Bulletin Today
Although buprenorphine treatment for opioid use disorder (OUD)has increased for most age groups, its use among younger individuals has decreased, according to a JAMA study published in January 2020.
“While it’s encouraging to see an overall increase in prescription rates for buprenorphine, the data suggest that the youngest group is having difficulty accessing this potentially lifesaving treatment,” said lead study author Mark Olfson, MD, MPH, Elizabeth K. Dollard professor of psychiatry, medicine, and law at Columbia University Vagelos College of Physicians and Surgeons, in a statement.
The researchers looked at U.S. data on buprenorphine prescriptions filled by individuals aged 15 to 80 years at retail and nonretail pharmacies from 2009 through 2018. They found that annual rates of buprenorphine use more than doubled, from 1.97 per 1,000 people in 2009 to 4.43 per 1,000 people in 2018.
Despite this overall increase, buprenorphine use dropped by around 20% (from 1.76 to 1.40 per 1,000 people) in persons aged 15 to 24 years. This age group also received relatively low doses and experienced low treatment retention. And while buprenorphine treatment is rising, its use is still lower than national estimates of people with OUD in the United States.
“These findings for young people are particularly worrisome, given that their decrease in buprenorphine treatment occurred during a period when there was an increase in opioid-related overdose deaths for this age group,” said Olfson. “Our results highlight the critical need to improve buprenorphine treatment services, especially for the youngest with opioid use disorder.”
More than one-half of dental prescriptions for opioids exceed recommended guidelines
A large-scale study of dental visits resulting in opioid prescriptions found that opioid overprescribing by dentists is common. The results, published in the February 3, 2020, issue of the American Journal of Preventive Medicine, indicate that more than one-half of opioid prescriptions written by dentists exceed the 3-day supply recommended by CDC in its 2016 guidelines for acute dental pain management.
“Unlike national trends, opioid overprescribing by dentists is increasing,” said lead study author Katie J. Suda, PharmD, MS, a professor at the University of Pittsburgh School of Medicine, in a statement. “Our results should initiate a call to action to professional organizations and public health and advocacy groups to improve the guidelines for prescribing opioids for oral pain. As high prescribers of opioids writing prescriptions for a 10th of the opioids dispensed in the U.S., dentists should be included as part of the multifaceted solution needed for the opioid epidemic.”
The research team analyzed more than half a million adult dental visits from 2011 to 2015 within the Truven Health MarketScan Research Databases, which occurred before implementation of the 2016 CDC guidelines. The team determined that 29% of the prescribed opioids were more powerful than deemed medically necessary, exceeding the recommended morphine milligram equivalents for appropriate management of acute pain.
New guideline provides recommendations for management of patients with ulcerative colitis
The American Gastroenterological Association has a new guideline for medical management of patients with ulcerative colitis. The recommendations, published in a recent issue of Gastroenterology, focus on adult outpatients with moderate to severe ulcerative colitis and hospitalized adult patients with acute severe ulcerative colitis.
Several drugs are available for long-term management of ulcerative colitis, and providers have had questions about optimal care for these patients. The guideline addresses these questions, concentrating on use of immunomodulators, biologics, and small molecules to induce and maintain remission as well as to decrease the risk of colectomy.
“With so many drugs available, the question for many gastroenterologists is what is the right drug for my patient,” said lead author Joseph D. Feuerstein, MD, of the division of gastroenterology and center for inflammatory bowel diseases at Beth Israel Deaconess Medical Center in Boston.
“This guideline takes a comprehensive evidence-based look at available therapies to provide the most trusted guidance to date on treatment options to ultimately improve the care of patients with moderate to severe ulcerative colitis,” Feuerstein continued. The top five most important recommendations are as follows:
- In adult outpatients with moderate to severe ulcerative colitis, use infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab over no treatment.
- In adult outpatients with moderate to severe ulcerative colitis who are new to biologics, use infliximab or vedolizumab rather than adalimumab to induce remission.
- In adult outpatients with moderate to severe ulcerative colitis who have been exposed to infliximab, particularly those who were not responsive, use ustekinumab or tofacitinib, rather than vedolizumab or adalimumab, to induce remission.
- In adult outpatients with moderate to severe ulcerative colitis, use biologics early with or without immunomodulator therapy, rather than gradual step-up after failure of 5-aminosalicylates.
- In hospitalized adult patients with acute severe ulcerative colitis refractory to I.V. corticosteroids, use infliximab or cyclosporine.
New Jersey pharmacies must now inform patients about medication disposal
Legislators in New Jersey don’t want medication disposal to be an afterthought any longer. On January 21, New Jersey Gov. Phil Murphy signed a bill into law that will require all New Jersey pharmacies to inform patients—in writing or verbally—about how to safely dispose of all controlled substances.
Pharmacies will also need to provide access to a safe disposal method for patients.
The bill—“Charlie’s Law”—was inspired by the opioid epidemic and took more than 2 years of legislative effort.
SGLT2 inhibitors may reduce gout risk in patients with diabetes
Sodium–glucose cotransporter-2 (SGLT2) inhibitors, such as canagliflozin, dapagliflozin, and empagliflozin, may lower the risk of gout in adults with type 2 diabetes, according to a study published on January 14, 2020, in Annals of Internal Medicine.
Using data from a U.S. nationwide commercial insurance database from March 2013 to December 2017, the study researchers compared the rate of gout associated with SGLT2 inhibitors, which are known to lower uric acid levels, and glucagon-like peptide-1 (GLP-1) receptor agonists, which do not.
They matched 120,000 adult patients with type 2 diabetes taking SGLT2 inhibitors with 120,000 patients taking GLP-1 receptor agonists. The patients were all new users of their medications.
The researchers excluded people who had a history of gout or had been treated previously for gout.
After a mean follow-up of 260 to 300 days, the researchers found that patients taking SGLT2 inhibitors experienced significantly lower incidence rates of gout than those who were taking GLP-1 receptor agonists (4.9 vs. 7.8 events per 1000 person-years).
The authors wrote that if the findings are confirmed in future studies, “SGLT2 inhibitors might be an effective class of medication for the prevention of gout for patients with diabetes or metabolic disorders.”
Jury still out on safety of chemicals in sunscreens
FDA continues to evaluate the safety of sunscreen products. In a new study published in JAMA on January 21, 2020, researchers from FDA’s Center for Drug Evaluation and Research assessed the systemic absorption of avobenzone, oxybenzone, octocrylene, homosalate, octisalate, and octinoxate—the active ingredients found in sunscreen products.
They divided 48 healthy volunteers randomly into four groups that each tested a different commercially available sunscreen product: lotion, aerosol spray, nonaerosol spray, or pump spray. The study volunteers applied each product once on the first day and four times on days 2 through 4, with investigators collecting dozens of blood samples over 3 weeks.
The main outcome was maximum plasma concentration of avobenzone over days 1 through 21, which was calculated at 7.1 ng/mL for the sunscreen lotion, 3.5 ng/mL for both the aerosol and nonaerosol sprays, and 3.3 ng/mL for the pump spray. Avobenzone is a common chemical in sunscreen that provides protection from UVB as well as UVA rays.
On the first day of use, avobenzone was systemically absorbed and subsequently produced plasma concentrations greater than 0.5 ng/mL—the threshold at which FDA may consider waiving some of the additional safety studies for sunscreens. The finding was applicable across the remaining five active ingredients as well. The investigators emphasized that the results do not support nonuse of sunscreen and that more study is needed.
In 2019, FDA said that only 2 of 16 currently marketed active ingredients used in sunscreens are recognized as safe and effective: zinc oxide and titanium dioxide. Another two ingredients, PABA and trolamine salicylate, are not considered safe and effective. This left 12 ingredients for which there are insufficient data to make a positive determination about safety and efficacy, said FDA.
Study finds steeper increases in blood pressure for women
New research published in JAMA Cardiology on January 15, 2020, indicates that high blood pressure starts at a younger age in women than in men and increases more rapidly.
The report used data collected over more than 4 decades in nearly 33,000 individuals aged 5 to 98 years. By the time women are in their 20s, the data indicated, they have faster increases in blood pressure than men, and the difference continues throughout their lives. The variation was significant for systolic and diastolic blood pressure measures as well as for pulse pressure and mean arterial pressure.
“In contrast with the notion that important vascular diseases in women lag behind men by 10 to 20 years, our findings indicate that certain vascular changes not only develop earlier but also progress faster in women than in men,” the authors wrote. “In effect, sex differences in physiology, starting in early life, may well set the stage for later-life cardiac as well as vascular diseases that often present differently in women compared with men.”
In an accompanying editorial, Nanette Wenger, MD, from Emory University School of Medicine, wondered if women are more likely than men to have uncontrolled hypertension and its adverse consequences because of the earlier and steeper blood pressure trajectory.
“Hypertension is the predominant diagnosis for ambulatory care visits for women. Yet, compared with men, women remain undertreated to goal, such that treated vs. untreated analyses remain flawed,” she wrote. “Again, contemporary data suggest that drug dosages may differ between the sexes, with unknown associations with hypertensive therapy adherence and blood pressure control. There are more adult U.S. women taking antihypertensive medications with blood pressure levels higher than treatment goals than men.”