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Roth KB, Goplerud DK, Babjak JS, Nguyen JL, Gilbert LR. Examining the association of rurality with opioid-related morbidity and mortality in Georgia: A geospatial analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209336. [PMID: 38494047 DOI: 10.1016/j.josat.2024.209336] [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: 07/26/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The US opioid epidemic continues to escalate, with overdose deaths being the most-used metric to quantify its burden. There is significant geographic variation in opioid-related outcomes. Rural areas experience unique challenges, yet many studies oversimplify rurality characterizations. Contextual factors, such as area deprivation, are also important to consider when understanding a community's need for treatment services and prevention programming. This study aims to provide a geospatial snapshot of the opioid epidemic in Georgia using several metrics of opioid-related morbidity and mortality and explore differences by rurality across counties. METHODS This was a spatial ecologic study. Negative binominal regression was used to model the relationship of county rurality with four opioid-related outcomes - overdose mortality, emergency department visits, inpatient hospitalizations, and overdose reversals - adjusting for county-level sex, racial/ethnic, and age distributions. Area Deprivation Index was also included. RESULTS There was significant geographic variation across the state for all four opioid-related outcomes. Counts remained highest among the metro areas. For rates, counties in the top quartile of rates varied by outcome and were often rural areas. In the final models, rurality designation was largely unrelated to opioid outcomes, with the exception of medium metro areas (inversely related to hospitalizations and overdose reversals) and non-core areas (inversely related to hospitalizations), as compared to large central metro areas. Higher deprivation was significantly related to increased ED visits and hospitalizations, but not overdose mortality and reversals. CONCLUSIONS When quantifying the burden of the opioid epidemic in a community, it is essential to consider multiple outcomes of morbidity and mortality. Understanding what outcomes are problematic for specific communities, in combination with their demographic and socioeconomic context, can provide insight into gaps in the treatment continuum and potential areas for intervention. Additionally, compared to demographic and socioeconomic factors, rurality may no longer be a salient predictor of the severity of the opioid epidemic in an area.
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Affiliation(s)
- Kimberly B Roth
- Mercer University School of Medicine, Department of Community Medicine, 1250 E 66(th) Street, Savannah, GA 31404, USA.
| | - Dana K Goplerud
- Johns Hopkins School of Medicine, Departments of Medicine and Pediatrics, Baltimore, MD 21205, USA
| | - Jennifer S Babjak
- Mercer University School of Medicine, Department of Community Medicine, 1250 E 66(th) Street, Savannah, GA 31404, USA
| | - Jennifer L Nguyen
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - Lauren R Gilbert
- Tilman J. Fertitta Family College of Medicine, University of Houston, 5055 Medical Circle, Houston, TX 77004, USA; Humana Integrated Health System Sciences Institute at the University of Houston, 5055 Medical Circle, Houston, TX 77004, USA
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2
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Xu JJ, Seamans MJ, Friedman JR. Drug overdose mortality rates by educational attainment and sex for adults aged 25-64 in the United States before and during the COVID-19 pandemic, 2015-2021. Drug Alcohol Depend 2024; 255:111014. [PMID: 38142465 DOI: 10.1016/j.drugalcdep.2023.111014] [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: 06/16/2023] [Revised: 10/01/2023] [Accepted: 10/24/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Dramatic increases in U.S. drug overdose deaths involving synthetic opioids, especially fentanyl, beginning around 2014 have driven a marked progression in overall drug overdose deaths in the U.S., which sharply rose to unprecedented levels amid the COVID-19 pandemic. Disparities in drug overdose deaths by educational attainment (EA) during the fentanyl era of the drug overdose epidemic and its intersection with the COVID-19 pandemic have not been widely scrutinized. METHODS Utilizing restricted-use mortality data from the National Vital Statistics System and population estimates from the American Community Survey, we estimated annual national age-adjusted mortality rates (AAMRs) from drug overdoses jointly stratified by EA and sex for adults aged 25-64 from 2015 to 2021. State-level AAMRs in 2015 and 2021 were also estimated to examine the geographic variation in the cumulative evolution of EA-related disparities over the course of the analysis period. RESULTS Nationally, AAMRs rose fastest among persons with at most a high school-level education, whereas little to no change was observed for bachelor's degree holders, widening pre-existing disparities. During the analysis period, the difference in national AAMRs between persons with at most a high school-level education and bachelor's degree holders increased from less than 8-fold (2015) to approximately 13-fold (2021). The national widening of EA-related disparities accelerated amid the COVID-19 pandemic, and they widened in nearly every state. Among non-bachelor's degree holders, national AAMRs increased markedly faster for males. CONCLUSIONS The widening disparities in drug overdose deaths by EA are a likely indicator of a rapidly increasing socioeconomic divide in drug overdose mortality more broadly. Policy strategies should address upstream socioeconomic drivers of drug use and overdose, particularly among males.
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Affiliation(s)
- Jay J Xu
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Marissa J Seamans
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Joseph R Friedman
- Center for Social Medicine and Humanities, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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3
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German D, Genberg B, Sugarman O, Saloner B, Sawyer A, Glick JL, Gribbin M, Flynn C. Reported xylazine exposure highly associated with overdose outcomes in a rapid community assessment among people who inject drugs in Baltimore. Harm Reduct J 2024; 21:18. [PMID: 38254198 PMCID: PMC10804796 DOI: 10.1186/s12954-024-00940-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] [Received: 10/18/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Addressing xylazine harms are now a critical harm reduction priority, but relatively little epidemiological information exists to determine prevalence, magnitude, and correlates of xylazine use or related outcomes. METHODS We conducted a rapid behavioral survey among people who inject drugs (n = 96) in Baltimore November-December 2022. Using a novel indicator of self-reported presumed xylazine effects, we examined prevalence and sociodemographic correlates of past year presumed xylazine effects and association with overdose and wound-related outcomes. Chi-square and descriptive statistics were used to examine bivariate associations overall and separately for those who reported xylazine by name and by reported fentanyl use frequency. RESULTS Almost two-thirds (61.5%) reported experiencing xylazine effects. There were no differences by socio-demographics, but xylazine effects were more commonly reported among those who reported injecting alone (66% vs 38%%, p < 0.007) and daily fentanyl use (47% vs 24% p < 0.003). Those reporting xylazine exposure was three times as likely to report overdose (32% vs 11%, p < 0.03) and twice as likely to have used naloxone (78% vs 46%, p < 0.003). They also more commonly reported knowing someone who died of an overdose (92% vs 76%, p < 0.09) and to report an abscess requiring medical attention (36% vs 19%, p < 0.80). These associations were higher among respondents who specifically named xylazine and those who used fentanyl more frequently, but fentanyl frequency did not fully explain the heightened associations with xylazine effects. CONCLUSIONS This study provides insight into the scope of xylazine exposure and associated health concerns among community-based PWID and suggests measures that may be instrumental for urgently needed research.
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Affiliation(s)
- Danielle German
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Olivia Sugarman
- Department of Health, Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Brendon Saloner
- Department of Health, Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Sawyer
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA
| | | | - Colin Flynn
- Maryland Department of Health, Baltimore, MD, USA
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4
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McCann NC, McMahan VM, Smith R, Majeski A, Johns SL, Kosakowski S, Wolfe S, Brennan S, Robinson M, Coffin PO, Walley AY. Feasibility and acceptability of a timeline follow-back method to assess opioid use, non-fatal overdose, and substance use disorder treatment. Addict Behav 2024; 148:107873. [PMID: 37801804 PMCID: PMC10618957 DOI: 10.1016/j.addbeh.2023.107873] [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: 05/15/2023] [Revised: 08/11/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Non-fatal overdoses are underreported and there is no accepted and feasible self-report research measure of non-fatal opioid overdose. Timeline follow-back (TLFB) calendar-based questionnaires assess self-reported risk behaviors. We assessed feasibility and acceptability of a new TLFB research measure for opioid use, non-fatal opioid overdose, and substance use disorder treatment among opioid overdose survivors. METHODS For the Repeated-dose Behavioral Intervention to Reduce Opioid Overdose Trial (REBOOT) study among opioid overdose survivors, we developed a TLFB questionnaire to assess daily non-prescribed opioid use, opioid overdose, facility stays, medications/behavioral treatment for opioid use disorder, and COVID-19 history during the previous 120 days. Staff assessors administered TLFB at four-monthly visits over the 16-month study participation period. To measure feasibility, we estimated TLFB completion time using an electronic timestamp tool. To measure acceptability, we administered a satisfaction survey to 103 participants who completed REBOOT. RESULTS Among 525 TLFB assessments conducted in 174 participants from January 2021-January 2023, opioid use was reported in 510 assessments, medication for opioid use disorder (MOUD) in 331 assessments, and ≥ 1 overdose in 107 assessments. Median TLFB completion time was 11 (IQR: 6-17) minutes for sections administered to all participants; detailed overdose questions administered to those reporting overdose took an additional 3 (IQR: 2-6) minutes. Report of ≥ 1 overdose and MOUD use were significantly associated with increased TLFB completion time. 88 % of participants reported that TLFB was very/somewhat acceptable. CONCLUSIONS Among opioid overdose survivors, REBOOT TLFB was a feasible and acceptable research measure, with similar completion time as other TLFB assessments of substance use.
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Affiliation(s)
- Nicole C McCann
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA.
| | - Vanessa M McMahan
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA
| | - Rachel Smith
- Boston University Chobanian & Avedisian School of Medicine, Boston MA
| | - Adam Majeski
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
| | - Sarah L Johns
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
| | - Sarah Kosakowski
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
| | - Shae Wolfe
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
| | - Sarah Brennan
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA
| | - Mackenzie Robinson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA
| | - Phillip O Coffin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA; University of California San Francisco, San Francisco CA
| | - Alexander Y Walley
- Boston University Chobanian & Avedisian School of Medicine, Boston MA; Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
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Afshar M, Oguss M, Callaci TA, Gruenloh T, Gupta P, Sun C, Safipour Afshar A, Cavanaugh J, Churpek MM, Nyakoe-Nyasani E, Nguyen-Hilfiger H, Westergaard R, Salisbury-Afshar E, Gussick M, Patterson B, Manneh C, Mathew J, Mayampurath A. Creation of a data commons for substance misuse related health research through privacy-preserving patient record linkage between hospitals and state agencies. JAMIA Open 2023; 6:ooad092. [PMID: 37942470 PMCID: PMC10629613 DOI: 10.1093/jamiaopen/ooad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
Objectives Substance misuse is a complex and heterogeneous set of conditions associated with high mortality and regional/demographic variations. Existing data systems are siloed and have been ineffective in curtailing the substance misuse epidemic. Therefore, we aimed to build a novel informatics platform, the Substance Misuse Data Commons (SMDC), by integrating multiple data modalities to provide a unified record of information crucial to improving outcomes in substance misuse patients. Materials and Methods The SMDC was created by linking electronic health record (EHR) data from adult cases of substance (alcohol, opioid, nonopioid drug) misuse at the University of Wisconsin hospitals to socioeconomic and state agency data. To ensure private and secure data exchange, Privacy-Preserving Record Linkage (PPRL) and Honest Broker services were utilized. The overlap in mortality reporting among the EHR, state Vital Statistics, and a commercial national data source was assessed. Results The SMDC included data from 36 522 patients experiencing 62 594 healthcare encounters. Over half of patients were linked to the statewide ambulance database and prescription drug monitoring program. Chronic diseases accounted for most underlying causes of death, while drug-related overdoses constituted 8%. Our analysis of mortality revealed a 49.1% overlap across the 3 data sources. Nonoverlapping deaths were associated with poor socioeconomic indicators. Discussion Through PPRL, the SMDC enabled the longitudinal integration of multimodal data. Combining death data from local, state, and national sources enhanced mortality tracking and exposed disparities. Conclusion The SMDC provides a comprehensive resource for clinical providers and policymakers to inform interventions targeting substance misuse-related hospitalizations, overdoses, and death.
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Affiliation(s)
- Majid Afshar
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Madeline Oguss
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Thomas A Callaci
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Timothy Gruenloh
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Preeti Gupta
- Division of Pulmonary and Critical Care, University of Illinois-Chicago, Chicago, IL 60607, United States
| | - Claire Sun
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Askar Safipour Afshar
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Joseph Cavanaugh
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Matthew M Churpek
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Edwin Nyakoe-Nyasani
- State of Wisconsin Department of Health Services, Madison, WI 53703, United States
| | | | - Ryan Westergaard
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
- State of Wisconsin Department of Health Services, Madison, WI 53703, United States
| | - Elizabeth Salisbury-Afshar
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
- State of Wisconsin Department of Health Services, Madison, WI 53703, United States
| | - Megan Gussick
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Brian Patterson
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Claire Manneh
- Datavant Incorporated, San Francisco, CA 94104, United States
| | - Jomol Mathew
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Anoop Mayampurath
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, United States
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Shearer RD, Rossom R, Christine PJ, Hoover M, Bauch J, Bodurtha P, Rai NK, Clegg M, Westgard BC, Ehresmann KR, Leite Bennett A, Winkelman TNA. Minnesota Data Sharing May Be Model For Near-Real-Time Tracking Of Drug Overdose Hospital And ED Trends. Health Aff (Millwood) 2023; 42:1568-1574. [PMID: 37931203 DOI: 10.1377/hlthaff.2023.00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The drug overdose epidemic in the US necessitates detailed and timely data to inform public health responses. In this article we describe how an electronic health record (EHR) data-sharing collaboration across health systems in Minnesota that was developed in response to the COVID-19 pandemic was adapted to monitor trends in substance use-related hospital and emergency department (ED) visits. We found large increases in methamphetamine- and opioid-involved hospital and ED visits. Throughout the study period, Native American, Black, and multiple-race people experienced the highest rates of drug-involved hospital and ED visits. Monitoring drug-involved health care use through EHR data has the potential to help public health officials detect trends in near real time before mortality spikes and may also inform early intervention. The use of EHR data also allows for detailed monitoring of the impact of the drug overdose epidemic across racial and ethnic groups.
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Affiliation(s)
- Riley D Shearer
- Riley D. Shearer, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca Rossom
- Rebecca Rossom, HealthPartners Institute, Bloomington, Minnesota
| | | | - Madison Hoover
- Madison Hoover, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Julie Bauch
- Julie Bauch, Hennepin County Public Health, Minneapolis, Minnesota
| | | | | | | | | | | | | | - Tyler N A Winkelman
- Tyler N. A. Winkelman , Hennepin Healthcare, Minneapolis, Minnesota, and Hennepin Healthcare Research Institute
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Zibbell JE, Aldridge A, Grabenauer M, Heller D, Clarke SD, Pressley D, McDonald HS. Associations between opioid overdose deaths and drugs confiscated by law enforcement and submitted to crime laboratories for analysis, United States, 2014-2019: an observational study. LANCET REGIONAL HEALTH. AMERICAS 2023; 25:100569. [PMID: 37583649 PMCID: PMC10423896 DOI: 10.1016/j.lana.2023.100569] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
Background The overdose epidemic in the United States (US) continues to generate unprecedented levels of mortality. There is urgent need for a national data system capable of yielding high-quality, timely, and actionable information on existing and emerging drugs. Public health researchers have started using law enforcement forensic laboratory data to obtain surveillance information on illicit drugs. This study is the first to use drug reports from the entire US to examine correlations between a changing drug supply and increasing opioid-involved overdose deaths (OOD) on a national scale. Methods This study is observational and investigates associations between law enforcement drug reports and OOD for the US from 2014 to 2019. OOD data are from the Centers for Disease Control and Prevention's National Vital Statistics System restricted-use multiple cause of death files. The US Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS) contains forensic laboratory-tested drug exhibit information for the entire US (NFLIS-Drug). Counts of forensic laboratory reports and OOD were aggregated for each state by month, quarter, and year. A difference-in-differences framework was used to estimate contemporaneous and lagged associations. Findings Between 2014 and 2019 in the US, 249,522 OOD were reported, with the annual number nearly doubling from 28,723 to 50,179. OOD involving illicitly manufactured fentanyls (IMF) also increased substantially during this period, from 19.4% to 72.9%. In addition, 3,817,438 forensic laboratory reports in the US that were reported to NFLIS-Drug contained an opioid, stimulant, or benzodiazepine. Reports of fentanyl and fentanyl-related compounds (FFRC) had the strongest association with OOD. Each additional FFRC exhibit was associated with a 2.97% (95% CI: 1.7%, 4.1%) increase in OOD per 100,000 persons per quarter. Interpretation Adding to the emerging consensus, protracted growth in IMF supply was more strongly associated with OOD than all other illicit drugs reported to NFLIS-Drug over the study time period. Findings demonstrate NFLIS-Drug data usefulness for research that require proxy indicators for the illicit drugs supply. A concerted effort between public health and public safety to make NFLIS-Drug more timely could strengthen its utility as a national, public health, drug surveillance system. Funding Sangeetha Arctic Slope Mission Services, LLC, ASMS Contract No. ASM5-00017.
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8
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Johnson C, Catlin M, Sinow L, Gupta R, Holtgrave DR. States' Methods for Capturing and Reporting Local Responses to Suspected Nonfatal Drug Overdoses. JAMA 2023; 329:761-763. [PMID: 36795390 PMCID: PMC9936379 DOI: 10.1001/jama.2023.0169] [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: 11/14/2022] [Accepted: 01/05/2023] [Indexed: 02/17/2023]
Abstract
This study examines the available data used to surveil state-level drug overdoses and characterizes them based on their timeliness, drug involvement, and specification of nonfatal outcomes.
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Affiliation(s)
| | - Megan Catlin
- White House Office of National Drug Control Policy, Washington, DC
| | - Lisa Sinow
- White House Office of National Drug Control Policy, Washington, DC
| | - Rahul Gupta
- White House Office of National Drug Control Policy, Washington, DC
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9
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Harris RA. Drug Overdose Deaths Among Non-Hispanic Black Men in the U.S.: Age-Specific Projections Through 2025. AJPM FOCUS 2023; 2:100063. [PMID: 37377540 PMCID: PMC10299749 DOI: 10.1016/j.focus.2022.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Introduction Fatal drug overdoses have risen sharply in the U.S. since 2015, reaching their highest levels during the pandemic. Non-Hispanic Black men have been disproportionately harmed by this latest surge; overdose mortality per 100,000 has increased fourfold since 2015. Whether the mortality rate will continue to climb is unknown. In this study, we addressed the narrower question of which age groups are likely to experience a significant increase or decrease in the burden of drug overdose deaths through 2025, based on foreseeable changes in the age structure of the Black male population. Methods We used the 2020 and provisional 2021 age-specific mortality rates from the Centers for Disease Control WONDER (Wide-Ranging Online Data for Epidemiologic Research) database and the standard population balancing equation to project overdose deaths in 2025. Overdose deaths were identified by ICD-10 codes. We bracketed the projections between 2 plausible alternatives: a pessimistic forecast based on time series extrapolations and an optimistic forecast that assumes success nationally in lowering overdose deaths through prevention, treatment, and harm reduction initiatives. Results Among Black men aged 31-47 years, overdose deaths in 2025 are expected to increase by 440 or 11% (95% CI=8%, 14%) relative to 2020. By contrast, overdose deaths among younger Black men aged 19-30 years are expected to decline by 160 or -9% (95% CI= -15%, -5%). Among older Black men aged 48-64 years, overdose deaths are also expected to decline by 330 or -7% (95% CI= -10%, -4%). Similar results were found using 2021 provisional mortality rates. Conclusions Overdose deaths are predicted to increase significantly over current levels among Black men in their 30s and 40s. Local policy makers should direct harm reduction resources, such as naloxone kits, syringes, and fentanyl test strips, to places frequented by Black men in this age group. Outreach messaging should be tailored to resonate with men of middle age. Equally urgent is the scaling up of nonstigmatizing, evidence-based drug treatment and recovery support services in Black neighborhoods.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Marcus SM. US Tracking System for Nonfatal Drug Overdoses. JAMA 2022; 328:2068. [PMID: 36413241 DOI: 10.1001/jama.2022.17494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Steven M Marcus
- Department of Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark
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11
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Gupta R, Holtgrave DR. US Tracking System for Nonfatal Drug Overdoses-Reply. JAMA 2022; 328:2068-2069. [PMID: 36413236 DOI: 10.1001/jama.2022.17497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rahul Gupta
- White House Office of National Drug Control Policy, Washington, DC
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