A wide range of preexisting psychiatric and behavioral conditions and the use of psychoactive drugs could be important risk factors leading to long-term use of opioid pain medications, reports a study in PAIN, the official publication of the International Association for the Study of Pain (IASP). 

Using a nationwide insurance database, the researchers identified 10.3 million patients who filed insurance claims for opioid prescriptions between 2004 and 2013. The study looked at whether preexisting psychiatric and behavioral conditions and use of psychoactive medications were predictors of later opioid use.

"We found that preexisting psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids," write Patrick D. Quinn, PhD, of Indiana University, Bloomington, and colleagues. The association appears stronger for long-term opioid use, and especially for patients with a previous history of substance-use disorders.

The results also suggest that some outcomes viewed as harmful outcomes of opioid use—substance-use disorders, depression, suicidal or self-injuring behavior, and motor vehicle crashes—are also predictors of which patients are at risk of long-term use of prescription opioids.

Overall, the results suggested a "modest" increase in any opioid prescriptions for patients with previous psychiatric or behavioral conditions (depression or anxiety disorders, opioid or other substance use disorders, suicide attempts or other self-injury, motor vehicle crashes, and sleep disorders) or use of psychoactive medications.

About 1.7% of patients with opioid prescriptions become long-term opioid users (6 months or longer). But the risk became substantially higher for patients with mental health conditions or psychoactive medication use. Relative increases in rates of long-term opioid use ranged from 1.5 times for patients taking medications for attention-deficit/hyperactivity disorder, to about 3 times for those with previous substance use disorders other than opioids, to nearly 9 times for those with previous opioid-use disorders.

Amid the continuing opioid epidemic, it's important to understand which patients select (or are selected for) treatment with these pain medications. Previous studies have suggested a pattern of "adverse selection": patients at greatest risk of harmful outcomes, including those with substance abuse and other psychiatric conditions, may be more likely to be prescribed opioids in higher doses and for longer durations.

"Our results add to existing evidence that the risk of long-term opioid receipt associated with [preexisting] psychiatric and behavioral conditions is widespread and relates to multiple diagnoses and psychoactive medications," Dr. Quinn and coauthors write. The results add to previous evidence suggesting that opioids are more likely to be prescribed to certain groups of patients at high risk for adverse outcomes.

Dr. Quinn and coauthors conclude: "Our findings support the ideas that clinical practice has deviated from the 'careful selection' under which most clinical trials are conducted and that thorough mental health assessment and intervention should be considered in conjunction with the use of long-term opioid therapy."

Click here to read “Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims.”

Article: “Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims” (doi: 10.1097/j.pain.0000000000000730)

Human papillomavirus-positive oropharynx cancers (cancers of the tonsils and back of the throat) are on rise. After radiation treatment, patients often experience severe, lifelong swallowing, eating, and nutritional issues. However, new clinical trial research shows reducing radiation for some patients with HPV-associated oropharyngeal squamous cell carcinomas can maintain high cure rates while sparing some of these late toxicities.

“We found there are some patients have very high cure rates with reduced doses of radiation,” said Barbara Burtness, MD, Professor of Medicine (Medical Oncology), Yale Cancer Center, Disease Research Team Leader for the Head and Neck Cancers Program at Smilow Cancer Hospital, and the chair of the ECOG-ACRIN head and neck committee. “Radiation dose reduction resulted in significantly improved swallowing and nutritional status,” she said.

The study, published in the December 26 issue of the Journal of Clinical Oncology, showed that patients treated with reduced radiation had less difficulty swallowing solids (40% versus 89% of patients treated with standard doses of radiation) or impaired nutrition (10% versus 44% of patients treated with regular doses of radiation).

“Today, many younger patients are presenting with HPV-associated squamous cell carcinoma of the oropharynx,” said Dr. Burtness. “And while traditional chemoradiation has demonstrated good tumor control and survival rates for patients, too often they encounter unpleasant outcomes that can include difficulty swallowing solid foods, impaired nutrition, aspiration and feeding tube dependence,” said Dr. Burtness. “Younger patients may have to deal with these side effects for decades after cancer treatment. We want to help improve our patients’ quality of life.”

The study included 80 patients from 16 ECOG-ACRIN Cancer Research Group sites who had stage three or four HPV-positive squamous cell carcinoma of the oropharynx, and were candidates for surgery. Eligible patients received three courses of induction chemotherapy with the drugs cisplatin, paclitaxel, and cetuximab. Patients with good clinical response then received reduced radiation.

Study results also showed that patients who had a history of smoking less than 10 packs of cigarettes a year had a very high disease control compared with heavy smokers.

Other authors on the paper include: Shanthi Marur (Johns Hopkins Medicine) and Anthony Cmelak (Vanderbilt University).

Mouth infections are currently regarded as the main reason why dental implants fail. A piece of research by The University of the Basque Country (UPV/EHU) in Spain has succeeded in developing coatings capable of preventing potential bacterial infection and should it arise, eliminate it as well as providing implants with osseointegrating properties, in other words, ones that facilitate anchoring to the bone.

The quest for surfaces capable of preventing bacterial colonisation and adhesion in the area surrounding the implant "is a subject of undoubted interest, borne out by the huge number of publications that have been developed in this field," explained Beatriz Palla, researcher in the Biomaterials Group of the UPV/EHU's Department of Polymer Science and Technology. The fact is that "about 10% of implants have to be removed due to osseointegration problems or to the onset of infections," she added.

When it comes to designing strategies to combat these problems, one has to bear in mind the challenge posed by providing the surface of titanium implants with antibacterial properties, and at the same time, by the tremendous resistance that bacterial strains are capable of developing to conventional therapies with antibiotics.

That was the challenge that the UPV/EHU group, which has for some time been developing materials geared towards dental implants, was keen to tackle. "We had already obtained coatings that facilitate the generating of bone around the implant and thus facilitate anchoring to the bone. In a bid to go a step further, we looked at how to turn these coatings into bactericides," said the researcher.

The method they used for this was sol-gel synthesis. Sol-gel synthesis is based on the preparation of a precursor solution (sol) that when left on its own for a while turns into a gel that can be used to coat the surface of the titanium screw, and after heat treatment at a high temperature in the kiln ends up finally being adhered to the screw that will be implanted. "We used silica as the precursor, because in many studies this compound has been shown to be osteoinductive, so it facilitates one of the objectives we wanted to achieve. What is more, to provide the materials with antibacterial characteristics, we added various antibacterial agents."

In the study carried out, Palla developed three types of coatings depending on the various antibacterial agents chosen; each one had a mechanism to tackle bacterial infections, either prophylactically by preventing the bacteria from becoming adhered initially and the subsequent infection, or else by eliminating it once it has developed.

What was needed in the case of prophylactic coatings was "a material with a very long degradation time so that it would remain adhered to the screw and work for as long as possible preventing bacteria from becoming adhered," said Palla. In the coatings designed to eradicate an infection that has already taken hold, however, "a rapidly degrading material is needed so that it can release the antibacterial agent as quickly as possible to attack the infection." What is more, one of the coatings developed for this purpose "is designed to be used in situ, at the dentist's surgery itself, on the infected screw without any need to extract the implant from the patient. This new material is in the process of being patented and remains a trade secret," pointed out the researcher.

In view of the results, Palla believes that "it is possible to confirm that coatings with an antibacterial capability and which do not affect the proper integration of the implant into the jawbone have been developed." She also admits, however, that there is still a long way to go until they can be applied and used at dentists' surgeries: "Apart from all the trials that remain to be carried out, it would also be advisable to pursue the research a little further to optimize the results more."

Albuquerque, NM, January 2, 2017–  The Ascend Dental Academy will serve as OCO Biomedical’s exclusive education partner to provide today’s dentists with comprehensive dental implant surgical and restorative training.   OCO Biomedical pledges to be the best resource and product provider for implant dentists, which includes providing the most practical and comprehensive training in the industry.  This has led to the partnership with Dr. Ara Nazarian, world renowned educator and widely respected implantologist.  The Ascend Dental Academy, a joint venture with Dr. Nazarian, was created to meet this demand and will be the exclusive OCO Biomedical education partner.  As the Chief Clinical Officer, Dr. Nazarian will oversee the program and share his knowledge of no-nonsense, comprehensive dental implant training with dentists who want to learn the most efficient, effective and profitable ways to place dental implants.  For more information, please visit ascenddentalacademy.com and ocobiomedical.com.

“I see OCO Biomedical continuing to affect implant dentistry with its visionary approach to providing products, materials and techniques that encourage dentists to provide the most for their patients while fulfilling their own potential.  The Ascend Dental Academy will deliver practical dental implant education and mentoring that promote optimal clinical results.” Ara Nazarian, DDS, DICOI, Chief Clinical Officer / Ascend Dental Academy

The Ascend Dental Academy provides dental professionals and their corresponding staff with advanced dental training and practice enhancement.