In my senior year at ETSU I produced a documentary about opioid abuse in East Tennessee. In 2016, two local health care providers and a university collaborated on a project that would bring an opioid treatment center to Gray, Tennessee. The center includes a methadone clinic, an addition that piqued the concern of many citizens living in Gray. The film evaluates the concerns citizens had about the clinic and explores the issue of opioid abuse in East Tennessee.

Objectives: 1) To determine 2010 pharmacy-related ambulatory care sensitive condition (ACSC) hospital discharges by Tennessee (TN) county; 2) To explore pharmacy-related ACSC hospital discharges across county characteristics for Tennessee counties, including community pharmacies per county, age, and county rurality; 3) To explore pharmacy-related ACSC hospital discharges across age for northeastern Tennessee counties. Methods: Data were obtained from the TN Department of Health Statistics (hospital discharge data), TN Board of Pharmacy (licensed community pharmacies), the United States (US) Census Bureau (county-level populations), the Office of Rural Health Policy (rural designations), and the US Health Resources and Services Administration (health professional shortage area designations). ACSC discharges were determined using the Agency for Healthcare Research & Quality's (AHRQ's) Prevention Quality Indictors (PQIs) for asthma, bacterial pneumonia, congestive heart failure, chronic obstructive pulmonary disease, hypertension, uncontrolled diabetes, and short-term and long-term diabetes complications. County-level analyses were population adjusted and analyzed across age. Analyses were conducted using SPSS and ArcGIS software. Results: In 2010, 79,683 hospital discharges were noted for pharmacy-related ACSCs, 55% of which were for residents 65 and over. For northeast Tennessee counties, 8,538 were documented accounting for 11% of Tennessee pharmacy-related ACSCs discharges. Bacterial pneumonia, heart failure, and COPD accounted for nearly 65% of discharges in northeastern Tennessee counties. The number of community pharmacies per Tennessee county was statistically significantly negatively correlated with county-level bacterial pneumonia (r=-0.339; p=0.001), CHF (r=-0.215; p=0.036), and COPD (r=-0.403; p<0.001) hospital discharges. Implications/Conclusions: Community pharmacies have the potential to positively impact the health needs of Tennesseans by targeting services (e.g., MTM, immunizations, adherence assistance) based on ambulatory care sensitive conditions. Future research is warranted to quantify current services and determine the capacity to provide such services.

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Book Summary: This outstanding resource guide for students and young adults provides an introduction to the history of prescription drug abuse that explains how this problem has arisen and examines the social, political, economic, and health issues associated with prescription drug abuse in modern society. • Explains the dangers associated with the use of prescription drugs for nonmedical purposes • Provides a detailed introduction for readers seeking to learn about the topic of prescription drug abuse and serves as an research tool for school projects • Includes thought-provoking perspective essays from individuals involved in the discussion of how to address prescription drug abuse • Supplies primary source documents in the form of excerpts from laws, administrative rulings, and court cases regarding prescription drug abuse as well as a glossary of key terms used in discussing the topic of prescription drug abuse

Background: The United States is currently experiencing an epidemic of opioid abuse. Individuals with opioid dependence may also have major depressive disorder (MDD) as a co-morbid state. MDD is one of the commonest mental health problems in the United States, affecting approximately 7% of the adult population. The relationship between opioid dependence and MDD and the factors that correlate with them have not been fully investigated. This study is designed to evaluate the prevalence of MDD and its associations with risk factors and health conditions such as age, race, sex, liver problems, anxiety, bipolar disorders, hypertension, heart diseases, neurologic damage, head injury and alcohol in opioid dependent patients. Method: The study population comprises of 1646 opioid dependent patients from the National Drug Abuse Treatment Trial Network (CTN) - CTN 0027. Baseline information on sex, age, race, liver disease, bipolar disorder, anxiety, neurologic damage, heart disease, hypertension, alcohol dependence, allergies, gastrointestinal problems and head injury were collected. Data analysis was done using univariate and multiple logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of MDD among patients with opioid dependence was 28.3% (22.8% for males and 39.5% for females). The prevalence initially increased with increasing age stratum but declined after age 50 years with the highest prevalence in the age 36 – 49years group. The multiple logistic regression analysis showed that MDD in opioid dependent patients was significantly associated with being female (OR =1.83, 95%CI = 1.32 -2.55; p = 0.003), liver disease (OR = 1.64, 95%CI = 1.15 - 2.34, p = 0.006), anxiety (OR = 6.12, 95%CI = 4.44 - 8.44, p

Drug poisoning due to overdose is a major health problem in Tennessee. In TN there has been an increase of 210% in accidental overdose deaths since 1999 to 2010. About 80% of drug poisonings in Tennessee were either accidental or self-inflicted. Also as indicated by the CDC in 2010 enough drugs were prescribed to medicate every American adult around-the-clock for one month and the vast amount of drugs increases the risk of misuse. Drug Take Back Events are a useful measure for reducing the number of prescription medications kept in the households. However, the extent to which these events have affected in the reduction of drug poisoning is not well known. The objective of this study was to investigate the relation between the total number of drugs collected at Take Back Events and emergency department admissions due to overdose in three Counties in Northeast TN. In partnership with Drug Enforcement Administration and local law enforcement, drop box donations for controlled substances (CS) were analyzed for Washington, Carter and Sullivan County, Tennessee, from 2009 to 2012. Data were obtained from Tennessee Department of Health on number of emergency department (ED) admissions due to overdose based on International Classification of Diseases (ICD)-9 codes occurred between 2009 and 2012 in the above-mentioned counties. Linear forecast trend-line method was used to evaluate associations between the amount of controlled substances collected via donation boxes and number of ED visits occurred during 2009-12. Furthermore Pearson’s correlation analyses were conducted to investigate relationship between drop box donations and ED admissions due to overdose. From 2009 – 2012 the ED visits shows a significant decrease as the amount of drugs collected increases for Washington and Carter County. Also a negative correlation is seen between the ED visit and drugs collection for Washington and Carter County with R2 values of -0.96 and -0.90 respectively. However the same is not true for Sullivan County as the trend was not inversely proportional and also the correlation between ED visits and gathered drugs is low with R2 value of -0.562. These results quantify the potential impact of drug take back events on reduction in drug poisoning due to overdose in Northeast Tennessee. Further study is required to examine the effect of the events on the epidemic of prescription drug abuse and misuse.

The US Food and Drug Administration (FDA) is encouraging the innovation of long-acting opioid formulations that are manipulation-resistant. The purpose of this commentary is to assess the benefits and limitations of abuse-deterrent opioid formulations (ADFs) and discuss their role in mitigating the current opioid epidemic. ADFs have been created with chemical properties that make it difficult for people who non-medically use prescription drugs to crush and dissolve opioid tablets, as well as by combining opioids with antagonists such as naloxone or naltrexone, which are released only when the dosage form has been manipulated or the drug is taken by a non-intended route. Despite these and other technologies, consensus regarding the effectiveness of these formulations in preventing non-medical use is lacking given the difficulty in obtaining post-marketing data. Researchers also question if the creation of abuse-deterrent drugs will have a positive effect on those struggling with a severe opioid-use disorder, fearing that current opioid users will simply find a new – perhaps more dangerous – drug of choice. Abuse-deterrent opioids are still opioids, and although they may make manipulation more difficult than non-ADF formulations, they are not “abuse proof.” The introduction of ADFs could provide a false sense of security among prescribers and dispensers, and we fear that ADFs may have a minimal impact on non-medical use of prescription opioids. Further epidemiological studies will be required to determine the large-scale impact of abuse-deterrent opioids in preventing opioid use disorder and its downstream consequences.

The next presentation will examine common gray areas of community pharmacy practice. For example: under what circumstances do pharmacists fill early, transferred controlled substance prescriptions for out-of-town patients; when do pharmacists sell syringes to patients without proof of medical need; and how do pharmacists determine that a buprenorphine prescriber is acting in a patient's best interest? These and other ethical or legal dilemmas challenge pharmacists as they try to balance identifying and preventing potential drug abuse and diversion with providing evidence-based, quality patient care. Based on data from pharmacists and pharmacy students, as well as established theory, presenters will describe typical approaches to decision-making. Multiple pharmacy cases will be discussed. Participants will learn how to integrate best-practice patient care systematically into common practice scenarios.

Thesis (MPH.) -- University of Limpopo, 2015 / Refere to document

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