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In this entry of Small Doses, we're bringing you news on the opioid crisis, a link between aspirin and breast cancer, and more.
Up next: Opioid use after surgery
Continued Opioid Use May Start After Surgery
Continued use of opioids after surgery is more common than previously thought, according to a study published in JAMA Surgery. Researchers at the University of Michigan looked at insurance claim data from 2013 to 2014 for more than 36,177 adult patients who underwent minor or major surgery and who had not used opioids in the previous year. They calculated the incidence of persistent opioid use for more than 90 days and found that, compared to a control group who had not had surgery, 5% to 6% continued to fill opioid prescriptions after their recovery period. Patients who had a history of smoking or abuse of alcohol or drugs had a 30% higher risk. There was no difference seen in continued use between minor or major surgery. “This suggests [persistent] use is not due to surgical pain but addressable patient-level predictors,” the authors concluded.
Brumett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. Published online April 12, 2017.
Low-Dose Aspirin Linked with Reduced Risk of Common Type of Breast Cancer
Taking an 81-mg dose of aspirin appears to be linked to a 20% reduction in risk of developing hormone-receptor positive, HER2 negative breast cancer. The finding comes from analysis of data from the California Teachers Study, a prospective study that enrolled 133,000 active and retired women educators in 1998. In 2005, more than 57,000 of these participants provided information on medications they used regularly. In this group, 1,457 women developed invasive breast cancer before 2013. The researchers found that developing breast cancer was inversely associated with taking three or more low-dose aspirin per week. This reduction was not seen with regular-dose aspirin or other nonsteroidal anti-inflammatory drugs. However, the study does not establish a causal relationship. A 20% reduction in risk is considered a moderate reduction.
Clarke CA, Conchola AJ, Neuhausen SL, et al.: Regular and low-dose aspirin, other non-steroidal anti-inflammatory medications and prospective risk of HER2-defined breast cancer: the California Teachers Study. Breast Cancer Res. 2017; 19:52.
Measles Outbreak Caused by Vaccine Skeptics
Health officials in Minnesota are blaming the state’s biggest measles outbreak in decades on vaccine skeptics. The outbreak, health officials say, proves that antivaccine advocates are wrong. Officials described a “natural experiment” where vaccination rates fell and disease rates went up. In Minnesota, 44 people, mostly children, have been infected, and 11 children have been hospitalized. Somali immigrants have been hardest hit by the outbreak. Health officials blame targeted efforts of antivaccine groups in spreading widespread doubts about the safety of vaccination in the Somali community.
Fox, M: “Measles outbreak in Minnesota caused by vaccine skeptics,” NBC News, accessed May 8, 2017. http://nbcnews.to/2pXYrap.
Two Studies Find Mixed News on Diabetes
An April issue of The New England Journal of Medicine produced both good and bad news about diabetes. One study found that the incidence of both type 1 and type 2 diabetes had increased significantly (by 1.8% and 4.8%, respectively) in American children between 2002 and 2012. The increase in T2D was larger among Blacks, Asian or Pacific Islanders, and Native Americans.
The other study analyzed data from patients in Sweden with either T1D or T2D. The study found that, between 1998 and 2014, mortality and the incidence of heart disease and stroke declined substantially in these patients. However, there was a lower reduction in fatalities among those patients with type 2 diabetes.
Mayer-Davis EJ, Lawrence JM, Dabelea D, et al. Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012. N Engl J Med 2017; 376:1419-1429. April 13, 2017. DOI: 10.1056/NEJMoa1610187.
Rawshani A, Rawshani A, Franzen S, et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med. 2017; 376:1407-1418. April 13, 2017.
Salesperson Pushing Opioids Also Addicted to Opioids
Jeffery Pearlman, a district sales manager for Insys Therapeutics, is one of many from Insys on trial for allegedly pushing their prescription painkiller, Subsys, onto doctors and, in Pearlman’s case, a nurse hired by the company to promote the drug. The case alleges that Insys enticed these nurses and doctors to generate more prescriptions for the drug. The irony was that during this whole process, Pearlman was addicted to the opioids he was pushing. After a car wreck left him in pain, he found himself becoming more and more addicted. A STAT exclusive article chronicles his addiction and recovery, and what this case may say about opioid addiction.
Armstrong, D: STAT news, “Sales executive for opioid maker was addicted to the drug he promoted” accessed May 8, 2017. http://bit.ly/2pUXejF