Highlights
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## Prescription opioid use

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/17-18/1202/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/188/17-18/1202/F1)

An acute hospital admission is an opportunity to engage patients with this common, chronic disorder in addiction treatment and, perhaps, to affect the course of their illness. Donroe and colleagues review the treatment of acute pain in this difficult patient group, and outline an approach to broaching issues of harm reduction and long-term addiction treatment while patients are still in hospital. **See Review, page [1232](http://www.cmaj.ca/lookup/volpage/188/1232)**

Several Canadian initiatives implemented since 2010 have been largely ineffective in curtailing morbidity and deaths related to spiralling prescription opioid use. Fischer and colleagues consider what effective, evidence-based policy might look like in the future. **See Analysis, page [1240](http://www.cmaj.ca/lookup/volpage/188/1240)**

Data from other countries provide evidence that facilitated access to buprenorphine/naloxone through primary care results in expanded uptake of addiction treatment for prescription opioid use disorder. **See Commentary, page [1208](http://www.cmaj.ca/lookup/volpage/188/1208)**

Some Canadian regulatory bodies have endorsed the CDC Guideline for Prescribing Opioids for Chronic Pain. However, the guidance has important limitations. A forthcoming Canadian guideline will incorporate the strengths of the CDC guideline and address its deficiencies. **See Commentary, page [1210](http://www.cmaj.ca/lookup/volpage/188/1210)**

## Hip fracture mortality by hospital size

Patients are less likely to die following hip fracture if they receive treatment at a teaching hospital or large community hospital than at a small or medium-sized community hospital. The authors analyzed discharge data for 168 340 patients 65 and older with a nonpathological first hip fracture who were admitted to hospital between 2004 and 2012. They suggest that future research examine the role of volume, demand and bed occupancy for observed differences. **See Research, page [1219](http://www.cmaj.ca/lookup/volpage/188/1219)**

## Maternal disease and CHD in offspring

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/17-18/1202/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/188/17-18/1202/F2)

In this population-based study from Taiwan, women with chronic diseases, (e.g., diabetes, hypertension, congenital heart defects, anemia, epilepsy, mood disorders), had an increased risk of giving birth to infants with congenital heart disease. However, only for mothers with congenital heart defects or type 2 diabetes was there a higher prevalence of severe congenital heart disease in offspring. **See Research, page [E438](http://www.cmaj.ca/lookup/volpage/188/E438)**

## Job insecurity and diabetes risk

Authors of this meta-analysis pooled individual-level data for more than 140 000 men and women in 19 cohort studies with a mean follow-up of nine years. Participants who reported a high level of job insecurity at baseline had a 19% increased risk of incident diabetes after adjustment for age and sex compared with workers who reported low job insecurity. The effect was slightly attenuated (12% risk) after adjustment for risk factors for diabetes (i.e., age, sex, socioeconomic status, obesity, inactivity, alcohol, smoking). **See Research, page [E447](http://www.cmaj.ca/lookup/volpage/188/E447)**

## Pregnancy outcomes in rural areas

![Figure3](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/17-18/1202/F3.medium.gif)

[Figure3](http://www.cmaj.ca/content/188/17-18/1202/F3)

In this population-based cohort study in BC, women in rural areas had higher rates of severe maternal morbidity and neonatal morbidity than those in urban centres. In the wake of maternity unit closures in rural areas, monitoring for potentially life-threatening maternal and perinatal complications that require advanced care should be a priority for maternity care providers in rural areas, say the authors. **See Research, page [E456](http://www.cmaj.ca/lookup/volpage/188/E456)**

## Treating patients in custody

![Figure4](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/17-18/1202/F4.medium.gif)

[Figure4](http://www.cmaj.ca/content/188/17-18/1202/F4)

A 25-year-old woman with type 1 diabetes is brought to the emergency department in handcuffs by police. Kouyoumdjian and colleagues discuss the physician’s ethical obligations when treating patients in custody. **See Decisions, page [1249](http://www.cmaj.ca/lookup/volpage/188/1249)**

## Treatment of frostbite

The usual approach to treating severe frostbite may be insufficient to prevent necrosis, with amputation often becoming the only solution. The authors describe two cases that occurred in northern Canada, in which iloprost, a vasodilator, was used to treat severe frostbite with good results. **See Cases, page [1255](http://www.cmaj.ca/lookup/volpage/188/1255)**

## Cutting through the shame

Cutting became the only way to “quell the storm brewing inside” this psychology student. **See Encounters, page [1265](http://www.cmaj.ca/lookup/volpage/188/1265)**