Jason Hoppe | University of Colorado Denver (original) (raw)

Papers by Jason Hoppe

Annals of Emergency Medicine, 2015

Opioid pain reliever prescribing at emergency department (ED) discharge has increased in the past... more Opioid pain reliever prescribing at emergency department (ED) discharge has increased in the past decade but specific prescription details are lacking. Previous ED opioid pain reliever prescribing estimates relied on national survey extrapolation or prescription databases. The main goal of this study is to use a research consortium to analyze the characteristics of patients and opioid prescriptions, using a national sample of ED patients. We also aim to examine the indications for opioid pain reliever prescribing, characteristics of opioids prescribed both in the ED and at discharge, and characteristics of patients who received opioid pain relievers compared with those who did not. This observational, multicenter, retrospective, cohort study assessed opioid pain reliever prescribing to consecutive patients presenting to the consortium EDs during 1 week in October 2012. The consortium study sites consisted of 19 EDs representing 1.4 million annual visits, varied geographically, and were predominantly academic centers. Medical records of all patients aged 18 to 90 years and discharged with an opioid pain reliever (excluding tramadol) were individually abstracted by standardized chart review by investigators for detailed analysis. Descriptive statistics were generated. During the study week, 27,516 patient visits were evaluated in the consortium EDs; 19,321 patients (70.2%) were discharged and 3,284 (11.9% of all patients and 17.0% of discharged patients) received an opioid pain reliever prescription. For patients prescribed an opioid pain reliever, mean age was 41 years (SD 14 years) and 1,694 (51.6%) were women. Mean initial pain score was 7.7 (SD 2.4). The most common diagnoses associated with opioid pain reliever prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). The most common opioid pain relievers prescribed were oxycodone (52.3%), hydrocodone (40.9%), and codeine (4.8%). Greater than 99% of pain relievers were immediate release and 90.0% were combination preparations, and the mean and median number of pills was 16.6 (SD 7.6) and 15 (interquartile range 12 to 20), respectively. In a study of ED patients treated during a single week across the country, 17% of discharged patients were prescribed opioid pain relievers. The majority of the prescriptions had small pill counts and almost exclusively immediate-release formulations.

The Journal of emergency medicine, Jan 19, 2015

Medication history discrepancies have the potential to cause significant adverse clinical effects... more Medication history discrepancies have the potential to cause significant adverse clinical effects for patients. More than 40% of medication errors can be traced to inadequate reconciliation. The objective of this study was to determine the accuracy of electronic medical record (EMR)-reconciled medication lists obtained in an academic emergency department (ED). Comprehensive research medication ingestion histories for the 48 h preceding ED visit were performed and compared to reconciled EMR medication lists in a convenience sample of ED patients. The reconciled EMR list of prescription, nonprescription, vitamins, herbals, and supplement medications were compared against a structured research medication history tool. We measured the accuracy of the reconciled EMR list vs. the research history for all classes of medications as the primary outcome. Five hundred and two subjects were enrolled. The overall accuracy of EMR-recorded ingestion histories in the preceding 48 h was poor. The EM...

Pharmacotherapy, 2010

After acetaminophen overdose, typical trends of aspartate and alanine aminotransferase (AST and A... more After acetaminophen overdose, typical trends of aspartate and alanine aminotransferase (AST and ALT, respectively) levels consist of a single peak followed by a decrease to baseline. Based on this pattern, declining AST or ALT levels have been proposed as a criterion for when to discontinue Nacetylcysteine therapy in patients with acetaminophen overdose. We describe three patients who experienced multiple aminotransferase peak levels after acetaminophen overdose. In each case, an initial peak was followed by a 20% or greater decrease in AST or ALT level, then a second, higher peak exceeding 1000 U/L. In two cases, the second peak correlated with encephalopathy or coagulopathy. Two patients were treated with a continuous infusion of intravenous N-acetylcysteine, with treatment interrupted for 4 hours in one of them. As observed in the three patients, multiple aminotransferase peak levels can occur after acetaminophen overdose. Although declining levels typically coincide with clinical improvement, the presence of other markers of liver injury, such as coagulopathy or encephalopathy, should prompt continued N-acetylcysteine treatment.

Western Journal of Emergency Medicine, 2013

To use Colorado&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s prescription drug monitoring pr... more To use Colorado&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s prescription drug monitoring program (PDMP) to describe the recent opioid prescription history of patients discharged from our emergency department (ED) with a prescription for opioid pain medications. Retrospective cohort study of 300 adult ED patients who received an opioid prescription. We abstracted prescription histories for the six months prior to the ED visit from the PDMP, and abstracted clinical and demographic variables from the chart. There were 5,379 ED visits during the study month, 3,732 of which were discharged. Providers wrote 1,165 prescriptions for opioid analgesics to 1,124/3,732 (30%) of the patients. Median age was 36 years. Thirty-nine percent were male. Patients were 46% Caucasian, 26% African American, 22% Hispanic, 2% Asian and 4% other. These were similar to our overall ED population. There was substantial variability in the number of prescriptions, prescribers and total number of pills. A majority (205/296) of patients had zero or one prescription. The 90th percentile for number of prescriptions was seven, while the 10th percentile was zero. Patients in the highest decile tended to be older, with a higher proportion of Caucasians and females. Patients in the lowest decile resembled the general ED population. The most common diagnoses associated with opioid prescriptions were abdominal pain (11.5%), cold/flu symptoms (9.5%), back pain (5.4%), flank pain (5.0%) and motor vehicle crash (4.7%). Substantial variability exists in the opioid prescription histories of ED patients, but a majority received zero or one prescription in the preceding six months. The top decile of patients averaged more than two prescriptions per month over the six months prior to ED visit, written by more than 6 different prescribers. There was a trend toward these patients being older, Caucasian and female.

Pain Medicine, 2014

The epidemic of prescription opioid-related morbidity and mortality demonstrates the need for a f... more The epidemic of prescription opioid-related morbidity and mortality demonstrates the need for a fresh, open, and balanced approach to managing pain while minimizing adverse personal and public health outcomes. Interventions by pharmacists in situations in which prescriptions are felt to be inappropriate have raised the ire of prescribers who feel their professional judgment is being questioned and their time is being usurped from patient care. Pharmacists, however, represent an important check and balance in the opioid analgesic prescribing chain, and prescribers should embrace their involvement and recognize that the time and effort of the pharmacist are directed at improving care of individual patients and keeping a watchful eye on the public health. Pharmacies need to keep a mindful eye toward professional practices of physicians and use noninvasive means, such as database inquiries, prior to directly contacting a prescriber. Collaboration is the most professional approach that can be taken to assure that our joint priority of caring for patients in distress will be accomplished effectively and safely.

Annals of Emergency Medicine, 2013

The American Journal of Emergency Medicine, 2009

As the use of atypical antipsychotic medications (AAPM) increases, the number of overdoses contin... more As the use of atypical antipsychotic medications (AAPM) increases, the number of overdoses continues to grow. Cardiovascular toxicity was common with older psychiatric medications, but appears uncommon with AAPM. We conducted a systematic literature review to describe the cardiovascular effects reported following overdose of 5 common AAPM: Aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone. We included case reports and case series describing overdose of these 5 medications identified in a search of MEDLINE, EMBASE and abstracts from major toxicology meetings. We found 13 pediatric cases (<7 yr), 22 adolescent cases (7-16 years) and 185 adult cases. No pediatric case described a ventricular dysrhythmia or a cardiovascular death. In the adolescent and adult cases we found numerous reports of prolonged QTC interval and hypotension, but there were only three cases of ventricular dysrhythmia and three deaths that may have been due to direct cardiovascular toxicity. The results from case series reports were similar to the single case report data. Our review suggests that overdose of AAPM is unlikely to cause significant cardiovascular toxicity.