Background: Patients with limited English proficiency (LEP) experience inferior health outcomes. The end-of-life period represents a particularly vulnerable time for LEP patients who may not receive optimal symptom management due to language barriers and other factors. There is limited data on disparities in provider practices around opioid administration based on patient LEP status, particularly at […]

Background: Methylnaltrexone (MNTX) is a peripherally acting µ-opioid receptor antagonist indicated for opioid-induced constipation (OIC). We evaluated whether baseline use of laxatives, including stimulants, osmotic agents, stool softeners, or combinations thereof affects the efficacy and safety of MNTX. Methods: This post hoc analysis included pooled data from 2 multicenter, randomized, double-blind, placebo (PBO)-controlled, institutional review […]

Background: With the dramatic increase in the usage of opioids for not only inpatient but also outpatient pain management, a potential increase in opioid-related deaths had led to a national concern regarding opioid usage. The World Health Organization analgesic ladder estimates 90% of the global population will use opioids at least once in their life, […]

Background: Neonatal abstinence syndrome (NAS) occurs when a neonate is exposed to licit or illicit chemical substances in utero and manifests withdrawal symptoms postnatally. Appropriate identification, documentation, and communication of NAS diagnosis is needed to qualify for federally funded therapies aimed at supporting development through early intervention (EI) programs. Our objective was to assess characteristics […]

Background: Hospitalists are at the forefront of the opioid epidemic. Over half of hospitalized patients are exposed to opioids during their admission, most of whom are opioid naïve.1 Patients discharged on opioids have a 15% chance of long-term use after one year.2 There is significant variation in provider opioid prescribing practices, even within the same […]

Background: In utero opioid exposure can result in neonatal abstinence syndrome (NAS). NAS is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system and gastrointestinal tract dysfunction. Newborns with NAS may require pharmacological management, have increased hospital costs, and have a prolonged hospital length of stay (LOS). NAS incidence has increased […]

Background: Opioid analgesia is an important treatment modality for patients with chronic pain, including pain attributed to cancer- and noncancer-related illness. Unfortunately, an estimated 40%–80% of opioid users experience opioid-induced constipation (OIC). Methylnaltrexone (MNTX) is indicated for the treatment of OIC. In clinical trials, the most common adverse events (AEs) were gastrointestinal (GI) in nature. […]

Case Presentation: A 34 year old male with a medical history of polysubstance abuse and hypothyroidism presented from subacute rehab after a combined thoracolumbar and sacral fixation surgery with worsening generalized weakness. The patient described deconditioning with increased difficulty standing despite 3-4 hours of daily physical therapy. Other acute symptoms included insomnia and mood swings. […]

Case Presentation: Central Adrenal Insufficiency (CAI) is a rare and often late diagnosis due to nonspecific signs, such as fatigue, hyponatremia, electrolyte abnormalities and fever of unknown origin (FUO). CAI suspicion arises in patients with pituitary tumors, cranial irradiation, surgery, injury, infection, exogenous glucocorticoid withdrawal, and less commonly known, opioid use disorder. A 31-year-old male […]

Case Presentation: A 56-year-old man with active polysubstance use disorder including daily intranasal heroin and cocaine use and previous abdominal surgery was admitted with a week of abdominal pain and constipation. His last bowel movement was one week prior to admission, though he did report ongoing flatus without nausea or vomiting. The abdomen was diffusely […]