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Aim: To establish and quantify the association between abuse‐deterrent formulation (ADF) oxycodone and 1‐year risk of opioid‐related harm. Design Propensity score‐matched cohort study of electronic medical records for years 2014–18, with patients followed up for 1 year after their index health‐care visit. Setting: More than 70 million patients from 56 US health‐care organizations. Participants: Patients aged 18–64 years at index health‐care visit with any indication for an oral opioid analgesic, with no past 12‐month history of oral oxycodone use or substance use disorder, and who were alive at the end of the 1‐year follow‐up (new episode of prescription oral ADF oxycodone [OxyContin], n = 45 045; new episode of non‐ADF oxycodone opioid preparation, n = 1 377 359). Measurements International Classification of Diseases diagnoses of any opioid‐related disorder or non‐fatal opioid poisoning within 1 year of the index health‐care visit. Pooled odds ratios (OR) with 95% confidence intervals (95% CI). Findings After propensity score matching, 89 802 patients with a mean age of 44 [standard deviation (SD) = 11] years (62% women, 68% white) were included. During 1‐year follow‐up, 1445 diagnoses of opioid use disorder or opioid poisoning occurred in the ADF oxycodone cohort (34.8/1000 person‐years) and 765 occurred in the non‐ADF oxycodone cohort (18.2/1000 person‐years). The odds of opioid‐related adverse outcomes were increased in the ADF oxycodone cohort compared with the non‐ADF oxycodone opioid cohort, including for opioid use disorders (OR = 2.02; 95% CI = 1.83, 2.23) and opioid poisoning (OR = 1.64 95% CI = 1.35, 1.99). Conclusions: Patients with a new prescription of abuse‐deterrent formulation oxycodone may be at increased risk of opioid‐related harm. [ABSTRACT FROM AUTHOR]

New arrangements for controlled drugs (CDs) have been established in the last few years to encourage good practice in the management of CDs, as well as help to detect at the earliest opportunity unusual or poor clinical practice systems, criminal activity, or risk to patients. This is a response to the Shipman Inquiry which examined how a GP was able to kill many of his patients with CDs over his career without being detected. One of the guiding principles of the new arrangements is that they should not interfere with the appropriate use of CDs and good clinical care. The safe governance principles should apply to all health and social care settings where CDs are supplied, prescribed, stored, administered or transported. All NHS bodies, hospices and registered independent hospitals (general and psychiatric) have a responsibility to assure that the quality of their CD management is an integral part of their clinical governance processes. Requirements for collaboration and information sharing between all health and social care providers, and relevant regulators and agencies have also been introduced. [ABSTRACT FROM AUTHOR]

The article offers news briefs on various issues. The Australian Cricketers' Association and Cricket Australia (CA) are considering 12-month trial of hair testing of players. Canadian provinces are likely to remove OxyContin and OxyNEO from the publicly funded drugs list. FIFA has insisted Brazil government to give the right to sell beer at the Brazil World Cup which is going to be held in 2014. Otto Perez, the Guatemala's new President has joined together with Latin American presidents over the issue of legalizing drugs.

The article reports on research which was conducted to investigate the pharmacokinetics of intranasal crushed oxycontin and intravenous oxycodone in nondependent prescription opioid abusers. Researchers evaluated eight healthy volunteers. They found that the intranasal and intravenous methods of delivery of the drugs resulted in the drugs getting into the subjects' bloodstreams faster than if they had been administered in tablet form and that all drug doses were well tolerated by subjects.

Burn injuries are common in children under 10 years of age. Thermal injury is the most common mechanism of injury and scalds account for >60% of such injuries. All children with burns will experience pain, regardless of the cause, size, or burn depth. Under treated pain can result in noncompliance with treatment and, consequently, prolonged healing. It is acknowledged that the monitoring and reporting of pain in children with burns has generally been poor. Due to the adverse physiological and emotional effects secondary to pain, adequate pain control is an integral and requisite component in the management of children with burns. A multi disciplinary approach is frequently necessary to achieve a robust pain relief. Key to successful treatment is the continuous and accurate assessment of pain and the response to therapy. This clinical review article discusses the essential aspects of the pathophysiology of burns in children provides an overview of pain assessment, the salient principles in managing pain, and the essential pharmacodynamics of commonly used drugs in children with burn injuries. Both pharmacological and nonpharmacological treatment options are discussed, although a detailed review of the latter is beyond the scope and remit of this article. [ABSTRACT FROM AUTHOR]

Aim: To identify and describe the nature of online discussion relating to prescription opioids within the UK., Methods: We performed analysis of posts originating in the UK related to buprenorphine, hydrocodone, oxycodone and tramadol using Social Studio, a web-monitoring platform. The study included posts published between January 2014 and December 2016. The data were cleaned to produce a final dataset consisting only of substantive mentions, which were then categorised by defined themes., Results: The final dataset included a total of 17 361 substantive mentions (2936 buprenorphine, 2894 hydrocodone, 3826 oxycodone and 7705 tramadol). The most common theme for all 4 drugs was sharing experience or opinion comprising over 90% of mentions for each drug, while discussion related to polysubstance use was present in >1/4 of mentions across drug substances. Mentions related to diversion were more common for hydrocodone and oxycodone (8.1% [6.3-10.1 95% confidence interval] and 7.8% [6.5-9.2], respectively) than buprenorphine or tramadol (4.1 and 3.9% [3.5-4.3], respectively)., Conclusion: This investigation shows that there is substantial online discussion relating to a variety of nonmedical use (NMU) behaviours of prescription opioids within the UK, including for hydrocodone, which is not medically available. Web monitoring provides useful data and merits future investigation; this could include expansion to other categories of drugs and a more in-depth analysis of motivations behind NMU, both of which could add timely evidence regarding the current situation in the UK and help inform public health interventions for NMU of prescription drugs., (© 2020 British Pharmacological Society.)

Aims This study aims to review ways in which UK and US practitioners manage post-operative dental pain following oral surgery procedures, focusing on the use of opioids in Boston, US and Birmingham, UK.Methods An anonymous online questionnaire was distributed to clinicians from either Birmingham Dental Hospital, UK and Harvard School of Dental Medicine or Boston University School of Dental Medicine, US. They were invited to fill this out via email link or in person using a tablet provided. Information was collected regarding age, years of experience, area of practice, area of undergraduate training, gender and levels of oral surgery activity. Participants were presented with six clinical scenarios and asked to indicate how they would achieve post-operative analgesia for each.Results A total of 44 responses were received, 22 from each city, including 27 males and 17 females. Fifty-five percent of respondents carried out at least ten weekly oral surgery procedures, with 52% having more than ten years' experience. Forty-one percent were aged greater than 40 years, with 32% less than 30. Boston dentists were 2.1 times (P = 0.016) more likely to opt for opioids than Birmingham dentists. Both cohorts were more likely to choose opioids for invasive surgeries involving flap procedures compared to simple extractions. Among the cases where UK respondents opted for opioids, codeine was chosen in 100% of cases compared to 9% for the US cohort, where the remainder chose more potent opioids (oxycodone, hydrocodone and tramadol).Conclusions Results of this preliminary study show that Boston practitioners were likely to opt for opioids in a higher proportion of cases (19.84%) than Birmingham practitioners (9.42%). Reasons for the discrepancies could be related to how practitioners are trained, patient expectations on pain relief and health policy in the two countries. Dental prescriptions have contributed to the US opioid epidemic and their decreased use will be important in combatting the crisis.

Background: Understanding prescription medication misuse is challenging due to lack of consistent measures of misuse behaviors and prevalence between countries. Tramadol is an atypical opioid with a dual mechanism, and has low drug liking compared to conventional opioids. We evaluate tramadol misuse compared to conventional opioids utilizing a harmonized validated national survey across four countries: Germany, Italy, Spain, and the United Kingdom (UK)., Methods: Data from the Survey of Non-Medical Use of Prescription Drugs (NMURx) Program online cross-sectional general population national surveys are analyzed from 2018 from four countries, with 45,000 total responses. Misuse and abuse of tramadol, codeine, morphine, and oxycodone are compared, and national prevalence estimates calculated via calibration weighting. Rates are calculated per population and per drug availability. Supplemental data are included from patients entering treatment centres and poison centre exposures., Results: In 2018, distribution, misuse, and abuse of four prescription opioids show similar patterns across four countries. In all countries, codeine is misused by the largest number of adults (estimated 861,181 in Italy to 4,676,680 in Spain in past 12 months). When adjusted for availability, tramadol is misused uncommonly with lowest or second lowest rates in all countries. Most abuse occurs by the oral route for all opioids, including tramadol with only 7.27 (Germany) to 54.92 (UK) cases per 100,000 units sold., Conclusions: In four countries, tramadol misuse and abuse are infrequent both in absolute number of cases and in comparison to conventional opioids. Even with availability of intravenous tramadol formulations, misuse by injection is rare., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: This study compared adverse outcomes and resource use for patients with a diagnosis of pain treated with tapentadol prolonged-release (PR) versus those treated with morphine controlled-release (CR) and oxycodone CR., Methods: Data were sourced from the Clinical Practice Research Datalink (CPRD), a database derived from UK primary care. Patients prescribed tapentadol PR between May 2011 and December 2016 were selected and matched to two groups of controls treated with either morphine CR or oxycodone CR on gender, age, pain duration, pain site, pain aetiology, Charlson index and prior analgesia. Times to first adverse event (constipation or nausea/vomiting) were compared within a Cox proportional hazards model. Rates of primary care contacts, accident and emergency contacts and, for a subset of patients linked to Hospital Episode Statistics (HES), inpatient admissions and outpatient contacts were compared using incidence rate ratios (IRRs) derived from Poisson regression., Results: A total of 1907 patients prescribed tapentadol PR were identified and 1791 (93.9%) had a pain diagnosis. Of these 1246 (65.3%) were matched to morphine controls and 829 (43.4%) to oxycodone controls. Compared to controls, gastrointestinal adverse events with tapentadol PR treatment were reduced; aHR = 0.532 (0.402-0.703; p < 0.001) versus morphine CR and 0.517 (0.363-0.735; p < 0.001) versus oxycodone CR. Compared with morphine CR, primary care contacts [IRR = 0.831 (0.802-0.861)], accident and emergency attendance [0.739 (0.572-0.951)], outpatient contacts [0.917 (0.851-0.989)] and inpatients contacts [0.789 (0.664-0.938)] were reduced. For oxycodone, the respective figures were 0.735 (0.703-0.768), 0.971 (0.699-1.352), 0.877 (0.799-0.962) and 0.748 (0.601-0.932)., Conclusion: Tapentadol PR was associated with significantly fewer adverse gastrointestinal events than morphine CR and oxycodone CR in patients with a diagnosis of pain. There was also significantly reduced primary and secondary care resource use. As with all observational studies, potential bias due to residual confounding and confounding by indication should be considered., Funding: Grünenthal Ltd.

This article presents medical news briefs. Purdue Frederick Company of Connecticut in the United States has pleaded guilty to misbranding OxyContin with intent to defraud and mislead the public. A recommendation from the British Food Standards Agency says bread should be fortified with folic acid to help prevent birth defects. A report on the number of stabbings that have resulted in hospital admissions in England has increased almost a third in eight years.