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Item Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: a qualitative study in Indiana(BMJ, 2017-11-12) Al Achkar, Morhaf; Revere, Debra; Dennis, Barbara; MacKie, Palmer; Gupta, Sumedha; Grannis, Shaun; Medicine, School of MedicineObjectives The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana’s opioid prescription legislation on the patient experiences around pain management. Setting This is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis. Participants Nine patient participants and five primary care providers were included in the study. Results Living with chronic pain is disruptive to patients’ lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient–provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change. Conclusions As a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.Item Long-term Prescription Opioid Utilization, Substance Use Disorders, and Opioid Overdoses after Adolescent Trauma(Wolters Kluwer, 2019-03) Bell, Teresa M.; Raymond, Jodi; Vetor, Ashley; Mongalo, Alejandro; Adams, Zachary; Rouse, Thomas; Carroll, Aaron; Surgery, School of MedicineBACKGROUND Injured adolescents have a 56% increased risk of developing a substance use disorder (SUD) within 3 years of their injury. The transition from medical prescription opioid use to nonmedical use in adolescent trauma patients has not been longitudinally studied long-term. The aim of this study is to describe 5-year patterns of opioid use in a cohort of injured adolescents as well as the proportion of patients experiencing overdose and SUD diagnoses. METHODS Our retrospective cohort study consisted of 736 patients 12-18 years old who were admitted for trauma from 2011-2013. We examined up to 5 years of regional health information exchange data containing information on prescription fills as well as diagnoses from inpatient, outpatient, and emergency department encounters. RESULTS At 1 year, over 20% of adolescents filled more than 2 opioid prescriptions after being discharged for their injury; and at 4 years, over 13% had received more than 8 opioid fills. Over the 5 year period, 11% received an opioid antagonist injection, 14% received an SUD diagnosis, and 8% had an overdose diagnosis. Relatively few patients had diagnoses for other mental health conditions including depression (5.5%), post-traumatic stress disorder (PTSD) (2.1%), and chronic pain (3.6%). CONCLUSIONS Opioid usage remains high for multiple years in a subset of the adolescent trauma population. Mental health diagnosis rates were substantially lower in injured adolescents than what has been reported in adults. However, overdose and SUD diagnoses occur in over 1 in 10 adolescents within 5 years of their injury.