2007). The effects of opioid treatment can be further complicated by a history of alcohol abuse. Past alcohol abuse is a risk factor for opioid misuse (McCabe et al., 2008). One alternative to opioid medication is Cognitive Behavioral Therapy for Chronic Pain (CBT-CP). CBT-CP has shown small to moderate effects on chronic pain after the end of treatment (Naylor, Keefe, Brigidi, Naud & Helzer, 2008). The current study examined the effect of CBT-CP on opioid prescriptions, as well as the role of past alcohol abuse in CBT-CP efficacy, through an archival data analysis of Veterans Affairs patient charts. In order to determine the effect of CBT-CP on opioid prescriptions, an opioid change score was calculated from treatment start date to twelve months post-treatment. An analysis of 106 patient charts demonstrated no statistically significant difference in opioid prescriptions between Veterans who were referred and attended treatment (n = 24) and those who were referred but did not attend (n = 82). Veterans from both groups showed a reduction in prescribed opioids during a 12-month period. Furthermore, there was no statistically significant difference between Veterans with versus without a history of alcohol abuse in terms of the change in opioid prescriptions over a 12-month period (both groups showed reductions). This research suggests that opioid prescriptions may decrease over time among Veterans referred for CBT-CP, even among those who do not participate in the groups. More work is needed to understand the relationship between opioid prescriptions and actual opioid use over time among Veterans who do and do not choose to participate in CBT-CP. Continuing to address poly-substance use in chronic pain patients also is critical to ensure that Veterans suffering from chronic pain receive appropriate intervention.
ContributorsMiller, Stephanie C (Author) / Roberts, Nicole (Thesis director) / Gress-Smith, Jenna (Thesis director) / Burgess, Lisa (Committee member) / School of Social Transformation (Contributor) / Department of Psychology (Contributor) / Edson College of Nursing and Health Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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Monitoring the Rise of Methamphetamine use Amidst the Opioid Epidemic in Two U.S. Cities via Wastewater-based Epidemiology

Description

The combined use of methamphetamine and opioids has been reported to be on the rise throughout the United States (U.S.). However, our knowledge of this phenomenon is largely based upon reported overdoses and overdose-related deaths, law enforcement seizures, and drug treatment records; data that are often slow, restricted, and only…

The combined use of methamphetamine and opioids has been reported to be on the rise throughout the United States (U.S.). However, our knowledge of this phenomenon is largely based upon reported overdoses and overdose-related deaths, law enforcement seizures, and drug treatment records; data that are often slow, restricted, and only track a portion of the population participating in drug consumption activities. As an alternative, wastewater-based epidemiology (WBE) has the capability to track licit and illicit drug trends within an entire community, at a low cost and in near real-time, while providing anonymity to those contributing to the sewer shed. In this study, wastewater was collected from two Midwestern U.S. cities (2017-2019) and analyzed for the prevalence of methamphetamine and the opioids oxycodone, codeine, fentanyl, tramadol, hydrocodone, and hydromorphone. Monthly 24-hour time-weighted composite samples (n = 48) from each city were analyzed using isotope dilution liquid chromatography tandem mass spectrometry. Results showed that methamphetamine and total opioid consumption (milligram morphine equivalents) in City 1 were strongly correlated only in 2017 (Spearman rank order correlation coefficient, ρ = 0.78), the relationship driven by fentanyl, hydrocodone, and hydromorphone. For City 2, methamphetamine and total opioid consumption were strongly positively correlated during the entire study (ρ = 0.54), with the correlations driven by hydrocodone and hydromorphone. In both cities, hydrocodone and hydromorphone mass loads were highly correlated, suggesting a parent and metabolite relationship. WBE provides important insights into licit and illicit drug consumption patterns in near real-time as they evolve; important information for community stakeholders in municipalities across the U.S.
ContributorsClick, Kathleen Grace (Author) / Halden, Rolf (Thesis director) / Gushgari, Adam (Committee member) / Driver, Erin (Committee member) / School of Life Sciences (Contributor) / School of Human Evolution & Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
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Relationship Selling in the Pharmaceutical Industry: Impact of the Opioid Crisis

Description
702,000 and counting. That is the estimated figure of deaths related to drug overdoses from 1997-2017 reported by the CDC. Almost 70% of those deaths can be attributed to prescribed or illicit opioids. Many have been quick to place blame and unsurprisingly no one seems to be coming forward to…

702,000 and counting. That is the estimated figure of deaths related to drug overdoses from 1997-2017 reported by the CDC. Almost 70% of those deaths can be attributed to prescribed or illicit opioids. Many have been quick to place blame and unsurprisingly no one seems to be coming forward to take responsibility. What was the cause of this crisis? A current lawsuit against Purdue Pharma alleges that they are responsible for not only starting but continuing the crisis. (Strickler 2019) One of the initial indications of how the crisis started was due to unprofessional and deceptive sales tactics. Along with this, there have been many unethical practices involving advertising of various pharmaceutical products to exacerbate the issue. These practices range from general advertising to holding conferences with Doctors. Considering how many different parties are involved with the production, sale, prescription, and use of these products I find it difficult to place blame on one party. I wanted to specifically research how sales representatives build trust and relationships with their clients within this industry and how the crisis itself has impacted these relationships. The majority of my research consists of the foundation of relationships, different types of relationships, and how to build and maintain productive relationships. Relationships can be difficult, especially in a professional sales environment because each party typically has their own interests throughout each interaction. By understanding how professional relationships can be built we can aim to avoid a crisis like this in the future, and ultimately save lives because of it.
ContributorsGriffith, Jacob Marcus (Author) / LaRosa, Julia (Thesis director) / Hass, Mark (Committee member) / Department of Management and Entrepreneurship (Contributor) / Department of Marketing (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
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Evaluating the Effectiveness of Opioid Legislation in the United States

Description
To address and evaluate opioid legislation in the United States and its effectiveness in combating the opioid epidemic.
This paper will assess current and past legislation, on both the state and federal level, in terms of its effectiveness by cross-examining it with existing data. This paper also examines failures on…

To address and evaluate opioid legislation in the United States and its effectiveness in combating the opioid epidemic.
This paper will assess current and past legislation, on both the state and federal level, in terms of its effectiveness by cross-examining it with existing data. This paper also examines failures on the state and federal levels to properly target at-risk groups. Furthermore, this paper makes recommendations for future legislation to properly allocate resources to localities most affected by the opioid epidemic, and contribute to the decrease in opioid-related overdose deaths.
ContributorsKelly, John C (Co-author) / Kapadia, Kajol (Co-author) / Hill, Alexander (Thesis director) / Foote, Nicola (Committee member) / Department of Economics (Contributor) / Dean, W.P. Carey School of Business (Contributor, Contributor) / Barrett, The Honors College (Contributor)
Created2020-05