1. More than one third of U.S. adults used a prescription opioid in 2015 and a substantial number of them reported misuse or abuse
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0865
Editorial: http://annals.org/aim/article/doi/10.7326/M17-1559
URLs go live when the embargo lifts
In 2015, more than a third (91.8 million) of the U.S. adult population used prescription opioids, 11.5 million adults reported misusing them, and 1.9 million said they had a use disorder. Results of the 2015 National Survey on Drug Use and Health (NSDUH) are published in Annals of Internal Medicine.
Misuse and use disorders were most commonly reported in adults who were uninsured, were unemployed, had low income, or had behavioral health problems. Relief from physical pain was the most commonly reported motivation for those who said they had misused an opioid in the past year. Misuse included using opioids without a prescription (59.9 percent) or obtaining them from friends or relatives (50.2 percent). Diversion of an opioid prescription also involved criminal activities, especially for those with use disorders. The survey showed that 13.8 percent of adults with use disorders obtained their most recently misused prescription opioids from drug dealers or strangers.
Such widespread social availability of prescription opioids suggests that they are commonly dispensed in amounts not fully consumed by the patients to whom they are prescribed. Diversion is especially common when opioids are prescribed in greater quantities than needed or for conditions for which they have no benefit. The findings highlight the importance of interventions targeting medication sharing, selling, and diversion and underscore the need to follow prescribing guidelines to minimize environmental availability of opioids.
Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. For an interview with the author, Wilson Compton, MD, MPE, please contact the NIDA press office at media@nida.nih.gov or 301-443-6245.
2. Updated review confirms efficacy and safety of most standard treatments for latent tuberculosis infection
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0609
URLs go live when the embargo lifts
Robust evidence confirms that most standard treatment regimens currently recommended by the World Health Organization and the Centers for Disease Control and Prevention for latent tuberculosis infection (LTBI), including rifampicin-isoniazid for 3 months, are safe and effective for preventing active TB. The evidence for rifapentine-isoniazid for 3 months with a reduced pill burden is improving, but more evidence is still needed. The results of an updated network meta-analysis are published in Annals of Internal Medicine and will inform the European Centre for Disease Prevention and Control's (ECDC) new guidance on programmatic LTBI control in the European Union/European Economic Area and candidate countries.
TB is a global priority infectious disease that caused an estimated 1.4 million deaths in 2015. Tackling LTBI, including providing preventive treatment to persons at high risk for TB, is a key action in achieving both the Sustainable Development Goal and the targets of the World Health Organization's End TB Strategy.
Researchers at Public Health England, University College London, and the ECDC reviewed 8 new studies in addition to 53 studies included in their 2014 report to compare the efficacy and harms of LTBI treatment regimens aimed at preventing active TB among adults and children. The data showed that standard antibiotic regimens of 6-month isoniazid monotherapy, rifampicin monotherapy, or combination therapies with 3 to 4 months of isoniazid and rifampicin and 3 months rifapentine-isoniazid are effective for preventing active TB. While the quality and reporting standards of the underlying studies was limited, the evidence for safety and efficacy of most standard treatment regimens was considered robust and reaffirms the strengthening evidence for shorter rifamycin regimens.
Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. For an interview with the lead author, Dominik Zenner, MD, please contact Clare Cook at Clare.Cook@phe.gov.uk.
3. Health insurance a consideration when debating whether or not to prescribe an antidepressant for depression
Medication and cognitive behavior therapy have similar efficacy, but access could be a barrier to some
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0966
URLs go live when the embargo lifts
According to recent guidelines from the American College of Physicians (ACP), second-generation antidepressants and nonpharmacologic treatments, such as cognitive behavior therapy, have similar efficacy for treating major depressive disorder. Physicians may choose either option depending on patient characteristics and preferences. However, access to nonpharmacologic alternatives could be a challenge to some. Two prominent clinical experts from Beth Israel Deaconess Medical Center (BIDMC) debate the treatment strategy for a patient with depression in a multicomponent educational article being published in Annals of Internal Medicine.
Mr. Y, a 64-year-old retired male, saw his primary care physician for depression that has been slowly worsening over time and may have been exacerbated by the 2016 presidential election. He does not feel hopeless, but he cannot seem to shake negative thoughts. He is reluctant to try medication.
General internist, Gerald W. Smetana, MD, argues in favor of a nonpharmacologic treatment for Mr. Y, as the patient is not in immediate danger and clearly has a preference. Dr. Smetana says that adverse events, such as sexual dysfunction, nausea, headache, and weight gain, may hinder adherence to medications. Alternative therapies, such as cognitive behavior therapy, acupuncture, and St. John's wort, have been shown to be as effective as antidepressants without the risk for negative side effects.
Psychiatrist, Roscoe Brady, MD, PhD, acknowledges the ACP guidelines but argues that they do not factor in accessibility, which is a factor that may determine initial treatment at least as much as tolerability or efficacy. For some patients, finding a therapist who accepts their insurance or finding time to visit may be a barrier to care. In addition, research has shown that patients treated with second-generation antidepressants in a real-world setting were twice as likely to achieve remission as those receiving other therapies.
All 'Beyond the Guidelines' papers are based on the Department of Medicine Grand Rounds at BIDMC in Boston and include print, video, and educational components. A list of topics is available at http://www.annals.org/grandrounds.
Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. To interview the experts, please contact Emily Barret at ebarret1@bidmc.harvard.edu or 617-667-7372.
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Also new in this issue:
Immune Checkpoint Inhibitor Therapy in a Liver Transplant Recipient With Melanoma
Gustavo Schvartsman, MD; Kristen Perez, PA-C; Gagan Sood, MD; Riham Katkhuda, MD; Hussein Tawbi, MD, PhD
Observation: Case Report
http://annals.org/aim/article/doi/10.7326/L17-0187
URL goes live when the embargo lifts
Journal
Annals of Internal Medicine