Early postpartum initiation of opioids associated with persistent use

Reviewed by James Ives, M.Psych. (Editor)Dec 18 2018Vanderbilt researchers have published findings indicating that regardless of whether a woman delivers a child by cesarean section or by vaginal birth, if they fill prescriptions for opioid pain medications early in the postpartum period, they are at increased risk of developing persistent opioid use.In a research letter published in the American Journal of Obstetrics and Gynecology, the authors examined the data of 102,541 women who gave birth while covered by Tennessee Medicaid (TennCare) to analyze their use of opioid pain relievers during the postpartum period. The study population was opioid naïve, meaning they had not used opioids in the 180 days before the delivery.”Studying postpartum women gives us an excellent opportunity to compare two demographically similar populations of women with a common experience of childbirth, one discharged with opioid prescriptions routinely (cesarean birth), and one not discharged with opioid prescriptions routinely (vaginal birth),” said Sarah Osmundson, MD, assistant professor of Maternal-Fetal Medicine in the Department of Obstetrics and Gynecology, the study’s lead author.Of the mothers included, 89 percent of the women who had a cesarean delivery and 53 percent with a vaginal delivery filled opioid prescriptions during the postpartum period. The incidence of persistent opioid use during the year following delivery was low overall — at less than 1 percent — and was higher among women with cesarean versus vaginal delivery. However, among women who filled an initial opioid prescription, the risk of persistent opioid use was similar between the delivery groups. Furthermore, filling additional prescriptions for opioids in the postpartum period substantially and consistently increased this risk in both groups.Because childbirth is so common, when the findings were projected to the number of women who give birth annually in the United States, the researchers estimated that unless postpartum opioid prescribing practices are modified, an alarming number of women who give birth annually could be at risk of becoming chronic opioid users.Related StoriesUS dentists write more opioid prescriptions than England dentistsPatients taking opioids for chronic pain could face health care access problemsPDFNJ campaign emphasizes the hazards of prescription opioids”This study is one of the firsts to indicate that regardless of the delivery type, postpartum initiation of opioid use — a modifiable practice — is associated with persistent opioid use,” said study senior author Carlos Grijalva, MD, MPH, associate professor of Health Policy. “If our estimates were projected to the number of women who give birth annually in the United States, we calculated that every year there would be around 21,000 women becoming chronic opioid users that would be attributable to opioid use in the postpartum period.””Opioid prescribing can have a huge impact in this population given that 86 percent of women will have at least one delivery and may be exposed to opioids, and that almost one-third of women undergoing childbirth in the United States will have a cesarean. Policies designed to standardize and improve opioid prescribing have the potential to influence exposures for a large proportion of our population,” Osmundson said.Based on their findings, the researchers are calling on obstetricians to exercise caution when prescribing potentially addictive pain medicine following childbirth and to consider alternative pain management measures.They hope additional research in this area will influence other medical specialties’ prescribing practices as well.”We are now doing additional studies of the characteristics of the first prescription and the patient factors that influence chronic opioid use,” Osmundson said. “Hopefully, this work will also provoke opioid prescribers in other fields — surgical and non-surgical — to consider the long-term implication of opioid prescribing and seek novel, safe and effective approaches to managing pain.” Source:http://news.vumc.org/2018/12/13/early-postpartum-opioids-linked-with-persistent-usage/ read more

Tesla CEOs peculiar conduct causes angst on Wall Street

In this Feb. 6, 2018, file photo, Elon Musk, founder, CEO, and lead designer of SpaceX, speaks at a news conference after the Falcon 9 SpaceX heavy rocket launched successfully from the Kennedy Space Center in Cape Canaveral, Fla. Musk’s quirky behavior has long been chalked up to that of a misunderstood genius. But never have his actions caused so much angst on Wall Street. Investors have for years endured millions of dollars in short-term losses in hopes of a long-term payoff. They might have even been able to stomach the $8.3 million that Telsa Inc. burns through each day. But it was a conference call Wednesday, May 2, that left many wondering how much more they can take. (AP Photo/John Raoux, File) © 2018 The Associated Press. All rights reserved. Investors have for years endured millions of dollars in short-term losses in hopes of a long-term payoff. They might have even been able to stomach the $8.3 million that Telsa Inc. burns through each day. But it was a conference call Wednesday night that left many wondering how much more they can take.Just after the electric car and solar panel company announced a record first-quarter loss, the Tesla CEO cut off two analysts who sought some basic answers: details about the company’s cash needs and orders for its all-important Model 3 mass-market electric car.”These questions are so dry. They’re killing me,” Musk said as he dismissed an RBC Capital Markets analyst in favor of a blogger who served up queries more to his liking.Musk called the analyst questions boring and “not cool.”Shares fell quickly in after-hours trading, and analysts began writing that Musk shouldn’t bite the hands that feed his company’s enormous cash needs because soon he may need more. By Thursday afternoon, Tesla stock had lost nearly 6 percent of its value.”While they may be dry in nature, we argue such questions are extremely important for a highly leveraged and cash-hungry company,” Morgan Stanley analyst Adam Jonas wrote in a note to investors.The conference call behavior was labeled bizarre by some investors. It also followed some recent wild tweets by Musk about building a cyborg dragon, how his eyebrows can grab things and an April 1 post in which he wrote, “Despite intense efforts to raise money, including a last-ditch mass sale of Easter Eggs, we are sad to report that Tesla has gone completely and totally bankrupt. So bankrupt, you can’t believe it.”To be sure, Musk has joked in the past and poked fun at critics. He often posts updates to his 21.5 million Twitter followers about his companies, retweets posts from happy customers and warns about artificial intelligence.A Tesla spokesman wouldn’t comment on Musk. But the stock slide showed that Wall Street’s seemingly endless patience with Musk—who is also a rocket scientist and tunnel company chief—may be growing thin.Tesla has fallen far short of Musk’s promises to ramp up Model 3 production, which the company has said is key to turning a profit. Tesla has more than 450,000 waiting orders, but it can’t monetize them unless the cars can be assembled en masse. Without additional cash, some analysts have predicted that Musk faces a reckoning if he needs more money from investors to fund operations, capital spending and debt payments that are due early next year. Tesla cash burn accelerates, CEO predicts profit ahead (Update) Musk, who has tweeted about sleeping at the Tesla factory, said they’ve overcome automation failures like a “fluffer bot” that couldn’t install fluffy Fiberglas mats atop battery packs. The first-quarter loss hit nearly $710 million with a cash burn of $745 million. Free cash flow, which is cash generated minus capital spending, was a negative $1 billion.Musk promised restructuring, more Model 3 output and capital spending cuts to ease cash strain. A net profit is likely by the third quarter, he said.But the growing cash burn, slow Model 3 production nearly a year after it began, and rising fixed costs have caused investor concerns to mount.”This is what puts companies out of business,” said Gartner analyst Michael Ramsey. “In this case the demand seems fine, but you can’t actually produce those vehicles. The amount of cash required may become so large that they can’t find their way out of it through share offerings anymore.”Investors have consistently given Musk a pass for frequent misses of lofty production targets in the past, and Ramsey said that probably won’t change. Investors see the targets as shooting for the stars, and they applaud if Tesla makes it only halfway there, he said. If Tesla does run short of cash, big institutional investors such as Fidelity likely will come to the rescue, but that may cause a change at the top, Ramsey said.In Detroit where auto executives marvel at Tesla’s stock price rise despite its losses and production problems, quiet cheers over the company’s troubles were almost a certainty. Bob Lutz, a retired General Motors vice chairman and chief spokesman for Detroit’s Tesla disdain, said the odd conference call and first-quarter numbers show the reckoning is near.”It’s classic Musk—he doesn’t want to talk reality, as reflected by disastrous numbers. He wants to deflect, and mesmerize the crowd with science-fiction tales: Mars, Hyperloop, Semis, Tunnels … why change? It’s worked so far,” Lutz said. “He is doomed.”After the conference call cutoffs, Musk, as he has in the past, showed humility and introspection. He talked about building a new factory for a second SUV and hitting 2,000 orders for a proposed Tesla semi. But he said the 15-year-old Tesla right now is focused on getting Model 3 output to more than 5,000 per week, with a good profit margin per car.”We need to become a profitable company,” he said. “It is high time we became profitable. And the truth is, you’re not a real company until you are, frankly.” Elon Musk’s quirky behavior has long been chalked up to that of a misunderstood genius. But never have his actions caused so much angst on Wall Street. This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only. Explore further Citation: Tesla CEO’s peculiar conduct causes angst on Wall Street (2018, May 3) retrieved 18 July 2019 from https://phys.org/news/2018-05-tesla-ceo-peculiar-angst-wall.html read more