Experts urge caution, increased education about opioid use for people
with heart disease

Date:
August 19, 2021
Source:
American Heart Association
Summary:
Opioid overdose is a leading cause of injury-related death for
adults ages 25 to 54 in the U.S. Recent data suggest that commonly
used opioids for pain management may interfere with medications
used to manage and treat cardiovascular disease and stroke.



FULL STORY ==========================================================================
The misuse of opioids in the United States continues to lead to high
rates of dependency as well as a staggering number of deaths due to
overdose. The American Heart Association is addressing the opioid
epidemic and advancing the science on opioid use and its effects on
heart and brain health through evidence-based research, detailed in a
new American Heart Association Presidential Advisory and published today
in the Association's flagship journal Circulation.


==========================================================================
More than 67,000 people died due to drug overdoses in the U.S. in 2018,
and two-thirds of those deaths involved opioids. In the 12-month period
from December 2019 to December 2020, there was a 30% increase in drug
overdose deaths compared to the previous 12-month period, according to
a recent, provisional data analysis from the U.S. Centers for Disease
Control and Prevention. The advisory notes several specific strategies
for addressing the issue: improve education and training for the public
and health care professionals on how to safely manage pain and opioid
overdose; and support treatment for opioid use disorder, including
creating and developing partnerships with federal, state, local and employer-based programs. Through strong, collaborative partnerships,
healthier communities with more equitable access to care can help to
reverse the rate of opioid overdoses and deaths in the U.S.

"Opioid abuse accelerated during the COVID-19 pandemic due to
disruption of the illicit drug supply environment, more limited
access to medications, and social isolation and depression related
to pandemic safety measures," said chair of the writing group Sheryl
L. Chow, Pharm.D., FAHA, an associate professor of pharmacy practice
at Western University of Health Sciences in Pomona, California, and
associate clinical professor of medicine at the University of California, Irvine. "Opioid overdose is now a leading cause of death for Americans 25
to 54 years of age, and opioid use disorder affects more than 2 million Americans." The AHA partnered with a team of leading health authorities
-- physicians, scientists and a pharmacist with expertise and knowledge in
the field of medicine, pharmacotherapy, research and federal regulations
-- to develop the presidential advisory. It highlights recommendations, algorithms and guidance for health care professionals and researchers
who specialize in heart and brain health. The volunteer writing group
used data and information from more than 90 evidence-based epidemiology studies, reviews, consensus statements and guidelines already published.

"Health care professionals who manage pain in the setting of
cardiovascular disease and stroke should be encouraged to receive training
in management of pain using non-opioid strategies and on screening
for opioid use disorder," said Chow. "Lay responders should also be
encouraged to receive formal CPR training with specific instructions on naloxone administration because opioid overdose often occurs in public,
and CPR is more likely to be given by bystanders." Key points detailed
in the advisory include:
* CPR guidelines and algorithms are reviewed for both health care
professionals and lay rescuers for when a person has a suspected
opioid overdose. CPR training for lay people should emphasize
calling 911 and initiating CPR before administering naloxone
because it may be hard for a lay rescuer to identify the cause
of the cardiac arrest, and naloxone will only be effective if
opioid overdose is the cause of the cardiac arrest. (Naloxone
is an emergency medication that can rapidly and effectively be
lifesaving in the case of an opioid or other illicit drug overdose.)
* For people with cardiovascular disease and muscle or joint pain,
acetaminophen, aspirin and non-acetylated salicylates should be
considered first for pain management as alternatives to opioids.

* Morphine is used to reduce pain for some coronary patients, yet the
medication may reduce the therapeutic effectiveness of
P2Y12-receptor antagonists (antiplatelet/clot-preventing
medications).

* Parenteral antiplatelet agents (medications given intravenously)
may be
considered for acute coronary syndrome treatment when administered
with morphine in the hospital setting.

* An expansion of free, syringe exchange programs should be
considered to
reduce the risk of infective endocarditis, a serious infection
of the heart lining, which can occur when needles are shared for
intravenous drug use.

* A coordinated approach to opioid management should occur among
federal,
state and local health and law enforcement agencies, as well as
in the workplace setting through organizational initiatives.

The American Heart Association is committed to advancing the science
on opioid use and its effects on patients with cardiovascular disease
through evidence- based research; improving education and training
for the public and health care professionals on how to safely manage
pain or opioid overdose and support treatment for opioid use disorder;
and creating and developing partnerships with federal, state, local and employer-based programs.

"This advisory includes both immediate and long-term strategies
to help mitigate the devastating intersection of opioid abuse and cardiovascular disease," said Ivor J. Benjamin, M.D., FAHA, former
president of the American Heart Association (2017-2018), and director
of the cardiovascular center, co- director of the NIH T32 Postdoctoral Fellowship in Cardiovascular Sciences and professor of medicine at the
Medical College of Wisconsin in Milwaukee.

"Together with our partners throughout public health, policy
and government infrastructures, we can help support health care
professionals and people in our communities more effectively avoid the preventable deaths caused by opioid use disorder and opioid overdose."
This presidential advisory was prepared by the volunteer writing group
on behalf of the American Heart Association.

Co-authors are Comilla Sasson, M.D., Ph.D., FAHA, vice-chair of the
writing committee, vice president for science & innovation for emergency cardiovascular care at the American Heart Association; Ivor J. Benjamin,
M.D., FAHA, former president of the American Heart Association,
and director of the cardiovascular center at the Medical College of
Wisconsin; Robert M. Califf, M.D., head of clinical policy and strategy
at Verily Life Sciences and Google Health, a former commissioner of the
U.S. Food and Drug Administration, former vice chancellor for health data science at Duke University School of Medicine and the founding director
of the Duke Clinical Research Institute; Wilson Compton, M.D., M.P.E.,
deputy director of the National Institute on Drug Abuse (NIDA) of the
National Institutes of Health; Elizabeth Oliva, Ph.D., investigator at
the VA Center for Innovation to Implementation (Ci2i) at the VA Palo Alto Health Care System and a senior evaluator for the VA Program Evaluation
and Resource Center; Chester Robson, D.O., M.H.C.D.S., medical director
of clinical programs and quality for Walgreens Corporation; and Eduardo
J. Sanchez, M.D., M.P.H., FAHA, FAAFP, the American Heart Association's
chief medical officer for prevention.

========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Sheryl L. Chow, Comilla Sasson, Ivor J. Benjamin, Robert M. Califf,
Wilson M. Compton, Elizabeth M. Oliva, Chester Robson, Eduardo J.

Sanchez. Opioid Use and Its Relationship to Cardiovascular Disease
and Brain Health: A Presidential Advisory From the American Heart
Association. Circulation, 2021; DOI: 10.1161/CIR.0000000000001007 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210819081459.htm

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