51
|
Green TC, Kaplowitz E, Langdon K, Hughto JMW, Goedel WC, Czynski AJ, Fraser G, Rich J. COBRE on Opioid and Overdose: A Collaborative Research-Based Center Addressing the Crises in Rhode Island and Beyond. R I Med J (2013) 2021; 104:22-26. [PMID: 33789404 PMCID: PMC8049088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Overdose deaths across the country have spiked since the onset of the COVID-19 pandemic. It is crucial now, more than ever, to address the continuing and worsening, complex and dynamic opioid and overdose epidemics. In 2018, The Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, based at Rhode Island Hospital, launched with three major goals: 1) establish a center of scientific excellence on opioids and overdose; 2) train the next generation of scientists to become independent investigators and address the opioid and overdose crises; and 3) contribute to the scientific progress and solutions to combat these epidemics. To date, we have made substantial progress. While the opioid and overdose crises continue to evolve, the COBRE on Opioid and Overdose and its team of investigators are well poised to address the daunting task of understanding and meaningfully addressing these deadly epidemics, with the ultimate goal of saving lives.
Collapse
Affiliation(s)
- Traci C Green
- Department of Emergency Medicine, Alpert School of Brown University; The Opioid Policy Research Collaborative, The Heller School of Social Policy and Management at Brandeis University; Department of Epidemiology, Brown University School of Public Health; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Eliana Kaplowitz
- The Center for Health and Justice Transformation, The Miriam Hospital; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Jaclyn M W Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown School of Public Health; Center for Health Promotion and Health Equity, Brown University; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - William C Goedel
- Department of Epidemiology, Brown School of Public Health; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Adam J Czynski
- Department of Pediatrics, Alpert Medical School of Brown University; Department of Pediatrics, Women & Infants Hospital; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Gayle Fraser
- The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Josiah Rich
- Departments of Medicine and Epidemiology, Brown University; The Center for Health and Justice Transformation, The Miriam Hospital; The COBRE on Opioids and Overdose, Rhode Island Hospital
| |
Collapse
|
52
|
Wightman RS, Erowid E, Erowid F, Thyssen S, Wheeler M, Pulminskas B, Olson R, Green TC. Confirmed reports of bupropion sold as crack cocaine in the illicit drug supply. Clin Toxicol (Phila) 2021; 59:1031-1032. [PMID: 33784932 DOI: 10.1080/15563650.2021.1898632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rachel S Wightman
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Mary Wheeler
- Healthy Streets Outreach Program at Health Innovations Inc, Malden, MA, USA
| | - Benjamin Pulminskas
- The Heller School for Social Policy and Management at Brandeis University, Waltham, MA, USA
| | - Rebecca Olson
- The Heller School for Social Policy and Management at Brandeis University, Waltham, MA, USA
| | - Traci C Green
- The Heller School for Social Policy and Management at Brandeis University, Waltham, MA, USA
| |
Collapse
|
53
|
Green TC, Stopka T, Xuan Z, Davis TC, Boggis J, Irwin AN, Gray M, Hartung DM, Bratberg J. Examining nonprescription syringe sales in Massachusetts and Rhode Island community pharmacies. J Am Pharm Assoc (2003) 2021; 61:e237-e241. [PMID: 33820716 PMCID: PMC8827136 DOI: 10.1016/j.japh.2021.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Abstract
Background: The role pharmacies play in addressing the opioid crisis and drug-related risks such as injection drug use is evolving. Estimating the prevalence of injection drug use at the community level is challenging because of the stigma of drug use. Many community pharmacies sell nonprescription sterile syringes; thus, pharmacy-level sales of injection equipment may be an indicator of drug-related harms and unmet needs of high-risk populations. Objectives: To describe, compare, and assess the convergent validity of staff-reported nonprescription syringe (NPS) sales volume and NPS administrative sales data from community pharmacies in Massachusetts (MA) and Rhode Island (RI). Methods: This study employed both prospective cross-sectional survey data collection and utilization of administrative pharmacy sales data. Between November 2017 and January 2018, we administered a telephone-based survey to estimate average weekly NPS type and volume for 191 chain pharmacies (CVS Health) located in communities experiencing fatal opioid overdoses above the state’s 2015 annual median rate. For the same time period, we obtained NPS sales data from surveyed pharmacies and all CVS Health pharmacies in the 2 states. We calculated Spearman correlations to assess convergence of average weekly volume between pharmacy staff reports and sales data. Results: All pharmacies responded to the survey. Most (98.4%) pharmacies surveyed sold NPS, but 42.0% reported running out of stock monthly or more frequently. Pharmacy staff tended to under-report syringe sales. Staff-reported weekly NPS sales volume was 67,922 versus 70,962 syringes from administrative pharmacy sales data. Spearman correlation between reported and actual NPS sales was 0.40 (95% CI 0.27e0.51). Conclusion: The counts of administrative pharmacy syringe sales data in MA and RI indicate high need, substantial volume, and notable access at community pharmacies. Future research should use NPS sales data rather than self-report data to track emerging trends and tailor local responses.
Collapse
Affiliation(s)
- Traci C. Green
- Correspondence: Traci C. Green, PhD, MSc, Professor and Director, Opioid Policy Research Collaborative, Heller School for Social Policy and Management, Brandeis University, 415 South Main St., MS035, Waltham MA 02454. (T.C. Green)
| | - Thomas Stopka
- Department of Community Health, Tufts University School of Medicine, Tufts University, Boston, MA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston University, Boston, MA
| | - Tyler C. Davis
- Pharmacy Professional Practice Standards, CVS Health, Woonsocket, RI
| | - Jesse Boggis
- Heller School for Social Policy & Management at Brandeis University, Brandeis University, Waltham, MA
| | - Adriane N. Irwin
- Oregon State University College of Pharmacy, Oregon State University, Corvallis, OR
| | | | - Daniel M. Hartung
- Oregon State University College of Pharmacy, Oregon State University, Corvallis, OR
| | - Jeffrey Bratberg
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI
| |
Collapse
|
54
|
Formica SW, Waye KM, Benintendi AO, Yan S, Bagley SM, Beletsky L, Carroll JJ, Xuan Z, Rosenbloom D, Apsler R, Green TC, Hunter A, Walley AY. Characteristics of post-overdose public health-public safety outreach in Massachusetts. Drug Alcohol Depend 2021; 219:108499. [PMID: 33421800 DOI: 10.1016/j.drugalcdep.2020.108499] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND As a response to mounting overdose fatalities, cross-agency outreach efforts have emerged to reduce future risk among overdose survivors. We aimed to characterize such programs in Massachusetts, with focus on team composition, approach, services provided, and funding. METHODS We conducted a two-phase cross-sectional survey of public health and safety providers in Massachusetts. Providers in all 351 municipalities received a screening survey. Those with programs received a second, detailed survey. We analyzed responses using descriptive statistics. RESULTS As of July 2019, 44 % (156/351) of Massachusetts municipalities reported post-overdose outreach programs, with 75 % (104/138) formed between 2016-2019. Teams conducted home-based outreach 1-3 days following overdose events. Police departments typically supplied location information on overdose events (99 %, 136/138) and commonly participated in outreach visits (86 %, 118/138) alongside public health personnel, usually from community-based organizations. Teams provided or made referrals to services including inpatient addiction treatment, recovery support, outpatient medication, overdose prevention education, and naloxone. Some programs deployed law enforcement tools, including pre-visit warrant queries (57 %, 79/138), which occasionally led to arrest (11 %, 9/79). Many programs (81 %, 112/138) assisted families with involuntary commitment to treatment - although this was usually considered an option of last resort. Most programs were grant-funded (76 %, 104/136) and engaged in cross-municipal collaboration (94 %, 130/138). CONCLUSIONS Post-overdose outreach programs have expanded, typically as collaborations between police and public health. Further research is needed to better understand the implications of involving police and to determine best practices for increasing engagement in treatment and harm reduction services and reduce subsequent overdose.
Collapse
Affiliation(s)
- Scott W Formica
- Social Science Research and Evaluation, Inc., 21-C Cambridge Street, Burlington, MA 01803, USA.
| | - Katherine M Waye
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Allyn O Benintendi
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Shapei Yan
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Sarah M Bagley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA 02118, USA
| | - Leo Beletsky
- Northeastern University School of Law and Bouve College of Health Sciences, 350 Huntington Avenue, Boston, MA 02115, USA; Division of Infectious Diseases and Global Public Health, University of California at San Diego School of Medicine, La Jolla, CA, USA
| | - Jennifer J Carroll
- Elon University, Department of Sociology and Anthropology, 2035 Campus Box, Elon, NC 27244, USA; Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - David Rosenbloom
- Boston University School of Public Health, Department of Health Law, Policy and Management, Talbot Building, 715 Albany Street, Boston, MA 02118, USA
| | - Robert Apsler
- Social Science Research and Evaluation, Inc., 21-C Cambridge Street, Burlington, MA 01803, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA; Brandeis University, The Heller School for Social Policy and Management, 415 South Street Waltham, MA 02453, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI 02906, USA
| | - Allie Hunter
- Police Assisted Addiction and Recovery Initiative (PAARI), 253 Amory Street, Boston, MA 02130, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| |
Collapse
|
55
|
Carroll JJ, Mital S, Wolff J, Noonan RK, Martinez P, Podolsky MC, Killorin JC, Green TC. Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose. Drug Alcohol Depend 2020; 217:108257. [PMID: 32947173 PMCID: PMC7475730 DOI: 10.1016/j.drugalcdep.2020.108257] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rates of fatal overdose (OD) from synthetic opioids rose nearly 60 % from 2016 to 2018. 911 Good Samaritan Laws (GSLs) are an evidenced-based strategy for preventing OD fatality. This study describes patrol officers' knowledge of their state's GSL, experience with OD response, and their perspectives on strategies to prevent and respond to opioid OD. METHODS An electronic survey assessed officers' knowledge of state GSLs and experiences responding to OD. Descriptive statistics and hierarchical linear modeling were generated to examine differences in knowledge, preparedness, and endorsement of OD response efforts by experience with OD response. RESULTS 2,829 officers responded to the survey. Among those who had responded to an OD call in the past six months (n = 1,946), 37 % reported administering naloxone on scene and 36 % reported making an arrest. Most (91 %) correctly reported whether their state had a GSL in effect. Only 26 % correctly reported whether that law provides limited immunity from arrest. Fifteen percent of officers who had responded to an OD work in departments that do not carry naloxone. Compared with officers who had not responded to any OD calls, those who reported responding OD calls at least monthly and at least weekly, were significantly less likely to endorse OD response efforts. CONCLUSION Officers who respond to OD calls are generally receiving training and naloxone supplies to respond, but knowledge gaps and additional training needs persist. Additional training and strategies to relieve compassion fatigue among those who have more experience with OD response efforts may be indicated.
Collapse
Affiliation(s)
- Jennifer J. Carroll
- Department of Sociology & Anthropology, Elon University, Elon, NC, United States,Department of Medicine, Brown University, Providence, RI, United States,Corresponding author at: Elon University, 100 Campus Drive, 2035 Campus Box, Elon, NC, United States
| | - Sasha Mital
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - Jessica Wolff
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - Rita K. Noonan
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - Pedro Martinez
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - Melissa C. Podolsky
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - John C. Killorin
- Atlanta-Carolinas High Intensity Drug Trafficking Areas, Peachtree Corners, GA, United States
| | - Traci C. Green
- Heller School for Social Policy and Development, Brandeis University, Waltham, MA, United States,Departments of Emergency Medicine and Epidemiology, Brown University, Providence, RI, United States
| |
Collapse
|
56
|
Green TC, Bratberg J, Baird J, Burstein D, Lenz K, Case P, Walley AY, Xuan Z. Rurality and differences in pharmacy characteristics and community factors associated with provision of naloxone in the pharmacy. International Journal of Drug Policy 2020; 85:102602. [DOI: 10.1016/j.drugpo.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/19/2019] [Accepted: 11/10/2019] [Indexed: 02/01/2023]
|
57
|
Gaur DS, Jacka BP, Green TC, Samuels EA, Hadland SE, Krieger MS, Yedinak JL, Marshall BDL. US drug overdose mortality: 2009-2018 increases affect young people who use drugs. Int J Drug Policy 2020; 85:102906. [PMID: 33070095 DOI: 10.1016/j.drugpo.2020.102906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/05/2020] [Accepted: 08/05/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Drug overdose mortality remains a public health concern in many countries globally. In the US, overdoses involving synthetic opioids are the primary contributor to overdose mortality. We aimed to assess trends in overdose death due to synthetic opioids among young people and describe key demographic and temporal changes. METHODS Data from the US National Vital Statistics System Multiple Cause of Death files for 2009-2018 were analysed to determine age-specific overdose death rates by region (i.e. east versus west of the Mississippi River). Age-adjusted overdose mortality rates were used to compare demographic differences in all drug and synthetic opioid overdose among young people (aged 15-34 years) using a joinpoint regression with Poisson-approximated standard errors. RESULTS Driven by synthetic opioid overdose, the age burden of mortality shifted towards young people in eastern states and remained approximately constant in western states over the study period. The highest increases in drug overdose mortality rates were observed in young Black and Hispanic people and those living in large metropolitan areas. CONCLUSIONS Rapid changes in the demographics of overdose demonstrate distinct but overlapping US overdose sub-epidemics, and highlight the need for targeted interventions to reduce overdose risk in young people.
Collapse
Affiliation(s)
- Dhruv S Gaur
- Department of Epidemiology, Brown University. 121 South Main Street, Providence, RI 02912, USA
| | - Brendan P Jacka
- Department of Epidemiology, Brown University. 121 South Main Street, Providence, RI 02912, USA
| | - Traci C Green
- Department of Epidemiology, Brown University. 121 South Main Street, Providence, RI 02912, USA; Department of Emergency Medicine, The Warren Alpert Medical School, Brown University. 55 Claverick Street, Suite 100, Providence, RI 02903, USA; Department of Emergency Medicine, Boston University School of Medicine. 771 Albany St, Room 1208, Boston, MA 02118, USA; Rhode Island Hospital, COBRE on Opioids and Overdose. 8 Third Street, 2nd Floor, Providence, RI 02906, USA
| | - Elizabeth A Samuels
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University. 55 Claverick Street, Suite 100, Providence, RI 02903, USA
| | - Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center. One Boston Medical Center Place, Boston, MA 02118, USA; Department of Pediatrics, Division of General Pediatrics, Boston University School of Medicine. 88 East Newton Street, Vose Hall Room 322, Boston, MA, USA, 02118
| | - Maxwell S Krieger
- Department of Epidemiology, Brown University. 121 South Main Street, Providence, RI 02912, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University. 121 South Main Street, Providence, RI 02912, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University. 121 South Main Street, Providence, RI 02912, USA.
| |
Collapse
|
58
|
Donovan E, Bratberg J, Baird J, Burstein D, Case P, Walley AY, Green TC. Pharmacy leaders' beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community. Res Social Adm Pharm 2020; 16:1493-1497. [PMID: 31983625 DOI: 10.1016/j.sapharm.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Naloxone is an antidote to opioid overdose, and community pharmacies nationwide now provide broad access to this medication. OBJECTIVE The aim of this qualitative study was to understand how leaders in pharmacy organizations perceive pharmacies and pharmacy staff can optimize dispensing of naloxone. METHODS In-depth interviews were conducted with 12 pharmacy leaders in Massachusetts and Rhode Island. Participants were recruited from three types of community pharmacies: (1) chain; (2) independent; and (3) hospital outpatient. Theory-driven immersion crystallization, using Brownlee et al.'s model of healthcare quality improvement, was used to inform coding of the interview data, with predetermined categories of staff; organization; and process. RESULTS Five main themes were identified: (1) Importance of staff training to increase comfort; (2) Strength through coordination of efforts; (3) Pharmacy as a community leader in the opioid crisis; (4) Persisting stigma; and (5) Ongoing workflow challenges. CONCLUSIONS The results uniquely reflect the experiences and insights of pharmacy leaders implementing public health initiatives during the opioid crisis and can be used for gaining insight into how pharmacists can efficiently provide naloxone to their communities.
Collapse
Affiliation(s)
| | | | - Janette Baird
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Dina Burstein
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Patricia Case
- Institute for Urban Health Research and Practice, Northeastern University, Boston, MA, USA
| | - Alexander Y Walley
- Clinical Addiction Research Education Unit, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Traci C Green
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Department of Epidemiology, Alpert Medical School of Brown University, Providence, RI, USA; Boston Medical Center Injury Prevention Center, Boston University School of Medicine, Department of Emergency Medicine, Boston, MA, USA
| |
Collapse
|
59
|
Green TC, Donovan E, Klug B, Case P, Baird J, Burstein D, Tapper A, Walley AY, Bratberg J. Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches. J Am Pharm Assoc (2003) 2020; 60:740-749. [PMID: 32334964 PMCID: PMC10948012 DOI: 10.1016/j.japh.2020.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Pharmacies provide accessible sources of naloxone to caregivers, patients taking opioids, and individuals using drugs. While laws permit expanded pharmacy naloxone access, prior work identified barriers like concerns about stigma of addiction and time constraints that inhibit scale-up. We sought to examine similarities and differences in experiences obtaining naloxone at the pharmacy over a 1-year period in 2 states, and to explore reactions from people with opioid use disorder, patients taking opioids for chronic pain, caregivers of opioid users, and pharmacists to communication tools and patient outreach materials designed to improve naloxone uptake. DESIGN Eight focus groups (FGs) held December 2016 to April 2017 in Massachusetts and Rhode Island. SETTING AND PARTICIPANTS Participants were recruited from pharmacies, health clinics, and community organizations; pharmacists were recruited from professional organizations and pharmacy colleges. OUTCOME MEASURES The FGs were led by trained qualitative researchers using a topic guide and prototypes designed for input. Five analysts applied a coding scheme to transcripts. Thematic analysis involved synthesis of coded data and connections between themes, with comparisons across groups and to first-year findings. RESULTS A total of 56 individuals participated: patients taking opioids for chronic pain (n = 13), people with opioid use disorders (n = 15), caregivers (n = 13), and pharmacists (n = 16). Fear of future consequences and stigma in the pharmacy was a prominent theme from the previous year. Four new themes emerged: experience providing pharmacy naloxone, clinician-pharmacist-partnered approaches, naloxone coprescription, and fentanyl as motivator for pharmacy naloxone. Prototypes for prompting consumers about naloxone availability, materials facilitating naloxone conversations, and posters designed to address stigma were well received. CONCLUSIONS Experiences dispensing naloxone are quickly evolving, and a greater diversity of patients are obtaining pharmacy naloxone. Persistent stigma-related concerns underscore the need for tools to help pharmacists offer naloxone, facilitate patient requests, and provide reassurance when getting naloxone.
Collapse
Affiliation(s)
- Traci C. Green
- Department of Emergency Medicine, The Warren Alpert School of Medicine, Brown University, 55 Claverick St. 2 Floor, Providence, RI 02903, United States
- Boston Medical Center Injury Prevention Center, Boston Medical School, Department of Emergency Medicine, 771 Albany St, Boston, MA, 02118, United States
| | | | - Brittany Klug
- Boston Medical Center Injury Prevention Center, Boston Medical School, Department of Emergency Medicine, 771 Albany St, Boston, MA, 02118, United States
| | - Patricia Case
- Northeastern University, Institute on Urban Health Research and Policy, Bouve College of Health Sciences,360 Huntington Ave, Boston, MA 02115, United States
| | - Janette Baird
- Department of Emergency Medicine, The Warren Alpert School of Medicine, Brown University, 55 Claverick St. 2 Floor, Providence, RI 02903, United States
| | - Dina Burstein
- Department of Emergency Medicine, The Warren Alpert School of Medicine, Brown University, 55 Claverick St. 2 Floor, Providence, RI 02903, United States
| | - Abigail Tapper
- Boston Medical Center Injury Prevention Center, Boston Medical School, Department of Emergency Medicine, 771 Albany St, Boston, MA, 02118, United States
| | - Alexander Y. Walley
- Boston Medical Center, Boston Medical School, Department of Internal Medicine, 801 Massachusetts Ave, Boston, MA, 02118, United States
| | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, 7 Greenhouse Road, Kingston, RI 02881, United States
| |
Collapse
|
60
|
Abstract
U.S. Immigration and Customs Enforcement (ICE) facilities house thousands of undocumented immigrants in environments discordant with the public health recommendations to reduce the transmission of 2019 novel coronavirus (COVID-19). Using ICE detainee population data obtained from the ICE Enforcement and Removal Operations (ERO) website as of March 2, 2020, we implemented a simple stochastic susceptible-exposed-infected-recovered model to estimate the rate of COVID-19 transmission within 111 ICE detention facilities and then examined impacts on regional hospital intensive care unit (ICU) capacity. Models considered three scenarios of transmission (optimistic, moderate, pessimistic) over 30-, 60-, and 90-day time horizons across a range of facility sizes. We found that 72% of individuals are expected to be infected by day 90 under the optimistic scenario (R0 = 2.5), while nearly 100% of individuals are expected to be infected by day 90 under a more pessimistic (R0 = 7) scenario. Although asynchronous outbreaks are more likely, day 90 estimates provide an approximation of total positive cases after all ICE facility outbreaks. We determined that, in the most optimistic scenario, coronavirus outbreaks among a minimum of 65 ICE facilities (59%) would overwhelm ICU beds within a 10-mile radius and outbreaks among a minimum of 8 ICE facilities (7%) would overwhelm local ICU beds within a 50-mile radius over a 90-day period, provided every ICU bed was made available for sick detainees. As policymakers seek to rapidly implement interventions that ensure the continued availability of life-saving medical resources across the USA, they may be overlooking the pressing need to slow the spread of COVID-19 infection in ICE's detention facilities. Preventing the rapid spread necessitates intervention measures such as granting ICE detainees widespread release from an unsafe environment by returning them to the community.
Collapse
Affiliation(s)
- Michael Irvine
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julianne Skarha
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-3, Providence, RI, 02912, USA
| | - Brandon Del Pozo
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-3, Providence, RI, 02912, USA
| | - Josiah Rich
- Brown University School of Medicine, The Miriam Hospital, Providence, RI, USA
| | - Faye Taxman
- Center for Advancing Correctional Excellence, Department of Criminology, Law and Society, George Mason University, Fairfax, VA, USA
| | - Traci C Green
- Opioid Policy Research Collaborative, Heller School for Social Policy and Management, Brandeis University, 415 South Main St. MS 035, Waltham, MA, 02454-9110, USA.
- Departments of Emergency Medicine and Epidemiology, Brown Schools of Medicine and Public Health, Providence, RI, USA.
| |
Collapse
|
61
|
Macmadu A, Adams JW, Bessey SE, Brinkley-Rubinstein L, Martin RA, Clarke JG, Green TC, Rich JD, Marshall BDL. Optimizing the impact of medications for opioid use disorder at release from prison and jail settings: A microsimulation modeling study. Int J Drug Policy 2020; 91:102841. [PMID: 32712165 DOI: 10.1016/j.drugpo.2020.102841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality. METHODS We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017-2024) were compared to the standard of care (i.e., limited access to MOUD). RESULTS In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively. CONCLUSIONS Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.
Collapse
Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI 02906, USA
| | - Joëlla W Adams
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
| | - S E Bessey
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC 27516, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 South Columbia Street, Chapel Hill, NC 27514, USA
| | - Rosemarie A Martin
- Department of Behavioral and Social Science, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
| | - Jennifer G Clarke
- Rhode Island Department of Corrections, 40 Howard Avenue, Cranston, RI 02920, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI 02906, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
| |
Collapse
|
62
|
Walley AY, Bernson D, Larochelle MR, Green TC, Young L, Land T. Response to Letter to the Editor: The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015. Public Health Rep 2020; 135:542-543. [PMID: 32614735 DOI: 10.1177/0033354920935076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alexander Y Walley
- 122591836Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.,1854Massachusetts Department of Public Health, Boston, MA, USA
| | - Dana Bernson
- 1854Massachusetts Department of Public Health, Boston, MA, USA
| | - Marc R Larochelle
- 122591836Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA
| | - Traci C Green
- Opioid Policy Research Collaborative, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Leonard Young
- 1854Massachusetts Department of Public Health, Boston, MA, USA
| | - Thomas Land
- 164186Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
63
|
Stone AC, Carroll JJ, Rich JD, Green TC. One year of methadone maintenance treatment in a fentanyl endemic area: Safety, repeated exposure, retention, and remission. J Subst Abuse Treat 2020; 115:108031. [PMID: 32600619 DOI: 10.1016/j.jsat.2020.108031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fentanyl is a potent synthetic opioid that has contributed to increasing overdose deaths in the United States in recent years. Concern over safety and efficacy of agonist treatment for fentanyl use may limit access to treatment. This study sought to address these potential concerns in a naturalistic setting. OBJECTIVES Measure 12-month treatment outcomes for methadone maintenance treatment (MMT) in a fentanyl endemic area. OUTCOMES Primary: 1) Treatment retention; 2) sustained remission (defined as 3 consecutive negative screens); 3) return to use; 4) methadone dosage required; and 5) number of days to achieve remission. Secondary: Mortality. METHODS A naturalistic follow-up study and retrospective review of consecutive patients newly admitted to a single methadone maintenance treatment program in Rhode Island. RESULTS We observed 154 unique intake events (representing 151 patients). Eighty percent (n = 121) tested positive for fentanyl at intake. Seventy-five percent of patients achieved remission within the 12-month study period. One-year retention was 53% for fentanyl-exposed individuals and 47% for those not exposed. The majority (99%) of patients who remained in treatment at 12 months achieved remission. We saw prolonged, sustained remission in 44% of patients exposed to fentanyl at intake and 47% of those who were not. Dose and time to remission were similar. Unfortunately, 4 patients died after leaving MMT prematurely. CONCLUSIONS This study suggests MMT is safe despite repeated exposure to fentanyl while taking methadone. Remission is achievable, and MMT is protective against death among fentanyl-exposed patients while in treatment.
Collapse
Affiliation(s)
- Andrew C Stone
- Discovery House CTC, 1625 Diamond Hill Road, Woonsocket, RI 02895, USA.
| | - Jennifer J Carroll
- Department of Sociology & Anthropology, Elon University, 100 Campus Drive, Elon, NC 27244, USA
| | - Josiah D Rich
- The Warren Alpert School of Medicine of Brown University, The Miriam Hospital, 164 Summit Ave, Providence, RI 02903, USA
| | - Traci C Green
- The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| |
Collapse
|
64
|
Affiliation(s)
- Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Traci C Green
- The Heller School for Social Policy and Management, , Brandeis University, Waltham, MA, USA.,The Warren Alpert School of Medicine of Brown University, Providence, RI, USA
| | - Josiah Rich
- The Warren Alpert School of Medicine of Brown University, Providence, RI, USA.,The Center for Prisoner Health and Human Rights at The Miriam Hospital, Providence, RI, USA
| |
Collapse
|
65
|
Green TC, Bratberg J, Finnell DS. Opioid use disorder and the COVID 19 pandemic: A call to sustain regulatory easements and further expand access to treatment. Subst Abus 2020; 41:147-149. [PMID: 32314951 DOI: 10.1080/08897077.2020.1752351] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We highlight the critical roles that pharmacists have related to sustaining and advancing the changes being made in the face of the current COVID-19 pandemic to ensure that patients have more seamless and less complex access to treatment. Discussed herein is how the current COVID-19 pandemic is impacting persons with substance use disorders, barriers that persist, and the opportunities that arise as regulations around treatments for this population are eased.
Collapse
Affiliation(s)
- Traci C Green
- Opioid Policy Research Collaborative, Institute for Behavioral Health at The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachussetts, USA.,Department of Emergency Medicine and Epidemiology, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
| | | |
Collapse
|
66
|
Green TC, Davis C, Xuan Z, Walley AY, Bratberg J. Laws Mandating Coprescription of Naloxone and Their Impact on Naloxone Prescription in Five US States, 2014-2018. Am J Public Health 2020; 110:881-887. [PMID: 32298179 DOI: 10.2105/ajph.2020.305620] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives. To examine early impacts of laws that require naloxone to be prescribed to patients at increased overdose risk.Methods. Using data from 2014 to 2018 from a large pharmacy chain, CVS Pharmacy, we examined the effects of naloxone-prescribing mandates 90 days before and after they took effect in Arizona, Florida, Rhode Island, Vermont, and Virginia. We compared the number of naloxone doses initiated directly by prescribers and by pharmacy standing order, prescriber specialty, pharmacies dispensing, and payor type by applying linear models and the χ2 test.Results. Naloxone-prescribing mandates increased pharmacy naloxone provision 255% from 90 days before to after implementation. This approach appeared to engage more prescribers (1028 before to 4285 after), complement ongoing naloxone provision under pharmacy standing orders, expand geographic reach (from 40% to 80% of pharmacies dispensing), and broaden the naloxone payor mix in 4 (P < .05) of 5 states.Conclusions. Mandating the prescribing of naloxone quickly expands access to this life-saving medication for more people in more places. Other states should consider mandating the coprescription of naloxone to individuals at increased risk of overdose.
Collapse
Affiliation(s)
- Traci C Green
- At the time of the study, Traci C. Green was with the Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston, MA. Corey Davis is with the Network for Public Health Law, Greensboro, NC. Ziming Xuan is with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexander Y. Walley is with the Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston. Jeffrey Bratberg is with the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Corey Davis
- At the time of the study, Traci C. Green was with the Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston, MA. Corey Davis is with the Network for Public Health Law, Greensboro, NC. Ziming Xuan is with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexander Y. Walley is with the Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston. Jeffrey Bratberg is with the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Ziming Xuan
- At the time of the study, Traci C. Green was with the Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston, MA. Corey Davis is with the Network for Public Health Law, Greensboro, NC. Ziming Xuan is with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexander Y. Walley is with the Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston. Jeffrey Bratberg is with the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Alexander Y Walley
- At the time of the study, Traci C. Green was with the Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston, MA. Corey Davis is with the Network for Public Health Law, Greensboro, NC. Ziming Xuan is with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexander Y. Walley is with the Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston. Jeffrey Bratberg is with the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Jeffrey Bratberg
- At the time of the study, Traci C. Green was with the Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston, MA. Corey Davis is with the Network for Public Health Law, Greensboro, NC. Ziming Xuan is with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexander Y. Walley is with the Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center Injury Prevention Center, Boston. Jeffrey Bratberg is with the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| |
Collapse
|
67
|
Rouhani S, Park JN, Morales KB, Green TC, Sherman SG. Trends in opioid initiation among people who use opioids in three US cities. Drug Alcohol Rev 2020; 39:375-383. [PMID: 32249463 DOI: 10.1111/dar.13060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION AND AIMS The increased availability of prescription opioids (PO) and non-medical prescription opioids (NMPO) has fundamentally altered drug markets and typical trajectories from initiation to high-risk use among people who use opioids (PWUO). This multi-site study explores trends in opioid initiation in three US cities and associations with sociodemographic factors, current drug use and overdose risk. DESIGN AND METHODS We analysed survey data from a cross-sectional study of PWUO in Baltimore, Maryland (n = 173), Boston, Massachusetts (n = 80) and Providence, Rhode Island (n = 75). Age of first exposure to PO, NMPO and heroin was used to calculate opioid of initiation, and multinomial regression was employed to explore correlates of initiating with each. RESULTS Thirty-three percent of PWUO initiated with heroin, 24% with PO, 18% with NMPO and 24% with multiple opioids in their first year of use. We observed a reduction in heroin initiation and gradual replacement with PO/NMPO over time. Women were more likely to initiate with NMPO [relative risk ratio (RRR) 2.4; 95% confidence interval (CI) 1.1, 5.0], PO (RRR 2.2, 95% CI 1.1, 4.4) or multiple opioids (RRR 2.1, 95% CI 1.1, 4.2), than heroin. PWUO initiating with NMPO had significantly higher current benzodiazepine use, relative to those initiating with heroin (RRR 3.2, 95% CI 1.4, 7.4), and a high prevalence of current fentanyl use (30%). DISCUSSION AND CONCLUSIONS Our study highlights women and PWUO initiating with NMPO as key risk groups amid the changing landscape of opioid use and overdose, and discusses implications for targeted prevention and treatment.
Collapse
Affiliation(s)
- Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kenneth B Morales
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Traci C Green
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, USA.,Alpert Medical School, Brown University, Providence, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| |
Collapse
|
68
|
Abstract
BACKGROUND Opioid overdose is a preventable injury leading to high morbidity and premature mortality in communities across the United States. Overdoses take place where people use drugs, including commercial and public locations like community pharmacies, and necessitate swift detection and response to avoid harm and, even more seriously, death. The presence of emergency and safety protocols improves occupational health and safety for all in the workplace. The aim of this study was to assess the prevalence of experience with on-site pharmacy overdose and to explore pharmacist and site characteristics associated with having a known protocol for responding to on-site overdose emergencies. Methods: An anonymous, online survey about naloxone provision and opioid safety was delivered by email, through professional pharmacy associations and continuing education attendance lists, to 3,100 pharmacists in Massachusetts and Rhode Island between October 2017 and January 2018. Survey items gauged socio-demographics, practice site characteristics, safer opioid dispensing and naloxone provision. Summary statistics and bivariate analyses were conducted to describe characteristics associated with items pertaining to on-site overdose policy awareness. Results: Of the 357 respondents (11.5% response rate), 154 (5.0%) answered the questions of interest: 17.5% reported having at least one suspected overdose on-site at their practice location, while 42.9% reported that they were knowledgeable about and could locate at their practice location an on-site overdose protocol detailing how to respond to an overdose. Pharmacists who were knowledgeable about protocols were also more likely to offer naloxone to patients (p = 0.02) and did not practice at a chain pharmacy (p = 0.01). Conclusions: Community pharmacies that stock and distribute naloxone are key parts of community efforts to address the opioid crisis. Pharmacies and other healthcare settings should develop and implement on-site overdose response protocols and cultivate a norm of naloxone provision to patients.
Collapse
Affiliation(s)
- Traci C Green
- Department of Emergency Medicine, Injury Prevention Center, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Emergency Medicine, Injury Prevention Center, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ayorinde Soipe
- Department of Emergency Medicine, Injury Prevention Center, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Brianna Baloy
- Department of Emergency Medicine, Injury Prevention Center, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dina Burstein
- Department of Emergency Medicine, Injury Prevention Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Abigail Tapper
- Department of Emergency Medicine, Injury Prevention Center, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Patricia Case
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Jeffrey Bratberg
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Janette Baird
- Department of Emergency Medicine, Injury Prevention Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
69
|
Carroll JJ, Rich JD, Green TC. The protective effect of trusted dealers against opioid overdose in the U.S. Int J Drug Policy 2020; 78:102695. [PMID: 32143185 DOI: 10.1016/j.drugpo.2020.102695] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Opioid overdose has become the leading cause of death among adults between 25 and 54 years old in the U.S. The purpose of this study is to explore the social and relational factors that shape the current opioid overdose epidemic. METHODS Between January 2016 and February 2017, adults in Providence, Rhode Island, who use opioids were recruited to complete structured survey and semi-structured interview about the social context of their substance use. RESULTS A total of 92 individuals completed a survey and an interview. Of those, 51 individuals (68.6% male, 49.0% white) discussed their relationships with drug suppliers in their interview and were included in this sub-study. Many of these participants indicated that long-term relationships with trusted dealers represent a key strategy for reducing the risk of substance use-related harm due to suppliers' alleged adoption of consumer protection strategies (e.g. refusing to sell fentanyl) and quality assurance measures (e.g. testing batches of drugs for fentanyl prior to sale). CONCLUSION Interpersonal relationships between individuals who use drugs and their suppliers strongly influence the risk and protective factors experienced by people who use drugs in today's opioid overdose epidemic. Evidence-based prevention strategies that are based on an awareness of-or even designed to harness-those positive and/or protective relationships that people who use drugs have already constructed for themselves are likely merited.
Collapse
Affiliation(s)
- Jennifer J Carroll
- Department of Sociology & Anthropology, Elon University, 100 Campus Dr. 2035 Campus Box, Elon, NC 27244, USA; The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA.
| | - Josiah D Rich
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA; Division of Infectious Diseases, The Miriam Hospital, 164 Summit Ave. Providence, RI 02906, United States; Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third St. Second Floor, Providence, RI 02906, USA
| | - Traci C Green
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Emergency Medicine, Boston University School of Medicine, 771 Albany St, Room 1208, Boston, MA 02118, USA
| |
Collapse
|
70
|
Burstein D, Baird J, Bratberg J, Donovan E, Soipe A, Tapper A, Case P, Walley AY, Green TC. Pharmacist attitudes toward pharmacy-based naloxone: A cross-sectional survey study. J Am Pharm Assoc (2003) 2020; 60:304-310. [PMID: 31870862 DOI: 10.1016/j.japh.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate pharmacist attitudes regarding recommending pharmacy-based naloxone (PBN). The influence of gender, practice setting, the number of years of practice, state, and PBN involvement were explored. Barriers to, and facilitators of, provision of PBN were also assessed. DESIGN A 71-question survey was designed to assess experience with, and attitudes toward, PBN. We employed a cross-sectional study design and utilized the online survey site Qualtrics (Qualtrics International Inc, Provo, UT). SETTING AND PARTICIPANTS The survey was e-mailed to approximately 2900 licensed pharmacists from all practice settings in Massachusetts (approximately 1400) and Rhode Island (approximately 1500) and was open from April 5, 2016, until July 13, 2016. OUTCOME MEASURES Attitudes toward opioid overdose prevention (12 questions) were used to develop the Opioid Overdose Prevention Attitude (OOPA) scale which consisted of 3 subscales: Opioid Overdose Prevention Attitude, Public Health Attitude, and Naloxone Dispensing Attitude. RESULTS Of the approximately 2900 pharmacists who received the survey, 402 responded (13%), and 245 (137 from Massachusetts and 108 from Rhode Island) were included in the analyses. The majority (79%) identified as White or Caucasian, and 127 (51.8%) stated they had ever dispensed naloxone. Of those, 85 (67%) had done so in the past 30 days. We examined differences in the OOPA subscales by pharmacists' characteristics and pharmacy practice settings. Working in a pharmacy that had a standing order or collaborative practice agreement allowing pharmacists to dispense naloxone without a physician's prescription, or in a pharmacy that stocked naloxone resulted in more positive attitudes toward opioid overdose prevention and public health prevention. CONCLUSION Respondents who practiced in a pharmacy with a standing order or collaborative practice agreement were more likely to have dispensed naloxone. Both stocking naloxone and ever having dispensed naloxone were associated with higher OOPA scores. More research is needed to better understand how pharmacist attitudes influence the distribution of naloxone.
Collapse
|
71
|
Macmadu A, Goedel WC, Adams JW, Brinkley-Rubinstein L, Green TC, Clarke JG, Martin RA, Rich JD, Marshall BDL. Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails. Drug Alcohol Depend 2020; 208:107858. [PMID: 32050112 PMCID: PMC7075016 DOI: 10.1016/j.drugalcdep.2020.107858] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality. METHODS We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016. RESULTS Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 - 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 - 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 - 1812) and 1609 (95% SI: 972 - 2037) lives saved per 10,000 persons incarcerated, respectively. CONCLUSIONS Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.
Collapse
Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI, USA
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Joëlla W Adams
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC, 27516, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 South Columbia Street, Chapel Hill, NC, 27514, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA; Department of Emergency Medicine, Boston University Medical Center, 725 Albany Street, Boston, MA, 02118, USA
| | - Jennifer G Clarke
- Rhode Island Department of Corrections, 40 Howard Avenue, Cranston, RI, 02920, USA
| | - Rosemarie A Martin
- Department of Behavioral and Social Science, Brown University, 121 South Main Street, Providence, RI 02903, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA.
| |
Collapse
|
72
|
Green TC, Park JN, Gilbert M, McKenzie M, Struth E, Lucas R, Clarke W, Sherman SG. An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples. Int J Drug Policy 2020; 77:102661. [PMID: 31951925 DOI: 10.1016/j.drugpo.2020.102661] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fentanyl has caused rapid increases in US and Canadian overdose deaths, yet its presence in illicit drugs is often unknown to consumers. This study examined the validity in identifying the presence of fentanyl of three portable devices that could be used in providing drug checking services and drug supply surveillance: fentanyl test strips, a hand-held Raman Spectrometer, and a desktop Fourier-Transform Infrared Spectrometer. METHODS In Fall 2017, we first undertook an assessment of the limits of detection for fentanyl, then tested the three devices' sensitivity and specificity in distinguishing fentanyl in street-acquired drug samples. Utilizing test replicates of standard fentanyl reference material over a range of increasingly lower concentrations, we determined the lowest concentration reliably detected. To establish the sensitivity and specificity for fentanyl, 210 samples (106 fentanyl-positive, 104 fentanyl-negative) previously submitted by law enforcement entities to forensic laboratories in Baltimore, Maryland, and Providence, Rhode Island, were tested using the devices. All sample testing followed parallel and standardized protocols in the two labs. RESULTS The lowest limit of detection (0.100 mcg/mL), false negative (3.7%), and false positive rate (9.6%) was found for fentanyl test strips, which also correctly detected two fentanyl analogs (acetyl fentanyl and furanyl fentanyl) alone or in the presence of another drug, in both powder and pill forms. While less sensitive and specific for fentanyl, the other devices conveyed additional relevant information including the percentage of fentanyl and presence of cutting agents and other drugs. CONCLUSION Devices for fentanyl drug checking are available and valid. Drug checking services and drug supply surveillance should be considered and researched as part of public health responses to the opioid overdose crisis.
Collapse
Affiliation(s)
- Traci C Green
- Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, USA; Department of Epidemiology, Brown University School of Public Health, 55 Claverick St., 2nd floor, Providence, RI 02903, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Michelle McKenzie
- Department of Immunology, The Miriam Hospital, Center for Prisoner Health and Human Rights, Providence, RI, USA.
| | - Eric Struth
- Department of Emergency Medicine, Rhode Island Hospital, 55 Claverick St., 2nd floor, Providence, RI 02903 USA
| | - Rachel Lucas
- Baltimore Police Department Forensic Laboratory, Baltimore, MD, USA.
| | - William Clarke
- Department of Pathology, Johns Hopkins Bloomberg School of Medicine, Baltimore, MD, USA.
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
73
|
Abstract
OBJECTIVES Buprenorphine/naloxone, an evidence-based treatment for opioid use disorder, is sometimes diverted for non-medical use. In Rhode Island, the prevalence of opioid use and, more recently, of fentanyl in the illicit drug supply is driving overdose fatalities, which increases the need for treatment and raises questions about the changing role of diverted medication in shaping overdose risk. METHODS This study considered data from 2 Rhode Island based studies (conducted in 2009 and 2016, respectively) of people who use illicit or diverted prescription opioids and their patterns of buprenorphine/naloxone diversion. Using targeted sampling, individuals who use opioids completed a brief questionnaire about their drug use. For the 2016 study, logistic regression was used to identify associations with recent and lifetime use of diverted medication. RESULTS A total of 128 individuals who use opioids non-medically participated in the 2016 study. Of these, 38% (n = 13) reported diverted buprenorphine/naloxone use in the past 2 months, similar to the pattern observed in 2009 (41%, n = 41). Common motivations for using diverted medication included the management of withdrawal symptoms (40%, n = 35) and self-treatment of opioid use disorder (39%, n = 34). Few reported using to "get high" (12%, n = 4). Seeking buprenorphine/naloxone treatment in the previous 12 months was positively associated with using diverted medication in the past 2 months (odds ratio = 5.14, 95% confidence interval = 1.0-26.5, P = 0.05). Participants of both studies reported the same barriers to care in 2009 and 2016. CONCLUSION The use of diverted/buprenorphine remains common among people who use opioids non-medically and indicates a severe shortage in treatment capacity and inaccessibility of existing services.
Collapse
Affiliation(s)
- Jennifer J. Carroll
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Josiah D. Rich
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA
- Division of Infectious Diseases, The Miriam Hospital. 164 Summit Ave. Providence, RI 02906, USA
| | - Traci C. Green
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Emergency Medicine, Boston University School of Medicine. 771 Albany St, Room 1208, Boston, MA 02118, USA
| |
Collapse
|
74
|
Kurian S, Baloy B, Baird J, Burstein D, Xuan Z, Bratberg J, Tapper A, Walley A, Green TC. Attitudes and perceptions of naloxone dispensing among a sample of Massachusetts community pharmacy technicians. J Am Pharm Assoc (2003) 2019; 59:824-831. [PMID: 31582224 DOI: 10.1016/j.japh.2019.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES There is limited research on the attitudes of pharmacy technicians toward pharmacy naloxone provision, despite their widespread role in the pharmacy. We examined attitudes and perceptions of pharmacy technicians in the provision of naloxone in a sample of Massachusetts pharmacies. DESIGN Thirty-nine community retail pharmacies from 1 U.S. chain were purposely sampled in 13 municipalities across Massachusetts. Pharmacies were divided into high-risk municipalities (HRMs) versus low-risk municipalities (LRMs) based on the state average opioid-related death rate from 2011 to 2015. SETTING AND PARTICIPANTS A pharmacy technician working in each pharmacy was administered an in-person survey. Survey topics included technician beliefs about current naloxone provision practices; patient groups at greater risk of overdose; whether individuals filling prescriptions would benefit from naloxone; and whether individuals purchasing syringes would benefit from naloxone. OUTCOME MEASURES Closed-ended responses were analyzed by Mann-Whitney U, Fisher exact, and chi-square tests. Open-ended responses were summarized for themes and then contrasted by municipality risk status. RESULTS Technician participation was 100% (n = 39). Technicians in both groups believed they could identify patient groups at risk of overdose in their practice, but HRM technicians recognized the need for naloxone for more of their at-risk patients (81% in HRM vs. 33% in LRM believed > 25% of patients need naloxone, P < 0.01). A willingness to provide naloxone was high (> 89%) in both groups. Open-ended responses revealed commonalities between groups, including the belief that patients need lower-cost naloxone, and a lack of patient and technician awareness that naloxone could prevent overdose in individuals at risk through use of prescription opioids not just through use of illicit drugs. CONCLUSION Pharmacy technicians would benefit from overdose prevention training and are well positioned to recognize overdose risk and offer preventive interventions, such as naloxone. Among technicians, there is a high willingness to be involved in implementing broader naloxone access in pharmacies.
Collapse
|
75
|
Walley AY, Bernson D, Larochelle MR, Green TC, Young L, Land T. The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015. Public Health Rep 2019; 134:667-674. [PMID: 31577519 PMCID: PMC6832088 DOI: 10.1177/0033354919878429] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Opioid-related overdoses are commonly attributed to prescription opioids. We examined data on opioid-related overdose decedents in Massachusetts. For each decedent, we determined which opioid medications had been prescribed and dispensed and which opioids were detected in postmortem medical examiner toxicology specimens. METHODS Among opioid-related overdose decedents in Massachusetts during 2013-2015, we analyzed individually linked postmortem opioid toxicology reports and prescription drug monitoring program records to determine instances of overdose in which a decedent had a prescription active on the date of death for the opioid(s) detected in the toxicology report. We also calculated the proportion of overdoses for which prescribed opioid medications were not detected in decedents' toxicology reports. RESULTS Of 2916 decedents with complete toxicology reports, 1789 (61.4%) had heroin and 1322 (45.3%) had fentanyl detected in postmortem toxicology reports. Of the 491 (16.8%) decedents with ≥1 opioid prescription active on the date of death, prescribed opioids were commonly not detected in toxicology reports, specifically: buprenorphine (56 of 97; 57.7%), oxycodone (93 of 176; 52.8%), and methadone prescribed for opioid use disorder (36 of 112; 32.1%). Only 39 (1.3%) decedents had an active prescription for each opioid detected in toxicology reports on the date of death. CONCLUSION Linking overdose toxicology reports to prescription drug monitoring program records can help attribute overdoses to prescribed opioids, diverted prescription opioids, heroin, and illicitly made fentanyl.
Collapse
Affiliation(s)
- Alexander Y. Walley
- Department of Medicine, Clinical Addiction Research and Education
Unit, Section of General Internal Medicine, Boston University School of Medicine
& Boston Medical Center, Boston, MA, USA
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Marc R. Larochelle
- Department of Medicine, Clinical Addiction Research and Education
Unit, Section of General Internal Medicine, Boston University School of Medicine
& Boston Medical Center, Boston, MA, USA
| | - Traci C. Green
- Department of Emergency Medicine, Injury Prevention Center, Boston
University School of Medicine & Boston Medical Center, Boston, MA, USA
| | - Leonard Young
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Thomas Land
- Department of Medicine, University of Massachusetts Medical School,
Worcester, MA, USA
| |
Collapse
|
76
|
Davis CS, Green TC, Hernandez-Delgado H, Lieberman AJ. Status of US State Laws Mandating Timely Reporting of Nonfatal Overdose. Am J Public Health 2019; 108:1159-1161. [PMID: 30088991 DOI: 10.2105/ajph.2018.304589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Corey S Davis
- Corey S. Davis is with the Network for Public Health Law, Los Angeles, CA, and the Brody School of Medicine, East Carolina University, Greenville, NC. Traci C. Green is with the Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, and the Departments of Medicine and Epidemiology, Brown Medical School, Providence, RI. Hector Hernandez-Delgado and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA
| | - Traci C Green
- Corey S. Davis is with the Network for Public Health Law, Los Angeles, CA, and the Brody School of Medicine, East Carolina University, Greenville, NC. Traci C. Green is with the Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, and the Departments of Medicine and Epidemiology, Brown Medical School, Providence, RI. Hector Hernandez-Delgado and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA
| | - Hector Hernandez-Delgado
- Corey S. Davis is with the Network for Public Health Law, Los Angeles, CA, and the Brody School of Medicine, East Carolina University, Greenville, NC. Traci C. Green is with the Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, and the Departments of Medicine and Epidemiology, Brown Medical School, Providence, RI. Hector Hernandez-Delgado and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA
| | - Amy Judd Lieberman
- Corey S. Davis is with the Network for Public Health Law, Los Angeles, CA, and the Brody School of Medicine, East Carolina University, Greenville, NC. Traci C. Green is with the Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, and the Departments of Medicine and Epidemiology, Brown Medical School, Providence, RI. Hector Hernandez-Delgado and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA
| |
Collapse
|
77
|
Goedel WC, Marshall BD, Spangler KR, Alexander-Scott N, Green TC, Wellenius GA, Weinberger KR. Increased Risk of Opioid Overdose Death Following Cold Weather: A Case-Crossover Study. Epidemiology 2019; 30:637-641. [PMID: 31205291 PMCID: PMC6679791 DOI: 10.1097/ede.0000000000001041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The United States is in the midst of an opioid overdose crisis. Little is known about the role of environmental factors in increasing risk of fatal opioid overdose. METHODS We conducted a case-crossover analysis of 3,275 opioid overdose deaths recorded in Connecticut and Rhode Island in 2014-2017. We compared the mean ambient temperature on the day of death, as well as average temperature up to 14 days before death, to referent periods matched on year, month, and day of week. RESULTS Low average temperatures over the 3-7 days before death were associated with higher odds of fatal opioid overdose. Relative to 11°C, an average temperature of 0°C over the 7 days before death was associated with a 30% higher odds of death (odds ratio: 1.3; 95% confidence interval, 1.1, 1.5). CONCLUSIONS Low average temperature may be associated with higher risk of death due to opioid overdose.
Collapse
Affiliation(s)
- William C. Goedel
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
| | - Brandon D.L. Marshall
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
| | - Keith R. Spangler
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
- Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
- Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, Rhode Island
| | | | - Traci C. Green
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Gregory A. Wellenius
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
- Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
| | - Kate R. Weinberger
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
- Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
| |
Collapse
|
78
|
Bouvier BA, Kinnard EN, Yedinak JL, Li Y, Elston B, Green TC, Hadland SE, Marshall BDL. Prevalence and Correlates of Depressive Symptomology among Young Adults Who Use Prescription Opioids Non-medically. J Psychoactive Drugs 2019; 51:441-452. [PMID: 31411548 DOI: 10.1080/02791072.2019.1654151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Non-medical prescription opioid (NMPO) use and depression frequently co-occur and are mutually reinforcing in adults, yet NMPO use and depression in younger populations has been under-studied. We examined the prevalence and correlates of depressive symptomology among NMPO-using young adults. The Rhode Island Young Adult Prescription Drug Study (RAPiDS) recruited young adults in Rhode Island who reported past 30-day NMPO use. We administered the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and used modified Poisson regression to identify the independent correlates of depressive symptomology (CES-D 10 score ≥10). Over half (59.8%, n = 119) screened positive for depressive symptomology. In modified Poisson regression analysis, diagnostic history of depressive disorder and childhood verbal abuse were associated with depressive symptomology. Participants with depressive symptomology were more likely to report using prescription opioids non-medically to feel less depressed or anxious, to avoid withdrawal symptoms, and as a substitute when other drugs are not available. Among young adult NMPO users, depressive symptomology is prevalent and associated with distinct motivations for engaging in NMPO use and represents a potential subgroup for intervention. Improving guidelines with tools such as screening for depressive symptomology among young adult NMPO users may help prevent NMPO-related harms.
Collapse
Affiliation(s)
- Benjamin A Bouvier
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Elizabeth N Kinnard
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Department of Emergency Medicine, Boston Medical Center Injury Prevention Center and Boston University School of Medicine, Boston, MA, USA.,Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Scott E Hadland
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA.,Department of Pediatrics, Division of General Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
79
|
Rouhani S, Park JN, Morales KB, Green TC, Sherman SG. Harm reduction measures employed by people using opioids with suspected fentanyl exposure in Boston, Baltimore, and Providence. Harm Reduct J 2019; 16:39. [PMID: 31234942 PMCID: PMC6591810 DOI: 10.1186/s12954-019-0311-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Exposure to potent synthetic opioids such as illicitly manufactured fentanyl (IMF) has fueled the escalating overdose crisis in the USA, particularly in the east coast. Drug checking services, which allow people who use drugs (PWUD) to learn about the contents of their drugs, remain limited and even criminalized in many states. Further, there is a persistent belief that PWUD are not willing or able to change their behaviors despite being aware of their potential exposure to fentanyl through drug use. METHODS We conducted a multi-site cross-sectional study among PWUD to assess what behaviors, if any, were employed in the case of suspected fentanyl exposure, and the correlates of engaging in harm reduction behaviors (HRB). PWUD (N = 334) were recruited in Boston (n = 80), Providence (n = 79), and in Baltimore (n = 175). At the time of the survey, no legal drug checking services were available in these cities. RESULTS The majority of PWUD (84%) expressed concern about fentanyl. Among those who suspected fentanyl exposure prior to using their drugs (n = 196), 39% reported employing HRB including using less of the drug (12%) or abstaining altogether (10%), using more slowly (5%), and doing a tester shot (5%). In adjusted logistic regression models, the odds (aOR) of practicing HRB after suspecting fentanyl exposure were increased among PWUD who were non-White (aOR 2.1; p = 0.004) and older (aOR 1.52 per decade of age; p < 0.001). Daily injection (aOR 0.50; p < 0.001), using drugs in public (aOR 0.58; p = 0.001), using drugs alone (aOR 0.68; p < 0.001), and experiencing multiple recent overdoses (aOR 0.55; p < 0.001) were associated with decreased odds of practicing HRB. CONCLUSIONS These data illustrate that PWUD employ a number of practices to reduce overdose risk in a context of unknown drug purity and content. Results may also guide efforts to identify early adopters of drug checking services and engage them in peer-outreach to target the most socially and structurally vulnerable PWUD, who are not reporting behavior change, with harm reduction messaging.
Collapse
Affiliation(s)
- Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Kenneth B Morales
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Traci C Green
- Miriam Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| |
Collapse
|
80
|
Goldman JE, Krieger MS, Buxton JA, Lysyshyn M, Sherman SG, Green TC, Bernstein E, Hadland SE, Marshall BDL. Suspected involvement of fentanyl in prior overdoses and engagement in harm reduction practices among young adults who use drugs. Subst Abus 2019; 40:519-526. [PMID: 31206354 DOI: 10.1080/08897077.2019.1616245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: From 2011 to 2016, the United States has experienced a 55% increase in overall overdose deaths and a 260% increase in fatal fentanyl-related overdoses. Increasing engagement in harm reduction practices is essential to reducing the rate of fentanyl-related overdoses. This study sought to examine the uptake of harm reduction practices among young adults who reported recent drug use and who were recruited for a study to assess the utility and acceptability of rapid fentanyl test strips. Methods: Between May and October 2017, 93 young adults who reported drug use in the past 30 days were recruited through word of mouth, Internet advertising, and public canvasing. Participants completed an interviewer-administered survey that assessed participants' sociodemographic and behavioral characteristics, suspected fentanyl exposure, and overdose history. We assessed harm reduction practices and other correlates associated with experiencing a suspected fentanyl-related overdose. Results: Of 93 eligible participants, 36% (n = 34) reported ever having experienced an overdose, among whom 53% (n = 18) suspected having experienced a fentanyl-related overdose. Participants who had ever experienced a fentanyl-related overdose were more likely to keep naloxone nearby when using drugs compared with those who had never experienced an overdose and those who had experienced an overdose that they did not suspect was related to fentanyl (P < .001). Additionally, experiencing a suspected fentanyl-related overdose was associated with having previously administered naloxone to someone else experiencing an overdose (P < .001). Conclusion: Those who had experienced a suspected fentanyl-related overdose were more likely to carry and administer naloxone. Future overdose prevention interventions should involve persons who have experienced a suspected fentanyl overdose and/or responded to an overdose in order to develop harm reduction programs that meet the needs of those at risk of an overdose.
Collapse
Affiliation(s)
- Jacqueline E Goldman
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Maxwell S Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Traci C Green
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Grayken Center for Addiction, School of Medicine, Boston University, Boston, Massachusetts, USA.,Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Edward Bernstein
- Department of Emergency Medicine, Grayken Center for Addiction, School of Medicine, Boston University, Boston, Massachusetts, USA.,Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Scott E Hadland
- Department of Emergency Medicine, Grayken Center for Addiction, School of Medicine, Boston University, Boston, Massachusetts, USA.,Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
81
|
Park JN, Sherman SG, Rouhani S, Morales KB, McKenzie M, Allen ST, Marshall BDL, Green TC. Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston. J Urban Health 2019; 96:353-366. [PMID: 31168735 PMCID: PMC6565790 DOI: 10.1007/s11524-019-00365-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Safe consumption spaces (SCS) are evidence-based interventions that reduce drug-related morbidity and mortality operating in many countries. However, SCS are yet to be widely implemented in the USA despite the escalating overdose epidemic. The aim of this multi-city study was to identify the factors associated with willingness to use a SCS among people who use drugs (PWUD) in Baltimore, Providence, and Boston, stratified by injection drug use status. Our secondary aim was to characterize the anticipated barriers to accessing SCS if they were to be implemented in these cities. PWUD were invited to complete a cross-sectional survey in 2017. The analysis was restricted to 326 opioid users (i.e., heroin, fentanyl, and non-medical opioid pill use). The majority (77%) of participants expressed willingness to use a SCS (Baltimore, 78%; Providence, 68%; Boston. 84%). Most respondents were male (59%), older than 35 years (76%), non-white (64%), relied on public/semi-public settings to inject (60%), had a history of overdose (64%), and recently suspected fentanyl contamination of their drugs (73%). A quarter (26%) preferred drugs containing fentanyl. Among injectors, female gender, racial minority status, suspicion of drugs containing fentanyl, and drug use in public/semi-public settings were associated with higher willingness to use a SCS; prior arrest was associated with lower willingness. Among non-injectors, racial minority status, preference for fentanyl, and drug use in public/semi-public settings were associated with higher willingness, whereas recent overdose held a negative association. The most commonly anticipated barriers to accessing a SCS in the future were concerns around arrest (38%), privacy (34%), confidentiality/trust/safety (25%), and cost/time/transportation (16%). These data provide evidence of high SCS acceptability among high-risk PWUD in the USA, including those who prefer street fentanyl. As SCS are implemented in the USA, targeted engagement efforts may be required to reach individuals exposed to the criminal justice system.
Collapse
Affiliation(s)
- Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth B Morales
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle McKenzie
- Miriam Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Emergency Medicine, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
82
|
Peterson M, Rich J, Macmadu A, Truong AQ, Green TC, Beletsky L, Pognon K, Brinkley-Rubinstein L. "One guy goes to jail, two people are ready to take his spot": Perspectives on drug-induced homicide laws among incarcerated individuals. Int J Drug Policy 2019; 70:47-53. [PMID: 31082662 DOI: 10.1016/j.drugpo.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND As overdose deaths have increased in the United States, some lawmakers have explored punitive, "supply-side" interventions aimed at reducing the supply of fentanyl. While a rationale of seeking to protect people who use drugs is often given to justify harsh sentences for fentanyl distribution, there is no research to our knowledge on perceptions of the effect of drug-induced homicide laws among people who use drugs. METHODS We conducted semi-structured, qualitative interviews with 40 people with opioid use disorder (OUD) who were enrolled in a medication for addiction treatment (MAT) program in a unified jail and prison system in Rhode Island on attitudes surrounding increased sentences for distribution of fentanyl, including recently enacted drug-induced homicide laws. Codes were developed using a generalized, inductive method and interviews analyzed in NVivo 12 after being coded by two coders. RESULTS Most participants stated that drug-induced homicide laws would not be an effective strategy to stem the overdose crisis. We identified key themes, including discussions surrounding the autonomy of people who use drugs, widespread fentanyl prevalence as a barrier to implementation of drug-induced homicide laws, discussions of mass incarceration as ineffective for addressing substance use disorders, feelings that further criminalization could lead to violence, criminalization as a justification for interpersonal loss, and intention as meaningful to categorizing an act as homicide. CONCLUSIONS Findings highlight the importance of centering the experiences of people with OUD in creating policies surrounding the overdose epidemic, potential unintended health consequences of drug-induced homicides laws such as deterrence from calling 911 and increased violence, and how drug-induced homicide laws may undermine advances made in expanding access to OUD treatment for people who are criminal justice-involved.
Collapse
Affiliation(s)
- Meghan Peterson
- School of Public Health, Brown University, Providence, RI, United States; Center for Prisoner Health and Human Rights, Providence, RI, United States.
| | - Josiah Rich
- Center for Prisoner Health and Human Rights, Providence, RI, United States; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, Providence, RI, United States; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | - Ashley Q Truong
- Center for Prisoner Health and Human Rights, Providence, RI, United States
| | - Traci C Green
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States; Rhode Island Hospital, Providence, RI, United States
| | - Leo Beletsky
- School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States; University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Kimberly Pognon
- Center for Prisoner Health and Human Rights, Providence, RI, United States
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, United States; Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States
| |
Collapse
|
83
|
Affiliation(s)
- Jennifer J Carroll
- Jennifer J. Carroll is with the Department of Medicine at Brown University, Providence, RI. Traci C. Green is with the Department of Emergency Medicine at Boston University School of Medicine, Boston, MA, and the Departments of Medicine and Epidemiology at Brown Medical School. Josiah D. Rich is with the Departments of Medicine and Epidemiology at Brown University, and is the Director of the Center for Prisoner Health and Human Rights at the Miriam Hospital, Providence
| | - Josiah D Rich
- Jennifer J. Carroll is with the Department of Medicine at Brown University, Providence, RI. Traci C. Green is with the Department of Emergency Medicine at Boston University School of Medicine, Boston, MA, and the Departments of Medicine and Epidemiology at Brown Medical School. Josiah D. Rich is with the Departments of Medicine and Epidemiology at Brown University, and is the Director of the Center for Prisoner Health and Human Rights at the Miriam Hospital, Providence
| | - Traci C Green
- Jennifer J. Carroll is with the Department of Medicine at Brown University, Providence, RI. Traci C. Green is with the Department of Emergency Medicine at Boston University School of Medicine, Boston, MA, and the Departments of Medicine and Epidemiology at Brown Medical School. Josiah D. Rich is with the Departments of Medicine and Epidemiology at Brown University, and is the Director of the Center for Prisoner Health and Human Rights at the Miriam Hospital, Providence
| |
Collapse
|
84
|
Goedel WC, Green TC, Viner-Brown S, Rich JD, Marshall BDL. Increased overdose mortality during the first week of the month: Revisiting the "check effect" through a spatial lens. Drug Alcohol Depend 2019; 197:49-55. [PMID: 30776571 PMCID: PMC10416546 DOI: 10.1016/j.drugalcdep.2018.12.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The timing of social service benefit issuance is thought to be associated with increased drug overdose fatalities. However, the extent to which this excess mortality is concentrated in communities with higher levels of benefit receipt has not been studied. We sought to examine if benefit receipt at the neighborhood level was associated with spatiotemporal patterns of overdose fatalities. METHODS We conducted a retrospective review of all accidental overdose deaths recorded in Rhode Island from 2014 to 2016 (n = 838). Overdose incident locations were geocoded to the census block group level. Clusters of census block groups with excess overdose mortality at the beginning of a month were identified using spatial scan methods. Logistic regression models were fit to identify characteristics associated with the inclusion of a census block group within a cluster. RESULTS Increased rates of overdose fatalities at the beginning of a month were observed relative to the end of a preceding month (Ratio: 1.17; 95% CI: 1.04, 1.38). The proportions of residents receiving cash public assistance or Supplemental Security Income were not associated with excess mortality at the beginning of a month; however, the proportion of residents living in unaffordable housing was (OR: 1.42; 95% CI: 1.05, 1.91). CONCLUSION Despite previous research on benefit check issuance and overdose, welfare receipt was not associated with excess overdose mortality at the beginning of a month at the neighborhood level. Future research on housing cost burden and its influence on overdose death risk at the individual level is needed.
Collapse
Affiliation(s)
- William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Traci C Green
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Samara Viner-Brown
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI, USA
| | - Josiah D Rich
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| |
Collapse
|
85
|
Glick JL, Christensen T, Park JN, McKenzie M, Green TC, Sherman SG. Stakeholder perspectives on implementing fentanyl drug checking: Results from a multi-site study. Drug Alcohol Depend 2019; 194:527-532. [PMID: 30551090 DOI: 10.1016/j.drugalcdep.2018.10.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The opioid epidemic is one of the greatest public health crises of our times, driven increasingly by synthetic opioids such as fentanyl in the heroin supply. The implementation of drug checking in community settings has the potential to reduce the burden of fatal overdose, provide harm reduction education around safer drug consumption, and increase health access among people who use drugs (PWUD). To inform program development, we explored stakeholder opinions on drug checking technologies and implementation considerations. METHODS This study, from the larger FORECAST study, utilized semi-structured in-depth interviews (n = 32) with a range of stakeholders in Baltimore, Boston, and Providence, many of whom were service providers. Stakeholders represented various roles and levels in organization types including harm reduction, public health, peer groups, and advocates. Interviews were audio recorded and transcribed. Data were coded using a priori codes; the coded text was analyzed for key themes. RESULTS Stakeholders responded positively to drug checking technology, though they shared apprehensions regarding service implementation. Primary topics requiring consideration included: utility in fentanyl endemic areas, trust and rapport between providers and PWUD, legality and policy concerns. Additional considerations included: technology accuracy, cost, ease of distribution, and service delivery setting. CONCLUSIONS Stakeholders overwhelmingly supported the concept of drug checking with the goals of providing needed risk reduction information and resources to PWUD and serving as a point for greater engagement in services. Programs need to be tailored to local circumstances. Law enforcement buy-in and policy change will be critical aspects of providing drug checking services.
Collapse
Affiliation(s)
- Jennifer L Glick
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 749, Baltimore, MD, 21205, USA.
| | - Tricia Christensen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 163, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 163, Baltimore, MD, USA
| | | | - Traci C Green
- Rhode Island Hospital, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 163, Baltimore, MD, USA
| |
Collapse
|
86
|
Affiliation(s)
- Corey S. Davis
- Corey S. Davis, Hector Hernandez-Delgado, and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA. Traci C. Green is with Boston University School of Medicine, Boston, MA, and the Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Traci C. Green
- Corey S. Davis, Hector Hernandez-Delgado, and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA. Traci C. Green is with Boston University School of Medicine, Boston, MA, and the Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Hector Hernandez-Delgado
- Corey S. Davis, Hector Hernandez-Delgado, and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA. Traci C. Green is with Boston University School of Medicine, Boston, MA, and the Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Amy Judd Lieberman
- Corey S. Davis, Hector Hernandez-Delgado, and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA. Traci C. Green is with Boston University School of Medicine, Boston, MA, and the Warren Alpert School of Medicine of Brown University, Providence, RI
| |
Collapse
|
87
|
Stone AC, Carroll JJ, Rich JD, Green TC. Methadone maintenance treatment among patients exposed to illicit fentanyl in Rhode Island: Safety, dose, retention, and relapse at 6 months. Drug Alcohol Depend 2018; 192:94-97. [PMID: 30243145 DOI: 10.1016/j.drugalcdep.2018.07.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/14/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Illicitly manufactured fentanyl (IMF) is a potent synthetic opioid that has been contributing to overdose deaths in the United States. This study examined intake toxicology and six-month treatment outcomes for patients newly admitted to a single methadone maintenance treatment program (MMTP) in Rhode Island with a high prevalence of illicit fentanyl. METHODS We conducted a retrospective chart review of patients admitted to a single MMTP between November 1st, 2016 and August 31st, 2017 followed for six months. Outcomes measured included: 1) retention in treatment at 6 months; 2) evidence of sustained abstinence; 3) relapse; 4) methadone dosage required to achieve sustained abstinence; and 5) the number of days required to achieve abstinence. RESULTS We observed 154 unique intake events (representing 147 patients). 80% (n = 123) tested positive for fentanyl at intake. During the six-month follow up period, 32% (n = 49) left treatment before six months, two individuals died within five weeks of discontinuation. No deaths were seen among those remaining in treatment. The majority (89%) who remained in treatment at six months achieved abstinence. No significant difference was seen for dose or time to achieve abstinence. Relapse was common (57%). Repeated exposure to fentanyl was seen frequently (71%) while in MMT before and after achieving abstinence. CONCLUSION While there is concern that the potency of IMF may reduce the effectiveness of MAT, this study suggests that MMT is safe, abstinence achievable, and MMT is protective against death among fentanyl-exposed patients.
Collapse
Affiliation(s)
- Andrew C Stone
- Discovery House Comprehensive Treatment Center, 1625 Diamond Hill Road, Woonsocket, RI 02895, USA.
| | - Jennifer J Carroll
- The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Department of Emergency Medicine, 55 Claverick Street, Providence, RI 02903, USA
| | - Josiah D Rich
- Brown University and The Center for Prisoner Health and Human Rights, The Miriam Hospital, 164 Summit Ave, Providence, RI 02906, USA
| | - Traci C Green
- The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Department of Emergency Medicine, 55 Claverick Street, Providence, RI 02903, USA
| |
Collapse
|
88
|
Krieger MS, Goedel WC, Buxton JA, Lysyshyn M, Bernstein E, Sherman SG, Rich JD, Hadland SE, Green TC, Marshall BDL. Use of rapid fentanyl test strips among young adults who use drugs. Int J Drug Policy 2018; 61:52-58. [PMID: 30344005 PMCID: PMC6701177 DOI: 10.1016/j.drugpo.2018.09.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The overdose epidemic has been exacerbated by a dramatic increase in deaths involving illicitly manufactured fentanyl (IMF). Drug checking is a novel strategy to identify IMF in illicit drugs. We examined the uptake and acceptability of rapid fentanyl test strips among young adults. METHODS From May to September 2017, we recruited 93 young adults in Rhode Island who reported injecting drugs or using heroin, cocaine, or illicitly obtained prescription pills in the past 30 days. Participants were asked to test either their urine after drug use (post-consumption) or a drug sample prior to use (pre-consumption) using rapid fentanyl test strips. After a questionnaire and a brief training, participants received ten strips for their personal use and were asked to return for a one-month follow-up visit, which assessed the uptake and acceptability of the rapid strips tests and the behavioral outcomes associated with receipt of a positive test. RESULTS Of the 81 (87%) participants who returned for follow-up and who had complete data, the mean age was 27, 45 (56%) were male, and 37 (46%) were non-white. A total of 62 participants (77%) reported using at least one test strip. Of these, 31 (50%) received at least one positive result. A positive result was associated with older age, homelessness, heroin use, injection drug use, ever witnessing an overdose, and concern about overdose or drugs being laced with fentanyl (all p < 0.05). Receiving a positive result was significantly associated with reporting a positive change in overdose risk behavior between baseline and follow-up (p ≤ 0.01). Among all participants, 79 (98%) reported confidence in their ability to use the test strips and 77 (95%) wanted to use them in the future. CONCLUSIONS Young adults reported high uptake and acceptability of fentanyl test strips to detect IMF in illicit drugs.
Collapse
Affiliation(s)
- Maxwell S Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Vancouver Coastal Health, Vancouver, Canada
| | - Edward Bernstein
- Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, USA; Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Josiah D Rich
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
| | - Scott E Hadland
- Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, USA; Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, USA
| | - Traci C Green
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, USA; Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, USA; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| |
Collapse
|
89
|
Marshall BD, Green TC, Elston B, Yedinak JL, Hadland SE, Clark MA. The Effectiveness of Internet- and Field-Based Methods to Recruit Young Adults Who Use Prescription Opioids Nonmedically. Subst Use Misuse 2018; 53:1688-1699. [PMID: 29364768 PMCID: PMC6128140 DOI: 10.1080/10826084.2018.1425725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nonmedical prescription opioid (NMPO) use is a problem among young adults, yet young NMPO users are a diverse population that has been challenging to engage in overdose prevention and harm reduction programs. OBJECTIVES This study compared the effectiveness and characteristics of persons recruited through two different sampling strategies to inform research and intervention efforts with young adult NMPO users. METHODS We analyzed data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which enrolled persons aged 18 to 29 who reported past 30-day NMPO use. We compared the characteristics of two samples recruited simultaneously between February 2015 and February 2016. One sample was recruited using field-based strategies (e.g., respondent-driven sampling, transit ads), and a second from internet sources (e.g., online classifieds). RESULTS Among 198 eligible participants, the median age was 25 (IQR: 22, 27), 130 (65.7%) were male, 123 (63.1%) were white, and 150 (78.1%) resided in urban areas. A total of 79 (39.9%) were recruited using field-based strategies and 119 (60.1%) were recruited from internet sources. Internet-recruited persons were younger (median = 24 [IQR: 21, 27] vs. 26 [IQR: 23, 28] years) and more likely to reside in rural areas (16.2% vs. 5.3%), although this finding was marginally significant. Field-recruited participants were more likely to have been homeless (36.7% vs. 17.7%), have been incarcerated (39.7% vs. 21.8%), and engage in daily NMPO use (34.6% vs. 14.5%). CONCLUSIONS Multipronged outreach methods are needed to engage the full spectrum of young adult NMPO users in prevention and harm reduction efforts.
Collapse
Affiliation(s)
- Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Traci C. Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
- Boston University School of Medicine, Department of Emergency Medicine, 771 Albany Street, Room 1208, Boston, MA, 02118, USA
- The Warren Alpert School of Medicine of Brown University, Department of Emergency Medicine, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jesse L. Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Scott E. Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 332, Boston, MA 02118, USA
- Department of Pediatrics, Boston Medical Center, 850 Harrison Ave, Boston, MA, 02118, USA
| | - Melissa A. Clark
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
- Department of Quantitative Health Sciences & Center for Health Policy and Research, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA
| |
Collapse
|
90
|
Brinkley-Rubinstein L, Macmadu A, Marshall BDL, Heise A, Ranapurwala SI, Rich JD, Green TC. Risk of fentanyl-involved overdose among those with past year incarceration: Findings from a recent outbreak in 2014 and 2015. Drug Alcohol Depend 2018; 185:189-191. [PMID: 29459328 DOI: 10.1016/j.drugalcdep.2017.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
Overdose is the leading cause of unintentional injury-related death. Rhode Island (RI) has the highest rate of illicit drug use nationally and the 5th highest overdose mortality rate. RI has experienced an outbreak of fentanyl-related overdoses. In incarcerated populations, risk of overdose is greatly elevated. However, little is known about fentanyl-related overdose post-release. In the current analyses, we identify changes in fentanyl-related fatal overdose among those who died in 2014 and 2015 who were incarcerated in the year before death. We linked data from the RI Office of the Medical Examiner with records from the RI Department of Corrections. We calculated risk ratios and 95% confidence intervals using log-binomial regression to compare risk of fentanyl-involved overdose death. We also compared median time to death since release, median sentence length, and median number of incarcerations in 2014 and 2015. Results indicate that the risk of dying of a fentanyl-related overdose increased (RR: 1.99 (95% CI: 1.11-3.57, p = 0.014)) from 2014 to 2015 among those with past year incarceration. This study is one of the first to describe fentanyl-related fatal overdose among those with past year incarceration. In 2015 the median sentence was longer among those with a fentanyl-related overdose death and the median time from release to death among all who had past year incarceration extended past 90 days. Access to medications for addiction treatment, overdose education, and naloxone should be available during community re-entry and extended beyond the early post-release period.
Collapse
Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, 333 S. Columbia St., Chapel Hill, NC 27516, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 S. Columbia St., Chapel Hill, NC 27516, USA.
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third St., 2nd floor, Providence, RI 02906, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main St., Providence, RI 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Providence, RI 02903, USA
| | - Andrew Heise
- Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 S. Columbia St., Chapel Hill, NC 27516, USA
| | - Shabbar I Ranapurwala
- Department of Epidemiology, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC 27599, USA
| | - Josiah D Rich
- Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third St., 2nd floor, Providence, RI 02906, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Providence, RI 02903, USA
| | - Traci C Green
- Department of Emergency Medicine, Boston University, 1 Boston Medical Center Pl., Boston, MA 02118, USA; Injury Prevention Research Center, Boston University, 1 Boston Medical Center Pl., Boston, MA 02118, USA
| |
Collapse
|
91
|
Green TC, Clarke J, Brinkley-Rubinstein L, Marshall BDL, Alexander-Scott N, Boss R, Rich JD. Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System. JAMA Psychiatry 2018; 75:405-407. [PMID: 29450443 PMCID: PMC5875331 DOI: 10.1001/jamapsychiatry.2017.4614] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This analysis examines the association of death from overdose among individuals released from the Rhode Island correctional system after implementation of a comprehensive program of medications for addiction therapy.
Collapse
Affiliation(s)
- Traci C. Green
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island,Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island,Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island,Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jennifer Clarke
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island,Rhode Island Department of Corrections, Cranston,Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | - Rebecca Boss
- Rhode Island Department of Behavioral Health, Disabilities, and Hospitals, Cranston
| | - Josiah D. Rich
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island,Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island,Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, Rhode Island
| |
Collapse
|
92
|
Green TC, Rich JD, Sharfstein J. Commentary on ‘Revisiting the ‘paradigm shift’ in opioid use: Developments and implications 10 years later’. Drug Alcohol Rev 2018; 37 Suppl 1:S206-S207. [DOI: 10.1111/dar.12684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Traci C. Green
- The Warren Alpert Medical School of Brown University; Rhode Island Hospital; Providence USA
- Boston University Schools of Medicine and Public Health; Boston Medical Center Injury Prevention Center; Boston USA
| | - Josiah D. Rich
- The Warren Alpert Medical School of Brown University; The Miriam Hospital; Providence USA
| | - Joshua Sharfstein
- Johns Hopkins University; The Bloomberg School of Public Health; Baltimore USA
| |
Collapse
|
93
|
Krieger MS, Yedinak JL, Buxton JA, Lysyshyn M, Bernstein E, Rich JD, Green TC, Hadland SE, Marshall BDL. High willingness to use rapid fentanyl test strips among young adults who use drugs. Harm Reduct J 2018; 15:7. [PMID: 29422052 PMCID: PMC5806485 DOI: 10.1186/s12954-018-0213-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/01/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Synthetic opioid overdose mortality among young adults has risen more than 300% in the USA since 2013, primarily due to the contamination of heroin and other drugs with illicitly manufactured fentanyl. Rapid test strips, which can be used to detect the presence of fentanyl in drug samples (before use) or urine (after use), may help inform people about their exposure risk. The purpose of this study was to determine whether young adults who use drugs were willing to use rapid test strips as a harm reduction intervention to prevent overdose. We hypothesized that those who had ever overdosed would be more willing to use the test strips. METHODS We recruited a convenience sample of young adults who use drugs in Rhode Island from May to September 2017. Eligible participants (aged 18 to 35 with past 30-day drug use) completed an interviewer-administered survey. The survey assessed participant's socio-demographic and behavioral characteristics, overdose risk, as well as suspected fentanyl exposure, and willingness to use take-home rapid test strips to detect fentanyl contamination in drugs or urine. Participants were then trained to use the test strips and were given ten to take home. RESULTS Among 93 eligible participants, the mean age was 27 years (SD = 4.8), 56% (n = 52) of participants were male, and 56% (n = 52) were white. Over one third (n = 34, 37%) had a prior overdose. The vast majority (n = 86, 92%) of participants wanted to know if there was fentanyl in their drug supply prior to their use. Sixty-five (70%) participants reported concern that their drugs were contaminated with fentanyl. After the brief training, nearly all participants (n = 88, 95%) reported that they planned to use the test strips. CONCLUSIONS More than 90% of participants reported willingness to use rapid test strips regardless of having ever overdosed, suggesting that rapid fentanyl testing is an acceptable harm reduction intervention among young people who use drugs in Rhode Island. Study follow-up is ongoing to determine whether, how, and under what circumstances participants used the rapid test strips and if a positive result contributed to changes in overdose risk behavior.
Collapse
Affiliation(s)
- Maxwell S Krieger
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Edward Bernstein
- Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, MA, USA
- Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
- Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, MA, USA
- Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Scott E Hadland
- Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, MA, USA
- Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
| |
Collapse
|
94
|
Bouvier BA, Waye KM, Elston B, Hadland SE, Green TC, Marshall BDL. Prevalence and correlates of benzodiazepine use and misuse among young adults who use prescription opioids non-medically. Drug Alcohol Depend 2018; 183:73-77. [PMID: 29241103 PMCID: PMC5803376 DOI: 10.1016/j.drugalcdep.2017.10.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Benzodiazepine use dramatically increases the risk of unintentional overdose among people who use opioids non-medically. However, little is known about the patterns of co-occurring benzodiazepine and opioid use among young adults in the United States. METHODS The Rhode Island Young Adult Prescription Drug Study (RAPiDS) was a cross-sectional study from January 2015-February 2016. RAPiDS recruited 200 young adults aged 18-29 who reported past 30-day non-medical prescription opioid (NMPO) use. Using Wilcoxon rank sum test and Fisher's exact test, we examined correlates associated with regular prescribed and non-medical use (defined as at least monthly) of benzodiazepines among NMPO users in Rhode Island. RESULTS Among participants, 171 (85.5%) reported lifetime benzodiazepine use and 125 (62.5%) reported regular benzodiazepine use. Nearly all (n=121, 96.8%) reported non-medical use and 43 (34.4%) reported prescribed use. Compared to the 75 participants who did not regularly use benzodiazepines, participants who reported regular use were more likely to be white (66.3% vs. 58.0%, p=0.03), have ever been incarcerated (52.8% vs. 37.3%, p=0.04), and have ever been diagnosed with a psychiatric disorder (bipolar: 29.6% vs. 16.0%, p=0.04; anxiety: 56.8 vs. 36.0%, p=0.01). Although the association was marginally significant, accidental overdose was higher among those who were prescribed the benzodiazepine they used most frequently compared to those who were not (41.9% vs. 24.4%, p=0.06). CONCLUSION Benzodiazepine use and misuse are highly prevalent among young adult NMPO users. Harm reduction and prevention programs for this population are urgently needed.
Collapse
Affiliation(s)
- Benjamin A Bouvier
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Katherine M Waye
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Scott E Hadland
- Boston Medical Center, Department of Pediatrics, 850 Harrison Avenue, Boston, MA, 02118, USA; Boston University School of Medicine, Department of Pediatrics, Division of General Pediatrics, 88 East Newton Street, Vose Hall Room 322, Boston, MA, 02118, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA; Boston Medical Center Injury Prevention Center and Boston University School of Medicine, Department of Emergency Medicine, 771 Albany Street, Room 1332, Boston, MA, 02118, USA; The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
| |
Collapse
|
95
|
Soipe AI, Taylor LE, Abioye AI, Green TC, Hadland SE, Marshall BD. Prevalence of Hepatitis C Screening, Testing, and Care Experience Among Young Adults Who Use Prescription Opioids Nonmedically. J Adolesc Health 2018; 62:114-117. [PMID: 29102250 PMCID: PMC5742053 DOI: 10.1016/j.jadohealth.2017.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/11/2017] [Accepted: 07/20/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE Examine the prevalence of hepatitis C virus (HCV) screening, confirmatory testing, and care experiences among young adult nonmedical prescription opioid (NMPO) users. METHODS We examined self-reported HCV screening history in a sample of 18- to 29-year-olds reporting past-month NMPO use, and we used modified Poisson regression to identify associated sociodemographic and drug use patterns. RESULTS Among 196 participants, 154 (78.6%) reported prior HCV screening, among whom 18 (11.7%) reported positive results. Of these, 13 (72.2%) reported receiving a confirmatory test; 12 (66.7%) were referred for specialty HCV care. Screening was associated with injection drug use (adjusted prevalence ratio [APR] = 1.19; 95% confidence interval [CI] = 1.05-1.33) and history of hospitalization for psychiatric illness (APR = 1.23; 95% CI = 1.09-1.39). Younger participants (18-23 years) were less likely to have been screened (APR = .69; 95% CI = .57-.85). CONCLUSION Among young adult NMPO users, post-HCV screening support and referral to care were inadequate.
Collapse
Affiliation(s)
- Ayorinde I. Soipe
- epartment of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box GS-121-2, Providence, RI 02912, USA
| | - Lynn E. Taylor
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, The Miriam Hospital, 164 Summit Avenue, Center for AIDS research (CFAR) Building Room 156, Providence, RI 02906, USA
| | - Ajibola I. Abioye
- Lifespan Center for International Health Research, Rhode Island Hospital/Warren Alpert Medical School, 55 Claverick Street, Providence, RI 02903, USA
| | - Traci C. Green
- epartment of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box GS-121-2, Providence, RI 02912, USA,Department of Emergency Medicine, Boston University School of Medicine, 771 Albany Street, Room 1208, Boston, MA 02118, USA,The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| | - Scott E. Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 322, Boston, MA 02118, USA,Department of Pediatrics, Boston Medical Center, 850 Harrison Street, Boston, MA, 02118, USA
| | - Brandon D.L. Marshall
- epartment of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box GS-121-2, Providence, RI 02912, USA,Send correspondence to: Brandon D.L. Marshall, Ph.D, Manning Assistant Professor of Epidemiology, Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, Tel:401-863-6427, Fax:401-863-317,
| |
Collapse
|
96
|
Liebling EJ, Green TC, Hadland SE, Marshall BD. Injection drug use and overdose among young adults who use prescription opioids non-medically. Addict Behav 2018; 76:20-26. [PMID: 28735037 DOI: 10.1016/j.addbeh.2017.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/29/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Non-medical prescription opioid (NMPO) use is a critical public health problem in the United States, with 2.1 million new initiates annually. Young adult NMPO users are at high risk for initiating injection drug use. We assessed correlates of injection drug use among young adult NMPO users in Rhode Island, a state heavily impacted by opioid overdose. METHODS We used data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which recruited 199 residents aged 18-29 who reported past-30-day NMPO use (65.3% male). We compared individuals who reported ever having injected with individuals who reported never injecting, using logistic regression to identify independent correlates of injection. RESULTS Among eligible participants, the mean age was 24.6years and 61.3% were white. Over one-quarter (n=59, 29.6%) of the sample had ever injected drugs. The majority (n=46, 78.0%) of participants who had ever injected drugs reported injecting heroin as her/his first drug; the majority also reported previously snorting her/his first drug that was injected (n=46, 78.0%). In multivariable analyses, white race, older age, lifetime homelessness, and ever having overdosed or seen someone overdose were independently associated with an increased likelihood of ever injecting drugs. CONCLUSIONS These findings demonstrate a high prevalence of lifetime injection drug use among young adults who use prescription opioids non-medically. Given the observed associations between injection drug use and witnessing as well as experiencing overdose, interventions are urgently needed to improve overdose education and naloxone distribution to young adult NMPO users who inject drugs.
Collapse
|
97
|
Marshall BDL, Yedinak JL, Goyer J, Green TC, Koziol JA, Alexander-Scott N. Development of a Statewide, Publicly Accessible Drug Overdose Surveillance and Information System. Am J Public Health 2017; 107:1760-1763. [PMID: 28933938 DOI: 10.2105/ajph.2017.304007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In response to Rhode Island's overdose epidemic, we developed a collaborative, statewide online "dashboard" to provide the public with timely overdose surveillance data. The Web site- www.PreventOverdoseRI.org (PORI)-offers user-friendly data visualizations, plain language education, and interactive resource maps. Development of the site has improved overdose data sharing and transparency in Rhode Island. Preliminary results suggest a successful site launch. Future research will evaluate the effectiveness of PORI in terms of informing strategic initiatives to reduce overdoses in affected communities.
Collapse
Affiliation(s)
- Brandon D L Marshall
- Brandon D. L. Marshall, Jesse L. Yedinak, and Traci C. Green are with the Department of Epidemiology, Brown University School of Public Health, Providence, RI. Jonathan Goyer is with the Anchor Recovery Community Center, Pawtucket, RI. Jennifer A. Koziol and Nicole Alexander-Scott are with the Rhode Island Department of Public Health, Providence
| | - Jesse L Yedinak
- Brandon D. L. Marshall, Jesse L. Yedinak, and Traci C. Green are with the Department of Epidemiology, Brown University School of Public Health, Providence, RI. Jonathan Goyer is with the Anchor Recovery Community Center, Pawtucket, RI. Jennifer A. Koziol and Nicole Alexander-Scott are with the Rhode Island Department of Public Health, Providence
| | - Jonathan Goyer
- Brandon D. L. Marshall, Jesse L. Yedinak, and Traci C. Green are with the Department of Epidemiology, Brown University School of Public Health, Providence, RI. Jonathan Goyer is with the Anchor Recovery Community Center, Pawtucket, RI. Jennifer A. Koziol and Nicole Alexander-Scott are with the Rhode Island Department of Public Health, Providence
| | - Traci C Green
- Brandon D. L. Marshall, Jesse L. Yedinak, and Traci C. Green are with the Department of Epidemiology, Brown University School of Public Health, Providence, RI. Jonathan Goyer is with the Anchor Recovery Community Center, Pawtucket, RI. Jennifer A. Koziol and Nicole Alexander-Scott are with the Rhode Island Department of Public Health, Providence
| | - Jennifer A Koziol
- Brandon D. L. Marshall, Jesse L. Yedinak, and Traci C. Green are with the Department of Epidemiology, Brown University School of Public Health, Providence, RI. Jonathan Goyer is with the Anchor Recovery Community Center, Pawtucket, RI. Jennifer A. Koziol and Nicole Alexander-Scott are with the Rhode Island Department of Public Health, Providence
| | - Nicole Alexander-Scott
- Brandon D. L. Marshall, Jesse L. Yedinak, and Traci C. Green are with the Department of Epidemiology, Brown University School of Public Health, Providence, RI. Jonathan Goyer is with the Anchor Recovery Community Center, Pawtucket, RI. Jennifer A. Koziol and Nicole Alexander-Scott are with the Rhode Island Department of Public Health, Providence
| |
Collapse
|
98
|
Baird J, Faul M, Green TC, Howland J, Adams CA, George A, Mello MJ. A retrospective review of unintentional opioid overdose risk and mitigating factors among acutely injured trauma patients. Drug Alcohol Depend 2017; 178:130-135. [PMID: 28647680 PMCID: PMC6070343 DOI: 10.1016/j.drugalcdep.2017.04.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/25/2017] [Accepted: 04/29/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primary purpose of this study was to assess the prevalence of substance use and unintentional opioid overdose risk among acutely injured trauma patients, and to examine the frequency and predictors of high opioid dose at discharge. METHODS A retrospective electronic medical record (EMR) review of three-months of data from two Level 1 trauma centers. We assessed the prevalence of substance misuse, unintentional opioid overdose risk, and presence of documentation of clinical strategies to mitigate these risks, such as co-prescription of the opioid agonist naloxone. RESULTS In total, 352 patient EMRs were examined. Over 40% of the patients reviewed had at least one indication of substance misuse (42.5% [95%CI: 37.3, 47.7]); at least 1 unintentional opioid overdose risk factor was identified in 240 EMR reviewed (68.2% [95%CI: 63.3, 73.1]). Dose of opioid medication was not significantly different for patients with substance misuse versus those without. There was no co-prescription of naloxone for any of the discharged patients. CONCLUSIONS Our results indicate that despite the high rates of substance misuse, the potential for misuse, dependence and unintentional overdose risk from prescribed opioid medications are prevalent among acutely injured trauma patients. Prescribing after acute trauma care should address these risk factors.
Collapse
Affiliation(s)
- Jannette Baird
- Warren Alpert School of Medicine at Brown University, United States.
| | - Mark Faul
- Centers for Disease Control and Prevention, United States
| | - Traci C Green
- Warren Alpert School of Medicine at Brown University, United States; Boston University School of Medicine, United States
| | - Jonathan Howland
- Warren Alpert School of Medicine at Brown University, United States; Boston University School of Medicine, United States
| | - Charles A Adams
- Rhode Island Hospital, Division of Trauma and Surgical Critical Care, United States
| | - Ann George
- University Surgical Associates, United States
| | - Michael J Mello
- Warren Alpert School of Medicine at Brown University, United States; Brown University School of Public Health, United States
| |
Collapse
|
99
|
Donovan E, Ranney ML, Patry EJ, McKenzie M, Baird J, Green TC. Beliefs About a Complementary and Alternative Therapy-Based Chronic Pain Management Program for a Medicaid Population. Pain Med 2017; 18:1805-1816. [PMID: 28398544 DOI: 10.1093/pm/pnx051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Rhode Island Medicaid offers high emergency department utilizers the opportunity to take part in the Chronic Pain Program, an integrated treatment approach that includes free complementary therapies (massage, chiropractic, and acupuncture). The aim of the current analysis was to understand beliefs about the Rhode Island Chronic Pain Program from the perspective of the patient receiving services, the provider delivering services, and the administrator implementing the program. Design A qualitative interview-based study. Subjects Patients (N = 24), providers (N = 13), and administrators (N = 11) who were already involved, or were eligible to be involved, in the Chronic Pain Program. Methods Semistructured interviews were conducted to elicit information about experiences with the program. Transcriptions of audio recordings were analyzed according to principles of deductive thematic analysis. Results Patient interviews revealed five themes: 1) relationship between stress and pain, 2) trusting patient-provider relationships, 3) increased quality of life, 4) temporary pain relief, and 5) anxiety and discomfort associated with acupuncture. Provider interviews revealed three themes: 1) a way to reach the disenfranchised, 2) not enough visits with patients, and 3) opportunity to build relationships with patients. Administrator interviews revealed two themes: 1) a means to offer a range of support services to complicated patients and 2) unanswered questions over whether the program adequately serves patients with the greatest needs. Conclusions Key stakeholders in this new initiative agree that the Rhode Island Chronic Pain Program shows promise and that the holistic approach may be a good match for this hard-to-reach population.
Collapse
Affiliation(s)
| | - Megan L Ranney
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Michelle McKenzie
- The Miriam Hospital, Providence, Rhode Island.,Department of Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Janette Baird
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Traci C Green
- Department of Emergency Medicine, Boston Medical Center Injury Prevention Center, Boston University School of Medicine, Boston, Massachusetts.,Departments of Emergency Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
100
|
Marshall BD, Krieger MS, Yedinak JL, Ogera P, Banerjee P, Alexander-Scott NE, Rich JD, Green TC. Epidemiology of fentanyl-involved drug overdose deaths: A geospatial retrospective study in Rhode Island, USA. International Journal of Drug Policy 2017; 46:130-135. [DOI: 10.1016/j.drugpo.2017.05.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
|