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Background: Accidental opioid-involved overdose deaths are increasing nationally in the wake of the COVID-19 pandemic, but it is unclear if this reflects a change in populations most at risk. Objective: To determine whether the demographic characteristics and controlled substance prescription history of accidental opioid-involved drug overdose decedents in 2020 differed from prior years. Methods: We identified accidental opioid-involved overdose decedents using Rhode Island (RI) State Medical Examiner's Office data. Decedents were linked to the RI Prescription Drug Monitoring Program database. We compared demographic characteristics and prescription history by year of death. Results: From 2018 to 2020, 763 RI residents died from accidental opioid-involved overdose in RI. From 2018 to 2019, deaths decreased by 7%, but then increased by 31% from 2019 to 2020. Demographic characteristics were similar by year of death (all p > 0.05). The percentage of decedents with a prior opioid prescription and a prior benzodiazepine prescription declined from 2018 to 2020 (p < 0.01 and p = 0.03). Conclusions: We found that opioid-involved overdose deaths in RI are increasing overall, but without significant changes in demographics. While prior exposure to some controlled substances did decline over time, it is not clear if these changes reflect more responsible prescribing practices, or a more concerning pattern such as patient abandonment or decreased healthcare access. More studies are needed to better describe the current trend of increasing opioid-involved deaths while also pursuing current evidence-based interventions. [ABSTRACT FROM AUTHOR]

To guide intervention efforts, we identified the proportion of individuals previously engaged in opioid agonist therapy among people who died of an accidental opioid-involved overdose. Most individuals (60.9%) had never received any prior buprenorphine or methadone treatment. Individuals who died of an overdose in 2020 had a similar demographic profile and treatment history compared with prior years. To prevent additional accidental opioid-involved overdose deaths, efforts should be directed toward linking individuals to care. [ABSTRACT FROM AUTHOR]

The Rhode Island Board of Medical Licensure and Discipline (BMLD) is the regulatory body for physicians in Rhode Island, granting licenses and imposing disciplinary actions. The BMLD created a framework in the context of Just Culture to evaluate allegations of misconduct regarding physicians. This framework incorporates core concepts from Just Culture, in order to help determine if a physician is blameless or blameworthy regarding the underlying allegations and to help determine accountability to the individual physician or attribute to systems issues. [ABSTRACT FROM AUTHOR]

In March 2017, Rhode Island released treatment standards for care of adult patients with opioid use disorder. These standards prescribe three levels of hospital and emergency department treatment and prevention of opioid use disorder and opioid overdose and mechanisms for referral to treatment and epidemiological surveillance. By June 2018, all Rhode Island licensed acute care facilities had implemented policies meeting the standards' requirements. This policy has standardized care for opioid use disorder, enhanced opioid overdose surveillance and response, and expanded linkage to peer recovery support, naloxone, and medication for opioid use disorder. [ABSTRACT FROM AUTHOR]

The article provides information on a report on an unintentional drug overdose death trends and ranking in Rhode Island. Topics discussed include trends and geographic patterns in unintentional drug overdose death in the state, comparison of Rhode Island's performance to neighboring states, and prediction on future four-year deaths due to drug overdose in the absence of effective interventions.

The article discusses that using the internet to power electronic health records, to transfer digital images across the world for interpretation, and to perform robotic surgery from the corners of the globe are a few examples of how to practice medicine in 2020. It mentions that telemedicine also requires that the same standard of care; and also mentions that it is important to use secure messaging, to appropriately document in an approved electronic medical record.

The Rhode Island Department of Health (RIDOH) uses emergency department data to monitor nonfatal opioid overdoses in Rhode Island. In April 2019, RIDOH detected an increase in nonfatal opioid overdoses in Woonsocket, Rhode Island, and sent an alert to state and local partners (eg, fire departments, emergency departments, faith leaders) with guidance on how to respond. To guide community-level, strategic response efforts, RIDOH analyzed surveillance data to identify overdose patterns, populations, and geographic areas most affected. During April–June 2019, nonfatal opioid overdoses in Woonsocket increased 463% (from 13 to 73) when compared with the previous 3 months. Because of the sustained increase in nonfatal opioid overdoses, RIDOH brought together community partners at a meeting in June 2019 to discuss RIDOH opioid overdose data and coordinate next steps. Data analyses were essential to framing the discussion and allowed community partners at the event to identify an unexpected increase in cocaine-involved nonfatal opioid overdoses in Woonsocket. Many patients with cocaine-involved nonfatal overdoses also had fentanyl in their system, and input from community partners suggested that many patients were unaware of using fentanyl. Community response actions included targeting harm reduction services (eg, distribution of naloxone, mobile needle exchange); deploying peer recovery support specialists to overdose hotspots to connect people to treatment and recovery resources; placing harm reduction messaging in high-traffic areas; and targeted social media messaging. After the meeting, nonfatal opioid overdoses returned to pre-outbreak levels. This case study provides an example of how timely opioid overdose data can be effectively used to detect a spike in nonfatal opioid overdoses and inform a strategic, community-level response. [ABSTRACT FROM AUTHOR]

Prescription drug abuse/misuse in Rhode Island and the US is an epidemic. Chronic pain is often treated with prescription opiates which offer some relief, yet present risks to the patient of dependence, addiction and overdose. Physicians find themselves at times at odds with their patients regarding the management of pain and may feel bullied or pressured regarding prescribing. The Rhode Island Board of Medical Licensure and Discipline recognizes the value of established parameters for responsible and safe prescribing. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate possible trends and risk factors for overlapping stimulant and opioid prescriptions in Rhode Island (RI). METHODS: All RI residents with a stimulant prescription dispensed between April 1, 2016 and March 31, 2020 were obtained from the RI Prescription Drug Monitoring Program (PDMP). Individuals were stratified by overlapping stimulant/opioid exposure and compared by demographic and prescription characteristics. RESULTS: While stimulant prescribing remained relatively constant, the percent of individuals with an overlapping opioid prescription declined. Individuals prescribed overlapping stimulant/opioid prescriptions differed significantly as a function of age, sex, payment method, type of stimulant prescribed, and prescriber type. CONCLUSIONS: Among residents who were dispensed at least one stimulant prescription, individuals who were older, female, and on Medicare insurance were more likely to have an overlapping stimulant/opioid prescription. The RI PDMP can be used to identify trends and risk factors regarding prescribing patterns, which can inform future health policy and practice. [ABSTRACT FROM AUTHOR]

Prescription opioids are an important step in the development of persistent opioid use. Our study estimates the change in long-term opioid use before and after a 2017 regulatory update on acute pain prescribing. Prescribing information was abstracted from the Rhode Island Prescription Drug Monitoring Program (PDMP). Using the changed rates of initial opioid prescriptions of 8 or more days, and a calculated Number Needed to Harm for prescriptions of that duration, the rates of long-term opioid use were estimated decrease by 111 long-term opioid users per month. [ABSTRACT FROM AUTHOR]

Boundary violations are serious occurrences that result in a breach of the physician-patient relationship. Boundary violations are regulated by the Rhode Island Board of Medical Licensure and Discipline (Board). A review of all disciplinary actions from 2012 through 2018 involving physicians found boundary violations relating to sexual misconduct the most common boundary violations. All disciplinary actions that pertained to boundary violations were isolated, and trends regarding gender, medical specialty, and outcome of action were assessed. Sexual boundary violations (n=15) represented 94% of all boundary violations during this time period. Psychiatrists (31.3%), internists (25%) and family medicine physicians (18.8%) were the most common specialties of those who had boundary issues. Loss of license occurred for all physicians who had sexual intercourse with a patient. Reinstatement of license was possible for some physicians after a comprehensive forensic psychiatry evaluation. Physicians are reminded of the ethical obligations we have to our patients and the profession and to maintain a professional relationship with their patients at all times. This type of professional misconduct is preventable and avoids injury to patients and to the medical profession. [ABSTRACT FROM AUTHOR]

The Rhode Island Prescription Drug Monitoring Program (PDMP) requires dispensers with an active Controlled Substance Registration to report Schedule II-V substances and opioid antagonists within 24 hours of dispensing. This database was designed to surveille diversion and identify high-risk prescribing to prevent drug related harms. Using PDMP data from January 1, 2017, to December 31, 2021, opioid, buprenorphine, stimulant, and benzodiazepine dispensing trends were explored. During this time, opioid prescriptions dispensed annually decreased by 27.3% (from 576,421 to 419,220), and benzodiazepine prescriptions dispensed annually decreased by 12.3% (552,430 to 484,496). High-risk prescribing also decreased with opioids prescriptions > 90 daily MME decreasing by 52.1% and instances of overlapping benzodiazepine and opioid prescriptions decreasing by 34.1%. Buprenorphine and stimulant dispensing have increased by 11.1% and 20.7%, respectively. Prevention interventions will continue to educate providers on appropriate prescribing practices and work to further reduce unnecessary prescribing within the state. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the rates and characteristics of physicians with medical malpractice adverse outcomes in Rhode Island. METHODS: A descriptive epidemiologic study of medical malpractice claims from 2008-2018 aggregated by the Board of Medical Licensure and Discipline of the Rhode Island Department of Health. To examine the demographic characteristics of physician malpractice cases we reviewed 10 years of data from Rhode Island medical malpractice lawsuits that were resolved, in whole or in part, via payment to the plaintiff. RESULTS: Over this 10-year period, there were 460 such cases, 88% of which involved a male physician and 48% of which involved surgical category specialists. Few cases, 17.6% of payments, were over one million dollars, and the mean payment value across all cases was $517,104. The rate of paid claims was found to be stable over the period studied. [ABSTRACT FROM AUTHOR]

Disciplinary actions against physicians are uncommon, and loss of license is less common. This unmatched, case-control, and descriptive study reviews disciplinary actions involving physician loss-of-license cases from January 1, 2009, to December 31, 2019. There were 82 physician loss-of-license cases involving 66 physicians, which were categorized by age, sex, and specialty and were compared to 4,347 non-disciplined controls. In this study, males (OR 4.69, p<0.001) were associated with an increased risk of loss of license; age was a separate risk factor (OR 1.24, p<0.05). Preventive strategies are discussed to reduce future physician loss of license. [ABSTRACT FROM AUTHOR]

• Non-fatal overdose risk increases in a dose responsive manner with increasing poverty. • Higher proportions of overdose hotspots have religious organizations, health centers, and police stations. • Risk of fatal and non-fatal overdose is increased in neighborhoods with above average crowded housing. • Risk of non-fatal overdose was lower in neighborhoods with the high proportion of high school graduates. • Poverty alleviation, housing stability, and partnering with existing community organizations may be effective strategies to reduce neighborhood-level overdose death. Examine differences in neighborhood characteristics and services between overdose hotspot and non-hotspot neighborhoods and identify neighborhood-level population factors associated with increased overdose incidence. We conducted a population-based retrospective analysis of Rhode Island, USA residents who had a fatal or non-fatal overdose from 2016 to 2020 using an environmental scan and data from Rhode Island emergency medical services, State Unintentional Drug Overdose Reporting System, and the American Community Survey. We conducted a spatial scan via SaTScan to identify non-fatal and fatal overdose hotspots and compared the characteristics of hotspot and non-hotspot neighborhoods. We identified associations between census block group-level characteristics using a Besag-York-Mollié model specification with a conditional autoregressive spatial random effect. We identified 7 non-fatal and 3 fatal overdose hotspots in Rhode Island during the study period. Hotspot neighborhoods had higher proportions of Black and Latino/a residents, renter-occupied housing, vacant housing, unemployment, and cost-burdened households. A higher proportion of hotspot neighborhoods had a religious organization, a health center, or a police station. Non-fatal overdose risk increased in a dose responsive manner with increasing proportions of residents living in poverty. There was increased relative risk of non-fatal and fatal overdoses in neighborhoods with crowded housing above the mean (RR 1.19 [95 % CI 1.05, 1.34]; RR 1.21 [95 % CI 1.18, 1.38], respectively). Neighborhoods with increased prevalence of housing instability and poverty are at highest risk of overdose. The high availability of social services in overdose hotspots presents an opportunity to work with established organizations to prevent overdose deaths. [ABSTRACT FROM AUTHOR]

The opioid epidemic presents an urgent public health problem. Rhode Island has enacted comprehensive rules to address primary prevention of opioid overdose. This study evaluates the efficacy of those regulations in altering prescribing behavior, specifically regarding the initial prescription. Using data extracted from the Rhode Island Prescription Drug Monitoring Program (PDMP), before and after the publication of updated acute pain management regulations, we studied the rate of opioid prescribing using statistical process control (SPC) charts and found that the rate of prescribing unsafe doses of opioids, more than 30 morphine milligram equivalents (MMEs) per day or more than 20 doses to opioid naïve patients, decreased significantly. [ABSTRACT FROM AUTHOR]

Background and Aims: Partial opioid agonist medications for opioid use disorder reduce mortality and morbidity, however long-term retention in treatment is challenging. The objective of this study was to identify patient and prescription characteristics associated with long-term buprenorphine treatment retention.Methods: We used data from the Rhode Island prescription drug monitoring program to identify residents who initiated buprenorphine treatment and determine if they were retained in long-term buprenorphine treatment 12-months after treatment initiation. Multivariable logistic regression models were used to identify sociodemographic and prescription characteristics associated with long-term buprenorphine retention.Findings: During the study period 4898 unique Rhode Island residents initiated buprenorphine treatment, of whom 37.8 % were retained in treatment at 12-months. Demographic factors associated with a higher odds of long-term buprenorphine retention included older age, female sex, Medicaid insurance (vs private), and living closer to the pharmacy where the prescription was filled. Individuals who were prescribed the tablet formulation (aOR: 0.82 [95 % CI 0.72, 0.93]) or received a non-buprenorphine opioid during the follow-up window (aOR: 0.37 [95 % CI 0.31, 0.44]) had lower odds of long-term treatment at 12-months. Individuals who received at least one day of overlapping benzodiazepine and buprenorphine prescriptions (aOR: 2.00 [95 % CI 1.70, 2.34]) and those given a longer days supply (aOR: 1.26 [95 % CI 1.01, 1.56]) had higher odds of long-term treatment at 12-months. Findings were similar for treatment retention at 6-months in sensitivity analyses.Conclusions: These findings highlight several modifiable prescribing practices associated with long-term buprenorphine retention, suggesting that clinicians and public health practitioners can help remove barriers to long-term retention. [ABSTRACT FROM AUTHOR]

A Joint Statement from the President of the Rhode Island Board of Nursing, the Chair of the Rhode Island Board of Dentistry, the Chief Administrative Officer of the Rhode Island Board of Medical Licensure and Discipline, and the Chief of Emergency Medical Services, Rhode Island Department of Health. [ABSTRACT FROM AUTHOR]