Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder

Prevalence and Correlates of Alcohol and Drug Harms to Others: Findings From the 2020 U.S. National Alcohol Survey

OBJECTIVE

The purpose of this study was to measure the prevalence and overlap of secondhand harms from other people's use of alcohol, cannabis, opioids, or other drugs and examine sociodemographic and other correlates of these secondhand harms.

METHOD

This cross-sectional analysis used data from 7,799 respondents (51.6% female; 12.9% Black, 15.6% Hispanic/Latiné; mean age = 47.6 years) in the 2020 U.S. National Alcohol Survey. Secondhand harms included family/marriage difficulties, traffic accidents, vandalism, physical harm, and financial difficulties. Weighted prevalence estimates provided nationally representative estimates of these harms. Logistic regression assessed associations between individual characteristics and secondhand harms.

RESULTS

Lifetime prevalence of secondhand harms from alcohol, cannabis, opioids, or other drugs was 34.2%, 5.5%, 7.6%, and 8.3%, respectively. There was substantial overlap among lifetime harms: Almost 30% of those reporting secondhand alcohol harms also reported secondhand drug harms. Significant correlates of secondhand substance harms included female sex (alcohol, other drugs); White (alcohol, opioids), American Indian/Alaska Native (opioids), and Black (cannabis) race/ethnicity; and separated/divorced/widowed marital status (opioids). Those reporting a family history of alcohol problems had significantly higher odds of reporting secondhand harms across substance types. Individuals who reported frequent cannabis use had higher odds of reporting secondhand alcohol and opioid harms compared to those with no cannabis use (aOR = 1.55; aOR = 2.38) but lower odds of reporting secondhand cannabis harms (aOR = 0.51).

CONCLUSIONS

Although less prevalent than secondhand alcohol harms, 14% of participants reported secondhand harms from someone else's drug use and frequently experienced secondhand harms attributed to multiple substances. Population-focused interventions are needed to reduce the total burden of alcohol and other drug use.

Prevalence and drug use correlates of inadvertent fentanyl exposure among individuals misusing drugs in seven U.S. states

Fentanyl has emerged as the leading cause of fatal drug overdoses in the U.S. Individuals misusing drugs may not always be aware of exposure to fentanyl.

To determine the prevalence of fentanyl use and extent of awareness of fentanyl exposure among a national sample of treatment-seeking individuals with opioid use disorder (n = 1098).

Participants provided oral fluid and urine specimens, which were tested for drugs by liquid chromatography/tandem mass spectrometry. Participants also provided self-reports of fentanyl use.

49.5% tested positive for fentanyl in oral fluid, urine, or both. Of those testing positive for fentanyl, 29.8% were unaware that they had been exposed to fentanyl. Participants testing positive for opioids methadone, and specifically 6-monoacetylmorphine (6-MAM), a unique metabolite of heroin, were significantly more likely to be unaware of fentanyl exposure than participants testing negative for these substances, with a similar trend for oxycodone and tramadol.

These findings may be due to fentanyl's effect being difficult to distinguish from that of other opioids, whereas when other types of drugs are adulterated with fentanyl, the differences in effects are likely to be readily discernable. These results support the importance of expanded drug-checking services.

Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies

INTRODUCTION

The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis.

AREAS COVERED

In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field.

EXPERT OPINION

Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies.

Strengthening Prevention Systems to Address the Overdose Crisis Through the HEAL Prevention Cooperative and HEAL Preventing Opioid Use Disorder Research Program

The HEAL Prevention Cooperative (HPC), a subset of the HEAL Preventing Opioid Use Disorder (OUD) Research Program, addresses the evidence gap of interventions for populations at higher risk for opioid use initiation, escalation, and disorder. Designed to yield programs that can be scaled up for dissemination, the studies address topics critical to systematic implementation including data harmonization, intervention costs, culturally responsive services, community engagement, working across the continuum of care, and bringing interventions to market. Ideally, interventions found to be effective will be considered for adoption by community stakeholders. However, the introduction and sustained use of evidence-based approaches remain challenging across the prevention field. Using SAMHSA/CSAP's framework for describing a modern and effective prevention system (Early Action, Easy Access, Effective Delivery, and Equitable Opportunities - the 4Es), this commentary describes ways to engage states, jurisdictions, territories, tribes, and communities to apply the lessons learned and pre-position their respective prevention systems for broad-scale implementation of HPC interventions.