geoffrey modest medical blogs

A recent study found that prescribing buprenorphine or methadone was confirmed to be the most effective treatments for those with opioid use disorder, but these treatments were dramatically underutilized (see opioid use disorder  insuff  ORT jama2020 in  dropbox ,  or doi:10.1001/jamanetworkopen.2019.20622. Details: -- 40,885 individuals with opioid use disorder (OUD) were evaluated, from the OptumLabs Data Warehouse, a large database of people with commercial or Medicare Advantage insurance, including medical, behavioral health, and pharmacy claims. From 2015-2017 -- mean age 48 (with pretty even distribution amongst the 10-year age groups), 54% male, 74% white/8% Hispanic/12% black, 58% commercial insurance/42% Medicare Advantage -- mental health diagnoses: 45% overall (depression 24%, anxiety 26%, alcohol 10%, bipolar 8%, ADHD 4%, PTSD 4%, psychosis 4%) -- injection drug use 14%, hepatitis C 5%, prior opioid overdose 5% -- OUD defined as: ...

From: Geoff A. Modest, M.D. Sent: Tuesday, January 28, 2020 7:45 AM To: Geoff A. Modest, M.D. <GModest@uphams.org> Subject: gabapentin and baclofen overdoses the US Poison Centers have experienced a dramatically increased rate of reports of gabapentin and baclofen exposures (see gabapentin OD clintox2019 in dropbox, or doi.org/10.1080/15563650.2019.1687902 )  Details: -- retrospective review of the US Poison Centers info (and entered in the National Poison Data System) assessed cases of exposure to gabapentin (2013 to 2017) and baclofen (2014-2017) in those over 18 years old -- isolated exposures were highlighted in this report, since they included only the single substance involved, and it would be difficult to disentangle the effects of one substance vs its combination with other drugs . Many people, however, do have exposures to multiple substances , and these were reported as the total number of exposures below --they define “mi...

naloxone: IM vs nasal? You forwarded this message on Wed 11/20/2019 7:33 AM  You forwarded this message on Wed 11/20/2019 7:33 AM G      Geoff A. Modest, M.D. Wed 11/20/2019 7:31 AM Geoff A. Modest, M.D.  JAMA just published a potentially important article from Australia finding that intramuscular naloxone worked more rapidly and effectively than intranasal naloxone for opioid overdose (see  opioid OD naloxone IM vs nasal jamaopen2019  in dropbox, or  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755306  ) Details: -- 197 patients were randomized to intranasal naloxone 800 µg plus IM placebo vs IM naloxone 800 µg plus intranasal placebo, in the Uniting Medically Supervised Injecting Center in Sydney, Australia, a supervised injecting site -- 88% male, mean age 34 -- 61% used heroin, 21% pharmaceutical opioids, 12% fentanyl, 5% meth...