Study: Opioid dose variability may be a risk factor for opioid overdose

DENVER Patients prescribed opioid pain medications whose doses varied over time were 3 times more likely to experience an overdose than patients prescribed stable opioid doses, according to an observational study from Kaiser Permanente published today in JAMA Network Open. The study also showed that patients who discontinued long-term opioid therapy for 3 or more months had half the risk of opioid overdose.

“Our study suggests that safely managing long-term opioid therapy is complex,” said Ingrid Binswanger, MD, senior investigator at Kaiser Permanente Institute for Health Research in Colorado and co-author of the study.

Ingrid Binswanger, MD
Ingrid Binswanger, MD

“This study suggests going up and down on opioid doses — also called dose variability — could present an increased risk of overdose,” Dr. Binswanger said. “Through this study, we also found eventually discontinuing opioid therapy may prevent overdoses. With continued studies, we hope to find out how care providers can help patients with their pain without putting them at unnecessary risk due to rapid changes in their dose.”

The 12-year study included more than 14,000 Kaiser Permanente members in Colorado who were prescribed long-term opioids. Researchers used electronic health records to track the history of patients to see if they had dose changes and overdoses from opioid pain medications and other opioid drugs.

The research team obtained a follow-up $ 2 million, 4-year grant from the National Institutes for Health. The study will look at how patients and doctors manage changes in opioid doses, including any long-term risks and benefits of discontinuing opioid pain medications.

Jason Glanz, PhD
Jason Glanz, PhD

“Kaiser Permanente, like many health care organizations across the country, has made significant changes to safely reduce opioid prescriptions for our members,” said Jason Glanz, PhD, senior investigator at the Institute for Health Research and co-author on the study.

“This study represents the first of many investigations that we plan to do on the topic,” Dr. Glanz said. “Our goal is to help identify the most safe and effective approaches for managing long-term opioid therapy. We want to be able to minimize patients’ pain and reduce their risk for overdose.”

This study was funded by the National Institute on Drug Abuse and conducted by researchers at Kaiser Permanente’s Institute for Health Research.

Additional study authors include Susan Shetterly, MS; Komal J. Narwaney, MPH, PhD; and Stan Xu, PhD.


About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.4 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.

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Kaiser Permanente JAMA Study Finds 10-Year Follow-up Interval After Negative Colonoscopies Is Associated with Reduced Risk of Colorectal Cancer and Mortality

OAKLAND, Calif. — Ten years after a negative colonoscopy, Kaiser Permanente members had 46 percent lower risk of being diagnosed with and were 88 percent less likely to die from colorectal cancer compared with those who did not undergo colorectal cancer screening, according to a study published today in JAMA Internal Medicine.

“Our study shows that following a colonoscopy with normal findings, there is a reduced risk of developing and dying from colorectal cancer for at least 10 years,” said study leader Jeffrey Lee, MD, Kaiser Permanente gastroenterologist and research scientist at the Division of Research.

“These findings suggest that physicians can feel confident following the guideline-recommended 10-year rescreening interval after a negative colonoscopy in which no colorectal cancer or polyps were found. There is now solid evidence supporting that recommendation.”

The U.S. Preventive Services Task Force currently recommends colorectal cancer screening for adults at average risk between 50 and 75 years old, with either colonoscopy every 10 years, sigmoidoscopy every five years or fecal testing every year, assuming these tests are normal.

Before this study, there was little evidence supporting the 10-year recommended screening interval after a colonoscopy with normal findings, Lee said. “That uncertainty was concerning because colorectal cancer is the second leading cause of cancer-related deaths in the United States.”

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“This large study is the first with a high enough number of average-risk individuals to evaluate cancer risks after colonoscopy examinations, compared with no screening,” said senior author Douglas Corley, MD, PhD, Kaiser Permanente gastroenterologist and research scientist with the Division of Research. “Such information provides greater certainty regarding the appropriate timing for rescreening after a negative colonoscopy.”

Colorectal cancer is an active area of study at Kaiser Permanente.

The National Cancer Institute funded the study through its Population-Based Research Optimizing Screening Through Personalized Regimens consortium.

In addition to Lee and Corley, co-authors were Christopher D. Jensen, PhD, Theodore R. Levin, MD, Natalia Udaltsova, PhD, Wei K. Zhao, MPH, Bruce H. Fireman, MA, and Charles P. Quesenberry, PhD, all of the Kaiser Permanente Division of Research; Ann G. Zauber, PhD, Memorial Sloan Kettering Cancer Center; Joanne E. Schottinger, MD, and Virginia P. Quinn, PhD, Kaiser Permanente Southern California Department of Research and Evaluation; and Chyke A. Doubeni, MD, University of Pennsylvania.


About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 400 epidemiological and health services research projects. For more information, visit www.dor.kaiser.org or follow us @KPDOR.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.3 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to share.kaiserpermanente.org.

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Even When Not In Rome, Eat A Mediterranean Diet To Cut Heart Disease Risk

Once again, your mother was right. You really do need to eat your vegetables. And while you are at it, put down the bacon and pick up the olive oil, because new research supports the contention that switching to a Mediterranean diet could significantly decrease the risk of heart disease.

According to a study published Friday in JAMA Network Open, people who followed this type of diet had 25 percent less risk of developing cardiovascular disease over the course of 12 years.

The diet’s components make sense to anyone who follows nutrition news. Avoid red meat in favor of “good” fats like fish and poultry. Swap out salt for herbs and spices. Ditch butter and margarine and opt for olive oil instead. Most important, eat a lot of fruits and vegetables. Nuts are good, so are whole grains. And, every once in a while, have a glass of red wine.

Since the 1950s, researchers have pointed out this diet’s possible cardiovascular benefits. More recently, it has been credited with addressing any number of ills, including Alzheimer’s disease, asthma and helping pregnant women control factors that lead to high-birth-weight babies and contribute to obesity risk factors as kids grow.

Until Friday’s study, though, no randomized trials had been conducted in the U.S. to determine this diet’s long-term effects. This research also sought to shed light on the molecular underpinnings of why.

The mechanisms by which the Mediterranean diet reduced cardiovascular disease “were sort of a black box,” said Shafqat Ahmad, the lead author of the paper and a researcher in the department of nutrition at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. “We know it reduced cardiovascular risk,” he added, but the precise ways it had this effect over time “are not well understood.”

Ahmad and his co-authors, using a panel of nine biomarkers in blood tests, were able to isolate exactly why the diet reduces heart disease.

The three biggest biological mechanisms were changes in inflammation, blood sugar and body mass index.

Inflammation was the issue for Meg Grigoletti, a 23-year-old graduate student from New Jersey who switched to a Mediterranean diet when she was recovering from back surgery in 2014. Her doctors recommended it to reduce swelling, hoping it would ease the pain in her back and help her migraines.

“It’s more of a lifestyle than a diet,” Grigoletti said. “It taught me what food is good for me and what’s not.”

Researchers followed more than 25,000 women who were part of the Women’s Health Study, a survey of female health professionals older than 45. At the beginning of the study, participants completed a questionnaire on 131 different foods to assess their diets. They were then assigned different “MED scores” on a scale of 1 to 9, based on how closely they followed the Mediterranean diet.

There were three levels, people who scored between zero and 3 were on the low end, 4 to 5 was in the middle and 6 and up was categorized as a high intake of Mediterranean diet foods.

The participants’ cardiovascular health was then tracked for 12 years.

When all was said and done, those in the middle category saw a 23 percent reduction in risk, and the upper category had 28 percent less risk of cardiovascular disease.

Heart disease is the leading cause of death for both men and women, according to the Centers for Disease Control and Prevention — claiming about 600,000 lives each year. Coronary heart disease is the most common form, killing more than 370,000 people annually. Each year, about 735,000 Americans have a heart attack.

The authors pointed out that these findings do have limitations. For instance, the study relied on self-reported data, which isn’t always accurate — especially when it involves diet choices. The participants, all of whom were female health professionals, also might lean toward healthier behaviors than the rest of the population.

The results of the study weren’t a shock to Dr. Andrew Freeman, the director of cardiovascular prevention and wellness at National Jewish Health hospital in Denver. He wasn’t involved in the study but has been recommending a Mediterranean diet, or a similar version of it that emphasizes vegetables and fruit, to his patients for years.

“There’s a lot of noise out there, but the signal that’s been out there the longest is this kind of plant-based diet is the best.”

He also acknowledged that there is a lot of competing nutritional information swirling around the airwaves and the internet, which amounts to “a whole lot of hype” that makes healthy eating habits a difficult regimen for many consumers.

And doctors often don’t have clear information, either. “The vast majority of cardiologists and health providers in general have very little nutrition training,” Freeman said.

He switched to a mostly plant-based diet after his residency, and lost 35 pounds. He now recommends this approach to his patients, too. He said he has seen his patients’ conditions — heart disease, high blood pressure and diabetes — improve.

“Nutrition and lifestyle medicine is the place where there’s a chance of a cure,” Freeman said.

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Coffee is so good for you that it might curb your risk of Alzheimer’s and Parkinson’s

coffee brain benefits

We as human have to live with a lot of unfortunate realities, including the fact that a lot of the things we love end up being bad for us. We all know by now that if we binge on tasty treats too much we’ll end up eating ourselves into an early grave, but in recent years it’s become increasingly clear that coffee, a well known vice of millions and millions of people, is actually pretty good for you.

Recent studies have shown that being a regular coffee drinker can reduce your risk of all kinds of ailments, including heart attack and stroke. Now, a new research effort reveals that dark roast coffee is particularly good at warding off some nasty brain conditions, including Alzheimer’s and Parkinson’s disease.

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Black Women Face High Risk, Dangers And Death Rates With Breast Cancer

Breast Cancer Awareness Month in October presents another opportunity to spread information about the disease and how it affects Black women. The disease is responsible for a high death rate in women of color, according to the Centers for Disease Control and Prevention.

Black women are 40 percent more likely to die from breast cancer despite doctors diagnosing the disease in African-American and white women at about the same rate, the CDC reported. Also, Black women are more often found to have triple-negative breast cancer, an aggressive type that frequently returns after treatment.

Age is also a big factor: breast cancer incidence rates were higher among African-American women younger than 60 years old but lower among those who are 60 or older.

One reason for this statistic could be that medical professionals tend to find this cancer at an earlier stage in white women.  Also, Black women may have inadequate medical care, including limited access to cancer screening technology.

Doctors encourage women, especially those at high risk due to a family history or having BRCA1 or BRCA2 genes, to get out ahead of the disease. Early detection measures such as mammograms and screenings are strongly recommended. Women can visit local hospitals that offer low-cost mammograms or call their local American Cancer Society chapter for help with screenings or doctor referrals.

In addition, researchers continue to look into why some women are more susceptible to triple-negative breast cancer, in order to find better treatment options.

Women can also choose a healthier lifestyle for a better chance of lowering risks for the disease. BreastCancer.org recommends exercise, a nutritious diet and avoiding smoking and alcohol as important in the battle against breast cancer — one that many women can win regardless of race.

Many women are speaking out to spread awareness about breast cancer and helping women to fight it. Serena Williams posted a powerful message about the disease recently.

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