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Liu P, Korthuis PT, Buchheit BM. Novel Therapeutic and Program-Based Approaches to Opioid Use Disorders. Annu Rev Med 2024; 75:83-97. [PMID: 37827194 DOI: 10.1146/annurev-med-050522-033924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Opioid use disorder continues to drive overdose deaths in many countries, including the United States. Illicit fentanyl and its analogues have emerged as key contributors to the complications and mortality associated with opioid use disorder. Medications for opioid use disorder treatment, such as methadone and buprenorphine, are safe and substantially reduce opioid use, infectious complications, and mortality risk, but remain underutilized. Polysubstance use and emerging substances such as xylazine and designer benzodiazepines create additional treatment challenges. Recent clinical and policy innovations in treatment delivery, including telemedicine, bridge clinics, and expanded models for accessing methadone have the potential to increase access to life-saving care for people living with opioid use disorder.
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Affiliation(s)
- Patricia Liu
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
| | - P Todd Korthuis
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Bradley M Buchheit
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Bauer AG, Bellot J, Bazan C, Gilmore A, Kideys K, Cameron A. Cultural considerations for substance use and substance use disorders among Black men. Bull Menninger Clin 2024; 88:108-127. [PMID: 38836848 DOI: 10.1521/bumc.2024.88.2.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
There are complex cultural considerations for understanding, assessing, and treating substance use disorders (SUD) among Black men, from the initiation of substance use through SUD-related outcomes. This narrative review provides insight into some of these factors, including the individual, interpersonal, and community-level risk and protective factors (e.g., family and social roles, religiosity, racism and discrimination, exposure to trauma and adversity) underlying relative risk for substance use and disparities in SUD-related outcomes. This article also highlights the ways that public attitudes and policies related to substance use have contributed to ongoing inequities in SUD treatment access for Black men. Recommendations for clinical research and practice include increasing focus on measurement equivalence, creating pathways for access to community-based and specialty treatment, and providing services that are culturally affirming, relevant, and appropriate. Comprehensive efforts are needed to reduce SUD-related inequities and promote positive well-being among Black men and their communities.
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Affiliation(s)
- Alexandria G Bauer
- Center of Alcohol & Substance Use Studies and the Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
| | - Jahnayah Bellot
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
| | - Carolyn Bazan
- School of Health Professions, Rutgers University, Piscataway, New Jersey
| | - Ayanna Gilmore
- New York State Psychiatric Institute, New York, New York
| | - Kaan Kideys
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, New Jersey
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Roberts K, Smith E, Sousa C, Young JE, Corley AG, Szczotka D, Sepanski A, Hartoch A. Centering persons who use drugs: addressing social determinants of health among patients hospitalized with substance use disorders. SOCIAL WORK IN HEALTH CARE 2024; 63:19-34. [PMID: 37929597 DOI: 10.1080/00981389.2023.2278777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
Social workers have emerged as leaders within Addiction Consult Services (ACS) due to their ability to provide a wide range of services, from crisis work and brief therapeutic interventions to connecting patients to community resources. Many hospitals have implemented ACS to address the overdose crisis and the sharp rise in drug use-related infections, including skin and soft tissue infections, osteomyelitis, and endocarditis; a result of unaddressed systemic social determinants of health (SDOH). Yet, despite social workers being at the forefront of inpatient substance use work, little guidance exists regarding social work's role in leading person-centered addiction care and addressing SDOH in the hospital setting. The authors of this paper are licensed clinical social workers who have worked across five different health systems, engaging persons who use drugs (PWUD) in the context of an ACS. This paper examines five practice interventions of social work practice within hospitals that represent key points for innovation. Drawing on social work's unique commitments to social justice, strengths, and person-in-environment, these interventions operate within eco-social approaches to help us grapple more effectively with ways that health - and disease - are socially and economically produced by multiple interacting factors. We provide a clinical roadmap of interventions for social workers in hospital settings with PWUD to demonstrate how social work leadership within inpatient care models can help us better address the impacts of various intersecting SDOH on the care of PWUD.
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Affiliation(s)
- Kate Roberts
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
| | - Emily Smith
- Michigan Opioid Collaboratived, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Cindy Sousa
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
| | - J Elaina Young
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anna Grace Corley
- Addiction Medicine, Prisma Health Internal Medicine, Greenville, South Carolina, USA
| | - Darin Szczotka
- Michigan Opioid Collaboratived, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Abby Sepanski
- Addiction Medicine, Prisma Health Internal Medicine, Greenville, South Carolina, USA
| | - Ashley Hartoch
- Psychiatry, Stanford Health Care, Palo Alto, California, USA
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Goldman ML, McDaniel M, Manjanatha D, Rose ML, Santos GM, Shade SB, Lazar AA, Myers JJ, Handley MA, Coffin PO. Impact of San Francisco's New Street crisis response Team on Service use among people experiencing homelessness with mental and substance use disorders: A mixed methods study protocol. PLoS One 2023; 18:e0295178. [PMID: 38051726 PMCID: PMC10697604 DOI: 10.1371/journal.pone.0295178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
Mobile crisis services for people experiencing distress related to mental health or substance use are expanding rapidly across the US, yet there is little evidence to support these specific models of care. These new programs present a unique opportunity to expand the literature by utilizing implementation science methods to inform the future design of crisis systems. This mixed methods study will examine the effectiveness and acceptability of the Street Crisis Response Team (SCRT), a new 911-dispatched multidisciplinary mobile crisis intervention piloted in San Francisco, California. First, using quantitative data from electronic health records, we will conduct an interrupted time series analysis to quantitatively examine the impacts of the SCRT on people experiencing homelessness who utilized public behavioral health crisis services in San Francisco between November 2019 and August 2022, across four main outcomes within 30 days of the crisis episode: routine care utilization, crisis care reutilization, assessment for housing services, and jail entry. Second, to understand its impact on health equity, we will analyze racial and ethnic disparities in these outcomes prior to and after implementation of the SCRT. For the qualitative component, we will conduct semi-structured interviews with recipients of the SCRT's services to understand their experiences of the intervention and to identify how the SCRT influenced their health-related trajectories after the crisis encounter. Once complete, the quantitative and qualitative findings will be further analyzed in tandem to assist with more nuanced understanding of the effectiveness of the SCRT program. This evaluation of a novel mobile crisis response program will advance the field, while also providing a model for how real-world program implementation can be achieved in crisis service settings.
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Affiliation(s)
- Matthew L. Goldman
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Megan McDaniel
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
| | - Deepa Manjanatha
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States of America
| | - Monica L. Rose
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, United States of America
| | - Starley B. Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ann A. Lazar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Division of Oral Epidemiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Janet J. Myers
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
- UCSF Partnerships for Research in Implementation Science for Equity (PRISE Center), San Francisco, San Francisco, CA, United States of America
| | - Margaret A. Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
- UCSF Partnerships for Research in Implementation Science for Equity (PRISE Center), San Francisco, San Francisco, CA, United States of America
| | - Phillip O. Coffin
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
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Moses J, Korona-Bailey J, Mukhopadhyay S. Exploring trends in benzodiazepine-positive fatal drug overdoses in Tennessee, 2019-2021. Ann Med 2023; 55:2287194. [PMID: 38039554 PMCID: PMC10836290 DOI: 10.1080/07853890.2023.2287194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Benzodiazepine-positive overdoses increased between 2019 and 2021 in Tennessee. We sought to determine the changes in the number and characteristics of prescription and illicit benzodiazepine-positive fatal drug overdoses during this period. MATERIALS AND METHODS A statewide study was conducted to determine changes in the number and characteristics of benzodiazepine-positive drug overdose decedents using 2019-2021 data from the Tennessee State Unintentional Drug Overdose Reporting System. The analyses were limited to Tennessee residents aged ≥ 18 years. A benzodiazepine-positive overdose was defined as any benzodiazepine on toxicology, regardless of the presence of other substances. Frequencies were generated to compare demographics, circumstances, prescription history, and toxicology between 2019 and 2021 for illicit and prescription benzodiazepine-positive fatal overdoses. RESULTS Between 2019 and 2021, 1666 benzodiazepine-positive unintentional or undetermined fatal drug overdoses out of 5916 total overdoses that occurred among adult Tennessee residents with available toxicological information. Prescription benzodiazepines were identified in 80.7% of deaths, whereas illicit benzodiazepines were identified in 12.0% of deaths. Many decedents had an anxiety disorder (45.5%), while over half of all decedents had a history of substance use disorder (52.3%). Most benzodiazepine-positive overdoses involved fentanyl (71.3%). CONCLUSIONS This analysis can inform local and regional public health workers to implement focused prevention and intervention efforts for people with co-occurring mental health conditions and substance use disorders to curb overdose epidemics among persons using benzodiazepines in Tennessee. Public health campaigns should focus on educating people on appropriate prescription medication use and the dangers of obtaining substances illicitly. Given the high proportion of opioids in this population, further education also is needed on the dangers of polysubstance drug use. The differences between prescription and illicit benzodiazepine-positive fatal overdoses indicate the need to develop substance-specific prevention and treatment strategies.
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Affiliation(s)
| | | | - Sutapa Mukhopadhyay
- TN Department of Health, Office of Informatics and Analytics, Nashville, TN, USA
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Xu KY, Huang V, Williams AR, Martin CE, Bazazi AR, Grucza RA. Co-occurring psychiatric disorders and disparities in buprenorphine utilization in opioid use disorder: An analysis of insurance claims. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100195. [PMID: 38023343 PMCID: PMC10630609 DOI: 10.1016/j.dadr.2023.100195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Background As the overdose crisis continues in the U.S. and Canada, opioid use disorder (OUD) treatment outcomes for people with co-occurring psychiatric disorders are not well characterized. Our objective was to examine the influence of co-occurring psychiatric disorders on buprenorphine initiation and discontinuation. Methods This retrospective cohort study used multi-state administrative claims data in the U.S. to evaluate rates of buprenorphine initiation (relative to psychosocial treatment without medication) in a cohort of 236,198 people with OUD entering treatment, both with and without co-occurring psychiatric disorders, grouping by psychiatric disorder subtype (mood, psychotic, and anxiety-and-related disorders). Among people initiating buprenorphine, we assessed the influence of co-occurring psychiatric disorders on buprenorphine retention. We used multivariable Poisson regression to estimate buprenorphine initiation and Cox regression to estimate time to discontinuation, adjusting for all 3 classes of co-occurring disorders simultaneously and adjusting for baseline demographic and clinical characteristics. Results Buprenorphine initiation occurred in 29.3 % of those with co-occurring anxiety-and-related disorders, compared to 25.9 % and 17.5 % in people with mood and psychotic disorders. Mood (adjusted-risk-ratio[aRR] = 0.82[95 % CI = 0.82-0.83]) and psychotic disorders (aRR = 0.95[0.94-0.96]) were associated with decreased initiation (versus psychosocial treatment), in contrast to greater initiation in the anxiety disorders cohort (aRR = 1.06[1.05-1.06]). We observed an increase in buprenorphine discontinuation associated with mood (adjusted-hazard-ratio[aHR] = 1.20[1.17-1.24]) and anxiety disorders (aHR = 1.12[1.09-1.14]), in contrast to no association between psychotic disorders and buprenorphine discontinuation. Conclusions We observed underutilization of buprenorphine among people with co-occurring mood and psychotic disorders, as well as high buprenorphine discontinuation across anxiety, mood, and psychotic disorders.
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Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Vivien Huang
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Arthur Robin Williams
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, USA
- Division of Substance Use Disorders, New York State Psychiatric Institute, New York, New York, USA
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology and the VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Alexander R. Bazazi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Richard A. Grucza
- Department of Family and Community Medicine, St. Louis University, St. Louis, Missouri, USA
- Department of Health and Clinical Outcomes Research, St. Louis University, St Louis, Missouri, USA
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Brown AR, Walters JE, Harmer B, Cates L, Jones AE. Non-prescribing clinicians' treatment orientations and attitudes toward treatments for opioid use disorder: Rural differences. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209153. [PMID: 37673286 DOI: 10.1016/j.josat.2023.209153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/31/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION The United States has experienced substantial increases in opioid use for more than two decades. This growth has impacted rural areas where overdoses have risen drastically during this time period and more often involve prescription opioids than in urban areas. Medications for opioid use disorders (MOUDs) are highly underutilized in rural settings due to lack of access, inadequate prescribing, and stigma. METHODS The study collected data using a cross-sectional online survey of nonprescribing clinicians (NPCs) involved in the treatment of substance use disorders (SUDs) in the United States. The study used multiple recruitment methods to obtain a purposive sample of NPCs from a variety of geographical contexts across the nation. The survey assessed demographic and practice characteristics including rurality of practice location, exposure and training related to MOUDs, treatment orientation, treatment preferences for opioid use disorder (OUD), and attitudes toward MOUDs. The study compared treatment preferences for OUD and attitudes toward MOUDs based on rurality of practice location. We tested a mediation model to determine whether the relationship between rurality of practice setting and attitudes toward MOUDs is mediated by treatment orientation. RESULTS Most of the 636 NPCs surveyed favored a combination of MOUDs and psychosocial treatment. Compared to clinicians practicing in suburban or urban areas, self-identified rural clinicians were more likely to favor MOUDs alone as most effective and less likely to endorse a combination of MOUDs and psychosocial treatment. Although most NPCs were supportive of MOUDs overall, many endorsed misconceptions related to MOUDs. Rural clinicians were less likely to perceive MOUDs as effective or acceptable compared to those in urban settings. Results of a mediation analysis indicated that practicing in a rural location compared to in an urban location directly and indirectly influenced attitudes toward MOUDs through an effect on treatment orientation. CONCLUSIONS NPCs play important roles in the implementation of MOUDs, and while efforts to increase their knowledge of and exposure to MOUDs have contributed broadly to more favorable attitudes toward MOUDs among NPCs, this study's findings indicate that additional efforts are still needed, particularly among NPCs who work in rural settings. Findings also indicate that, among rural clinicians, increasing knowledge of and exposure to harm reduction principles may be a necessary prerequisite to engaging them in the implementation of specific harm reduction strategies such as MOUDs.
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Affiliation(s)
- Aaron R Brown
- University of Kentucky, College of Social Work, 619 Patterson Office Tower, Lexington, KY 40506-0027, USA.
| | - Jayme E Walters
- Utah State University, Department of Social Work, 0730 Old Main Hill, Logan, UT 84322-0730, USA
| | - Beth Harmer
- Western Carolina University, Department of Social Work, 3971 Little Savannah Rd, Cullowhee, NC 28723, USA
| | - Lara Cates
- Western Carolina University, Department of Social Work, 3971 Little Savannah Rd, Cullowhee, NC 28723, USA
| | - Aubrey E Jones
- University of Kentucky, College of Social Work, 619 Patterson Office Tower, Lexington, KY 40506-0027, USA
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Simon J, Guynn I, Thompson M, Hambright S, Jones C, Lich KH. Strengthening the System Supporting Perinatal People with Substance Use Disorder in the Midwest Using Group Model Building. Matern Child Health J 2023; 27:128-142. [PMID: 37477728 PMCID: PMC10692270 DOI: 10.1007/s10995-023-03751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Providing comprehensive, evidence-based care to perinatal people with substance use disorders (SUD) requires multi-stakeholder collaboration and alignment. The National Maternal and Child Health Workforce Development Center facilitated a system-strengthening process with the Midwest substance use in pregnancy (SUPper) club, a regional collaborative of health care providers, state public health agencies, and community-rooted organizations. METHODS Facilitators led a 2 day group model building (GMB) workshop with 20 participants and two semi-structured interviews. Workshop participants were invited to complete an evaluation. RESULTS Two primary trends were identified as priorities for change: (1) Birthing people's perception/experience of stigma and (2) The Midwest SUPper Club's reach and influence. Three causal loop diagrams (CLDs) were created to capture the interconnected dynamics of the Midwest perinatal SUD system: (1) the influence of stigma on maternal and infant health outcomes, (2) the role of clinic, organizational, and state policies, and (3) the impact of workforce education and evidence-based practices on care. From the CLDs, four priorities for action emerged: (1) align and promote shared mental models across stakeholders, (2) expand education and training opportunities for the perinatal SUD workforce, (3) strengthen systems infrastructure to support care navigation for patients and providers, and (4) collaboratively identify evidence-based practices that meet regional needs. All evaluation respondents reported that the workshop supported the development of a shared mental model. DISCUSSION The GMB process strengthened collaboration and advanced strategic planning for the SUPper Club. GMB can be further utilized among diverse stakeholders across MCH systems to create shared mental models and accelerate collaborative planning efforts.
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Affiliation(s)
- Jessica Simon
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, DC, 20006, USA.
- Department of Maternal and Child Health, National MCH Workforce Development Center, University of North Carolina at Chapel Hill, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA.
| | - Isabella Guynn
- Department of Maternal and Child Health, National MCH Workforce Development Center, University of North Carolina at Chapel Hill, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavaran-Greenberg Hall, Chapel Hill, NC, 27599, USA
| | - Meagan Thompson
- Susan S. Morrison School of Nursing, University of St. Thomas, 2115 Summit Ave, St. Paul, MN, 55105, USA
| | - Sarah Hambright
- Department of OBGYN, Maternal Substance Use Disorder Clinic, University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Cresta Jones
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, 606 24th Ave S, Suite 401, Minneapolis, MN, 55455, USA
| | - Kristen Hassmiller Lich
- Department of Maternal and Child Health, National MCH Workforce Development Center, University of North Carolina at Chapel Hill, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavaran-Greenberg Hall, Chapel Hill, NC, 27599, USA
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Chen L, Sethi S, Poland C, Frank C, Tengelitsch E, Goldstick J, Sussman JB, Bohnert ASB, Lin L(A. Prescriptions for Buprenorphine in Michigan Following an Education Intervention. JAMA Netw Open 2023; 6:e2349103. [PMID: 38127344 PMCID: PMC10739087 DOI: 10.1001/jamanetworkopen.2023.49103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Buprenorphine is an underused treatment for opioid use disorder (OUD) that can be prescribed in general medical settings. Founded in 2017, the Michigan Opioid Collaborative (MOC) is an outreach and educational program that aims to address clinician and community barriers to buprenorphine access; however, the association between the MOC and buprenorphine treatment is unknown. Objective To evaluate the association between MOC service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine. Design, Setting, and Participants This cohort study exploited staggered implementation of MOC services across all Michigan counties. Difference-in-difference analyses were conducted by applying linear fixed-effects regression across all counties to estimate the overall association of MOC engagement with outcomes and linear regression for each MOC-engaged county separately to infer county-specific results using data from May 2015 to August 2020. Analyses were conducted from September 2021 to November 2023. Exposures MOC engagement. Main Outcomes and Measures County-level monthly numbers of buprenorphine prescribers and patients receiving buprenorphine (per 100 000 population). Results Among 83 total counties, 57 counties (68.7%) in Michigan were engaged by MOC by 2020, with 3 (3.6%) initiating engagement in 2017, 19 (22.9%) in 2018, 27 (32.5%) in 2019, and 8 (9.6%) in 2020. Michigan is made up of 83 counties with a total population size of 9 990 000. A total of 5 070 000 (50.8%) were female, 1 410 000 (14.1%) were African American or Black, 530 000 (5.3%) were Hispanic or Latino, and 7 470 000 (74.7%) were non-Hispanic White. The mean (SD) value of median age across counties was 44.8 (6.4). The monthly increases in buprenorphine prescriber numbers in the preengagement (including all time points for nonengaged counties) and postengagement periods were 0.07 and 0.39 per 100 000 population, respectively, with the absolute difference being 0.33 (95% CI, 0.12-0.53) prescribers per 100 000 population (P = .002). The numbers of patients receiving buprenorphine increased by an average of 0.6 and 7.15 per 100 000 population per month in preengagement and postengagement periods, respectively, indicating an estimated additional 6.56 (95% CI, 2.09-11.02) patients receiving buprenorphine per 100 000 population (P = .004) monthly increase after engagement compared with before. Conclusions and Relevance In this cohort study measuring buprenorphine prescriptions in Michigan over time, counties' engagement in OUD-focused outreach and clinician education services delivered by a multidisciplinary team was associated with a temporal increase in buprenorphine prescribers and patients receiving buprenorphine.
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Affiliation(s)
- Liying Chen
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Sheba Sethi
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Cara Poland
- Department of Obstetrics, Gynecology and Reproductive Health, Michigan State University, East Lansing
| | - Christopher Frank
- Department of Family Medicine, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Jason Goldstick
- Injury Prevention Center, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor
| | - Jeremy B. Sussman
- Division of General Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Amy S. B. Bohnert
- Department of Anesthesiology, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Lewei (Allison) Lin
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
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Shukla R, Turner BJ, Ramos GG, Love M, D'Isabella J, Soto C. American Indian and Alaska Native substance use treatment: Barriers and facilitators according to an implementation framework. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209095. [PMID: 37277023 DOI: 10.1016/j.josat.2023.209095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Substance use disorder (SUD) and overdose deaths are higher in the American Indian and Alaska Native (AIAN) population than in other racial/ethnic groups. Multi-level gaps hinder SUD treatment for AIAN patients. Few studies have engaged front-line clinicians and administrators of SUD treatment programs serving AIAN patients to identify barriers and facilitators to improve the implementation of effective treatment. METHODS We conducted key informant interviews with a diverse sample of providers and administrators of SUD treatment programs across California regarding barriers and facilitators to treatment for AIAN patients. An AIAN-majority community advisory board (CAB) guided the development of an interview guide and helped to recruit respondents from five types of SUD programs statewide. Using ATLAS.ti, the research team coded interviews and classified emergent themes as barriers and facilitators related to Outer, Inner, and Individual domains of the Consolidated Framework for Implementation Research (CFIR). RESULTS Representatives of 13 of 15 invited SUD treatment programs participated and 9 of the 13 interviewed self-identified as AIAN. Related to Outer Setting barriers from coded interviews, a dominant barrier was policies that defund or underfund SUD treatment, especially detoxification centers. Outer Setting facilitators included consistent Indian Health Service (IHS) eligibility criteria, judicial system connections for direct treatment access, and community programs advocating SUD treatment. Key themes related to barriers for the Inner Setting were limited bed capacity, poor coordination of intake and care, and lack of telehealth technology. Facilitators integrated mental health, linkage to external resources, and culturally centered care. Individual-level barriers were negative attitudes such as SUD stigma, distrust of governmental programs, and lack of transportation while individual engagement was facilitated by programs addressing negative attitudes and providing telemedicine for remote care. CONCLUSION The public health threat of SUD for the AIAN population mandates the implementation of interventions and policies that facilitate care. This qualitative study with primarily AIAN clinical leaders of SUD treatment highlights opportunities to improve care at multiple CFIR levels, focusing on capacity, coordination, culturally congruent care, and community initiatives to promote engagement.
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Affiliation(s)
- Rit Shukla
- University of Southern California Price School of Public Policy, 650 Childs Way, Los Angeles, CA 90089, United States of America
| | - Barbara J Turner
- Department of Medicine, Keck Medical Center of University of Southern California, 2020 Zonal Avenue, Los Angeles, CA 90033, United States of America.
| | - Guadalupe G Ramos
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
| | - Morgan Love
- California Consortium for Urban Indian Health, 1016 Lincoln Blvd #111, San Francisco, CA 94129, United States of America
| | - Julia D'Isabella
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
| | - Claradina Soto
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
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Ware OD, Sacco P, Cagle JG, Frey JJ, Wagner FA, Wimberly AS, Gyebi-Foster B, Diaz M, Peters K, Zemore SE. Higher perceived stress during admission is associated with shorter retention in short-term residential substance use disorder treatment. Addict Behav Rep 2023; 18:100502. [PMID: 38170055 PMCID: PMC10758394 DOI: 10.1016/j.abrep.2023.100502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Over one million people in the U.S. received residential treatment for a substance use disorder (SUD) in 2020. Longer treatment retention is associated with better outcomes (e.g., reduced substance use). Entering treatment with higher stress may be associated with shorter retention. This paper examines the impact of perceived stress at admission on SUD treatment retention in short-term residential treatment. Methods A sample of 271 treatment episodes with admissions between October 2019 and February 2020 were collected from de-identified records of an urban mid-Atlantic adult 28-day short-term residential SUD treatment facility. Treatment completion involved finishing 28 days. Sociodemographic, substance use, perceived stress, and treatment discharge variables were analyzed. Bivariate analyses examined differences between treatment completion and early discharge, and Cox regression investigated the effect of perceived stress on treatment retention with covariates. Results The sample was primarily male (73.8%) and non-Hispanic Black (71.6%). A majority used heroin as their primary substance (54.6%) and reported polysubstance use (72.3%). About half (51.3%) completed treatment, and completed an average of 18.7 (SD = 10.7) days. Those who prematurely discharged from treatment stayed an average of 8.9 (SD = 7.0) days. The Cox regression model found that higher perceived stress (adjusted hazard ratio (AHR) = 1.028; 95% CI = [1.005, 1.053], p =.019) and a race/ethnicity other than non-Hispanic Black (AHR = 1.546, 95% CI = [1.037, 2.305], p =.033) predicted premature discharge. Conclusions Perceived stress at admission is associated with shorter treatment retention. Early stress management interventions may help increase treatment retention.
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Affiliation(s)
- Orrin D. Ware
- University of North Carolina at Chapel Hill School of Social Work, United States
| | - Paul Sacco
- University of Maryland School of Social Work, United States
| | - John G. Cagle
- University of Maryland School of Social Work, United States
| | - Jodi J. Frey
- University of Maryland School of Social Work, United States
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Ho HC, Wong SSC, Cheung CW. Individual-level and neighborhood-level shifts in mortality patterns among drug poisoning deaths in a high-density Asian city: a territory-wide, case-only analysis. Int Health 2023; 15:715-722. [PMID: 36916328 PMCID: PMC10629959 DOI: 10.1093/inthealth/ihad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The shifts in individual-level and neighborhood-level patterns of drug poisoning deaths in a high-density Asian city over time have been underestimated, although they provide essential information for community-based surveillance and interventions. METHODS A case-only analysis with a 16-y, territory-wide, population-based registry in Hong Kong was applied to compare drug poisoning deaths from 2001 to 2010 with 2011 to 2016. Drug poisoning deaths, deaths from heroin and deaths from other opioids (codeine or morphine) were extracted (ICD codes: T36-T50, T40.1, T40.2). Binomial regressions were used to estimate the shifts in mortality patterns. RESULTS Among 3069 drug poisoning deaths, a significant shift in mortality patterns was found despite a decreasing mortality trend in Hong Kong. Overall, drug poisoning deaths shifted towards middle-aged/young-old, widowed/divorced, economically active, white collar and non-local born. Since 2011, more deaths from heroin were in older ages and non-local born, but less were never married and economically inactive. More deaths from other opioids were middle-aged, young-old and divorced. In particular, most decedents shifted towards young-old, especially deaths from other opioids. Compared with deaths during 2001-2010, there were 3.72- and 6.50-fold more deaths from heroin and deaths from other opioids in those aged ≥60 y since 2021 (ORs: 3.72 [2.37, 5.86], 6.50 [3.97, 10.65]), respectively. Additionally, drug poisoning deaths shifted towards areas with less neighborhood deprivation (more high-education individuals and a mix of private/public housing residents), especially deaths from other opioids. CONCLUSION Misuse of registered drugs (e.g. opioid pain relievers) could be a rising trend among vulnerable subpopulations in Hong Kong other than illegal drug use (heroin). Health officials should provide more advice and support on drug information. Specifically, an improved health system with education regarding the appropriate use of registered drugs for medical treatments should be provided to mid-/high-income and local-born individuals.
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Affiliation(s)
- Hung Chak Ho
- Department of Anaesthesiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Stanley Sau-Ching Wong
- Department of Anaesthesiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Chi Wai Cheung
- Department of Anaesthesiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
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Harris RA, Mandell DS. Years of life lost to drug overdose in the Latinx community during the most recent wave of overdose deaths. Am J Addict 2023; 32:610-614. [PMID: 37543854 PMCID: PMC10662957 DOI: 10.1111/ajad.13459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study estimated years of life lost (YLL) among US Latinx individuals during the most recent wave of drug overdose deaths. METHODS A serial cross-sectional study of YLL (life expectancy minus age at death) from death certificate records of Latinx individuals who died from drug overdoses from 2015 to mid-2022. RESULTS Over the study period, 58,209 Latinx individuals aged 15-64 years died from drug overdoses resulting in 2,266,784 YLL. Age-group YLL differences remained stable, but gender YLL trajectories diverged. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE This study extends our understanding of the immense loss to Latinx communities from preventable drug deaths.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
| | - David S. Mandell
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
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Evans KN, Vettese T, Wortley PM, Gandhi AP, Bradley H. HIV and HCV testing at clinical encounters among people who inject drugs, 2013-2018-Opportunities for increased testing and prevention. J Viral Hepat 2023; 30:848-858. [PMID: 37726974 DOI: 10.1111/jvh.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023]
Abstract
People who inject drugs (PWID) with unsafe injection practices have substantial risk for HIV and hepatitis C virus (HCV) infections. We describe frequency of, and factors associated with, HIV and HCV testing during clinical encounters with PWID. Inpatient and Emergency Department clinical encounters at an Atlanta hospital were abstracted from medical records spanning January 2013-December 2018. We estimated frequency of HIV and HCV testing during injection drug use (IDU)-related encounters among PWID without previous diagnoses. We assessed associations between patient factors and testing using generalized estimating equations models. HIV testing occurred in 39.3% and HCV testing occurred in 17.1% of eligible IDU-related encounters. Testing was more likely in IDU-related encounters during 2017-2018 than in encounters during 2013-2014; (HIV, AOR = 2.14, 95% CI, 1.32-3.49, p < .01). Testing was less likely among Black/African American patients compared to White patients (adjusted odds ratio [AOR]: HIV, AOR = 0.48, 95% confidence interval [CI], 0.33-0.72, p < .01); HCV, AOR = 0.41, 95% CI, 0.24-0.70, p < .01). This difference may be attributable to recent testing among Black patients in non-IDU related encounters. HIV and HCV testing improved over time; however, missed opportunities for testing still existed. Strategies should aim to improve equitable HIV and HCV testing among PWID.
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Affiliation(s)
- Kimberly N Evans
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Theresa Vettese
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Ami P Gandhi
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
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Zerden LDS, Sullivan C, Galloway E, Richman EL, Gaiser MG, Lombardi B. Are DEA-waivered buprenorphine prescribers colocated with behavioral health clinicians? Am J Addict 2023; 32:574-583. [PMID: 37559344 DOI: 10.1111/ajad.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Medication for opioid use disorder (MOUD) in primary care includes a combination of medication, behavioral therapy, and/or other psychosocial services. This study assessed rates of colocation between waivered prescribers and behavioral health clinicians across the United States to understand if rates varied by provider type and geographic indicators. METHODS Data from the DEA-Drug Addiction Treatment Act of 2000 provider list as of March 2022 and the National Plan and Provider Enumeration System's National Provider Identifier database were gathered, cleaned, and formatted in Stata. Data were geocoded with ESRI StreetMap® database and ArcGIS software. Covariates at individual, county, and state levels were examined and compared. Chi-square statistics and a mixed-effects logistic regression were analyzed. RESULTS The sample (N = 71, 292 prescribers) included physicians (64%), nurse practitioners (29%), and physician assistants (7%). About 48% of prescribers were colocated with a behavioral health clinician. Physicians were the least likely to be colocated (47%), but differences between provider types were modest. We observed significant geographic differences in provider colocation by provider type. Mixed effects logistic regression identified significant predictors of colocation at individual, county, and state levels. DISCUSSION AND CONCLUSIONS Optimally distributing the workforce providing MOUD is necessary to broadly ensure the provision of comprehensive MOUD care based on practice guidelines. SCIENTIFIC SIGNIFICANCE Less than half of all waivered prescribers, outside of hospitals, are colocated with behavioral health clinicians. Findings offer greater clarity on where integrated MOUD is occurring, among which types of providers, and where it needs to be expanded to increase MOUD uptake.
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Affiliation(s)
- Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, UNC Behavioral Health Workforce Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Connor Sullivan
- Cecil G. Sheps Center for Health Services Research, UNC Behavioral Health Workforce Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evan Galloway
- Cecil G. Sheps Center for Health Services Research, UNC Behavioral Health Workforce Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erica L Richman
- Cecil G. Sheps Center for Health Services Research, UNC Behavioral Health Workforce Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maria G Gaiser
- Cecil G. Sheps Center for Health Services Research, UNC Behavioral Health Workforce Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brianna Lombardi
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, UNC Behavioral Health Workforce Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Family Medicine, School of Social Work, Cecil G. Sheps Center for Health Services Research, UNC Behavioral Health Workforce Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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DeBruin H, St Marie BJ. Health disparities in ethnic and racial minority populations with pain and opioid use disorder. J Opioid Manag 2023; 19:23-36. [PMID: 37879657 DOI: 10.5055/jom.2023.0796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Healthcare providers are not prepared to address health disparities among ethnic and racial minority populations with either persistent and chronic pain or substance use disorder (SUD). Recognizing biases from policies to provide pain management and treatment for SUD in our healthcare systems, from our individual state laws and federal guidelines, is necessary. Biases are embedded in the screening and treatment of patients with chronic pain through the use of screening tools, opioid treatment agreements, and prescription drug monitoring programs. Additionally, the punitive treatment of people of ethnic and racial minority populations who experience persistent and chronic pain, opioid use disorders, or other SUDs needs to be redirected to facilitate solutions rooted in equity.
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Affiliation(s)
| | - Barbara J St Marie
- University of Iowa, College of Nursing, Iowa City, Iowa. ORCID: https://orcid.org/0000-0003-0231-9464
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Nykin D, Haley CB, Saadat S, Luu T, Sahota PK, Chakravarthy B. Why is naloxone prescription not more common in emergency departments? A survey of physician practices and attitudes. J Opioid Manag 2023; 19:11-15. [PMID: 37879655 DOI: 10.5055/jom.2023.0794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Emergency physicians (EPs) have a singular opportunity to prescribe naloxone and decrease fatal overdoses in opioid users. We surveyed EPs patterns of naloxone prescription and identified barriers to prescribing naloxone. DESIGN Surveys were conducted at an emergency medicine conference from 2018 to 2019. We used a Likert scale for all questions and a chi-square or chi-square for trend tests to determine statistical significance. SETTING Emergency medicine conferences and emergency departments. PARTICIPANTS Forty-one EPs were surveyed. INTERVENTION Oral survey. MAIN OUTCOME MEASURES Prevalence of naloxone prescription and EP attitude toward naloxone. RESULTS 65.0 percent of residents and 33.3 percent of attending physicians had never prescribed naloxone to patients. 90.2 percent believed ED naloxone prescription is safe, 82.9 percent did not refrain from prescribing due to ethical concerns, and 73.2 percent believed it is not a waste of resources. CONCLUSIONS Many resident physicians had never prescribed naloxone despite agreeing it was safe, ethical, and a productive use of resources. The time needed to counsel patients on naloxone use was a barrier to prescription, and various interventions are needed to make this practice more common.
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Affiliation(s)
- David Nykin
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Or-ange, California
| | - Campbell Belisle Haley
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, California. ORCID: https://orcid.org/0000-0002-1903-2788
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, California
| | - Tiffany Luu
- University of California, Irvine School of Medicine, Orange, California
| | - Preet Kaur Sahota
- Arizona College of Osteopathic Medicine-Midwestern University, Glendale, Arizona
| | - Bharath Chakravarthy
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, California
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Barbalat G, Reddy G, Franck N. Association of globalization with the burden of opioid use disorders 2019. A country-level analysis using targeted maximum likelihood estimation. Global Health 2023; 19:76. [PMID: 37845722 PMCID: PMC10577998 DOI: 10.1186/s12992-023-00980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The "opioid crisis" has been responsible for hundreds of thousands deaths in the US, and is at risk of dissemination worldwide. Within-country studies have demonstrated that the rise of opioid use disorders (OUD) is linked to increased access to opioid prescriptions and to so-called "diseases of despair". Both have been related to the emergence of globalization policies since the 1980s. First, globalized countries have seen a reorganization of healthcare practices towards quick and easy answers to complex needs, including increased opioid prescriptions. Second, despair has gained those suffering from the mutations of socio-economic systems and working conditions that have accompanied globalization policies (e.g. delocalization, deindustrialization, and the decline of social services). Here, using data with high quality ratings from the Global Burden of Disease database, we evaluated the country-based association between four levels of globalization and the burden of OUD 2019. RESULTS The sample included 87 countries. Taking into account potential country-level confounders, we found that countries with the highest level of globalization were associated with a 31% increase in the burden of OUD 2019 compared to those with the lowest level of globalization (mean log difference: 0.31; 95%CI, 0.04-0.57; p = 0.02). Additional analyses showed a significant effect for low back pain (mean log difference: 0.07; 95%CI, 0.02-0.12; p = 0.007). In contrast, despite sharing some of the risk factors of OUD, other mental and substance use disorders did not show any significant relationship with globalization. Finally, socio-cultural de jure globalization, which compiles indicators related to gender equality, human capital and civil rights, was specifically associated with the burden of OUD (mean log difference: 0.49; 95%CI: 0.23,0.75; p < 0.001). CONCLUSIONS These findings suggest that OUD may have inherent underpinnings linked to globalization, and more particularly socio-cultural aspects of globalization. Key factors may be increased rights to access prescriptions, as well as increased feelings of despair related to the erosion of local cultures and widening educational gaps.
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Affiliation(s)
- Guillaume Barbalat
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Pôle Centre rive gauche UMR 5229, Hôpital Le Vinatier, CNRS & Université Lyon 1, Lyon, France.
| | - Geeta Reddy
- International Committee of the Red Cross (ICRC), 19, Avenue de la Paix, Geneva, 1202, Switzerland
| | - Nicolas Franck
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Pôle Centre rive gauche UMR 5229, Hôpital Le Vinatier, CNRS & Université Lyon 1, Lyon, France
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Butelman ER, Huang Y, Epstein DH, Shaham Y, Goldstein RZ, Volkow ND, Alia-Klein N. Overdose mortality rates for opioids and stimulant drugs are substantially higher in men than in women: state-level analysis. Neuropsychopharmacology 2023; 48:1639-1647. [PMID: 37316576 PMCID: PMC10517130 DOI: 10.1038/s41386-023-01601-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 06/16/2023]
Abstract
Drug overdoses from opioids and stimulants are a major cause of mortality in the United States. It is unclear if there are stable sex differences in overdose mortality for these drugs across states, whether these differ across the lifespan, and if so, whether they can be accounted for by different levels of drug misuse. This was a state-level analysis of epidemiological data on overdose mortality, across 10-year age bins (age range: 15-74), using the CDC WONDER platform for decedents in the United States in 2020-1. The outcome measure was rate of overdose death (per 100,000) for: synthetic opioids (e.g., fentanyl), heroin, psychostimulants with potential for misuse (e.g., methamphetamine), and cocaine. Multiple linear regressions controlled for ethnic-cultural background, household net worth, and sex-specific rate of misuse (from NSDUH, 2018-9). For all these drug categories, males had greater overall overdose mortality than females, after controlling for rates of drug misuse. The mean male/female sex ratio of mortality rate was relatively stable across jurisdictions: synthetic opioids (2.5 [95% CI, 2.4-7]), heroin, (2.9 [95% CI, 2.7-3.1], psychostimulants (2.4 [95% CI, 2.3-5]), and cocaine (2.8 [95% CI, 2.6-9]). With data stratified in 10-year age bins, the sex difference generally survived adjustment (especially in the 25-64 age range). Results indicate that males are significantly more vulnerable than females to overdose deaths caused by opioid and stimulant drugs, taking into account differing state-level environmental conditions and drug misuse levels. These results call for research into diverse biological, behavioral, and social factors that underlie sex differences in human vulnerability to drug overdose.
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Affiliation(s)
- Eduardo R Butelman
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Departments of Psychiatry and Neuroscience Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Yuefeng Huang
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Departments of Psychiatry and Neuroscience Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Yavin Shaham
- National Institute on Drug Abuse (NIDA), Baltimore, MD, USA
| | - Rita Z Goldstein
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Departments of Psychiatry and Neuroscience Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nora D Volkow
- National Institute on Drug Abuse (NIDA), Baltimore, MD, USA
| | - Nelly Alia-Klein
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Departments of Psychiatry and Neuroscience Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Cody SL, Newman S, Bui C, Sharp-Marbury R, Scott L. Substance use and opioid-related stigma among Black communities in the rural South. Arch Psychiatr Nurs 2023; 46:127-132. [PMID: 37813495 DOI: 10.1016/j.apnu.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 07/03/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE This study examined perceived substance use, opioid knowledge, and barriers to Black people accessing treatment for substance and opioid use disorder (SUD/OUD). METHODS Thirty-nine participants completed the community survey and The Brief Opioid Overdose Knowledge questionnaire. Qualitative interviews were conducted with 18 stakeholders and 9 people with SUD/OUD. FINDINGS Out of 39 participants, <50 % knew where to refer someone for treatment and fewer knew where to access naloxone. Majority of the stakeholders and people with SUD/OUD reported stigma as a treatment barrier. CONCLUSION Studies related to provider anti-stigma trainings and psychoeducation for Black people living in the rural South are warranted.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama in Tuscaloosa, AL 35401, USA.
| | - Sharlene Newman
- Alabama Life Research Institute, The University of Alabama in Tuscaloosa, AL 35401, USA
| | - Chuong Bui
- Alabama Life Research Institute, The University of Alabama in Tuscaloosa, AL 35401, USA
| | | | - Letisha Scott
- Capstone College of Nursing, The University of Alabama in Tuscaloosa, AL 35401, USA
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Cano M, Mendoza N, Ignacio M, Rahman A, Daniulaityte R. Overdose deaths involving synthetic opioids: Racial/ethnic and educational disparities in the eastern and western US. Drug Alcohol Depend 2023; 251:110955. [PMID: 37699286 DOI: 10.1016/j.drugalcdep.2023.110955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND This study examined racial/ethnic and educational disparities in US synthetic opioid overdose mortality East and West of the Mississippi River. METHODS Using restricted-access 2018-2021 mortality data from the Centers for Disease Control and Prevention and population estimates from the American Community Survey, age-standardized rate ratios (SRRs) and 95% Confidence Intervals (CIs) were used to compare rates of synthetic opioid mortality by race/ethnicity and educational attainment level in the regions East and West of the Mississippi River. RESULTS Racial/ethnic disparities in synthetic opioid mortality rates, relative to the Non-Hispanic (NH) White population, were observed in the NH Black (SRR, 1.5 [95% CI, 1.5-1.6]) and NH American Indian/Alaska Native (SRR, 2.1 [95% CI, 1.9-2.2]) populations in the West, and the Puerto Rican (SRR, 1.3 [95% CI, 1.3-1.3]) and NH American Indian/Alaska Native (SRR, 1.5 [95% CI, 1.4-1.6]) populations in the East. Relative to those with a Bachelor's degree or higher: in the West, the synthetic opioid mortality rate was more than seven times as high for those with a high school diploma only (SRR 7.7 [95% CI, 7.4-8.0]), and in the East, approximately thirteen times as high for those with a high school diploma only (SRR, 13.0 [95% CI, 12.7-13.3]) or less than a high school diploma (SRR, 13.3 [95% CI, 13.0-13.7]). CONCLUSION Disparities in rates of synthetic opioid mortality differ in the eastern and western US, supporting tailored responses within each region.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ, USA.
| | - Natasha Mendoza
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Matt Ignacio
- School of Social Work, Arizona State University, Tucson, AZ, USA
| | - Abir Rahman
- Cabell-Huntington Health Department, Huntington, WV, USA
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Rosen H, Cunningham CO. Time to End Racial Disparities in Buprenorphine Access. Am J Public Health 2023; 113:1083-1085. [PMID: 37590915 PMCID: PMC10484128 DOI: 10.2105/ajph.2023.307388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Henry Rosen
- Henry Rosen is the Chief of Staff at the New York State Office of Addiction Services and Supports, New York, NY. Chinazo O. Cunningham is the Commissioner of the New York State Office of Addiction Services and Supports and is a clinical professor of medicine at the Albert Einstein College of Medicine, New York, NY
| | - Chinazo O Cunningham
- Henry Rosen is the Chief of Staff at the New York State Office of Addiction Services and Supports, New York, NY. Chinazo O. Cunningham is the Commissioner of the New York State Office of Addiction Services and Supports and is a clinical professor of medicine at the Albert Einstein College of Medicine, New York, NY
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Zhu DT. Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review. Harm Reduct J 2023; 20:131. [PMID: 37700329 PMCID: PMC10498612 DOI: 10.1186/s12954-023-00867-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Xylazine, an α2-adrenoceptor agonist sedative commonly used in veterinary medicine, is not approved for human use. Nevertheless, xylazine-involved overdose rates have surged in recent years, fueled by an increasingly toxic and synthetic illicit drug supply in North America. METHODS This narrative review assessed major epidemiological trends in xylazine-involved overdoses in North America, aiming to identify harm reduction priorities. A literature search was conducted using four bibliographic databases (PubMed, Scopus, Embase, and ScienceDirect) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) on May 28, 2023, to capture articles related to combinations of keywords such as "xylazine", "opioid", and "harm reduction". RESULTS Xylazine emerged as an adulterant in Puerto Rico in 2001, likely diverted from veterinary supplies. By the mid-2010s, it began proliferating across unregulated US drug markets, often contemporaneously with illicitly manufactured fentanyl (IMF), displaying characteristics of a syndemic. Initially concentrated in Northeastern regions (e.g., Philadelphia, Connecticut, Maryland), xylazine-involved overdoses later extended to the Rust Belt, Southern, and Western regions of the USA in the late 2010s and early 2020s. During this time, xylazine-involved overdoses also surged in Canada, particularly in Western provinces (British Columbia and Alberta) and Ontario with established IMF-dominated unregulated drug markets. DISCUSSION Over the past two decades, xylazine-involved overdoses have been rapidly rising in North America and exhibit few signs of slowing down, representing a serious public health epidemic. Numerous factors may have contributed to this, including limited epidemiological surveillance and drug checking for xylazine and emerging novel adulterants; further, barriers to comprehensive, trauma-informed, non-stigmatizing treatment and social services have also exacerbated this issue. While several epidemiological and ethnographic studies have assessed these factors in the USA, limited evidence is available in Canada where xylazine emerged more recently. This underscores the need for additional research and harm reduction measures. CONCLUSION Harm reduction-informed public health guidelines and programs are urgently needed to promote a safer supply, strengthen the healthcare system capacity to prevent and respond to xylazine-involved overdoses, and address social and structural disparities in health outcomes.
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Affiliation(s)
- David T Zhu
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, 1201 E Marshall St, Richmond, VA, 23298, USA.
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Pytell JD, Fojo AT, Keruly JC, Snow LN, Falade-Nwulia O, Moore RD, Chander G, Lesko CR. Measuring time in buprenorphine treatment stages among people with HIV and opioid use disorder by retention definition and its association with cocaine and hazardous alcohol use. Addict Sci Clin Pract 2023; 18:51. [PMID: 37660116 PMCID: PMC10474763 DOI: 10.1186/s13722-023-00408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND We use a novel, longitudinal approach to describe average time spent in opioid use disorder (OUD) cascade of care stages for people with HIV (PWH) and with OUD, incorporating four definitions of treatment retention. Using this approach, we describe the impact of cocaine or hazardous alcohol use on time spent retained on buprenorphine. METHODS We followed PWH with OUD enrolled in the Johns Hopkins HIV Clinical Cohort from their first buprenorphine treatment episode between 2013 and 2020. We estimated 4-year restricted mean time spent on buprenorphine below buprenorphine retention threshold, on buprenorphine above retention threshold, off buprenorphine and in HIV care, loss to follow-up, and death. Retention definitions were based on retention threshold (180 vs 90 days) and allowable treatment gap (7 vs 30 days). Differences in 2-year restricted mean time spent retained on buprenorphine were estimated for patients with and without cocaine or hazardous alcohol use. RESULTS The study sample (N = 179) was 63% male, 82% non-Hispanic Black, and mean age was 53 (SD 8) years. Patients spent on average 13.9 months (95% CI 11.4, 16.4) on buprenorphine over 4 years. There were differences in time spent retained on buprenorphine based on the retention definition, ranging from 6.5 months (95% CI 4.6, 8.5) to 9.6 months (95% CI 7.4, 11.8). Patients with cocaine use spent fewer months retained on buprenorphine. There were no differences for patients with hazardous alcohol use. CONCLUSIONS PWH with OUD spend relatively little time receiving buprenorphine in their HIV primary care clinic. Concurrent cocaine use at buprenorphine initiation negatively impact time on buprenorphine.
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Affiliation(s)
- Jarratt D Pytell
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 E. 17Th Ave, Aurora, CO, 80045, USA.
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - LaQuita N Snow
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hosea K, Mashburn P, Kennelty K, Westrick SC, Look K, Evon D, Carpenter DM. Naloxone analogy and opioid overdose terminology preferences among rural caregivers: Differences by race. J Am Pharm Assoc (2003) 2023; 63:1521-1529.e3. [PMID: 37149142 PMCID: PMC10660692 DOI: 10.1016/j.japh.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Despite national and state policies aimed at increasing naloxone access via pharmacies, opioid overdose death rates rose during the COVID-19 pandemic, particularly among Blacks and American Indians (AIs) in rural areas. Caregivers, or third parties who can administer naloxone during an overdose event, are important individuals in the naloxone administration cascade, yet no studies have explored rural caregivers' opioid overdose terminology and naloxone analogy preferences or whether these preferences differ by race. OBJECTIVES To identify rural caregivers' overdose terminology and naloxone analogy preferences and determine whether preferences differ by race. METHODS A sample of 40 caregivers who lived with someone at high risk of overdose and used pharmacies in 4 largely rural states was recruited. Each caregiver completed a demographic survey and a 20- to 45-minute audio-recorded semi-structured interview that was transcribed, de-identified, and imported into a qualitative software package for thematic analysis by 2 independent coders using a codebook. Overdose terminology and naloxone analogy preferences were analyzed for differences by race. RESULTS The sample was 57.5% white, 35% Black, and 7.5% AIs. Many participants (43%) preferred that pharmacists use the term "bad reaction" to refer to overdose events over the terms "accidental overdose" (37%) and "overdose" (20%). The majority of white and Black participants preferred "bad reaction" while AI participants preferred "accidental overdose." For naloxone analogies, "EpiPen" was most preferred (64%), regardless of race. "Fire extinguisher" (17%), "lifesaver" (9.5%), and other analogies (9.5%) were preferred by some white and Black participants but not AI participants. CONCLUSION Our findings suggest that pharmacists should use the "bad reaction" term and "EpiPen" analogy when counseling rural caregivers about overdose and naloxone, respectively. Caregivers' preferences varied by race, suggesting that pharmacists may want to tailor the terminology and analogy they use when discussing naloxone with caregivers.
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Tam CC, Qiao S, Garrett C, Zhang R, Aghaei A, Aggarwal A, Litwin AH, Li X. Substance use, psychiatric symptoms, personal mastery, and social support among COVID-19 long haulers: A compensatory model. PLoS One 2023; 18:e0289413. [PMID: 37535623 PMCID: PMC10399860 DOI: 10.1371/journal.pone.0289413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/10/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Substance use has become a critical health concern during the COVID-19 pandemic, and emerging attention has been paid to people with the persistent symptoms of COVID-19 (COVID-19 long haulers) due to their high vulnerability. However, scant research has investigated their substance use and relevant psychosocial factors. The current study was to (1) examine substance use behaviors (i.e., legal drug use, illicit drug use, and non-medical use of prescription drugs); and (2) assessed their associations with psychiatric symptoms (i.e., depression, anxiety, and post-traumatic stress disorder) and psychosocial factors (i.e., personal mastery and social support) among COVID-19 long haulers. METHODS In January-March 2022, 460 COVID-19 long haulers (50% female), with an average age of 32, completed online surveys regarding their demographics, substance use, psychiatric symptoms, and psychosocial factors. RESULTS In the past three months, the most commonly used or non-medically used substances were tobacco (82%) for legal drugs, cocaine (53%) for illicit drugs, and prescription opioids (67%) for prescription drugs. Structural equation modeling suggested that psychiatric symptoms were positively associated with substance use behaviors (βs = 0.38 to .68, ps < 0.001), while psychosocial factors were negatively associated with substance use behaviors (βs = -0.61 to -0.43, ps < 0.001). CONCLUSION Substance use is common in COVID-19 long haulers and psychiatric symptoms are the risk factors. Personal mastery and social support appear to offer protection offsetting the psychiatric influences. Substance use prevention and mental health services for COVID-19 long haulers should attend to personal mastery and social support.
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Affiliation(s)
- Cheuk Chi Tam
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Camryn Garrett
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Ran Zhang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Atefeh Aghaei
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Abhishek Aggarwal
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Alain H. Litwin
- School of Health Research, Clemson University, Greenville, SC, United States of America
- Department of Medicine, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States of America
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
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Walters SM, Kerr J, Cano M, Earnshaw V, Link B. Intersectional Stigma as a Fundamental Cause of Health Disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time. STIGMA AND HEALTH 2023; 8:325-343. [PMID: 37744082 PMCID: PMC10516303 DOI: 10.1037/sah0000426] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Recent evidence points to racial and ethnic disparities in drug-related deaths and health conditions. Informed by stigma, intersectionality, intersectional stigma, and fundamental cause theories, we aimed to explore whether intersectional stigma was a fundamental cause of health. We document key events and policies over time and find that when progress is made new mechanisms emerge that negatively affect health outcomes for Black and Hispanic persons. We then focus on intersectional stigma targeting Black and Hispanic persons who use drugs. We document that when a person, or group of people, occupy multiple stigmatized identities the processes of stigmatization and scapegoating are particularly persistent and pernicious since people and groups can be stigmatized and scapegoated on varying intersections. We propose that an intersectional stigma framework allows for a better understanding of observed patterns over time, thereby providing a better guide for policies and interventions designed to reduce disparities. As a framework, intersectional stigma aims to recognize that when different sources of stigma collide, a new set of circumstances is created for those who reside in the intersection. We conclude that intersectional stigma is a fundamental cause of health inequities and provide policy recommendations aimed at dismantling intersectional stigma processes and mitigating the effects of intersectional stigmas to ultimately promote better health outcomes for Black and Hispanic persons who use drugs.
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Affiliation(s)
- Suzan M Walters
- School of Global Public Health, New York University, New York, NY
- Center for Drug Use and HIV/HCV Research, New York, NY
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY
| | - Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | - Bruce Link
- Department of Sociology, University of California Riverside, Riverside, CA
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Chang JE, Franz B, Pagán JA, Lindenfeld Z, Cronin CE. Substance Use Disorder Program Availability in Safety-Net and Non-Safety-Net Hospitals in the US. JAMA Netw Open 2023; 6:e2331243. [PMID: 37639270 PMCID: PMC10463097 DOI: 10.1001/jamanetworkopen.2023.31243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023] Open
Abstract
Importance Safety-net hospitals (SNHs) are ideal sites to deliver addiction treatment to patients with substance use disorders (SUDs), but the availability of these services within SNHs nationwide remains unknown. Objective To examine differences in the delivery of different SUD programs in SNHs vs non-SNHs across the US and to determine whether these differences are increased in certain types of SNHs depending on ownership. Design, Setting, and Participants This cross-sectional analysis used data from the 2021 American Hospital Association Annual Survey of Hospitals to examine the associations of safety-net status and ownership with the availability of SUD services at acute care hospitals in the US. Data analysis was performed from January to March 2022. Main Outcomes and Measures This study used 2 survey questions from the American Hospital Association survey to determine the delivery of 5 hospital-based SUD services: screening, consultation, inpatient treatment services, outpatient treatment services, and medications for opioid use disorder (MOUD). Results A total of 2846 hospitals were included: 409 were SNHs and 2437 were non-SNHs. The lowest proportion of hospitals reported offering inpatient treatment services (791 hospitals [27%]), followed by MOUD (1055 hospitals [37%]), and outpatient treatment services (1087 hospitals [38%]). The majority of hospitals reported offering consultation (1704 hospitals [60%]) and screening (2240 hospitals [79%]). In multivariable models, SNHs were significantly less likely to offer SUD services across all 5 categories of services (screening odds ratio [OR], 0.62 [95% CI, 0.48-0.76]; consultation OR, 0.62 [95% CI, 0.47-0.83]; inpatient services OR, 0.73 [95% CI, 0.55-0.97]; outpatient services OR, 0.76 [95% CI, 0.59-0.99]; MOUD OR, 0.6 [95% CI, 0.46-0.78]). With the exception of MOUD, public or for-profit SNHs did not differ significantly from their non-SNH counterparts. However, nonprofit SNHs were significantly less likely to offer all 5 SUD services compared with their non-SNH counterparts (screening OR, 0.52 [95% CI, 0.41-0.66]; consultation OR, 0.56 [95% CI, 0.44-0.73]; inpatient services OR, 0.45 [95% CI, 0.33-0.61]; outpatient services OR, 0.58 [95% CI, 0.44-0.76]; MOUD OR, 0.61 [95% CI, 0.46-0.79]). Conclusions and Relevance In this cross-sectional study of SNHs and non-SNHs, SNHs had significantly lower odds of offering the full range of SUD services. These findings add to a growing body of research suggesting that SNHs may face additional barriers to offering SUD programs. Further research is needed to understand these barriers and to identify strategies that support the adoption of evidence-based SUD programs in SNH settings.
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Affiliation(s)
- Ji E. Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, Ohio University, Athens
| | - José A. Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Zoe Lindenfeld
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Cory E. Cronin
- College of Health Sciences and Professions, Ohio University, Athens
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Lawrence WR, Freedman ND, McGee-Avila JK, Berrington de González A, Chen Y, Emerson MA, Gee GC, Haozous EA, Haque AT, Inoue-Choi M, Jackson SS, Lord B, Nápoles AM, Pérez-Stable EJ, Vo JB, Williams F, Shiels MS. Trends in Mortality From Poisonings, Firearms, and All Other Injuries by Intent in the US, 1999-2020. JAMA Intern Med 2023; 183:849-856. [PMID: 37399025 PMCID: PMC10318548 DOI: 10.1001/jamainternmed.2023.2509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/30/2023] [Indexed: 07/04/2023]
Abstract
Importance Although deaths due to external causes are a leading cause of mortality in the US, trends over time by intent and demographic characteristics remain poorly understood. Objective To examine national trends in mortality rates due to external causes from 1999 to 2020 by intent (homicide, suicide, unintentional, and undetermined) and demographic characteristics. External causes were defined as poisonings (eg, drug overdose), firearms, and all other injuries, including motor vehicle injuries and falls. Given the repercussions of the COVID-19 pandemic, US death rates for 2019 and 2020 were also compared. Design, Setting, and Participants Serial cross-sectional study using national death certificate data obtained from the National Center for Health Statistics and including all external causes of 3 813 894 deaths among individuals aged 20 years or older from January 1, 1999, to December 31, 2020. Data analysis was conducted from January 20, 2022, to February 5, 2023. Exposures Age, sex, and race and ethnicity. Main Outcomes and Measures Trends in age-standardized mortality rates and average annual percentage change (AAPC) in rates calculated by intent (suicide, homicide, unintentional, and undetermined), age, sex, and race and ethnicity for each external cause. Results Between 1999 and 2020, there were 3 813 894 deaths due to external causes in the US. From 1999 to 2020, poisoning death rates increased annually (AAPC, 7.0%; 95% CI, 5.4%-8.7%). From 2014 to 2020, poisoning death rates increased the most among men (APC, 10.8%; 95% CI, 7.7%-14.0%). During the study period, poisoning death rates increased in all the racial and ethnic groups examined; the most rapid increase was among American Indian and Alaska Native individuals (AAPC, 9.2%; 95% CI, 7.4%-10.9%). During the study period, death rates for unintentional poisoning had the most rapid rate of increase (AAPC, 8.1%; 95% CI, 7.4%-8.9%). From 1999 to 2020, firearm death rates increased (AAPC, 1.1%; 95% CI, 0.7%-1.5%). From 2013 to 2020, firearm mortality increased by an average of 4.7% annually (95% CI, 2.9%-6.5%) among individuals aged 20 to 39 years. From 2014 to 2020, mortality from firearm homicides increased by an average of 6.9% annually (95% CI, 3.5%-10.4%). From 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, and homicide due to firearms and all other injuries. Conclusions and Relevance Results of this cross-sectional study suggest that from 1999 to 2020, death rates due to poisonings, firearms, and all other injuries increased substantially in the US. The rapid increase in deaths due to unintentional poisonings and firearm homicides is a national emergency that requires urgent public health interventions at the local and national levels.
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Affiliation(s)
- Wayne R. Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jennifer K. McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Marc A. Emerson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles
| | - Emily A. Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico
| | - Anika T. Haque
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Sarah S. Jackson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Brittany Lord
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Eliseo J. Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Jacqueline B. Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Powell D, Peet ED, Pacula RL. Understanding the rise in overdose deaths involving opioids and non-opioid prescription drugs in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104104. [PMID: 37422359 PMCID: PMC10770297 DOI: 10.1016/j.drugpo.2023.104104] [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] [Received: 01/11/2023] [Revised: 04/11/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Previous studies demonstrate that the reformulation of OxyContin in the U.S. in 2010 induced substitution to illicit opioids, causing illicit opioid markets to grow disproportionately fast in states more exposed to the reformulation. In this paper, we examine if this shift to the illicit market also led to a rise in polysubstance overdose deaths involving non-opioid prescription drugs, including gabapentinoids and "Z-drugs" and, separately, benzodiazepines. METHODS Using a difference-in-differences framework, the relationship between exposure to reformulation and overdose death rates including specific substances was studied in each year from 1999 to 2020 while accounting for fixed differences across states, common nationwide shocks, and state-level differences in pain reliever misuse prior to reformulation. Exposure to reformulation was measured as the pre-reformulation rate of OxyContin misuse. RESULTS Exposure to reformulation predicted growth in overdose deaths involving gabapentinoids and Z-drugs. There is less evidence that it predicted growth in overdose deaths involving benzodiazepines. However, for all substances, there is strong evidence that pre-reformulation OxyContin misuse rates predicted post-reformulation growth in overdose deaths concurrently involving synthetic opioids. DISCUSSION The opioid crisis has changed in radical ways. This study links a major supply-side intervention to the increase in polysubstance overdose deaths involving non-opioid prescription drugs, specifically gabapentinoids and Z-drugs.
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Affiliation(s)
- David Powell
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202 USA.
| | - Evan D Peet
- RAND Corporation, 4570 Fifth Ave, Pittsburgh, PA 15213 USA
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Argenyi MS, Evans JK, Gay Y, Epstein DH, Weiss ST. The Opioid Overdose Resuscitation Education for Addiction Counselors and Trainees (Opioid Overdose REACT) naloxone response education pilot project improved confidence and knowledge among addiction counselors and trainees. Clin Toxicol (Phila) 2023; 61:509-517. [PMID: 37427894 PMCID: PMC10528373 DOI: 10.1080/15563650.2023.2229508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Community programs to teach nonmedical laypeople how to recognize an opioid overdose and effectively resuscitate the victim using naloxone have proliferated recently as a significant component of harm-reduction efforts. Although many such programs target laypeople like first responders or friends and family members of people who use drugs, there are currently no programs that specifically target addiction counselors, despite their work with a client population at high risk of an opioid overdose. METHODS The four-hour curriculum designed by the authors covered opioid agonist and antagonist pharmacology; opioid toxidrome signs; legal implications and indications for using the naloxone kits; and hands-on training. Participants were two cohorts of addiction counselors and addiction counseling trainees at our institution and an affiliated Opioid Treatment Program methadone clinic. Surveys testing participant knowledge and confidence were conducted at baseline, immediately post-training, six months post-training, and 12 months post-training. RESULTS Overall, opioid and naloxone pharmacology knowledge, as well as the confidence to intervene in an overdose emergency, improved among participants in both cohorts. Knowledge scores at baseline (n = 36, median 5/10) improved significantly immediately post-training (n = 31, median 7/10, P < 0.0001, Wilcoxon signed-rank test) and were sustained six (n = 19) and 12 months (n = 11) later. Two participants reported using their naloxone kits to successfully reverse a client overdose in the 12 months after taking the course. DISCUSSION These results from our knowledge translation pilot project suggest that our educational program to train addiction counselors in opioid pharmacology and toxicology, allowing them to recognize and respond to an opioid overdose, is feasible and could be effective. Specific barriers to implementing such educational programs include cost, stigma, and unclear best practice for designing and conducting these programs. CONCLUSIONS Further study of providing opioid pharmacology education and overdose and naloxone training to addiction counselors and counseling trainees appears to be warranted.
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Affiliation(s)
- Michael S. Argenyi
- Wake Forest Addiction Research and Clinical Health Program, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Joni K. Evans
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Yasmin Gay
- Wake Forest Addiction Research and Clinical Health Program, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - David H. Epstein
- Translational Addiction Medicine Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
| | - Stephanie T. Weiss
- Wake Forest Addiction Research and Clinical Health Program, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
- Translational Addiction Medicine Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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Cartus AR, Goedel WC, Jent VA, Macmadu A, Pratty C, Hallowell BD, Allen B, Li Y, Cerdá M, Marshall BDL. Neighborhood-level association between release from incarceration and fatal overdose, Rhode Island, 2016-2020. Drug Alcohol Depend 2023; 247:109867. [PMID: 37084507 PMCID: PMC10198932 DOI: 10.1016/j.drugalcdep.2023.109867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 04/02/2023] [Indexed: 04/23/2023]
Abstract
The association between recent release from incarceration and dramatically increased risk of fatal overdose is well-established at the individual level. Fatal overdose and. arrest/release are spatially clustered, suggesting that this association may persist at the neighborhood level. We analyzed multicomponent data from Rhode Island, 2016-2020, and observed a modest association at the census tract level between rates of release per 1000 population and fatal overdose per 100,000 person-years, adjusting for spatial autocorrelation in both the exposure and outcome. Our results suggest that for each additional person released to a given census tract per 1000 population, there is a corresponding increase in the rate of fatal overdose by 2 per 100,000 person years. This association is more pronounced in suburban tracts, where each additional release awaiting trial is associated with an increase in the rate of fatal overdose of 4 per 100,000 person-years and 6 per 100,000 person-years for each additional release following sentence expiration. This association is not modified by the presence or absence of a licensed medication for opioid use disorder (MOUD) treatment provider in the same or surrounding tracts. Our results suggest that neighborhood-level release rates are moderately informative as to tract-level rates of fatal overdose and underscore the importance of expanding pre-release MOUD access in correctional settings. Future research should explore risk and resource environments particularly in suburban and rural areas and their impacts on overdose risk among individuals returning to the community.
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Affiliation(s)
- Abigail R Cartus
- Department of Epidemiology, Brown University School of Public Health, United States
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Victoria A Jent
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Claire Pratty
- Department of Epidemiology, Brown University School of Public Health, United States
| | | | - Bennett Allen
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, United States.
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McFadden LM. Changes in buprenorphine visits in frontier and remote locations: Effects of the SARS-CoV-2 pandemic. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100155. [PMID: 37065774 PMCID: PMC10052936 DOI: 10.1016/j.dadr.2023.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
Background The pandemic has changed many aspects of healthcare, including the treatment of people with opioid use disorder with buprenorphine. Prior to the pandemic, rural health disparities existed in the accessibility of this treatment. Rural and frontier areas of the United States, particularly the Great Plains, had few or no providers of this evidence-based treatment. This study aimed to investigate how access to buprenorphine changed in the Great Plains during the pandemic. Methods This retrospective observational study compared the number of weekly patient appointments resulting in a buprenorphine prescription for 55 weeks before the start of the SARS-CoV-2 pandemic and 55 weeks after. Electronic health records of the largest rural health provider in the Great Plains were queried. Patients were categorized as coming from a frontier location or a non-frontier location based on the home address provided at the visit. The USDA defines frontier as communities that are small and distant from urban centers. Time series analysis was utilized to understand changes in weekly visits during this period. Results A significant increase in weekly buprenorphine visits occurred after the pandemic's start. Further, females and people from frontier locations had significantly higher numbers of buprenorphine visits. Conclusions In an area of the country with low pre-existing access to buprenorphine treatment for opioid use disorder, increases in buprenorphine visits were found after the pandemic began. This was particularly true of females who reside in frontier areas. Pandemic-related changes may have reduced barriers to this critical treatment, especially among rural populations.
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Affiliation(s)
- Lisa M. McFadden
- University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069, USA
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84
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Hong JH, de Dios C, Badawi JC, Tonkin SS, Schmitz JM, Walss-Bass C, Meyer TD. Types of Traumatic Experiences in Drug Overdose-Related Deaths: An Exploratory Latent Class Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.30.23289256. [PMID: 37205511 PMCID: PMC10187323 DOI: 10.1101/2023.04.30.23289256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Aim Drug overdose related-deaths in the US are increasing, with over 100,000 deaths occurring in 2020, an increase of 30% from the previous year and the highest number recorded in a single year. It is widely known that experiences of trauma and substance use very often co-occur, but little is known about the role of trauma in the context of drug overdose-related deaths. Latent class analysis (LCA) was used to classify drug overdose-related deaths based on type of traumatic experiences and individual, social, and substance use characteristics. Methods Psychological autopsy data were obtained from the University of Texas Health Science Center at Houston (UTHealth) Brain Collection. A total of 31 drug overdose-related deaths collected from January 2016 through March 2022 were included in this study. LCA was used to identify latent factors via experience of four trauma categories (illness/accidents, sexual/interpersonal violence, death/trauma to another, other situations where life was in danger). Generalized linear modeling (GLM) was used to explore differences on demographic, social, substance use, and psychiatric variables between the latent classes in separate models. Results LCA identified 2 classes: C1 ( n =12; 39%) was characterized by higher incidence of overall trauma exposure as well as variation in trauma type; C2 ( n =19; 61%) had lower levels of overall trauma exposure with sexual/interpersonal violence as the most frequent. GLMs indicated that C1 membership was associated with higher incidence of polysubstance use, being married, and having suicidal ideation compared to C2 membership ( p s<0.05). Conclusion Among individuals who died by drug overdose, the exploratory LCA identified two distinct subgroups that differed in type of trauma experienced and substance use pattern, the first group having more "typical" characteristics of drug overdoses cases, the other group less typical. This suggests that those at risk of drug overdose may not always exhibit high-risk characteristics.
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85
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Stopka TJ, Larochelle MR, Li X, Bernson D, Li W, Ackerson LK, Bayly R, Dammann O, Bauer C. Opioid-related mortality: Dynamic temporal and spatial trends by drug type and demographic subpopulations, Massachusetts, 2005-2021. Drug Alcohol Depend 2023; 246:109836. [PMID: 36931131 PMCID: PMC10121848 DOI: 10.1016/j.drugalcdep.2023.109836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Fatal opioid-related overdoses (OOD) present significant public health challenges. Intuitive and replicable analytical approaches are needed to inform targeted public health responses. METHODS We obtained fatal OOD data for 2005-2021 from the Massachusetts Registry of Vital Records and Statistics. We conducted heatmap analyses to assess trends in fatal OOD rates per 100,000 residents, visualizing rates by death year and decedent age at one-year intervals, stratifying by race/ethnicity, sex, rurality, and involved substances. We calculated Getis-Ord Gi* statistics to identify spatial clusters of OOD rates. RESULTS Among 20,774 fatal OODs, rates were higher among males, and highly variable by race/ethnicity, age group, and rurality. While fatal OOD rates increased in urban before rural communities, rates were higher in rural communities by 2018-2019. Stimulant-related fatal OODs were elevated in 2020 and 2021. Fatal OOD rates involving fentanyl and stimulants increased precipitously and simultaneously in the non-Hispanic Black population in 2020 and 2021, with a bimodal age distribution peaking among those in their 40s and 60s. Elevated rates among 30-to-60 year old Hispanic residents were largely tied to synthetic opioids from 2015 to 2021. Spatial clusters were detected for prescription opioids, heroin, and stimulants in western Massachusetts. For synthetic opioids, hotspots became more ubiquitous across the state from 2016 to 2021, intensifying in southeastern Massachusetts. CONCLUSION Our novel approach uncovered new time varying and spatial patterns in fatal OOD rates not previously reported. Identified shifts in fatal OOD rates by sex, age, and race/ethnicity can inform location-specific field actions targeting subpopulations at disproportionally high risk.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States.
| | - Marc R Larochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, United States
| | - Xiaona Li
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dana Bernson
- Office of Population Health, Department of Public Health, Commonwealth of Massachusetts, Boston, MA, United States
| | - Wenjun Li
- Center for Health Statistics and Department of Public Health, University of Massachusetts Lowell, Lowell, MA, United States
| | - Leland K Ackerson
- Center for Health Statistics and Department of Public Health, University of Massachusetts Lowell, Lowell, MA, United States
| | - Ric Bayly
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States; Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Cici Bauer
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Simpson MJ, Ritger C, Hoppe JA, Holland WC, Morris MA, Nath B, Melnick ER, Tietbohl C. Implementation strategies to address the determinants of adoption, implementation, and maintenance of a clinical decision support tool for emergency department buprenorphine initiation: a qualitative study. Implement Sci Commun 2023; 4:41. [PMID: 37081581 PMCID: PMC10117277 DOI: 10.1186/s43058-023-00421-7] [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] [Received: 11/17/2022] [Accepted: 03/22/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Untreated opioid use disorder (OUD) is a significant public health problem. Buprenorphine is an evidence-based treatment for OUD that can be initiated in and prescribed from emergency departments (EDs) and office settings. Adoption of buprenorphine initiation among ED clinicians is low. The EMBED pragmatic clinical trial investigated the effectiveness of a clinical decision support (CDS) tool to promote ED clinicians' behavior related to buprenorphine initiation in the ED. While the CDS intervention was not associated with increased rates of buprenorphine treatment for patients with OUD at intervention ED sites, attending physicians at intervention EDs were more likely to initiate buprenorphine at least once over the duration of the study compared to those in the usual care arms (44.4% vs 34.0%, P = 0.01). This suggests the CDS intervention may be associated with increased adoption of buprenorphine initiation. As a secondary aim, we sought to identify the determinants of CDS adoption, implementation, and maintenance in a variety of ED settings and geographic locations. METHODS We purposively sampled and conducted semi-structured, in-depth interviews with clinicians across EMBED trial sites randomized to the intervention arm from five healthcare systems. Interviews elicited clinician experiences regarding buprenorphine initiation and CDS use. Interviews were analyzed using directed content analysis informed by the Practical, Robust Implementation and Sustainability Model (PRISM). We used a hybrid approach (a priori codes informed by PRISM and emergent codes) for codebook development. ATLAS.ti (version 9.0) was used for data management. Coded data were analyzed within individual interview transcripts and across all interviews to identify major themes. This process involved (1) combining, comparing, and making connections between codes; (2) writing analytic memos about observed patterns; and (3) frequent team meetings to discuss emerging patterns. RESULTS Twenty-eight interviews were conducted. Major themes that influenced the successful adoption, implementation, and maintenance of the EMBED intervention and ED-initiated BUP were organizational culture and commitment, clinician training and support, the ability to connect patients to ongoing treatment, and the ability to tailor implementation to each ED. These findings informed the identification of implementation strategies (framed using PRISM domains) to enhance the ED initiation of buprenorphine. CONCLUSION The findings from this qualitative analysis can provide guidance to build better systems to promote the adoption of ED-initiated buprenorphine.
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Affiliation(s)
- Matthew J Simpson
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Box F496, Aurora, CO, 80045, USA.
| | - Carly Ritger
- Adult and Child Center for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, 13199 E. Montview Boulevard, Suite 300, Aurora, CO, 80045, USA
| | - Jason A Hoppe
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Box B215, Aurora, CO, 80045, USA
| | - Wesley C Holland
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06510, USA
| | - Megan A Morris
- Adult and Child Center for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, 13199 E. Montview Boulevard, Suite 300, Aurora, CO, 80045, USA
| | - Bidisha Nath
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Ste 260, New Haven, CT, 06519, USA
| | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Ste 260, New Haven, CT, 06519, USA
| | - Caroline Tietbohl
- Adult and Child Center for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, 13199 E. Montview Boulevard, Suite 300, Aurora, CO, 80045, USA
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Kasson E, Filiatreau LM, Kaiser N, Davet K, Taylor J, Garg S, El Sherief M, Aledavood T, De Choudhury M, Cavazos-Rehg P. Using Social Media to Examine Themes Surrounding Fentanyl Misuse and Risk Indicators. Subst Use Misuse 2023; 58:920-929. [PMID: 37021375 PMCID: PMC10464934 DOI: 10.1080/10826084.2023.2196574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: Opioid misuse is a crisis in the United States, and synthetic opioids such as fentanyl pose risks for overdose and mortality. Individuals who misuse substances commonly seek information and support online due to stigma and legal concerns, and this online networking may provide insight for substance misuse prevention and treatment. We aimed to characterize topics in substance-misuse related discourse among members of an online fentanyl community. Method: We investigated posts on a fentanyl-specific forum on the platform Reddit to identify emergent substance misuse-related themes potentially indicative of heightened risk for overdose and other adverse health outcomes. We analyzed 27 posts and 338 comments with a qualitative codebook established using a subset of user posts via inductive and deductive methods. Posts and comments were independently reviewed by two coders with a third coder resolving discrepancies. The top 200 subreddits with the most activity by r/fentanyl members were also inductively analyzed to understand interests of r/fentanyl users. Results: Functional/quality of life impairments due to substance misuse (29%) was the most commonly occurring theme, followed by polysubstance use (27%) and tolerance/dependence/withdrawal (20%). Additional themes included drug identification with photos, substances cut with other drugs, injection drugs, and past overdoses. Media-focused subreddits and other drug focused communities were among the communities most often followed by r/fentanyl users. Conclusion: Themes closely align with DSM-V substance use disorder symptoms for fentanyl and other substances. High involvement in media-focused subreddits and other substance-misuse-related communities suggests digital platforms as acceptable for overdose prevention and recovery support interventions.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Lindsey M. Filiatreau
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Kevin Davet
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Jordan Taylor
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Sanjana Garg
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Mai El Sherief
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Talayeh Aledavood
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
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Schieber LZ, Dunphy C, Schieber RA, Lopes-Cardozo B, Moonesinghe R, Guy GP. Hospitalization Associated With Comorbid Psychiatric and Substance Use Disorders Among Adults With COVID-19 Treated in US Emergency Departments From April 2020 to August 2021. JAMA Psychiatry 2023; 80:331-341. [PMID: 36790774 PMCID: PMC9932946 DOI: 10.1001/jamapsychiatry.2022.5047] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 02/16/2023]
Abstract
Importance During the COVID-19 pandemic, US emergency department (ED) visits for psychiatric disorders (PDs) and drug overdoses increased. Psychiatric disorders and substance use disorders (SUDs) independently increased the risk of COVID-19 hospitalization, yet their effect together is unknown. Objective To assess how comorbid PD and SUD are associated with the probability of hospitalization among ED patients with COVID-19. Design, Setting, and Participants This retrospective cross-sectional study analyzed discharge data for adults (age ≥18 years) with a COVID-19 diagnosis treated in 970 EDs and inpatient hospitals in the United States from April 2020 to August 2021. Exposures Any past diagnosis of (1) SUD from opioids, stimulants, alcohol, cannabis, cocaine, sedatives, or other substances and/or (2) PD, including attention-deficit/hyperactivity disorder (ADHD), anxiety, bipolar disorder, major depression, other mood disorder, posttraumatic stress disorder (PTSD), or schizophrenia. Main Outcomes and Measures The main outcome was any hospitalization. Differences in probability of hospitalization were calculated to assess its association with both PD and SUD compared with PD alone, SUD alone, or neither condition. Results Of 1 274 219 ED patients with COVID-19 (mean [SD] age, 54.6 [19.1] years; 667 638 women [52.4%]), 18.6% had a PD (mean age, 59.0 years; 37.7% men), 4.6% had a SUD (mean age, 50.1 years; 61.7% men), and 2.3% had both (mean age, 50.4 years; 53.1% men). The most common PDs were anxiety (12.9%), major depression (9.8%), poly (≥2) PDs (6.4%), and schizophrenia (1.4%). The most common SUDs involved alcohol (2.1%), cannabis (1.3%), opioids (1.0%), and poly (≥2) SUDs (0.9%). Prevalence of SUD among patients with PTSD, schizophrenia, other mood disorder, or ADHD each exceeded 21%. Based on significant specific PD-SUD pairs (Q < .05), probability of hospitalization of those with both PD and SUD was higher than those with (1) neither condition by a weighted mean of 20 percentage points (range, 6 to 36; IQR, 16 to 25); (2) PD alone by 12 percentage points (range, -4 to 31; IQR, 8 to 16); and (3) SUD alone by 4 percentage points (range, -7 to 15; IQR, -2 to 7). Associations varied by types of PD and SUD. Substance use disorder was a stronger predictor of hospitalization than PD. Conclusions and Relevance This study found that patients with both PD and SUD had a greater probability of hospitalization, compared with those with either disorder alone or neither disorder. Substance use disorders appear to have a greater association than PDs with the probability of hospitalization. Overlooking possible coexisting PD and SUD in ED patients with COVID-19 can underestimate the likelihood of hospitalization. Screening and assessment of both conditions are needed.
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Affiliation(s)
- Lyna Z. Schieber
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher Dunphy
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard A. Schieber
- Office of Director, Center for Surveillance, Epidemiology, and Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara Lopes-Cardozo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Glidden E, Suen K, Mustaquim D, Vivolo-Kantor A, Brent J, Wax P, Aldy K. Characterization of Nonfatal Opioid, Cocaine, Methamphetamine, and Polydrug Exposure and Clinical Presentations Reported to the Toxicology Investigators Consortium Core Registry, January 2010-December 2021. J Med Toxicol 2023; 19:180-189. [PMID: 36650409 PMCID: PMC10050626 DOI: 10.1007/s13181-022-00924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION To characterize and compare opioid-only, cocaine-only, methamphetamine-only, opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure and to examine clinical presentations, leading to a better understanding of overdose effects involving these drug exposures. METHODS We examined drug exposures in the Toxicology Investigators Consortium (ToxIC) Core Registry from January 2010 to December 2021, a case registry of patients presenting to participating healthcare sites that receive a medical toxicology consultation. Demographic and clinical presentations of opioid-only, cocaine-only, methamphetamine-only, and opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure consultations were described; differences between single and polydrug exposure subgroups were calculated to determine statistical significance. Clinical presentations associated with exposures were evaluated through calculated adjusted relative risk. RESULTS A total of 3,883 consultations involved opioids, cocaine, methamphetamine, opioid-and-cocaine exposure, or opioid-and-methamphetamine exposure. Opioid-only (n = 2,268, 58.4%) and methamphetamine-only (n = 712, 18.3%) comprised most consultations. There were significant differences in clinical presentations between exposure subgroups. Opioid-and-cocaine exposure consultations were 8.15 times as likely to present with a sympathomimetic toxidrome than opioid-only. Conversely, opioid-and-cocaine exposure and opioid-and-methamphetamine exposure were 0.32 and 0.42 times as likely to present with a sympathomimetic toxidrome compared to cocaine-only and methamphetamine-only consultations, respectively. Opioid-and-cocaine exposure was 0.67 and opioid-and-methamphetamine exposure was 0.74 times as likely to present with respiratory depression compared to opioid-only consultations. Similarly, opioid-and-cocaine exposure was 0.71 and opioid-and-methamphetamine exposure was 0.78 times as likely to present with CNS depression compared to opioid-only consultations. CONCLUSIONS Used in combination, opioids and stimulants may mask typical clinical presentations of one another, misattributing incorrect drugs to overdose in both clinical treatment and public health surveillance.
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Affiliation(s)
- Emily Glidden
- National Network of Public Health Institutes, New Orleans, LA USA
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Kyle Suen
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
- Department of Emergency Medicine, Division of Medical Toxicology, Emory School of Medicine, Atlanta, GA USA
| | - Desiree Mustaquim
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Alana Vivolo-Kantor
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Jeffery Brent
- University of Colorado School of Medicine, Aurora, CO USA
| | - Paul Wax
- University of Texas Southwestern Medical Center, Dallas, TX USA
- American College of Medical Toxicology, Phoenix, AZ USA
| | - Kim Aldy
- University of Texas Southwestern Medical Center, Dallas, TX USA
- American College of Medical Toxicology, Phoenix, AZ USA
| | - On behalf of the Toxicology Investigators Consortium (ToxIC) Study Group
- National Network of Public Health Institutes, New Orleans, LA USA
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA USA
- Department of Emergency Medicine, Division of Medical Toxicology, Emory School of Medicine, Atlanta, GA USA
- University of Colorado School of Medicine, Aurora, CO USA
- University of Texas Southwestern Medical Center, Dallas, TX USA
- American College of Medical Toxicology, Phoenix, AZ USA
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90
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Hong S, Morelli PT, Lee YJ, Park MLN, Smith THH, Curtis AB. Overdose Data to Action - Care Coordination and Capacity Building (OD2A-C3) Project. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:94-98. [PMID: 37034058 PMCID: PMC10074451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Seunghye Hong
- Department of Social Work, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, HI
| | - Paula T Morelli
- Department of Social Work, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, HI
| | - Yeonjung Jane Lee
- Department of Social Work, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, HI
| | - Mei Linn N Park
- Department of Social Work, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, HI
| | - Tammie Healani Hoapili Smith
- Department of Social Work, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, HI
| | - Amy B Curtis
- Department of Social Work, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, HI
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91
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Russell E, Johnson J, Kosinski Z, Kaplan C, Barnes N, Allen S, Haroz E. A scoping review of implementation considerations for harm reduction vending machines. Harm Reduct J 2023; 20:33. [PMID: 36927354 PMCID: PMC10018614 DOI: 10.1186/s12954-023-00765-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Community-based harm reduction vending machines (HRVM) are not new to the field of public health; numerous countries have implemented them in response to the needs of people who use drugs over the last three decades. However, until recently, few existed in the United States. Given the rapidity with which communities are standing up harm reduction vending machines, there is a pressing need for a consolidated examination of implementation evidence. This scoping review summarizes existing literature using multiple implementation science frameworks. METHODS The scoping review was conducted in five stages including (1) Identify the research question; (2) Identify relevant studies; (3) Select the publications based on inclusion/exclusion criteria; (4) Review and extract data; and, (5) Summarize results. PubMed, Embase, and Web of Science were searched and authors screened publications in English from any year. Data were extracted by applying implementation constructs from RE-AIM and the Consolidated Framework for Implementation Research (CFIR). Both frameworks provided a useful lens through which to develop knowledge about the facilitators and barriers to HRVM implementation. The review is reported according to PRISMA guidelines. RESULTS After applying the full inclusion and exclusion criteria, including the intervention of interest ("vending machines") and population of interest ("people who use drugs"), a total of 22 studies were included in the scoping review. None of the studies reported on race, making it difficult to retroactively apply a racial equity lens. Among those articles that examined effectiveness, the outcomes were mixed between clear effectiveness and inconclusive results. Evidence emerged, however, to address all CFIR constructs, and positive outcomes were observed from HRVM's after-hour availability and increased program reach. RECOMMENDATIONS HRVM implementation best practices include maximizing accessibility up to 24 h, 7 days a week, offering syringe disposal options, ensuring capability of data collection, and allowing for anonymity of use. Organizations that implement HRVM should establish strong feedback loops between them, their program participants, and the broader community upfront. Considerations for future research include rigorous study designs to evaluate effectiveness outcomes (e.g. reduced drug overdose deaths) and examination of HRVM reach among ethnic and racial communities.
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92
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Butelman ER, Huang Y, Epstein DH, Shaham Y, Goldstein RZ, Volkow ND, Alia-Klein N. Overdose mortality rates for opioids or stimulants are higher in males than females, controlling for rates of drug misuse: State-level data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.20.23284833. [PMID: 36711659 PMCID: PMC9882660 DOI: 10.1101/2023.01.20.23284833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Importance Drug overdoses from opioids like fentanyl and heroin and stimulant drugs such as methamphetamine and cocaine are a major cause of mortality in the United States, with potential sex differences across the lifespan. Objective To determine overdose mortality for specific drug categories across the lifespan of males and females, using a nationally representative state-level sample. Design State-level analyses of nationally representative epidemiological data on overdose mortality for specific drug categories, across 10-year age bins (age range: 15-74). Setting Population-based study of Multiple Cause of Death 2020-2021 data from the Centers of Disease Control and Prevention (CDC WONDER platform). Participants Decedents in the United States in 2020-2021. Main outcome measures The main outcome measure was sex-specific rates of overdose death (per 100,000) for: synthetic opioids excluding methadone (ICD-10 code: T40.4; predominantly fentanyl), heroin (T40.1), psychostimulants with potential for misuse, excluding cocaine (T43.6, predominantly methamphetamine; labeled "psychostimulants" hereafter), and cocaine (T40.5). Multiple regression analyses were used to control for ethnic-cultural background, household net worth, and sex-specific rate of misuse of the relevant substances (from the National Survey on Drug Use and Health, 2018-2019). Results For each of the drug categories assessed, males had greater overall overdose mortality than females, after controlling for rates of drug misuse. The mean male/female sex ratio of mortality rate for the separate drug categories was relatively stable across jurisdictions: synthetic opioids (2.5 [95%CI, 2.4-2.7]), heroin, (2.9 [95%CI, 2.7-3.1], psychostimulants (2.4 [95%CI, 2.3-2.5]), and cocaine (2.8 [95%CI, 2.6-2.9]). With data stratified in 10-year age bins, the sex difference generally survived adjustment for state-level ethnic-cultural and economic variables, and for sex-specific misuse of each drug type (especially for bins in the 25-64 age range). For synthetic opioids, the sex difference survived adjustment across the lifespan (i.e., 10-year age bins ranging from 15-74), including adolescence, adulthood and late adulthood. Conclusions and Relevance The robustly greater overdose mortality in males versus females for synthetic opioids (predominantly fentanyl), heroin, and stimulant drugs including methamphetamine and cocaine indicate that males who misuse these drugs are significantly more vulnerable to overdose deaths. These results call for research into diverse biological, behavioral, and social factors that underlie sex differences in human vulnerability to drug overdose.
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Affiliation(s)
- Eduardo R Butelman
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Departments of Psychiatry and Neuroscience Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yuefeng Huang
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Departments of Psychiatry and Neuroscience Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Yavin Shaham
- National Institute on Drug Abuse (NIDA), Baltimore, MD
| | - Rita Z Goldstein
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Departments of Psychiatry and Neuroscience Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nora D Volkow
- National Institute on Drug Abuse (NIDA), Baltimore, MD
| | - Nelly Alia-Klein
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Departments of Psychiatry and Neuroscience Icahn School of Medicine at Mount Sinai, New York, NY
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93
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Harris RA, Mandell DS. Years of Life Lost to Drug Overdose Among Black Female Individuals in the US, 2015-2021. JAMA Psychiatry 2023; 80:276-277. [PMID: 36515939 PMCID: PMC9857300 DOI: 10.1001/jamapsychiatry.2022.4194] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This cross-sectional study calculates years of life lost to drug overdose in non-Hispanic Black female individuals and describes the changes in years of life lost that have occurred during the current overdose crisis.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - David S. Mandell
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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94
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Williams LD, Lee E, Kristensen K, Mackesy-Amiti ME, Boodram B. Community-, network-, and individual-level predictors of uptake of medication for opioid use disorder among young people who inject drugs and their networks: A multilevel analysis. Drug Alcohol Depend 2023; 244:109782. [PMID: 36738633 PMCID: PMC10041678 DOI: 10.1016/j.drugalcdep.2023.109782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Opioid use has been increasing at alarming rates over the past 15 years, yet uptake of medication for opioid use disorder (MOUD) remains low. Much of the research on individual characteristics predicting MOUD uptake is equivocal, and there is a dearth of research on setting-level and network-level characteristics that predict MOUD uptake. Towards a more holistic, multilevel understanding, we explore individual-level, network-level, and community-level characteristics associated with MOUD uptake. METHODS Baseline data from a longitudinal study of young people who inject drugs and their injection and support network members living in Chicago (N = 165) was used to conduct cross-sectional multilevel logistic regression analyses to examine associations between MOUD uptake and a set of potential predictors at the individual-, network-, and community-levels that were chosen based on theoretical relevance or support from previous empirical studies. RESULTS Stigma at both the individual and community levels was significantly associated with MOUD uptake (though in different directions). Greater individual-level stigma was associated with a higher likelihood of MOUD uptake, while having a more normatively stigmatizing community environment was associated with a lower likelihood of MOUD uptake. Using heroin and cocaine simultaneously and having a larger support network were associated with a greater likelihood of MOUD uptake. CONCLUSIONS The present study's holistic, multilevel approach identified three individual-level characteristics, one network-level characteristic, and one community-level characteristic associated with MOUD uptake. However, more research is needed examining multilevel predictors, to help with developing interventions addressing barriers to MOUD use at multiple levels of influence.
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Affiliation(s)
- Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
| | - Eunhye Lee
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Kathleen Kristensen
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Mary Ellen Mackesy-Amiti
- Community Outreach Intervention Projects, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Basmattee Boodram
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
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95
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Xia Z, Stewart K. A counterfactual analysis of opioid-involved deaths during the COVID-19 pandemic using a spatiotemporal random forest modeling approach. Health Place 2023; 80:102986. [PMID: 36774811 PMCID: PMC9902297 DOI: 10.1016/j.healthplace.2023.102986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
The global pandemic of SARS-CoV-2 (COVID-19) has been linked to adversely impacting individuals with opioid use disorder in the United States. This study focuses on analyzing opioid-involved mortality in the context of COVID-19 in the U.S. from a geospatial perspective. We investigated spatiotemporal patterns of opioid-involved deaths during 2020 and compared the spatiotemporal pattern of these deaths with patterns for the previous three years (2017-2019) to understand changes in the context of the COVID-19 pandemic. A counterfactual analysis framework together with a space-time random forest (STRF) model were used to estimate the increase in opioid-involved deaths related to the pandemic. To gain further insight into the relationship between opioid deaths and COVID-19-related factors, we built a space-time random forest model for the City of Chicago, that experienced a steep increase in opioid-related deaths during 2020. High ranking indicators identified by the model such as the number of positive COVID-19 cases adjusted by population and the change in stay-at-home dwell time during the pandemic were used to generate a vulnerability index for opioid overdoses during the COVID-19 pandemic in Chicago.
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Affiliation(s)
- Zhiyue Xia
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, 20742, MD, USA.
| | - Kathleen Stewart
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, 20742, MD, USA
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96
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Badreldin N, Ditosto JD, Holder K, Beestrum M, Yee LM. Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review. J Midwifery Womens Health 2023; 68:187-204. [PMID: 36811227 PMCID: PMC10089962 DOI: 10.1111/jmwh.13475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 02/24/2023]
Abstract
INTRODUCTION As deaths related to opioids continue to rise, reducing opioid use for postpartum pain management is an important priority. Thus, we conducted a systematic review of postpartum interventions aimed at reducing opioid use following birth. METHODS From database inception through September 1, 2021, we conducted a systematic search in Embase, MEDLINE, Cochrane Library, and Scopus including the following Medical Subject Heading (MeSH) terms: postpartum, pain management, opioid prescribing. Studies published in English, restricted to the United States, and evaluating interventions initiated following birth with outcomes including an assessment of change in opioid prescribing or use during the postpartum period (<8 weeks postpartum) were included. Authors independently screened abstracts and full articles for inclusion, extracted data, and assessed study quality using the Grading of Recommendations, Assessment, Development, and Evaluation tool and risk of bias using the Institutes of Health Quality Assessment Tools. RESULTS A total of 24 studies met inclusion criteria. Sixteen studies evaluated interventions aimed at reducing postpartum opioid use during the inpatient hospitalization, and 10 studies evaluated interventions aimed at reducing opioid prescribing at postpartum discharge. Inpatient interventions included changes to standard order sets and protocols for the management of pain after cesarean birth. Such interventions resulted in significant decreases in inpatient postpartum opioid use in all but one study. Additional inpatient interventions, including use of lidocaine patches, postoperative abdominal binder, valdecoxib, and acupuncture were not found to be effective in reducing postpartum opioid use during inpatient hospitalization. Interventions targeting the postpartum period included individualized prescribing and state legislative changes limiting the duration of opioid prescribing for acute pain both resulted in decreased opioid prescribing or opioid use. DISCUSSION A variety of interventions aimed at reducing opioid use following birth have shown efficacy. Although it is not known if any single intervention is most effective, these data suggest that implementation of any number of interventions may be advantageous in reducing postpartum opioid use.
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Affiliation(s)
- Nevert Badreldin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julia D Ditosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kai Holder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Molly Beestrum
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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97
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Mauro PM, Kaur N, Askari MS, Keyes KM. Alcohol or Drug Self-Help Use Among Adults in the United States: Age, Period, and Cohort Effects Between 2002 and 2018. Int J Ment Health Addict 2023:1-15. [PMID: 36785551 PMCID: PMC9907883 DOI: 10.1007/s11469-023-01012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
In the context of an ongoing and worsening drug overdose epidemic in the USA, increases in free support services like self-help groups may be expected. We estimated differences in self-help use by age, period, or cohort among people who may have needed treatment. We included N = 92,002 adults from the 2002-2018 National Surveys on Drug Use and Health who met past-year DSM-IV substance use disorder criteria or received alcohol/drug treatment in any location. We used hierarchical age-period-cohort (HAPC) modeling to estimate average age-period-cohort associations with self-help. Level-1 covariates included age, race and ethnicity, household income, and sex. We quantified level-2 variance components using the median odds ratio (MOR). We found small positive HAPC period effects for alcohol/drug self-help that were driven by alcohol-specific effects. Birth cohort differences were observed starting at age 48. Younger birth cohorts, especially among Black adults, were less likely to report self-help use than older birth cohorts. MOR was consistently elevated for cohort effects (MOR = 1.17; covariance parameter: 0.15; 95% CI [0.11, 0.23]) but not for period effects. Overall, self-help use did not increase in the context of substantial treatment needs and worsening overdose racialized disparities. Instead, cohort effects explained trends in alcohol/drug self-help. Findings could indicate that younger birth cohorts may need additional supports, especially services tailored for Black and Hispanic people. Supplementary Information The online version contains supplementary material available at 10.1007/s11469-023-01012-2.
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Affiliation(s)
- Pia M. Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Navdep Kaur
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Melanie S. Askari
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
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98
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Englander H, Gregg J, Levander XA. Envisioning Minimally Disruptive Opioid Use Disorder Care. J Gen Intern Med 2023; 38:799-803. [PMID: 36401107 PMCID: PMC9676870 DOI: 10.1007/s11606-022-07939-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022]
Abstract
Most people who need and want treatment for opioid addiction cannot access it. Among those who do get treatment, only a fraction receive evidence-based, life-saving medications for opioid use disorder (MOUD). MOUD access is not simply a matter of needing more clinicians or expanding existing treatment capacity. Instead, many facets of our health systems and policies create unwarranted, inflexible, and punitive practices that create life-threatening barriers to care. In the USA, opioid use disorder care is maximally disruptive. Minimally disruptive medicine (MDM) is a framework that focuses on achieving patient goals while imposing the smallest possible burden on patients' lives. Using MDM framing, we highlight how current medical practices and policies worsen the burden of treatment and illness, compound life demands, and strain resources. We then offer suggestions for programmatic and policy changes that would reduce disruption to the lives of those seeking care, improve health care quality and delivery, begin to address disparities and inequities, and save lives.
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Affiliation(s)
- Honora Englander
- Section of Addiction Medicine in Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. .,Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | | | - Ximena A Levander
- Section of Addiction Medicine in Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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99
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Tanz LJ, Jones CM, Davis NL, Compton WM, Baldwin GT, Han B, Volkow ND. Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2251856. [PMID: 36662523 PMCID: PMC9860517 DOI: 10.1001/jamanetworkopen.2022.51856] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/29/2022] [Indexed: 01/21/2023] Open
Abstract
Importance Buprenorphine remains underused in treating opioid use disorder, despite its effectiveness. During the onset of the COVID-19 pandemic, the US government implemented prescribing flexibilities to support continued access. Objective To determine whether buprenorphine-involved overdose deaths changed after implementing these policy changes and highlight characteristics and circumstances of these deaths. Design, Setting, and Participants This cross-sectional study used data from the State Unintentional Drug Overdose Reporting System (SUDORS) to assess overdose deaths in 46 states and the District of Columbia occurring July 2019 to June 2021. Data were analyzed from March 7, 2022, to June 30, 2022. Main Outcomes and Measures Buprenorphine-involved and other opioid-involved overdose deaths were examined. Monthly opioid-involved overdose deaths and the percentage involving buprenorphine were computed to assess trends. Proportions and exact 95% CIs of drug coinvolvement, demographics, and circumstances were calculated by group. Results During July 2019 to June 2021, 32 jurisdictions reported 89 111 total overdose deaths and 74 474 opioid-involved overdose deaths, including 1955 buprenorphine-involved overdose deaths, accounting for 2.2% of all drug overdose deaths and 2.6% of opioid-involved overdose deaths. Median (IQR) age was similar for buprenorphine-involved overdose deaths (41 [34-55] years) and other opioid-involved overdose deaths (40 [31-52] years). A higher proportion of buprenorphine-involved overdose decedents, compared with other opioid-involved decedents, were female (36.1% [95% CI, 34.2%-38.2%] vs 29.1% [95% CI, 28.8%-29.4%]), non-Hispanic White (86.1% [95% CI, 84.6%-87.6%] vs 69.4% [95% CI, 69.1%-69.7%]), and residing in rural areas (20.8% [95% CI, 19.1%-22.5%] vs 11.4% [95% CI, 11.2%-11.7%]). Although monthly opioid-involved overdose deaths increased, the proportion involving buprenorphine fluctuated but did not increase during July 2019 to June 2021. Nearly all (92.7% [95% CI, 91.5%-93.7%]) buprenorphine-involved overdose deaths involved at least 1 other drug; higher proportions involved other prescription medications compared with other opioid-involved overdose deaths (eg, anticonvulsants: 18.6% [95% CI, 17.0%-20.3%] vs 5.4% [95% CI, 5.2%-5.5%]) and a lower proportion involved illicitly manufactured fentanyls (50.2% [95% CI, 48.1%-52.3%] vs 85.3% [95% CI, 85.1%-85.5%]). Buprenorphine decedents were more likely to be receiving mental health treatment than other opioid-involved overdose decedents (31.4% [95% CI, 29.3%-33.5%] vs 13.3% [95% CI, 13.1%-13.6%]). Conclusions and Relevance The findings of this cross-sectional study suggest that actions to facilitate access to buprenorphine-based treatment for opioid use disorder during the COVID-19 pandemic were not associated with an increased proportion of overdose deaths involving buprenorphine. Efforts are needed to expand more equitable and culturally competent access to and provision of buprenorphine-based treatment.
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Affiliation(s)
- Lauren J. Tanz
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher M. Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole L. Davis
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Grant T. Baldwin
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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100
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Thomas SA, Wagner KD, Clements-Nolle KD, Omaye S, Lu M, Yang W. Associations between Circumstances Surrounding Overdose and Underlying Classes of Polysubstance Overdose Deaths. Subst Use Misuse 2023; 58:434-443. [PMID: 36617896 DOI: 10.1080/10826084.2023.2165414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The overdose crisis is worsening, with polysubstance overdose deaths involving psychostimulants increasing in the U.S. Substance-specific prevention and intervention activities may not be as effective for polysubstance use, so we sought to classify substances used among overdose decedents to identify unique factors related to these classes. METHODS We used data from the Nevada State Unintentional Drug Overdose Reporting System, Jan 2019-Jun 2021, which comes from death certificates, coroner/medical examiner reports, and postmortem toxicology. Latent class analysis, multinomial logistic regression, and Chi-squared tests determined underlying drug use classes, differences in characteristics and circumstances surrounding overdose, and assessed relationships between circumstances and drug use classes. RESULTS We identified four latent classes: (1) prescription drugs (19.1%), (2) predominately methamphetamine (31.4%), (3) multi-drug (28.9%), and (4) opioid and stimulant (20.6%). Compared to other classes, the prescription drug class had a higher percentage of female decedents, from rural counties, with mental health diagnoses, who died at home. The predominately methamphetamine class had a higher percentage of decedents experiencing homelessness. The multi-drug use class had higher percentage of younger and Hispanic decedents. Those in the opioid and stimulant class had higher odds of being recently released from an institutional setting, compared to the multi drug class. CONCLUSIONS These underlying classes were associated with several characteristics and circumstances that can prove useful for prevention, treatment, and harm reduction agencies when designing programs and interventions to target specific groups of people at-risk for drug overdose.
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Affiliation(s)
- Shawn A Thomas
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Karla D Wagner
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | | | - Stanley Omaye
- College of Agriculture, Biotechnology, & Natural Resources, University of Nevada, Reno, Reno, NV, USA
| | - Minggen Lu
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Wei Yang
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
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