Alana Hippensteele, Associate Editor

Since prior research has observed an existing link between opioid prescriptions and obesity in the United States, 2 new studies were conducted to investigate and advance the understanding of this association.

The first study, published on March 27 in the 

, focused on the impact of obesity on prescription opioid use, investigating specifically the link between obesity and long-term prescription use.

 The results of the study showed that patients with higher body mass indices (BMIs) were up to 158% more likely to use prescription opioids long-term, and that 27% of long-term opioid prescriptions from 2000 to 2015 were attributable to higher BMIs.

The second study, published on April 2 in 

, built upon the previously established link between opioid prescriptions and obesity to advance understanding regarding pain diagnosis as a reason for primary care clinicians to prescribe opioids for individuals with higher BMIs.

 The results showed that the risk of receiving prescription opioids increased progressively with a patient’s BMI.

 Prescription opioids for the management of osteoarthritis and other joint disorders had stronger associations with obesity than the mean for any pain diagnosis, with osteoarthritis, other joint disorders, and other back disorders combined accounting for 53.4% of the difference in prescription of opioids by obesity.

Andrew Stokes, PhD, assistant professor of global health at Boston University School of Public Health (BUSPH), led both studies. In a press release, he explained, “Research on the opioid crisis to date has focused heavily on the supply-side factors that increased access to opioids,” adding that, “Our studies offer new evidence for policymakers to consider how addressing the roots of this crisis will require attention to the underlying sources of demand for pain relief, including obesity through its association with pain.”

 study results helped to show that overweight or obese patients are more likely to get prescribed opioids than patients with BMIs in the normal range, which, the results show, is largely due to overweight or obese patients having more pain in their joints and back.

 study, the results clarified that patients with higher BMIs are also more likely to use opioids long-term.

 For patients with BMIs considered overweight, there was a 24% increased likelihood of long-term use, whereas there was a 158% increased likelihood for those with BMIs in the obese II range. Commonly identified reasons for opioid prescriptions in this study included joint pain, back pain, injury, and muscle/nerve pain.

“Policy efforts are urgently needed to regulate the obesogenic environment in this country,” said Dielle Lundberg, a research fellow in the Department of Global Health at BUSPH and co-author of both studies, in a press release. “When people are denied access to affordable, healthy food and to the sort of built environments that promote physical activity and health across the life course, obesity is more likely to occur. The results of both studies suggest that through obesity, such environments can also increase pain and create future demand for prescription opioids.”

The researchers noted that the data also highlight an urgent need for improved pain management approaches for millions of Americans who suffer from chronic pain.

“The lack of sufficient medication options, woeful underutilization of physical therapy (which is well-supported by high-quality evidence for these conditions), and challenges in supporting weight loss efforts have led to prescription of opioids in management of painful musculoskeletal conditions where little evidence exists to support their use,” said Tuhina Neogi, MD, PhD, professor of epidemiology at BUSPH, professor of rheumatology at the Boston University School of Medicine, chief of rheumatology at Boston Medical Center, and co-author of the 

Stokes A, Lundberg DJ, Hempstead K, et al. Obesity and Incident Prescription Opioid Use in the U.S., 2000—2015. 

. 2020. doi: 10.1016/j.amepre.2019.12.018.

Stokes A, Lundberg DJ, Sheridan B, et al. Association of Obesity with Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US. 

Opioid prescriptions linked to obesity [news release]. 

; April 2, 2020. sciencedaily.com/releases/2020/04/200402155738.htm. Accessed April 8, 2020.

Articles

Research explores the impact of obesity on prescription opioid use, investigating specifically the link between obesity and long-term prescription use.

New Studies Link Opioid Prescriptions to Obesity

The Liu group at Texas A&M University, led by chemist Wenshe Ray Liu, PhD, identified the antiviral drug remdesivir as a viable treatment for coronavirus disease 2019 (COVID-19) in January.

 Remdesivir was originally developed as a treatment for Ebola in 2014, but upon the surge of COVID-19 in Wuhan, China, before the virus spread throughout the rest of the world, the Liu group investigated its use in treating COVID-19.

“The motivation that drove us was the rush against time to find alternative medicines that might be put in use to fight against the virus when it spread to the United States,” Liu said in an article in 

Following the Liu group’s research, remdesivir has been tested in at least 5 large-scale clinical trials around the world and has been delivered to some patients, including the first confirmed COVID-19 patient in the United States on January 21 in Washington state.

 After treatment with remdesivir, that patient successfully recovered.

Although Liu remains convinced that remdesivir is the right drug to treat COVID-19, he explained in the interview that due to the reports of multiple strains of COVID-19, success in treating the coronavirus should not be viewed as following a single approach.

Despite his caution, Liu explained further, “Remdesivir is still the best and probably the only option to target the virus directly in patients.”

remdesivir in the United States set to finish this week, Liu remains optimistic that the results of the study will prove the treatment’s efficacy.

 However, he also acknowledges that in the wide-scale use of any virus treatment, drug-resistant virus strains are likely to develop.

 This may be especially true for COVID-19, since multiple strains of the coronavirus have been reported to exist already.

“The infectivity of the original strain shown in Wuhan was not as high as what we have observed for the current strain in the United States,” he said in the interview, adding that, “At this stage, the scientific community needs to prepare for the worst and work to bring other treatment options to the forefront.”

Morse JS, Lalonde T, Xu S, Liu WR. Learning from the Past: Possible Urgent Prevention and Treatment Options for Severe Acute Respiratory Infections Caused by 2019‐nCoV. 

. 2020;21(5):730. doi: 10.1002/cbic.202000047.

Hutchins, SK. Texas A&M Chemists Working on Drugs to Treat COVID-19. 

2020. today.tamu.edu/2020/04/02/texas-am-chemists-working-on-drugs-to-treat-covid-19/. Accessed April 8, 2020.

Chemists working on drugs to treat COVID-19 [news release]. 

; April 6, 2020. sciencedaily.com/releases/2020/04/200406190509.htm. Accessed April 8, 2020.

The antiviral drug remdesivir was originally developed as a treatment for Ebola in 2014, but upon the surge of COVID-19, its use was investigated in treating COVID-19.

Chemist Remains Optimistic About Success of Antiviral in Treating COVID-19

New research conducted by scientists at the University of Pittsburgh School of Medicine (Pitt Med) presents a potential vaccine for coronavirus disease 2019 (COVID-19). Published on April 1 in 

the study appeared shortly after COVID-19 infections began to increase exponentially in the United States because the scientists were able to build on their prior research from previous coronavirus epidemics.

The results of the study showed that this vaccine—which the authors are calling PittCoVacc, short for Pittsburgh Coronavirus Vaccine&mdash;when tested on mice, produces antibodies specific to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at quantities thought to be sufficient for neutralizing the virus within 2 weeks.

 SARS-CoV-2, the official name of the causative agent of COVID-19, shares similarities with previous coronavirus causative agents SARS coronavirus (SARS-CoV) and Middle East respiratory syndrome-related coronavirus (MERS-CoV).

“We had previous experience on SARS-CoV in 2003 and MERS-CoV in 2014. These two viruses, which are closely related to SARS-CoV-2, teach us that a particular protein, called a spike protein, is important for inducing immunity against the virus. We knew exactly where to fight this new virus,” said co-author Andrea Gambotto, associate professor of surgery at Pitt Med, in a press release. “That’s why it’s important to fund vaccine research. You never know where the next pandemic will come from.”

In their research in 2014, the scientists tested the pre-clinical immunogenicity of MERS-CoV vaccines in mice, which were delivered subcutaneously by traditional needle injection or intracutaneously by dissolving microneedle arrays (MNAs).

 They then evaluated the virus-specific immunoglobulin G antibodies in the serum of vaccinated mice by the enzyme-linked immunosorbent assay (ELISA) and used virus neutralization assays.

 Based on this research, the scientists found that it would be effective to use the same strategy to develop the MNA SARS-CoV-2 subunit vaccines upon the emergence of COVID-19.

“Our ability to rapidly develop this vaccine was a result of scientists with expertise in diverse areas of research working together with a common goal,” said co-author Louis Falo, professor and chair of dermatology at Pitt Med and the University of Pittsburgh Medical Center (UPMC), in a press release.

Compared with the experimental mRNA vaccine candidate that recently entered clinical trials, PittCoVacc follows a more established approach that will work similarly to current flu shots.

 However, the delivery of this vaccine will be different from flu shots, as the results of the SARS-CoV-2 research showed that MNAs are preferable over a single needle because they increase potency due to the skin-targeted delivery.

The MNA goes on like a Band-Aid and includes 400 microneedles that together are no larger than a fingertip.

 Once placed on the skin, the needles are able to dissolve as they are made entirely of sugar and protein pieces.

“We developed this to build on the original scratch method used to deliver the smallpox vaccine to the skin, but as a high-tech version that is more efficient and reproducible patient to patient,” Falo said in a press release. “And it’s actually pretty painless—it feels kind of like Velcro.”

The MNA delivery system is highly scalable as it can be mass-produced at an industrial level. Once manufactured, the vaccine is also able to sit at room temperature, eliminating the need for refrigeration during transport or while in storage.

The authors of the study are now applying for an investigational new drug approval from the FDA in order to start a phase 1 human clinical trial in the next few months.

“Testing in patients would typically require at least a year and probably longer,” Falo explained in a press release. “This particular situation is different from anything we’ve ever seen, so we don’t know how long the clinical development process will take. Recently announced revisions to the normal processes suggest we may be able to advance this faster.”

Kim E, Erdos G, Huang S, et al. Microneedle array delivered recombinant coronavirus vaccines: Immunogenicity and rapid translational development. 

. 2020;51(16):2352-3964. doi: 10.1016/j.ebiom.2020.102743.

COVID-19 Vaccine Candidate Shows Promise in First Peer-Reviewed Research [news release]. Pittsburgh, PA: Pittwire; April 2, 2020. pittwire.pitt.edu/news/covid-19-vaccine-candidate-shows-promise-first-peer-reviewed-research. Accessed April 8, 2020.

PittCoVacc produces antibodies specific to SARS-CoV-2 at quantities thought to be sufficient for neutralizing COVID-19 within 2 weeks.

COVID-19 Vaccine Candidate from University of Pittsburgh Shows Promise in New Study

The coronavirus disease 2019 (COVID-19) pandemic has made it necessary to implement social (physical) distancing policies in the United States, which required the closure of schools across the country. Evidence that school closures are an effective method of reducing mortality comes from experience with influenza, the spread of which has historically not resulted in absenteeism among the health care labor force due to child-care obligations.

Now, the decision to maintain school closures during the COVID-19 epidemic raises unique challenges regarding the benefits of closures weighed against the costs of resulting health care worker absenteeism. A study published in 

 addressed these challenges and found that at least 1 in 7 medical workers may have to miss work to care for their children aged 3 to 12 years, a number that takes into account childcare provided by non-working adults and older siblings within the same household.¹

“Closing schools comes with many trade-offs and can create unintentional child-care shortages that put a strain on the health care system,” said professor Eli Fenichel from Yale University, a co-author of the study, in a press release. “Health care workers spending less time providing patient care to look after their own children can directly influence the development of an epidemic and the survival of those patients. Understanding these tradeoffs is vital when planning the public health response to COVID-19 because if the survival of infected patients is sufficiently sensitive to declines in the health care workforce, then school closures could potentially increase deaths from COVID-19.”²

The authors used data from monthly releases between January 2018 and January 2020 of the US Current Population Survey to characterize the family structure and probable within-household childcare options of US health care workers.¹ The US health care sector has some of the highest childcare obligations in the United States, with 15% of the health care workforce still needing child care in the event of a school closure.¹

Notably, school closures will be especially challenging for nurse practitioners (22% will need childcare), physician's assistants (21%), diagnostic technicians (19%), and physicians and surgeons (16%), as well as nearly 13% of the nursing and home health aides who are single parents and helping the elderly with infection control in nursing homes.¹

“The US health care system appears disproportionately prone to labor shortages from school closures, particularly among those health care workers providing infection control in nursing homes,” said co-author Jude Bayham, PhD, from Colorado State University, in a press release. “These potential health care workforce shortages should be a priority when assessing the potential benefits and costs of school closures, and alternative child-care arrangements must be part of the school closure plan.”²

The results of the study showed that, when taking into account reasonable parameters for COVID-19, such as a 15% case reduction from school closings and 2% baseline mortality rate, a reduction in the health care labor force would need to decrease the survival probability per percent health care worker lost by 17.6% in order for a school closure to increase cumulative mortality.¹ However, the authors estimate that if the infection mortality rate of COVID-19 increases from 2% to 2.35% while the health care workforce simultaneously declines by 15%, school closures could lead to a greater number of deaths than they prevent.¹

Bayham J, Fenichel E. Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study. 

. 2020. doi: 10.1016/S2468-2667(20)30082-7.

US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality [news release]. 

; April 4, 2020. http://sciencedaily.com/releases/2020/04/200404155613.htm. Accessed April 6, 2020.

School closures during the COVID-19 epidemic raises unique challenges regarding the benefits weighed against the costs of resulting health care worker absenteeism.