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Han DH, Lee S, Seo DC. Using machine learning to predict opioid misuse among U.S. adolescents. Prev Med 2020; 130:105886. [PMID: 31705938 DOI: 10.1016/j.ypmed.2019.105886] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/28/2019] [Accepted: 11/05/2019] [Indexed: 01/05/2023]
Abstract
This study evaluated prediction performance of three different machine learning (ML) techniques in predicting opioid misuse among U.S. adolescents. Data were drawn from the 2015-2017 National Survey on Drug Use and Health (N = 41,579 adolescents, ages 12-17 years) and analyzed in 2019. Prediction models were developed using three ML algorithms, including artificial neural networks, distributed random forest, and gradient boosting machine. The performance of the ML prediction models was compared with performance of the penalized logistic regression. The area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC) were used as metrics of prediction performance. We used the AUPRC as the primary measure of prediction performance given that it is considered more informative for assessing binary classifiers on imbalanced outcome variable than AUROC. The overall rate of opioid misuse among U.S. adolescents was 3.7% (n = 1521). Prediction performance was similar across the four models (AUROC values range from 0.809 to 0.815). In terms of the AUPRC, the distributed random forest showed the best performance in prediction (0.172) followed by penalized logistic regression (0.162), gradient boosting machine (0.160), and artificial neural networks (0.157). Findings suggest that machine learning techniques can be a promising technique especially in the prediction of outcomes with rare cases (i.e., when the binary outcome variable is heavily lopsided) such as adolescent opioid misuse.
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Affiliation(s)
- Dae-Hee Han
- Department of Applied Health Science, Indiana University School of Public Health in Bloomington, USA
| | - Shieun Lee
- Department of Applied Health Science, Indiana University School of Public Health in Bloomington, USA
| | - Dong-Chul Seo
- Department of Applied Health Science, Indiana University School of Public Health in Bloomington, USA.
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Sutton A, Lichter DT, Sassler S. Rural-Urban Disparities in Pregnancy Intentions, Births, and Abortions Among US Adolescent and Young Women, 1995-2017. Am J Public Health 2019; 109:1762-1769. [PMID: 31622143 PMCID: PMC6836770 DOI: 10.2105/ajph.2019.305318] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To examine rural-suburban-urban disparities in intendedness and resolution of first pregnancies among adolescent and young women (aged 15-19 and 20-24 years) across racial/ethnic backgrounds in the United States.Methods. We used the National Survey of Family Growth and pooled pregnancy files from 2002 through the 2015-2017 surveys. We report baseline rural-suburban-urban disparities in first pregnancy intention and outcomes. We used multinomial logistic regression to estimate these disparities, accounting for sociodemographic background, religious upbringing, and other factors.Results. The first adolescent pregnancies of rural women were more likely to be unintended and end in live birth relative to their urban counterparts. Disparities were most striking among Black adolescents, with about 60% of first adolescent pregnancies among rural Black women being unintended and ending in live birth (urban: 51%). Newly collected state health department data on rural and urban adolescent births and abortions corroborate the findings from the National Survey of Family Growth.Conclusions. Rural-urban differences in the share of first adolescent pregnancies ending in live births are not accounted for by pregnancy intention or confounding individual-level characteristics. Future research should explore the role of structural barriers, including access to family planning and abortion services.
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Affiliation(s)
- April Sutton
- April Sutton is with the Department of Sociology, University of California, San Diego, La Jolla. Daniel T. Lichter and Sharon Sassler are with the Department of Policy Analysis and Management, Cornell University, Ithaca, NY. Daniel T. Lichter is also with the Department of Sociology, Cornell University
| | - Daniel T Lichter
- April Sutton is with the Department of Sociology, University of California, San Diego, La Jolla. Daniel T. Lichter and Sharon Sassler are with the Department of Policy Analysis and Management, Cornell University, Ithaca, NY. Daniel T. Lichter is also with the Department of Sociology, Cornell University
| | - Sharon Sassler
- April Sutton is with the Department of Sociology, University of California, San Diego, La Jolla. Daniel T. Lichter and Sharon Sassler are with the Department of Policy Analysis and Management, Cornell University, Ithaca, NY. Daniel T. Lichter is also with the Department of Sociology, Cornell University
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Tsai AC, Alegría M, Strathdee SA. Addressing the context and consequences of substance use, misuse, and dependence: A global imperative. PLoS Med 2019; 16:e1003000. [PMID: 31770369 PMCID: PMC6879121 DOI: 10.1371/journal.pmed.1003000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In an Editorial, Guest Editors Alexander Tsai, Margarita Alegria and Steffanie Strathdee discuss the accompanying Special Issue on Substance Use, Misuse and Dependence.
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Affiliation(s)
- Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Margarita Alegría
- Harvard Medical School, Boston, Massachusetts, United States of America
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, University of California at San Diego School of Medicine, San Diego, California, United States of America
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Derefinko KJ, Salgado García FI, Talley KM, Bursac Z, Johnson KC, Murphy JG, McDevitt-Murphy ME, Andrasik F, Sumrok DD. Adverse childhood experiences predict opioid relapse during treatment among rural adults. Addict Behav 2019; 96:171-174. [PMID: 31102882 DOI: 10.1016/j.addbeh.2019.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/19/2022]
Abstract
Adverse childhood experiences (ACE) are a public health concern and strong predictor of substance abuse, but no studies to date have explored the association between ACE and opioid relapse during medication-assisted treatment. Using an observational design, we examined this relationship using archived medical records of 87 patients who attended opioid use disorder treatment (buprenorphine-naloxone and group counseling) at a rural medical clinic. All variables were collected from medical files. ACE scores were derived from a 10-item screening questionnaire administered at intake, a regular procedure for this clinic. The primary outcome was opioid relapse observed at each visit, as indicated by self-reported opioid use, positive urine drug screen for opioids, or prescription drug database results for opioid acquisition. The sample was 100% Caucasian and 75% male. A total of 2052 visit observations from the 87 patients were extracted from the medical records. Patients had an average of 23.6 (SD = 22) treatment visits. Opioid relapse occurred in 54% of patients. Results indicated that for every unit increase in ACE score, there was an increase of 17% in the odds of relapse (95% CI: 1.05-1.30, p = .005). Additionally, each treatment visit was associated with a 2% reduction in the odds of opioid relapse (95% CI: 0.97-0.99, p = .008). We conclude that ACE may increase the risk for poor response to buprenorphine-naloxone treatment due to high rates of opioid relapse during the first treatment visits. However, consistent adherence to treatment is likely to reduce the odds of opioid relapse.
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Affiliation(s)
- Karen J Derefinko
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA.
| | - Francisco I Salgado García
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
| | - Kevin M Talley
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
| | - Zoran Bursac
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
| | - Karen C Johnson
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
| | - James G Murphy
- University of Memphis, Psychology Building, 400 Innovation Dr., Memphis, TN 38111, USA
| | | | - Frank Andrasik
- University of Memphis, Psychology Building, 400 Innovation Dr., Memphis, TN 38111, USA
| | - Daniel D Sumrok
- University of Tennessee Health Science Center, 66 North Pauline St., Room 649, Memphis, TN 38163-2181, USA
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Sheidow AJ, McCart MR, Chapman JE, Drazdowski TK. Capacity of juvenile probation officers in low-resourced, rural settings to deliver an evidence-based substance use intervention to adolescents. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:76-88. [PMID: 31393146 DOI: 10.1037/adb0000497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Substance use is a major public health problem with a host of negative outcomes. Justice-involved youth have even higher risks and lack access to evidence-based interventions, particularly in rural communities. Task-shifting, or redistribution of tasks downstream to an existing workforce with less training, may be an innovative strategy to increase access to evidence-based interventions. Initial findings are presented from a services research trial conducted primarily in rural communities in which an existing workforce, juvenile probation/parole officers (JPOs), were randomized either to learn and deliver contingency management (CM) or to continue delivering probation services as usual (PAU). This study used the prevailing version of CM for adolescents, that is, family-based with behavior modification and cognitive behavioral components. Data included JPOs' self-reports, as well as audio-recorded youth/family sessions with JPOs rated by expert and trained observational coders. Data also included ratings from a comparison study in which therapists were trained and supervised by experts to deliver CM to justice-involved youth/families. Results showed JPOs can feasibly incorporate CM into their services. When adherence of CM JPOs was compared against CM therapists, JPOs delivered significantly more cognitive behavioral components of CM and similar levels of behavior modification components of CM. These findings suggest that JPOs can be leveraged to provide evidence-based substance use interventions like CM in similar, or even greater, capacities to clinically trained therapists. This task-shifting approach could dramatically expand service access for these high-risk youth, particularly in rural areas where substance use services are limited or nonexistent. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Methadone Matters: What the United States Can Learn from the Global Effort to Treat Opioid Addiction. J Gen Intern Med 2019; 34:1039-1042. [PMID: 30729416 PMCID: PMC6544670 DOI: 10.1007/s11606-018-4801-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/13/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
In the midst of an opioid epidemic, mortality related to opioid overdose continues to rise in the US. Medications to treat opioid use disorder, including methadone and buprenorphine, are highly effective in reducing the morbidity and mortality related to illicit opioid use. Despite the efficacy of these life-saving medications, the majority of people with an opioid use disorder lack access to treatment. This paper briefly reviews the evidence to support the use of medications to treat opioid use disorder with a specific focus on methadone. We discuss the current state of methadone therapy for the treatment of opioid use disorder in the US and present logistical barriers that limit its use. Next, we examine three international pharmacy-based models in which methadone dispensing to treat opioid use disorder occurs outside of an opioid treatment facility. We discuss current challenges and opportunities to incorporate similar methods of methadone dispensing for the treatment of opioid use disorder in the US. Finally, we present our vision to integrate pharmacy-based methadone dispensing into routine opioid use disorder treatment through collaboration between clinicians and pharmacies to improve local access to this life-saving medication.
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Wheeler PB, Stevens-Watkins D, Moody M, Dogan J, Lewis D. Culturally relevant risk and protective factors for nonmedical use of prescription opioids among incarcerated African American men. Addict Behav 2019; 93:46-51. [PMID: 30690415 PMCID: PMC6488416 DOI: 10.1016/j.addbeh.2019.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent studies have demonstrated that nonmedical use of prescription opioids (NMUPO) is a national phenomenon affecting a multitude of subpopulations, including incarcerated African American men. However, there has been little investigation of the correlates of NMUPO among this population. OBJECTIVE Grounded in primary socialization theory, the current study aimed to examine the association between family bonds, family history of prescription drug misuse, and mental health symptoms on NMUPO among African American incarcerated men. METHOD A step-wise logistic regression was conducted to determine whether family and mental health factors affected the likelihood of lifetime NMUPO. RESULTS Prescription drug misuse among immediate family members (p < 0.001) and lifetime experience of serious anxiety (p = 0.003) were significantly associated with an increased likelihood of NMUPO. Having a close personal relationship with one's father was significantly associated with a decreased likelihood of NMUPO (p = 0.034). CONCLUSIONS/IMPORTANCE Risk and protective factors are identified that can be incorporated into interventions aimed at reducing or preventing NMUPO among African American men. Directions for future research on NMUPO among African American incarcerated men are discussed.
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Affiliation(s)
- Paris B Wheeler
- College of Education, Department of Educational, School, and Counseling Psychology, University of Kentucky, Dickey Hall, 251 Scott Street, Lexington, KY 40508, United States.
| | - Danelle Stevens-Watkins
- College of Education, Department of Educational, School, and Counseling Psychology, University of Kentucky, Dickey Hall, 251 Scott Street, Lexington, KY 40508, United States.
| | - Myles Moody
- College of Liberal Arts and Sciences, Department of Sociology, University of Kentucky, 1515 Patterson Office Tower, Lexington, KY 40506-0027, United States.
| | - Jardin Dogan
- College of Education, Department of Educational, School, and Counseling Psychology, University of Kentucky, Dickey Hall, 251 Scott Street, Lexington, KY 40508, United States.
| | - Dominiqueca Lewis
- College of Education, Department of Educational, School, and Counseling Psychology, University of Kentucky, Dickey Hall, 251 Scott Street, Lexington, KY 40508, United States.
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Bares CB, Weaver A, Kelso MF. Adolescent opioid use: Examining the intersection of multiple inequalities. J Prev Interv Community 2019; 47:295-309. [DOI: 10.1080/10852352.2019.1617382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cristina B. Bares
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary F. Kelso
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Prescription opioid misuse among African-American adults: A rural-urban comparison of prevalence and risk. Drug Alcohol Depend 2019; 197:191-196. [PMID: 30844615 DOI: 10.1016/j.drugalcdep.2019.01.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/18/2018] [Accepted: 01/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prescription opioid misuse (POM) remains a public health concern in the United States. Although the problem has been studied extensively, little research attention is paid to POM among African-Americans (AAs), and even fewer studies consider rural status in their analysis. The goal of this study, therefore, was to identify and compare prevalence and predictors of POM among rural and urban AA adults using data from a nationally representative sample. METHODS Using pooled data across five years (2012-2016) of the National Survey on Drug Use and Health, multivariate logistic regression models were estimated to determine which factors were associated with POM among AA adults. RESULTS Findings show that urban and rural AAs have comparable prevalence rates of POM, which is somewhat surprising given that POM often varies based on rural status. A number of factors (e.g., receiving government assistance, religiosity, smoking tobacco or marijuana, misuse of other prescription medications) were significantly correlated with POM for urban and rural AAs, while others (e.g., being age 50+, graduating high school, visiting an emergency department, being arrested, binge drinking) varied by rural status. CONCLUSION Results indicate that AA nonmedical prescription opioid users are not a monolith and have distinct demographic, clinical, and psychosocial profiles based on geographic region. Because AAs have been virtually ignored in the POM literature, our findings are an important step towards understanding POM among this understudied group. These results invite additional investigation into AA POM and encourage researchers to consider rural status in their analysis of POM among AAs.
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Kelly BC, Vuolo M. Social network ties to nightlife and healthcare professionals and prescription drug misuse among young adults. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 66:48-56. [PMID: 30703607 DOI: 10.1016/j.drugpo.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nightlife scenes have been characterized as risk environments where social ecology and network ties facilitate substance use. In contrast to other substances, the prescription drug problem also has been shaped by the healthcare system. How network ties to professionals in these domains are associated with prescription drug misuse remains a key area of study. METHODS We analyzed a sample of 404 young adults who misuse prescription drugs, recruited from nightlife venues primarily via time-space sampling. We evaluated nine types of network ties via friends and family (5 nightlife professions and 4 healthcare professions) as well as total ties in each occupational domain and their relationship to three different outcomes - frequency of misuse, escalation to non-oral use, and substance-related problems. Negative binomial, logistic, and linear regression methods were employed. We then examined mechanisms by which these network associations may operate. RESULTS Ties to party promoters (p < .05) and bouncers (p < .01) were positively associated with all three outcomes. A single outcome each was associated with ties to DJs (problems, p < .01), musicians (frequency, p < .05), and bartenders (escalation, p < .05). The total number of network ties in the nightlife domain was positively associated with all three outcomes, with each additional tie increasing frequency (20.3%, p < .001), odds of escalation (OR = 42.9%, p < .01), and problems (12.5%, p < .01). The number of sources, peer norm context, and social bonding were explanatory mechanisms for all three outcomes for nightlife networks. Specific occupational ties and the total number of ties to healthcare professionals were not associated with any outcome. CONCLUSION Embeddedness in nightlife networks is related to patterns of prescription drug misuse, and some of this association can be explained by multiple mechanisms of social networks. By contrast, ties to healthcare professionals are not associated with patterns of misuse among such young adults.
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Affiliation(s)
- Brian C Kelly
- Purdue University, Dept. of Sociology, 700 W State St., West Lafayette, IN, 47907, United States.
| | - Mike Vuolo
- The Ohio State University, Dept. of Sociology, United States
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Cancilliere MK, Spirito A, Monti P, Barnett N. Brief Alcohol Interventions for Youth in the Emergency Department: Exploring Proximal and Distal Outcomes. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2019; 27:311-321. [PMID: 31440019 PMCID: PMC6706063 DOI: 10.1080/1067828x.2018.1529645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Brief interventions (BI) for alcohol use in the emergency department (ED) have been shown efficacious among adolescents and young adults; however, whether these interventions extend to other outcomes - proximal and distal - are less explored. This study examined outcomes of ED BIs in four completed trials showing reductions in alcohol use. Limited and inconsistent effects were found on proximal outcomes including parental monitoring, and distal outcomes including tobacco use. Identifying the mechanisms that underlie alcohol-focused BIs as well the intervention processes that may lead to generalized, positive effects on other variables is an important area of future research.
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Affiliation(s)
- Mary Kathryn Cancilliere
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, 02881 USA
| | - Anthony Spirito
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI, 02912 USA
- Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI, 02912 USA
| | - Peter Monti
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI, 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912 USA
| | - Nancy Barnett
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI, 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912 USA
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García MC, Heilig CM, Lee SH, Faul M, Guy G, Iademarco MF, Hempstead K, Raymond D, Gray J. Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System - United States, 2014-2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:25-30. [PMID: 30653483 PMCID: PMC6336190 DOI: 10.15585/mmwr.mm6802a1] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Drug overdose is the leading cause of unintentional injury-associated death in the United States. Among 70,237 fatal drug overdoses in 2017, prescription opioids were involved in 17,029 (24.2%) (1). Higher rates of opioid-related deaths have been recorded in nonmetropolitan (rural) areas (2). In 2017, 14 rural counties were among the 15 counties with the highest opioid prescribing rates.* Higher opioid prescribing rates put patients at risk for addiction and overdose (3). Using deidentified data from the Athenahealth electronic health record (EHR) system, opioid prescribing rates among 31,422 primary care providers† in the United States were analyzed to evaluate trends from January 2014 to March 2017. This analysis assessed how prescribing practices varied among six urban-rural classification categories of counties, before and after the March 2016 release of CDC's Guideline for Prescribing Opioids for Chronic Pain (Guideline) (4). Patients in noncore (the most rural) counties had an 87% higher chance of receiving an opioid prescription compared with persons in large central metropolitan counties during the study period. Across all six county groups, the odds of receiving an opioid prescription decreased significantly after March 2016. This decrease followed a flat trend during the preceding period in micropolitan and large central metropolitan county groups; in contrast, the decrease continued previous downward trends in the other four county groups. Data from EHRs can effectively supplement traditional surveillance methods for monitoring trends in opioid prescribing and other areas of public health importance, with minimal lag time under ideal conditions. As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction, community health care practices and intervention programs must continue to be tailored to community characteristics.
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Milano G, Vergani HM, Cattedra S, Carrozzino R, Mattioli F, Robbiano L, Martelli A. Co-Occurring Psychiatric and Substance Use Disorders: Clinical Survey Among a Rural Cohort of Italian Patients. Neuropsychiatr Dis Treat 2019; 15:3453-3459. [PMID: 31908460 PMCID: PMC6927221 DOI: 10.2147/ndt.s222567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/23/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Dual diagnosis (DD) is the co-occurrence of both a mental illness and a substance use disorder (SUD). Lots of studies have analysed the integrated clinical approach, which involves both psychiatry and toxicology medical experts. The purpose of this study is to analyse the socio-demographic characteristics and treatment strategies of patients with DD in a rural area of Italy. PATIENTS AND METHODS Clinical data of 750 patients were collected in 2016 through the analysis of health plan records. RESULTS The rate of co-occurring disorders is highly variable among people with SUD. In the considered area, patients with DD are 24%, of these only 46.1% have been treated with an integrated clinical program. Moreover, this percentage is further reduced (35.8%) if only patients with heroin use disorder are considered. CONCLUSION A comprehensive revision of DD treatment is needed, especially for people suffering from heroin use disorder and living in remote areas. Meticulous data analysis from other addiction health services of rural areas could be necessary to identify a science-based clinical intervention.
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Affiliation(s)
- Giulia Milano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Hayley M Vergani
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Simone Cattedra
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | | | - Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Luigi Robbiano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Antonietta Martelli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
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Cunningham RM, Walton MA, Carter PM. The Major Causes of Death in Children and Adolescents in the United States. N Engl J Med 2018; 379:2468-2475. [PMID: 30575483 PMCID: PMC6637963 DOI: 10.1056/nejmsr1804754] [Citation(s) in RCA: 410] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rebecca M Cunningham
- From the University of Michigan Injury Prevention Center (R.M.C., M.A.W., P.M.C.), the Firearm Safety among Children and Teens Consortium (R.M.C., M.A.W., P.M.C.), the Department of Emergency Medicine (R.M.C., P.M.C.), and the Addiction Center, Department of Psychiatry (M.A.W.), University of Michigan School of Medicine, and the Youth Violence Prevention Center (R.M.C., P.M.C.) and Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health - both in Ann Arbor
| | - Maureen A Walton
- From the University of Michigan Injury Prevention Center (R.M.C., M.A.W., P.M.C.), the Firearm Safety among Children and Teens Consortium (R.M.C., M.A.W., P.M.C.), the Department of Emergency Medicine (R.M.C., P.M.C.), and the Addiction Center, Department of Psychiatry (M.A.W.), University of Michigan School of Medicine, and the Youth Violence Prevention Center (R.M.C., P.M.C.) and Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health - both in Ann Arbor
| | - Patrick M Carter
- From the University of Michigan Injury Prevention Center (R.M.C., M.A.W., P.M.C.), the Firearm Safety among Children and Teens Consortium (R.M.C., M.A.W., P.M.C.), the Department of Emergency Medicine (R.M.C., P.M.C.), and the Addiction Center, Department of Psychiatry (M.A.W.), University of Michigan School of Medicine, and the Youth Violence Prevention Center (R.M.C., P.M.C.) and Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health - both in Ann Arbor
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Naloxone distribution, trauma, and supporting community-based overdose responders. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 74:255-256. [PMID: 30527865 DOI: 10.1016/j.drugpo.2018.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
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Voepel-Lewis T, Boyd CJ, McCabe SE, Zikmund-Fisher BJ, Malviya S, Grant J, Weber M, Tait AR. Deliberative Prescription Opioid Misuse Among Adolescents andEmerging Adults: Opportunities for Targeted Interventions. J Adolesc Health 2018; 63:594-600. [PMID: 30348282 PMCID: PMC6658888 DOI: 10.1016/j.jadohealth.2018.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/20/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND One in five adolescents and emerging adults have reported prescription opioid misuse (POM), posing significant risks for opioid-related adverse outcomes. Devising prevention strategies requires a better understanding of the decisional factors underlying risky misuse behavior. This research examined the associations between past opioid use behavior, opioid risk knowledge and perceptions, and intentional POM decisions. METHODS Participants aged 15-23years completed surveys assessing past prescription opioid use and misuse, opioid risk knowledge, opioid risk perceptions, and pain relief preferences (i.e., analgesic benefit vs. risk aversion preference). The outcome, Willingness to Misuse (i.e., intentional decisions to use a prescription opioid in a non-compliant manner) was measured using hypothetical pain decision scenarios. RESULTS Surveys were completed by 972 adolescents and young adults. In total, 44% had taken a prescription opioid and 32% of these reported past POM. Willingness to Misuse was significantly associated with lower opioid misuse risk perceptions (β = .75 [95% CI .66-.86]) and past opioid misuse (β = 1.81 [95% CI 1.13-2.91]) but not simple risk knowledge (β = .81 [95% CI .58-1.11]. The probability of future misuse was highest for those who reported past opioid misuse and had low risk perceptions (58.7% [95% CI 51.3-65.8]) and high pain relief preferences (53.4% [95% CI 45.3%-61.3%]). CONCLUSIONS Findings suggest that simple knowledge of prescription opioid risks is insufficient to curtail misuse among adolescents and emerging adults. Rather, it may be important to heighten opioid risk perceptions and strengthen opioid risk aversion values when prescribing opioid analgesics to better prevent future misuse in this high risk population.
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Affiliation(s)
- Terri Voepel-Lewis
- Department of Anesthesiology, Children's and Women's Hospital, University of Michigan, Ann Arbor, Michigan.
| | - Carol J Boyd
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Sean E McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Brian J Zikmund-Fisher
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Shobha Malviya
- Department of Anesthesiology, Children's and Women's Hospital, University of Michigan, Ann Arbor, Michigan
| | - John Grant
- Departments of Orthopaedic Surgery and Sports Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monica Weber
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Alan R Tait
- Department of Anesthesiology, Children's and Women's Hospital, University of Michigan, Ann Arbor, Michigan
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67
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Wagner J, Neitzke-Spruill L, O’Connell D, Highberger J, Martin SS, Walker R, Anderson TL. Understanding Geographic and Neighborhood Variations in Overdose Death Rates. J Community Health 2018; 44:272-283. [DOI: 10.1007/s10900-018-0583-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
There are inconsistent findings regarding the rates of nonmedical prescription drug use (NMPDU) among Black Americans. The majority of previous studies used pharmaceutical names of drugs and relied on national data that excludes incarcerated populations, in which Black men are overrepresented. Therefore, the current study aimed to describe pre-incarceration rates of NMPDU among Black men in prison using culturally relevant alternative drug names. We recruited 208 incarcerated (adult age 18 or older) Black men nearing community reentry to urban counties from four state prisons in Kentucky. Results indicated the majority of participants engaged in lifetime NMPDU. The most commonly endorsed class of prescription drug was, "Other Sedatives, Hypnotics, and Tranquilizers" and the most commonly endorsed specific prescription drugs were "Syrup," Lortab/Hydrocodone, and Xanax. There were significant age differences in the number of days that drugs were used in the year prior to incarceration. The current study contributes to the dearth of literature on NMPDU among Black Americans. These findings have implications for disease transmission, overdose risk, and culturally relevant data collection methods and interventions aimed at reducing NMPDU among Black men.
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69
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Opioid-related mortality in rural America: Geographic heterogeneity and intervention strategies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 57:119-129. [DOI: 10.1016/j.drugpo.2018.04.011] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/09/2018] [Accepted: 04/16/2018] [Indexed: 01/27/2023]
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Luu H, Slavova S, Freeman PR, Lofwall M, Browning S, Bush H. Trends and Patterns of Opioid Analgesic Prescribing: Regional and Rural-Urban Variations in Kentucky From 2012 to 2015. J Rural Health 2018; 35:97-107. [PMID: 29664203 DOI: 10.1111/jrh.12300] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/02/2018] [Accepted: 03/09/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Increased opioid analgesic prescribing (OAP) has been associated with increased risk of prescription opioid diversion, misuse, and abuse. We studied regional and rural-urban variations in OAP trends in Kentucky, from 2012 to 2015, and examined potential county-level risk and protective factors. METHODS This study used prescription drug monitoring data. Marginal models employing generalized estimating equations were used to model repeated counts of residents with opioid analgesic prescriptions within county-quarter, 2012-2015, with offset for resident population, by rural-urban classification exposure, and adjusting for time-varying socioeconomic and relevant health status measures. FINDINGS There were significant downward trends in rates of residents receiving dispensed opioid analgesic prescriptions, with no regional or rural/urban differences in the degree of decline over time. The adjusted models showed the Kentucky Appalachian region retained a significantly higher rate of residents with opioid analgesic prescriptions per 1,000 residents (30% higher than Central Kentucky and 19% higher than Kentucky Delta regions). Residents of nonmetropolitan not adjacent-to-metropolitan counties had significantly higher adjusted rates of OAP (33% higher than metropolitan counties and 17% higher compared to nonmetropolitan adjacent-to-metropolitan counties). The rate of OAP was significantly positively associated with emergency department visit injury rates and negatively associated with buprenorphine/naloxone prescribing rates. CONCLUSIONS Information on OAP trends and patterns will be used by Kentucky stakeholders to inform targeted interventions. Further research is needed to evaluate the availability and accessibility of nonopioid pain treatment in rural counties and the role of geography and time/distance traveled as risk factors for increased OAP.
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Affiliation(s)
- Huong Luu
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky.,Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky.,Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Svetla Slavova
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky.,Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Michelle Lofwall
- Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Steven Browning
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Heather Bush
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky
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71
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Fonseca J, Chang A, Chang F. Perceived Barriers and Facilitators to Providing Methadone Maintenance Treatment Among Rural Community Pharmacists in Southwestern Ontario. J Rural Health 2017; 34:23-30. [DOI: 10.1111/jrh.12264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/16/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Joseph Fonseca
- Gateway Centre of Excellence in Rural Health; Seaforth Ontario Canada
- School of Pharmacy; University of Waterloo; Waterloo Ontario Canada
| | - Andrew Chang
- School of Pharmacy; University of Waterloo; Waterloo Ontario Canada
| | - Feng Chang
- Gateway Centre of Excellence in Rural Health; Seaforth Ontario Canada
- School of Pharmacy; University of Waterloo; Waterloo Ontario Canada
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72
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Jones EB. Medication-Assisted Opioid Treatment Prescribers in Federally Qualified Health Centers: Capacity Lags in Rural Areas. J Rural Health 2017; 34:14-22. [PMID: 28842930 DOI: 10.1111/jrh.12260] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/18/2017] [Accepted: 06/16/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE This study explores correlates of on-site availability of substance use disorder treatment services in federally qualified health centers, including buprenorphine treatment that is critical to addressing the opioid epidemic. METHODS We employed descriptive and multivariable analyses with weighted 2010 Assessment of Behavioral Health Services survey data and the 2010 Uniform Data System. FINDINGS In 2010, 47.6% of health centers provided on-site substance use disorder treatment, 12.3% provided buprenorphine treatment for opioids, and 38.8% were interested in expanding buprenorphine availability. Urban health centers, those in the West, and health centers with electronic health records had higher odds of offering on-site substance use disorder treatment. Compared with on-site mental health treatment, substance use disorder treatment was available in fewer clinic sites within each organization. Health centers in rural areas had lower odds of providing on-site buprenorphine treatment (OR = 0.49, 95% CI: 0.26-0.94), and those in the South had lower odds of providing on-site buprenorphine treatment compared with health centers in other regions. Rural health centers had lower odds of expressing interest in expanding the availability of buprenorphine treatment (OR = 0.58, 95% CI: 0.35-0.97). CONCLUSIONS Improving access to substance use disorder treatment in primary care is a critical part of the strategy to combat the opioid use disorder epidemic. These findings highlight the important role of health centers as portals of access to substance use disorder treatment services in underserved communities. Recent investments to expand treatment capacity in health centers will expand the availability of substance use disorder services, but urban/rural and regional disparities should be monitored.
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Affiliation(s)
- Emily B Jones
- Department of Health Policy and Management, The Milken Institute School of Public Health and Health Services, The George Washington University, Washington, DC
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Camsari UM, Libertin CR. Small-Town America's Despair: Infected Substance Users Needing Outpatient Parenteral Therapy and Risk Stratification. Cureus 2017; 9:e1579. [PMID: 29057191 PMCID: PMC5647128 DOI: 10.7759/cureus.1579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background An active intravenous substance use disorder is often the primary cause of infectious diseases in this population of users and creates a barrier to successful parenteral antimicrobial management. The dilemma is compounded by dramatically limited resources in small US towns. Methods This retrospective review from January 2014 through July 2016 aimed to develop a risk stratification approach to aid rural healthcare providers in determining who among patients with addictive disorders could safely be discharged for outpatient antimicrobial therapy with a peripherally inserted central catheter (PICC). Results The high-risk group had a greater likelihood of noncompliance with antimicrobial therapy completion, as well as subsequent illicit drug use during that time frame, compared with the moderate- and low-risk groups. The low-risk group and most of the moderate-risk group could be safely discharged into the community with PICC lines. Conclusions Key in the risk stratification proposal was identifying risk behaviors and determining their degree. Such information provides pivotal delineators in developing risk stratification criteria.
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Affiliation(s)
- Ulas M Camsari
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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Pattison-Sharp E, Estrada RD, Elio A, Prendergast M, Carpenter DM. School nurse experiences with prescription opioids in urban and rural schools: A cross-sectional survey. J Addict Dis 2017; 36:236-242. [PMID: 28786772 DOI: 10.1080/10550887.2017.1361725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Few studies have examined the use of prescription opioids in schools. The current study aimed to: (1) describe the context within which school nurses encounter student opioid prescriptions; (2) assess school nurses' preferences for training and student education; and (3) explore urban-rural differences in school nurses' experiences and training preferences. A convenience sample of school nurses (n = 633) from North Carolina and South Carolina participated in a brief, anonymous, online survey. Qualitative data were analyzed thematically and statistical tests (t-tests and Chi-square tests) were performed to investigate urban-rural differences. Many school nurses (40.3%) had encountered a student with an opioid prescription, but only 3.6% had naloxone available in case of an overdose. Most school nurses (69.9%), especially rural school nurses, believed students would benefit from opioid education (74.9 versus 66.6%, p = 0.03). The majority of school nurses (83.9%) were interested in opioid-related training. Many school nurses encounter students with prescription opioids and would like additional opioid-related training. The potential benefits of providing naloxone access to prevent opioid-related deaths at schools should be explored.
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Affiliation(s)
| | - Robin Dawson Estrada
- b College of Nursing , University of South Carolina , Columbia , South Carolina , USA
| | - Alice Elio
- c Mountain Area Health Education Center Asheville , North Carolina , USA
| | - Melissa Prendergast
- d Director of Nursing , Charleston County School District , Charleston , South Carolina , USA
| | - Delesha M Carpenter
- e Eshelman School of Pharmacy (Asheville satellite campus) , University of North Carolina , Asheville , North Carolina , USA
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Ford JA, Sacra SA, Yohros A. Neighborhood characteristics and prescription drug misuse among adolescents: The importance of social disorganization and social capital. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:47-53. [DOI: 10.1016/j.drugpo.2017.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/05/2017] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
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76
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Black P, Hendy HM. Do painkillers serve as “hillbilly heroin” for rural adults with high levels of psychosocial stress? J Ethn Subst Abuse 2017; 18:224-236. [DOI: 10.1080/15332640.2017.1333478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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77
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Wolf JP, Ponicki WR, Kepple NJ, Gaidus A. Are community level prescription opioid overdoses associated with child harm? A spatial analysis of California zip codes, 2001-2011. Drug Alcohol Depend 2016; 166:202-8. [PMID: 27496625 PMCID: PMC4987103 DOI: 10.1016/j.drugalcdep.2016.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/08/2016] [Accepted: 07/13/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Non-medical prescription opioid use is increasing globally within high-income countries, particularly the United States. However, little is known about whether it is associated with negative outcomes for children. In this study, we use prescription opioid overdose as a proxy measure for non-medical prescription opioid use and ask the following: Do California communities with greater rates of non-medical prescription opioid use also have higher rates of child maltreatment and unintentional child injury? METHODS We used longitudinal population data to examine ecological associations between hospital discharges involving overdose of prescription opioids and those for child maltreatment or child injury in California zip codes between 2001 and 2011 (n=18,517 zip-code year units) using Bayesian space-time misalignment models. RESULTS The percentage of hospital discharges involving prescription opioid overdose was positively associated with the number of hospital discharges for child maltreatment (relative rate=1.089, 95% credible interval (1.004, 1.165)) and child injury (relative rate=1.055, 95% credible interval (1.012, 1.096)) over the ten-year period, controlling for other substance use and environmental factors. CONCLUSIONS Increases in community level prescription opioid overdoses between 2001 and 2011 are associated with a 2.06% increase in child maltreatment discharges and a 1.27% increase in discharges for child injury. Communities with higher rates of non-medical prescription opioid use may experience greater levels of child harms.
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Affiliation(s)
- Jennifer Price Wolf
- Division of Social Work, California State University, Sacramento 600 J Street, Sacramento, CA 95812, United States; Pacific Institute for Research and Evaluation, Prevention Research Center, 180 Grand Avenue, Oakland, CA 94612, United States.
| | - William R Ponicki
- Pacific Institute for Research and Evaluation, Prevention Research Center, 180 Grand Avenue, Oakland, CA 94612, United States
| | - Nancy J Kepple
- School of Social Welfare, University of Kansas, 1545 Lilac Ln., Lawrence, KS 66045, United States
| | - Andrew Gaidus
- Pacific Institute for Research and Evaluation, Prevention Research Center, 180 Grand Avenue, Oakland, CA 94612, United States
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