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Scholl L, Seth P, Kariisa M, et al. MMWR Morb Mortal Wkly Rep. 2018;67:1419-1427.
This Centers for Disease Control and Prevention report provides drug and opioid overdose death figures for 2016. The rate of overdose deaths continues to rise, with the largest increase due to synthetic opioids such as fentanyl. The report calls for enhancing prevention and response measures, including the use of naloxone.
Vivolo-Kantor AM, Seth P, Gladden M, et al. MMWR Morb Mortal Wkly Rep. 2018;67:279-285.
The opioid epidemic continues unabated in the United States. Although efforts such as the 2016 Centers for Disease Control and Prevention guideline for opioid prescribing have raised awareness and changed practice, rates of opioid-related deaths are still rising. This study reports trends in emergency department visits for opioid overdose between July 2016 and September 2017. Researchers noted a nearly 30% increase in opioid overdose rates. Overdoses increased in all regions and most states, with the most prominent spikes noted in the West and Midwest. This sobering, high-quality, and timely data will inform initiatives to reduce high-risk prescribing, promote medication-assisted treatment, and improve secondary prevention of overdose. An Annual Perspective outlines strategies for mitigating opioid harms.
Guy GP, Zhang K, Bohm MK, et al. MMWR Morb Mortal Wkly Rep. 2017;66:697-704.
This analysis of retail prescription data revealed that opioid prescribing has declined from a peak in 2010, but it remains higher than in 1999. Increased rates of opioid prescribing occurred in areas that are not urban, have a greater proportion of white populations, and higher unemployment and Medicaid enrollment. These results are consistent with prior studies about the opioid epidemic.
Shah A, Hayes CJ, Martin BC. MMWR Morb Mortal Wkly Rep. 2017;66:265-269.
Opioid use has become a growing patient safety concern. Recent studies have documented wide variation in opioid prescribing for acute pain and a significant rate of chronic opioid use after patients receive a first prescription for an acute indication. This retrospective medical record review study identified risk factors for remaining on an opioid medication for more than 1 year following their initial prescription. Older, female, and publicly or self-insured patients were more likely to remain on an opioid compared with younger, male, and privately insured patients. Patients started on higher doses (cumulative dose ≥ 700 mg morphine equivalent), provided prescriptions with longer duration (more than 10 days), or given 3 or more prescriptions for opioids were most likely to continue to use opioid medications 1 year later. The authors recommend prescribing fewer than 7 days of opioids for acute pain and adhering to the Centers for Disease Control and Prevention guideline for opioid use to improve prescribing practices.
García MC, Dodek AB, Kowalski T, et al. MMWR Morb Mortal Wkly Rep. 2016;65:1125-1131.
Adverse drug events related to opioid medications are a significant patient safety concern. This analysis of insurer claims data demonstrated that changing opioid prescribing requirements, including implementing patient–provider agreements, requiring prior authorization, and enforcing quantity limits, led to a decline in opioid prescribing. The authors recommend that insurers implement policies from the Centers for Disease Control and Prevention opioid guidelines to improve safety.
Rudd RA, Seth P, David F, et al. MMWR Morb Mortal Wkly Rep. 2016;65:1445-1452.
Opioid medications are frequently associated with adverse drug events in inpatient and outpatient settings. This surveillance report from the Centers for Disease Control and Prevention demonstrated that the magnitude of patient harm from opioid use is growing rapidly. Opioid overdose deaths are increasing each year, through 2015, and current rates are the highest ever recorded. The types of opioids most commonly involved in overdose deaths are natural and semisynthetic opioids, which are often prescribed as pain relievers. The authors suggest that the adoption of new prescribing guidelines and more widespread use of the opioid reversal agent naloxone will help address this growing epidemic. An earlier version of this article included data through 2014. A previous WebM&M commentary described a fatal opioid overdose.
Dowell D, Haegerich TM, Chou R. MMWR Recomm Rep. 2016;65:1-49.
Opioid pain medications carry high risk for adverse drug events and misuse. Due to climbing rates of opioid use and associated adverse events, the Centers for Disease Control and Prevention released new guidelines for prescribing opioid medications for chronic pain. These guidelines do not apply to patients receiving cancer treatment, palliative care, or end-of-life care. The authors recommend using opioids for chronic pain only if nonopioid medications and nonpharmacologic approaches to chronic pain are not effective and prescribing immediate-release instead of long-acting medications. For acute pain, they recommend limiting duration of therapy, stating that more than 1 week of medications should rarely be needed. The guidelines also suggest minimizing concurrent use of opioids and other sedating medications and dispensing naloxone to prevent overdoses. A previous WebM&M commentary describes an adverse event related to opioids.

Visser SN, Zablotsky B, Holbrook JR, Danielson ML, Bitsko RH. Natl Health Stat Report. 2015;(81):1-8.

This survey of parents of children with attention-deficit/hyperactivity disorder examined how this diagnosis was established. There was variation in the diagnostic process, including testing methods and types of practitioners involved (primary care physician, psychologist, psychiatrist). These results demonstrate the inherent challenge of diagnosing a heterogeneous condition even when diagnostic guidelines and criteria exist.
Fridkin S, Baggs J, Fagan R, et al. MMWR Morb Mortal Wkly Rep. 2014;63:194-200.
Antibiotics are among the most remarkable life-saving advances of modern medicine. However, when used incorrectly these medications pose serious risks for patients due to adverse effects and the potential to cause complicated infections, including those resistant to multiple antibiotics. This national database study found that more than half of all patients discharged from a hospital in 2010 received antibiotics during their stay. Many of these antibiotics were deemed to be unnecessary, and there was wide variation seen in antibiotic usage across hospital wards. A model accounting for both direct and indirect effects of antibiotics predicted that decreasing hospitalized patients' exposure to broad-spectrum antibiotics by 30% would lead to a 26% reduction in Clostridium difficile infection. The CDC recommends that all hospitals implement antibiotic stewardship programs, and this article provides core elements to guide these efforts. An AHRQ WebM&M commentary describes inappropriate antibiotic usage that resulted in a patient death. Dr. Alison Holmes spoke about infection prevention and antimicrobial stewardship in a recent AHRQ WebM&M interview.
Moran J, Scanlon D. Health Aff (Millwood). 2013;32:27-35.
The Leapfrog Group pioneered efforts to improve hospital quality by emphasizing adoption of evidence-based practices for safer care. Although adoption of the Leapfrog recommendations has not been shown to decrease inpatient mortality, it has been associated with improved quality of care in other areas. The Leapfrog Group targeted specific cities and states, asking hospitals within these regions to publicly report their implementation of the recommended practices in the Leapfrog Hospital Survey. This analysis of Leapfrog survey data found minimal improvement over time in two key Leapfrog recommendations: computerized provider order entry implementation and intensivist staffing of critical care units. These findings, according to the authors, may indicate that hospitals did not have a business case for investing in patient safety.
Schechter MA, O'Brien PJ, Cox MW. J Vasc Surg. 2013;57:276-81.
This review article characterizes the types of clinical issues that can occur when an intravascular device becomes malpositioned or damaged. A case of a broken peripherally inserted central venous catheter (PICC) that required surgical removal is discussed in an AHRQ WebM&M commentary.