1
|
Byrne CJ, Sani F, Thain D, Fletcher EH, Malaguti A. Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis. Harm Reduct J 2024; 21:81. [PMID: 38622647 PMCID: PMC11017611 DOI: 10.1186/s12954-024-00999-8] [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: 09/18/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND AND AIMS Psychological and social status, and environmental context, may mediate the likelihood of experiencing overdose subsequent to illicit drug use. The aim of this systematic review was to identify and synthesise psychosocial factors associated with overdose among people who use drugs. METHODS This review was registered on Prospero (CRD42021242495). Systematic record searches were undertaken in databases of peer-reviewed literature (Medline, Embase, PsycINFO, and Cinahl) and grey literature sources (Google Scholar) for work published up to and including 14 February 2023. Reference lists of selected full-text papers were searched for additional records. Studies were eligible if they included people who use drugs with a focus on relationships between psychosocial factors and overdose subsequent to illicit drug use. Results were tabulated and narratively synthesised. RESULTS Twenty-six studies were included in the review, with 150,625 participants: of those 3,383-4072 (3%) experienced overdose. Twenty-one (81%) studies were conducted in North America and 23 (89%) reported polydrug use. Psychosocial factors associated with risk of overdose (n = 103) were identified and thematically organised into ten groups. These were: income; housing instability; incarceration; traumatic experiences; overdose risk perception and past experience; healthcare experiences; perception of own drug use and injecting skills; injecting setting; conditions with physical environment; and social network traits. CONCLUSIONS Global rates of overdose continue to increase, and many guidelines recommend psychosocial interventions for dependent drug use. The factors identified here provide useful targets for practitioners to focus on at the individual level, but many identified will require wider policy changes to affect positive change. Future research should seek to develop and trial interventions targeting factors identified, whilst advocacy for key policy reforms to reduce harm must continue.
Collapse
Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK.
| | - Fabio Sani
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
| | - Donna Thain
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Emma H Fletcher
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Amy Malaguti
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
- Tayside Drug and Alcohol Recovery Psychology Service, NHS Tayside, Dundee, UK
| |
Collapse
|
2
|
Crepeault H, Ti L, Jutras-Aswad D, Wood E, Le Foll B, Lim R, Bach P, Brar R, Socias ME. Correlates of nonfatal overdose among treatment-seeking individuals with non-heroin opioid use disorder: Findings from a pragmatic, pan-Canadian, randomized control trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209158. [PMID: 37683803 DOI: 10.1016/j.josat.2023.209158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/12/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Misuse of prescription and synthetic opioids is a primary contributor to the escalating overdose crisis in North America. However, factors associated with nonfatal overdose (NFO) in this context are poorly understood. We examined individual and socio-structural level correlates of NFO among treatment-seeking adults with an opioid use disorder (OUD) not attributed to heroin (nonheroin opioid use disorder [NH-OUD]). METHODS The study drew data from OPTIMA, a pan-Canadian, multicenter, pragmatic, two-arm randomized control trial comparing supervised methadone and flexible take-home dosing buprenorphine/naloxone models of care among adults with NH-OUD conducted between 2017 and 2020. We used bivariable and multivariable logistic regression to determine factors associated with a lifetime history of NFO among participants enrolled in the trial. RESULTS Of 267 included participants, 154 (58%) reported a NFO in their lifetime, of whom 83 (55 %) had an NFO in the last 6 months. In multivariable analyses, positive urine drug test (UDT) for methamphetamine/amphetamine (Adjusted Odds Ratio [AOR] = 2.59; 95 % confidence interval [CI]: 1.17-5.80), positive UDT for fentanyl (AOR = 2.31; 95 % CI: 1.01-5.30), receiving income assistance (AOR = 2.17; 95 % CI: 1.18-4.09) and homelessness (AOR = 2.40; 95 % CI: 1.25-4.68) were positively associated with a lifetime history of NFO. CONCLUSIONS We found a high prevalence of NFO history in treatment-seeking adults with NH-OUD, particularly among participants with certain drug use patterns and markers of socio-structural marginalization at the time of enrollment. Given the known impact of prior NFO on future harms, these findings highlight the need for comprehensive care approaches that address polysubstance use and social determinants of health to mitigate future overdose risk.
Collapse
Affiliation(s)
- Hannah Crepeault
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Acute Care Programme, CAMH, Toronto, ON, Canada
| | - Ron Lim
- Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rupinder Brar
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Regional Addiction Program, Vancouver Coastal Health, Vancouver, BC, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
3
|
Wagner KD, Fiuty P, Page K, Tracy EC, Nocera M, Miller CW, Tarhuni LJ, Dasgupta N. Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services. Drug Alcohol Depend 2023; 252:110985. [PMID: 37826988 PMCID: PMC10688611 DOI: 10.1016/j.drugalcdep.2023.110985] [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: 08/07/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Overdose deaths involving stimulants and opioids simultaneously have raised the specter of widespread contamination of the stimulant supply with fentanyl. METHODS We quantified prevalence of fentanyl in street methamphetamine and cocaine, stratified by crystalline texture, analyzing samples sent voluntarily to a public mail-in drug checking service (May 2021-June 2023). Samples from 77 harm reduction programs and clinics originated in 25 US states. Sample donors reported expected drug and physical descriptions. Substances were identified by gas chromatography-mass spectrometry. Negative binomial models were used to calculate fentanyl prevalence, adjusting for potential confounders related to sample selection. We also examined if xylazine changed donors' accuracy of detecting fentanyl. RESULTS We analyzed 718 lab-confirmed samples of methamphetamine (64%) and cocaine (36%). The adjusted prevalence of fentanyl was 12.5% (95% CI: 2.2%, 22.9%) in powder methamphetamine and 14.8% (2.3%, 27.2%) in powder cocaine, with notable geographic variation. Crystalline forms of both methamphetamine (Chisq=57, p<0.001) and cocaine (Chisq=18, p<0.001) were less likely to contain fentanyl: less than 1% of crystal methamphetamine (2/276) and no crack cocaine (0/53). Heroin was present in 6.6% of powder cocaine samples. Xylazine reduced donors' ability to detect fentanyl, with correct classification dropping from 92% to 42%. CONCLUSIONS Fentanyl was detected primarily in powder forms of methamphetamine and cocaine. Recommended interventions include expanding community-based drug checking, naloxone and fentanyl test strip distribution for people who use stimulants , and supervised drug consumption sites. New strategies to dampen variability in street drug composition are needed to reduce inadvertent fentanyl exposure.
Collapse
Affiliation(s)
- Karla D Wagner
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, NV 89557, USA.
| | | | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
| | - Erin C Tracy
- Injury Prevention Research Center, University of North Carolina, CB 7505, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599, USA.
| | - Maryalice Nocera
- Injury Prevention Research Center, University of North Carolina, CB 7505, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599, USA.
| | - Colin W Miller
- Injury Prevention Research Center, University of North Carolina, CB 7505, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599, USA.
| | - Lina J Tarhuni
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; Department of Pharmacy, University of Washington, Seattle, WA 98195, USA.
| | - Nabarun Dasgupta
- Injury Prevention Research Center, University of North Carolina, CB 7505, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599, USA.
| |
Collapse
|
4
|
Enich M, Flumo R, Campos S, Flores N, Sullivan N, Mellor J, O'Neill C, Nyaku AN. Overdose education and naloxone distribution program design informed by people who use drugs and naloxone distributors. Prev Med Rep 2023; 35:102374. [PMID: 37680861 PMCID: PMC10480625 DOI: 10.1016/j.pmedr.2023.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
People who use drugs (PWUD) are the most directly affected by the overdose epidemic. However, they are not often targets of overdose education and naloxone distribution (OEND) programs. Instead, these programs target friends or family members of people prescribed opioids or general community members. This study aimed to understand the perspectives of PWUD and community naloxone distributors on OEND program design. We used a community-based participatory research model to elucidate participant perspectives on what OEND programs should look like in the context of each individual's specific risk environment. We conducted semi-structured in-depth interviews with PWUD and naloxone distributors (n = 30) in New Brunswick and Newark, New Jersey between February and November of 2022. We analyzed interviews using thematic analysis and identified the following themes: increasing naloxone knowledge, peer-based naloxone access, increasing PWUD-informed OEND program design, and desired broader OEND program scope. All Participants knew what naloxone was and emphasized that naloxone needed to be ubiquitous in the community. Participants prioritized peer-based distribution, integrating distribution into community organizations, and addressing psychosocial issues related to naloxone administration and drug use. In summary, PWUD and community naloxone distributors emphasized peer-led community naloxone distribution that prioritized novel ways for PWUD to access naloxone. OEND program design should prioritize PWUD's perspectives and direct community naloxone distribution.
Collapse
Affiliation(s)
- Michael Enich
- Rutgers University School of Social Work, 120 Albany Street, New Brunswick, NJ 08901, USA
- New Jersey Harm Reduction Coalition, 37 Easton Ave., Suite 200, New Brunswick, NJ 08901. USA
| | - Rachel Flumo
- Rutgers University School of Public Health, 163 Hoes Lane, Piscataway, NJ 08854, USA
| | - Stephanie Campos
- John Jay College of Criminal Justice, Department of Anthropology, 524 West 59th Street, New York, NY 10019. USA
| | - Netanya Flores
- Temple University School of Podiatric Medicine, 148 N 8 St, Philadelphia, PA 19107, USA
| | - Nora Sullivan
- Rutgers University School of Social Work, 120 Albany Street, New Brunswick, NJ 08901, USA
| | - Jenna Mellor
- New Jersey Harm Reduction Coalition, 37 Easton Ave., Suite 200, New Brunswick, NJ 08901. USA
| | - Caitlin O'Neill
- New Jersey Harm Reduction Coalition, 37 Easton Ave., Suite 200, New Brunswick, NJ 08901. USA
| | - Amesika N. Nyaku
- New Jersey Harm Reduction Coalition, 37 Easton Ave., Suite 200, New Brunswick, NJ 08901. USA
- Rutgers New Jersey Medical School, Department of Medicine, Division of Infectious Diseases, 185 South Orange Ave, MSB I689, Newark, NJ 07103, USA
| |
Collapse
|
5
|
Tobin K, Heidari O, Volpi C, Sodder S, Duncan D. Use of geofencing interventions in population health research: a scoping review. BMJ Open 2023; 13:e069374. [PMID: 37536963 PMCID: PMC10401224 DOI: 10.1136/bmjopen-2022-069374] [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: 12/02/2022] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES Technological advancements that use global positioning system (GPS), such as geofencing, provide the opportunity to examine place-based context in population health research. This review aimed to systematically identify, assess and synthesise the existing evidence on geofencing intervention design, acceptability, feasibility and/or impact. DESIGN Scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance for reporting. DATA SOURCES PubMed, CINAHL, EMBASE, Web of Science, Cochrane and PsycINFO for articles in English published up to 31 December 2021. ELIGIBILITY CRITERIA Articles were included if geofencing was used as a mechanism for intervention delivery. EXCLUSION CRITERIA (1) a component or combination of GPS, geographical information system or ecological momentary assessment was used without delivery of an intervention; (2) did not include a health or health-related outcome from the geofencing intervention; or (3) was not a peer-reviewed study. DATA EXTRACTION AND SYNTHESIS Several researchers independently reviewed all abstracts and full-text articles for final inclusion. RESULTS A total of 2171 articles were found; after exclusions, nine studies were included in the review. The majority were published in 5 years preceding the search (89%). Geofences in most studies (n=5) were fixed and programmed in the mobile application carried by participants without their input. Mechanisms of geofencing interventions were classified as direct or indirect, with five studies (56%) using direct interventions. There were several different health outcomes (from smoking to problematic alcohol use) across the five studies that used a direct geofencing intervention. CONCLUSIONS This scoping review found geofencing to be an emerging technology that is an acceptable and feasible intervention applied to several different populations and health outcomes. Future studies should specify the rationale for the locations that are geofenced and user input. Moreover, attention to mechanisms of actions will enable scientists to understand not only whether geofencing is an appropriate and effective intervention but why it works to achieve the outcomes observed.
Collapse
Affiliation(s)
- Karin Tobin
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Omeid Heidari
- Child, Family and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Connor Volpi
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shereen Sodder
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dustin Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| |
Collapse
|
6
|
Kristensen K, Williams LD, Kaplan C, Pineros J, Lee E, Kaufmann M, Mackesy-Amiti ME, Boodram B. A Novel Index Measure of Housing-related Risk as a Predictor of Overdose among Young People Who Inject Drugs and Injection Networks. RESEARCH SQUARE 2023:rs.3.rs-3083889. [PMID: 37461549 PMCID: PMC10350242 DOI: 10.21203/rs.3.rs-3083889/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background For people who inject drugs (PWID), housing instability due to decreasing housing affordability and other factors (e.g., loss of housing due to severed relational ties, evictions due to drug use) results in added pressure on an already vulnerable population. Research has shown that housing instability is associated with overdose risk among PWID. However, the construct of housing instability has often been operationalized as a single dimension (e.g., housing type, homelessness, transience). We propose a multi-dimensional measure of housing instability risk and examine its association with drug overdose to promote a more holistic examination of housing status as a predictor of overdose. Methods The baseline data from a network-based, longitudinal study of young PWID and their networks living in metropolitan Chicago, Illinois was analyzed to examine the relationship between a housing instability risk index-consisting of five dichotomous variables assessing housing instability-and lifetime overdose count using negative binomial regression. Results We found a significant positive association between the housing instability risk score and lifetime overdose count after adjusting for 12 variables. Conclusions Our results support the practical utility of a multi-dimensional measure of housing instability risk in predicting overdose and highlight the importance of taking a holistic approach to addressing housing instability when designing interventions.
Collapse
Affiliation(s)
| | | | | | | | - Eunhye Lee
- University of Illinois Chicago School of Public Health
| | | | | | | |
Collapse
|
7
|
Ding X, Li X, Xu M, He Z, Jiang H. The effect of repetitive transcranial magnetic stimulation on electroencephalography microstates of patients with heroin-addiction. Psychiatry Res Neuroimaging 2023; 329:111594. [PMID: 36724624 DOI: 10.1016/j.pscychresns.2023.111594] [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: 11/11/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 01/30/2023]
Abstract
The effects of transcranial magnetic stimulation in treating substance use disorders are gaining attention; however, most existing studies used subjective measures to examine the treatment effects. Objective electroencephalography (EEG)-based microstate analysis is important for measuring the efficacy of transcranial magnetic stimulation in patients with heroin addiction. We investigated dynamic brain activity changes in individuals with heroin addiction after transcranial magnetic stimulation using microstate indicators. Thirty-two patients received intermittent theta-burst stimulation (iTBS) over the left dorsolateral prefrontal cortex. Resting-state EEG data were collected pre-intervention and 10 days post-intervention. The feature values of the significantly different microstate classes were computed using a K-means clustering algorithm. Four EEG microstate classes (A-D) were noted. There were significant increases in the duration, occurrence, and contribution of microstate class A after the iTBS intervention. K-means classification accuracy reached 81.5%. The EEG microstate is an effective improvement indicator in patients with heroin addiction treated with iTBS. Microstates were examined using machine learning; this method effectively classified the pre- and post-intervention cohorts among patients with heroin addiction and healthy individuals. Using EEG microstate to measure heroin addiction and further exploring the effect of iTBS in patients with heroin addiction merit clinical investigation.
Collapse
Affiliation(s)
- Xiaobin Ding
- School of Psychology, Northwest Normal University, Lanzhou 730000, China
| | - Xiaoyan Li
- School of Psychology, Northwest Normal University, Lanzhou 730000, China.
| | - Ming Xu
- School of Psychology, Northwest Normal University, Lanzhou 730000, China
| | - Zijing He
- School of Psychology, Northwest Normal University, Lanzhou 730000, China
| | - Heng Jiang
- School of Psychology, Northwest Normal University, Lanzhou 730000, China
| |
Collapse
|
8
|
Khan MR, Hoff L, Elliott L, Scheidell JD, Pamplin JR, Townsend TN, Irvine NM, Bennett AS. Racial/ethnic disparities in opioid overdose prevention: comparison of the naloxone care cascade in White, Latinx, and Black people who use opioids in New York City. Harm Reduct J 2023; 20:24. [PMID: 36841763 PMCID: PMC9959933 DOI: 10.1186/s12954-023-00736-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/12/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Drug overdose mortality is rising precipitously among Black people who use drugs. In NYC, the overdose mortality rate is now highest in Black (38.2 per 100,000) followed by the Latinx (33.6 per 100,000) and white (32.7 per 100,000) residents. Improved understanding of access to harm reduction including naloxone across racial/ethnic groups is warranted. METHODS Using data from an ongoing study of people who use illicit opioids in NYC (N = 575), we quantified racial/ethnic differences in the naloxone care cascade. RESULTS We observed gaps across the cascade overall in the cohort, including in naloxone training (66%), current possession (53%) daily access during using and non-using days (21%), 100% access during opioid use (20%), and complete protection (having naloxone and someone who could administer it present during 100% of opioid use events; 12%). Naloxone coverage was greater in white (training: 79%, possession: 62%, daily access: 33%, access during use: 27%, and complete protection: 13%, respectively) and Latinx (training: 67%, possession: 54%, daily access: 22%, access during use: 24%, and complete protection: 16%, respectively) versus Black (training: 59%, possession: 48%, daily access:13%, access during use: 12%, and complete protection: 8%, respectively) participants. Black participants, versus white participants, had disproportionately low odds of naloxone training (OR 0.40, 95% CI 0.22-0.72). Among participants aged 51 years or older, Black race (versus white, the referent) was strongly associated with lower levels of being trained in naloxone use (OR 0.20, 95% CI 0.07-0.63) and having 100% naloxone access during use (OR 0.34, 95% CI 0.13-0.91). Compared to white women, Black women had 0.27 times the odds of being trained in naloxone use (95% CI 0.10-0.72). CONCLUSIONS There is insufficient protection by naloxone during opioid use, with disproportionately low access among Black people who use drugs, and a heightened disparity among older Black people and Black women.
Collapse
Affiliation(s)
- Maria R. Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - Lee Hoff
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Luther Elliott
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY USA
| | - Joy D. Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - John R. Pamplin
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY USA
| | - Tarlise N. Townsend
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - Natalia M. Irvine
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Alex S. Bennett
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Center for Anti-Racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, NY USA
| |
Collapse
|
9
|
Bennett AS, Guarino H, Britton PC, O'Brien-Mazza D, Cook SH, Taveras F, Cortez J, Elliott L. U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts. Ann Med 2022; 54:1826-1838. [PMID: 35792749 PMCID: PMC9262363 DOI: 10.1080/07853890.2022.2092896] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
U.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010-2019. Risk for overdose among veterans is complex and influenced by ongoing interaction among physiological/biological, psychological, and socio-structural factors. A thorough understanding of opioid-related overdose among veterans, one that goes beyond simple pharmacological determinism, must examine the interplay of pain, pain treatment, and stress, as well as psychological and social experiences-before, during, and after military service. Comprehensive efforts to tackle the overdose crisis among veterans require interventions that address each of these dimensions. Promising interventions include widespread naloxone distribution and increased provision of low-threshold wrap-around services, including medications for opioid use disorder (MOUD) and holistic/complementary approaches. Interventions that are delivered by peers - individuals who share key experiential or sociodemographic characteristics with the population being served - may be ideally suited to address many of the barriers to opioid-related risk mitigation common among veterans. Community care models could be beneficial for the large proportion of veterans who are not connected to the Veterans Health Administration and for veterans who, for various reasons including mental health problems and the avoidance of stigma, are socially isolated or reluctant to use traditional substance use services. Interventions need to be tailored in such a way that they reach those more socially isolated veterans who may not have access to naloxone or the social support to help them in overdose situations. It is important to incorporate the perspectives and voices of veterans with lived experience of substance use into the design and implementation of new overdose prevention resources and strategies to meet the needs of this population. Key messagesU.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010-2019.The risks for overdose that veterans face need to be understood as resulting from an ongoing interaction among biological/physiological, psychological, and social/structural factors.Addressing drug overdose in the veteran population requires accessible and non-judgemental, low threshold, wraparound, and holistic solutions that recognise the complex aetiology of overdose risk for veterans.
Collapse
Affiliation(s)
- Alex S Bennett
- School of Global Public Health, New York University, New York, NY, USA.,Center for Drug Use and HIV/HCV Research (cduhr.org), New York, NY, USA
| | - Honoria Guarino
- Center for Drug Use and HIV/HCV Research (cduhr.org), New York, NY, USA.,CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Peter C Britton
- VA Center for Excellence, University of Rochester, Rochester, NY, USA
| | | | - Stephanie H Cook
- School of Global Public Health, New York University, New York, NY, USA.,Center for Drug Use and HIV/HCV Research (cduhr.org), New York, NY, USA
| | - Franklin Taveras
- School of Global Public Health, New York University, New York, NY, USA
| | - Juan Cortez
- OnPoint, New York Harm Reduction Educators/Washington Heights Corner Project, New York, NY, USA
| | - Luther Elliott
- School of Global Public Health, New York University, New York, NY, USA.,Center for Drug Use and HIV/HCV Research (cduhr.org), New York, NY, USA
| |
Collapse
|
10
|
Macmadu A, Frueh L, Collins AB, Newman R, Barnett NP, Rich JD, Clark MA, Marshall BDL. Drug use behaviors, trauma, and emotional affect following the overdose of a social network member: A qualitative investigation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103792. [PMID: 35816791 PMCID: PMC9462427 DOI: 10.1016/j.drugpo.2022.103792] [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: 04/27/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Scant research has examined the influence of overdoses occurring in social networks (i.e., knowing someone who has overdosed) on individual overdose risk. We sought to characterize drug use behaviors of individuals following the overdose of someone in their social network. METHODS We conducted semi-structured interviews with 25 people who use drugs and knew someone who overdosed in the prior 90 days. All interviews were conducted in person in Rhode Island from July to October 2021. Data were stratified by drug use behaviors following the overdose of a network member (i.e., risk behaviors, protective behaviors, no change; selected a priori) and analyzed using a thematic analysis variation to identify salient themes. RESULTS We identified variation in the effect of knowing someone who overdosed on subsequent drug use behaviors and emotional affect. Several participants described increasing their drug use or using more types of drugs than usual to manage feelings of bereavement and trauma, and a subset of these participants described increased drug use with suicidal intention and increased suicidal ideations following the overdose event. Other participants described reducing their drug use and engaging in protective behaviors in response to heightened perceived overdose risk, protection motivation (i.e., increased motivation to protect oneself), and concern for others. Additionally, some participants reported no change in drug use behaviors, and these participants described already engaging in harm reduction practices, feeling desensitized due to frequent or repeated exposure to overdose, and ambivalence about living. CONCLUSIONS Findings suggest a need for enhanced investment in network-based overdose prevention interventions, as well as more robust integration of bereavement support and mental health services in settings that serve people who use drugs. The findings also suggest a need for future research to identify mediators of the effect of overdose occurring in social networks on individual overdose risk.
Collapse
Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Lisa Frueh
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Roxxanne Newman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Josiah D Rich
- The Center for Health + Justice Transformation, The Miriam Hospital, 1125 North Main Street, Providence, RI, USA
| | - Melissa A Clark
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA.
| |
Collapse
|
11
|
Bennett AS, Scheidell J, Bowles JM, Khan M, Roth A, Hoff L, Marini C, Elliott L. Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City. Harm Reduct J 2022; 19:20. [PMID: 35246165 PMCID: PMC8894821 DOI: 10.1186/s12954-022-00604-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. Methods We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n = 575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥ 50 years (PR: 1.18 (CI 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI 1.00, 1.28); and with small social networks (< 5 persons) (APR: 1.14 (CI 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI 1.49, 4.04), suicidality (PR: 1.72 (CI 1.19, 2.49), depression (PR: 1.54 (CI 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI 1.23, 1.96), but not with network size. Conclusions Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.
Collapse
Affiliation(s)
- Alex S Bennett
- School of Global Public Health, New York University, New York, USA. .,Center for Drug Use and HIV/HCV Research, New York University, New York, USA.
| | - Joy Scheidell
- Center for Drug Use and HIV/HCV Research, New York University, New York, USA.,Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, New York, USA
| | - Jeanette M Bowles
- Centre for Drug Policy and Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Maria Khan
- Center for Drug Use and HIV/HCV Research, New York University, New York, USA.,Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, New York, USA
| | - Alexis Roth
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lee Hoff
- Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, New York, USA
| | - Christina Marini
- School of Global Public Health, New York University, New York, USA
| | - Luther Elliott
- School of Global Public Health, New York University, New York, USA.,Center for Drug Use and HIV/HCV Research, New York University, New York, USA
| |
Collapse
|
12
|
Naumann RB, Guynn I, Clare HM, Lich KH. Insights from system dynamics applications in addiction research: A scoping review. Drug Alcohol Depend 2022; 231:109237. [PMID: 34974268 DOI: 10.1016/j.drugalcdep.2021.109237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Substance misuse and use disorders are dynamic and complex problems, situated within systems of interacting social, environmental, and neurobiological factors. System dynamics (SD) methods broaden, test, and improve understanding of complex systems and can help inform effective action. We sought to systematically review the use of SD tools in addiction-related research. METHODS Following PRISMA guidelines, we searched several databases from 1958 to 2019. We included studies focused on addiction-related screening and diagnosis, treatment, and return to use, as well as studies focused on earlier stages that may begin a path to addiction (e.g., experimentation, misuse onset). RESULTS We extracted information from 59 articles with a median publication year of 2014. In addition to using SD to understand the underlying complexity driving addiction-related trends, other commonly cited reasons for use of SD included assessing impacts of potential actions (n = 35), predicting future trends (n = 28), and supporting strategic planning processes (n = 22). Most studies included simulation models (n = 43); however, some presented insights from qualitative SD diagrams (n = 9) and concept models (n = 6). The majority of studies focused on stages leading to potential addiction: initiation/ experimentation (n = 42) and misuse onset (n = 38). One-third (n = 20) engaged persons with lived experience or other stakeholders during the modeling process. CONCLUSIONS Addiction-related SD research has increased over the last few decades with applications varying in several ways, from model purpose and types of data used to stakeholder involvement. Future applications should consider the benefits of stakeholder engagement throughout the modeling process and expanding models to include concomitant substance use.
Collapse
Affiliation(s)
- Rebecca B Naumann
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 MLK Jr Blvd, CB #7505, Chapel Hill, NC 27599, USA.
| | - Isabella Guynn
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA
| | - Hannah Margaret Clare
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA
| |
Collapse
|
13
|
Gauthier GR, Markowski K, Smith JA, Harcy S, Johnston B. Co-use among confidants: An examination of polysubstance use and personal relationships in southeastern Nebraska. Addict Behav 2022; 124:107116. [PMID: 34562776 PMCID: PMC8542383 DOI: 10.1016/j.addbeh.2021.107116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
This study examines the relationship between personal networks and polysubstance use among people who use drugs (PWUD) in a medium sized city in the Midwest. A large body of work has demonstrated that personal relationships have an ambivalent association with substance use. On the one hand, a supportive network is associated with safer drug use practices and dramatically improves the outlook for recovery. However, individuals whose personal networks are composed of co-drug use partners are more likely to engage in risky practices. We argue that this notion of "supportive" social contacts and "risky" social contacts is ultimately incomplete: risky behaviors are introduced and further developed in a social context, often with the people who provide emotional support. We argue that personal networks with more multiplex relationships (where co-drug use and confiding fuse) are harmful because they combine norms of trust and reciprocity with drug use. We use data from the Rural Health Cohort (RHC) study to test this idea. The sample consists of 120 adult PWUD in a medium sized city located in southeastern Nebraska who were recruited using respondent-driven sampling. Participants listed up to nine confidants and nine co-drug use partners, indicating any overlap between the two networks. Our results demonstrate that multiplex ties are as strongly associated with polysubstance use as simple co-drug use relationships. As the drug crisis has increasingly shifted to underserved populations outside large urban centers, this paper represents an important advance in our understanding of the current drug crisis.
Collapse
Affiliation(s)
- G. Robin Gauthier
- Department of Sociology, University of Nebraska-Lincoln, Nebraska, USA,Rural Addiction Research Center, University of Nebraska-Lincoln, Nebraska, USA,Please address correspondence to Robin Gauthier, Research, Department of Sociology, 719 Oldfather Hall, University of Nebraska-Lincoln NE 68588-0623.
| | - Kelly Markowski
- Department of Sociology, University of Nebraska-Lincoln, Nebraska, USA,Rural Addiction Research Center, University of Nebraska-Lincoln, Nebraska, USA
| | - Jeffrey A. Smith
- Department of Sociology, University of Nebraska-Lincoln, Nebraska, USA,Rural Addiction Research Center, University of Nebraska-Lincoln, Nebraska, USA
| | - Sela Harcy
- Department of Sociology, University of Nebraska-Lincoln, Nebraska, USA,Rural Addiction Research Center, University of Nebraska-Lincoln, Nebraska, USA
| | - Bergen Johnston
- Rural Addiction Research Center, University of Nebraska-Lincoln, Nebraska, USA
| |
Collapse
|
14
|
Parsons AA, Leggett D, Vollmer D, Perez V, Smith R, Goodman E, Mayes C, McLellan C, Laird N, Beck AF, Kahn R, Riley C. Cultivating social relationships and disrupting social isolation in low-income, high-disparity neighbourhoods in Ohio, USA. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1876-1886. [PMID: 33560567 DOI: 10.1111/hsc.13301] [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: 12/29/2019] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
Social isolation undermines health. Inequities in social networks exist due to historical and contemporary practices of socioeconomic and racial segregation. Thus, lower income and minority families are less likely to have the number, strength, and variety of social connections as higher income and white families. Therefore, social isolation may contribute to inequities in health and well-being across socioeconomic and racial groups. Disrupting social isolation by strengthening social networks may be a meaningful way to equitably improve population health. In this study we aimed to better understand the factors that influence the formation and sustainment of social connections in neighbourhoods experiencing a disproportionate burden of social needs and poor health outcomes. Participants were recruited through our community-academic partnership, Healthy Homes (HH). Healthy Homes serves families with pregnant women and/or children <6 years in two low-income, high-morbidity neighbourhoods, focusing on supporting families' needs and hopes. Between October 2016 and April 2017, we conducted in-depth qualitative interviews (n = 20) with English-speaking mothers and grandmothers of children under <6 years. Interviews were audio-recorded, transcribed verbatim and independently coded. After applying an a priori code list, we conducted emergent coding to identify additional themes. Themes focused on the social environment, including social connections and social isolation, among vulnerable populations in included neighbourhoods. Families want connection to one another and to resources but look to others to facilitate those connections. Families may want or need social connections but do not engage if it means sacrificing their values or sense of self-worth. These findings provide a deeper understanding of the factors that might allow us to disrupt social isolation by building relationships in communities that face social and health inequities.
Collapse
Affiliation(s)
- Allison A Parsons
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dawna Leggett
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | | | | | | | | | | | | | - Nancy Laird
- Santa Maria Community Services, Cincinnati, OH, USA
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General & Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General & Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carley Riley
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
15
|
Bennett AS, Elliott L. Naloxone's role in the national opioid crisis-past struggles, current efforts, and future opportunities. Transl Res 2021; 234:43-57. [PMID: 33684591 PMCID: PMC8327685 DOI: 10.1016/j.trsl.2021.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023]
Abstract
Over the past 25 years, naloxone has emerged as a critical lifesaving overdose antidote. Public health advocates and community activists established early methods for naloxone distribution to people who inject drugs, but a legacy of stigmatization and opposition to universal naloxone access continues to limit the drug's full potential to reduce opioid-related mortality. The establishment of naloxone distribution programs under the umbrella of syringe exchange programs faces the same practical, ideological and financial barriers to expansion similar to those faced by syringe exchange programs themselves. The expansion of naloxone from the confines of a few syringe exchange programs to what we see today represents an enormous triumph for the grass-roots activists, service providers, and public health professionals who have fought to guarantee lay access to naloxone. Despite the extensive efforts to expand access to naloxone, naloxone continues to remains a scarce resource in many US localities. Considerable naloxone "deserts" remain and even where there is naloxone access, it does not always reach those at risk. Promising areas for expansion include the development of more robust telehealth methods for naloxone distribution, including subsidized mail delivery programs; lowering barriers to pharmacy access; working with hospitals, ambulances, and law enforcement to expand naloxone "leave behind" programs; providing naloxone co-prescription with medications for opioid use disorder; and working with prisons, shelters, and networks of people who use drugs to increase access to the lifesaving medication. Efforts to ensure over-the-counter and low- or no-cost naloxone are ongoing and stand alongside medication-assisted treatments as efficacious, readily-actionable, and cost-efficient population-level interventions available for combatting opioid-related overdose in the United States.
Collapse
Affiliation(s)
- Alex S Bennett
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York; Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York.
| | - Luther Elliott
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York; Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York
| |
Collapse
|
16
|
Past 12-month nonfatal overdose among people who inject drugs in Ukraine: City-level estimates and risk factors from a cross-sectional study. Drug Alcohol Depend 2021; 220:108513. [PMID: 33556695 DOI: 10.1016/j.drugalcdep.2021.108513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nonfatal overdose contributes to high morbidity and is among the strongest proxies for the occurrence of overdose fatality - the leading cause of death among those who use opioids. In Ukraine, a majority of people who inject drugs (PWID) use opioids, but little is known about the relationship between drug market characteristics, nonfatal overdose (NFOD) prevalence, and risk factors for NFOD. METHODS We used cross-sectional respondent-driven sampling (RDS) data to explore the variability of recent (past 12 months) NFOD among PWID across Ukrainian cities and associations with individual factors. The population-averaged -cross-sectional associations were estimated and compared using generalized linear models for the binary outcome (NFOD vs. not) with robust variance estimates. RESULTS Recent self-reported NFOD varied between 1% and 14 % across Ukrainian cities. In adjusted analyses, overdose was associated with fewer years of injecting drugs; a higher number of types of drugs used in the past 12 months; using desomorphine, methadone, tramadol, heroin, amphetamine-type drugs or cocaine within past 12 months; using alcohol daily or weekly; recent drug treatment; and history of incarceration. Buying drugs or their ingredients through "stashes" (i.e., drugs secretly hidden in various places) and the perception of drug price increase were associated with higher odds of reporting NFOD. CONCLUSION The identified risk factors underscore the importance of evidence-based prevention efforts, such as scaling-up opioid agonist therapy, providing naloxone in the community and upon prison release, targeting those most likely to witness overdose and sharing overdose prevention strategies with them, and continuous monitoring of trends and contributing factors.
Collapse
|
17
|
Mazhnaya A, Kiriazova T, Chernova O, Tobin K, Owczarzak J. ``Now it is mostly done through stashes, to do it in person one has to trust you'': Understanding the retail injection drug market in Dnipro, Ukraine. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102988. [PMID: 33129134 DOI: 10.1016/j.drugpo.2020.102988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
Little research has been conducted in Ukraine since the 1990s to understand the organization of drug market and its implications for people who inject drugs (PWID). In this study, we explore how PWID perceive the retail drug market in a large Ukrainian city. Qualitative data were obtained during in-depth interviews and analyses included open coding, coding tree development and revision, axial coding, and identification of higher-level domains. Participants' narratives focused on types and forms of drugs available, perceptions about drug quality, methods of buying drugs, and the relationships that are formed and maintained by participating in the drug economy. The described technical organization of the drug market, with multiple contingent combinations of drug types, forms and means of obtaining drugs (hand-to-hand vs stash-based) resulted from diversification and digitalization of the retail injection drug market. The social organization of the drug market in the form of relationships with sellers and drug use partners represented the response to the fundamental problem of uncertainty. The lens of ``transaction cost'' helps explain strategies PWID used to manage uncertainties, including finding reliable and suitable sellers, sending money and picking up the stash under the threat of being stiffed or caught by the police, choosing the product itself, using the intermediaries to outsource risky operations and forming groups to procure and inject together. Our results indicate that the technical and social organization of drug distribution in Ukraine stimulates formation and continuation of relationships and impacts the choices of what, how, and when to inject beyond individual preferences. The policy and practice implications include the need to monitor and understand the retail drug market to develop and deliver more efficient and client-oriented services, incorporate and leverage social networks structure for information sharing and behavior change, pilot and implement drug testing services to assist with management of uncertainties.
Collapse
Affiliation(s)
- Alyona Mazhnaya
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
| | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 5 Biloruska Street, Kyiv 04050, Ukraine
| | - Olena Chernova
- Ukrainian Institute on Public Health Policy, 5 Biloruska Street, Kyiv 04050, Ukraine
| | - Karin Tobin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA
| |
Collapse
|
18
|
Riggs KR, Hoge AE, DeRussy AJ, Montgomery AE, Holmes SK, Austin EL, Pollio DE, Kim YI, Varley AL, Gelberg L, Gabrielian SE, Blosnich JR, Merlin J, Gundlapalli AV, Jones AL, Gordon AJ, Kertesz SG. Prevalence of and Risk Factors Associated With Nonfatal Overdose Among Veterans Who Have Experienced Homelessness. JAMA Netw Open 2020; 3:e201190. [PMID: 32181829 PMCID: PMC7078753 DOI: 10.1001/jamanetworkopen.2020.1190] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE Individuals with a history of homelessness are at increased risk for drug or alcohol overdose, although the proportion who have had recent nonfatal overdose is unknown. Understanding risk factors associated with nonfatal overdose could guide efforts to prevent fatal overdose. OBJECTIVES To determine the prevalence of recent overdose and the individual contributions of drugs and alcohol to overdose and to identify characteristics associated with overdose among veterans who have experienced homelessness. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted from November 15, 2017, to October 1, 2018, via mailed surveys with telephone follow-up for nonrespondents. Eligible participants were selected from the records of 26 US Department of Veterans Affairs medical centers and included veterans who had received primary care at 1 of these Veterans Affairs medical centers and had a history of experiencing homelessness according to administrative data. Preliminary analyses were conducted in October 2018, and final analyses were conducted in January 2020. MAIN OUTCOMES AND MEASURES Self-report of overdose (such that emergent medical care was obtained) in the previous 3 years and substances used during the most recent overdose. All percentages are weighted according to propensity to respond to the survey, modeled from clinical characteristics obtained in electronic health records. RESULTS A total of 5766 veterans completed the survey (completion rate, 40.2%), and data on overdose were available for 5694 veterans. After adjusting for the propensity to respond to the survey, the mean (SD) age was 56.4 (18.3) years; 5100 veterans (91.6%) were men, 2225 veterans (38.1%) were black, and 2345 veterans (40.7%) were white. A total of 379 veterans (7.4%) reported any overdose during the past 3 years; 228 veterans (4.6%) reported overdose involving drugs, including 83 veterans (1.7%) who reported overdose involving opioids. Overdose involving alcohol was reported by 192 veterans (3.7%). In multivariable analyses, white race (odds ratio, 2.44 [95% CI, 2.00-2.98]), self-reporting a drug problem (odds ratio, 1.66 [95% CI, 1.39-1.98]) or alcohol problem (odds ratio, 2.54 [95% CI, 2.16-2.99]), and having witnessed someone else overdose (odds ratio, 2.34 [95% CI, 1.98-2.76]) were associated with increased risk of overdose. CONCLUSIONS AND RELEVANCE These findings suggest that nonfatal overdose is relatively common among veterans who have experienced homelessness. While overdose involving alcohol was more common than any specific drug, 1.7% of veterans reported overdose involving opioids. Improving access to addiction treatment for veterans who are experiencing homelessness or who are recently housed, especially for those who have experienced or witnessed overdose, could help to protect this population.
Collapse
Affiliation(s)
- Kevin R. Riggs
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | | | | | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Public Health, Birmingham
| | | | - Erika L. Austin
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Public Health, Birmingham
| | | | - Young-il Kim
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | - Allyson L. Varley
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, California
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles
| | - Sonya E. Gabrielian
- VA Greater Los Angeles Health Care System, Los Angeles, California
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles
| | | | | | - Adi V. Gundlapalli
- University of Utah School of Medicine, Salt Lake City
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Audrey L. Jones
- University of Utah School of Medicine, Salt Lake City
- VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Adam J. Gordon
- University of Utah School of Medicine, Salt Lake City
- VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Stefan G. Kertesz
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| |
Collapse
|
19
|
Katzman JG, Takeda MY, Greenberg N, Moya Balasch M, Alchbli A, Katzman WG, Salvador JG, Bhatt SR. Association of Take-Home Naloxone and Opioid Overdose Reversals Performed by Patients in an Opioid Treatment Program. JAMA Netw Open 2020; 3:e200117. [PMID: 32101312 PMCID: PMC7137685 DOI: 10.1001/jamanetworkopen.2020.0117] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/29/2019] [Indexed: 01/09/2023] Open
Abstract
Importance The US opioid crisis was deemed a public health emergency in 2017. More than 130 individuals in the US die daily as a result of unintentional opioid overdose deaths. Objective To measure use of take-home naloxone for overdose reversals performed by study participants with opioid use disorder receiving treatment at an opioid treatment program. Design, Setting, and Participants In a year-long cohort study, between April 4, 2016, and May 16, 2017, 395 study participants enrolled at the University of New Mexico Addiction and Substance Abuse Opioid Treatment Program, an outpatient clinic treating substance use disorders. Inclusion criteria included all patients enrolled at University of New Mexico Addiction and Substance Abuse Opioid Treatment Program during the study enrollment period; positive history of opioid use disorder treated with methadone, buprenorphine, or naltrexone; and age 18 years or older. Exclusion criteria included allergy to naloxone and age younger than 18 years. The study closed 1 year after enrollment, on May 17, 2018. Data analysis was performed from May 2018 to July 2019. Exposure Two doses of take-home naloxone combined with opioid overdose education were provided to study participants. Main Outcomes and Measures The primary outcome was to measure the association of take-home naloxone with overdose reversals performed by patients with opioid use disorder enrolled in an opioid treatment program. Results We enrolled 395 study participants (270 female [68.4%]; mean [SD] age, 35.4 [12.6] years; 260 [65.8%] with Hispanic white race/ethnicity) in the 1-year prospective trial. Sixty-eight female participants (25.2% of all female participants) were pregnant at the time of enrollment. Seventy-three of the 395 study participants (18.0%) performed 114 overdose reversals in the community. All community reversals were heroin related. Most study participants (86.8%) stated that the person on whom they performed an overdose reversal was a friend, relative, acquaintance, or significant other. In the year before enrollment, only 18 study participants (4.5%) had been prescribed naloxone. Conclusions and Relevance Take-home naloxone as part of overdose education and naloxone distribution provided to patients in an opioid treatment program may be associated with a strategic targeted harm reduction response for reversing opioid overdose-related deaths. Policy makers may consider regulations to mandate overdose education and naloxone distribution in opioid treatment programs.
Collapse
Affiliation(s)
- Joanna G. Katzman
- Department of Neurosurgery, University of New Mexico, Albuquerque
- Project ECHO, ECHO Institute, Albuquerque, New Mexico
| | | | - Nina Greenberg
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque
| | | | - Amal Alchbli
- Department of Neurosurgery, University of New Mexico, Albuquerque
| | | | - Julie G. Salvador
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Snehal R. Bhatt
- UNM Addiction and Substance Use Program, Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| |
Collapse
|
20
|
Otachi JK, Vundi N, Surratt HL. Examining Factors Associated with Non-Fatal Overdose among People Who Inject Drugs in Rural Appalachia. Subst Use Misuse 2020; 55:1935-1942. [PMID: 32552243 PMCID: PMC9121392 DOI: 10.1080/10826084.2020.1781179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Overdose (OD) deaths have continued to rise in the United States posing a critical public health challenge. Various factors have been associated with increased likelihood of OD, including history of injection drug use. Purpose: This study examined multi-level factors associated with non-fatal OD among current people who inject drugs (PWID) in Appalachian Kentucky. Methods: This cross-sectional study utilized data from 324 PWID recruited via Respondent-Driven Sampling techniques in three Appalachian counties. The analysis focused on correlates of overdose history among people who inject drugs (PWID). Findings: Approximately 36.7% of our sample reported having overdosed in their lifetime, with only 21.4% currently having access to a naloxone kit for OD reversal. Respondents who had injected fentanyl alone or in combination with another drug (OR = 4.26, 95% CI= 2.31,7.86) had 4 times higher odds of an OD than those who did not. Our study found those who injected buprenorphine as primary drug (OR = 0.29, 95% CI = 0.10,0.81) had lower odds of OD compared to those who injected heroin. Conclusions/Importance: Given an increase in OD prevalence among PWID in the U.S, and especially among people living in the Appalachian region of Kentucky, assessing factors associated with OD is critical in development of tailored public health interventions to address the disparate rates of non-fatal OD in this vulnerable population.
Collapse
Affiliation(s)
- Janet K Otachi
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Nikita Vundi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Hilary L Surratt
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
21
|
Cleland CM, Bennett AS, Elliott L, Rosenblum A, Britton PC, Wolfson-Stofko B. Between- and within-person associations between opioid overdose risk and depression, suicidal ideation, pain severity, and pain interference. Drug Alcohol Depend 2020; 206:107734. [PMID: 31775106 PMCID: PMC6980716 DOI: 10.1016/j.drugalcdep.2019.107734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To better understand overdose (OD) risk and develop tailored overdose risk interventions, we surveyed 234 opioid-using veterans residing in New York City, 2014-2017. Our aim was to better understand how predictors of OD may be associated with physical and mental health challenges, including pain severity and interference, depression and suicidal ideation over time. METHODS Veterans completed monthly assessments of the Overdose Risk Behavior Scale (ORBS), pain severity and interference, suicidal ideation, and depression for up to two years and were assessed an average of 14 times over 611 days. To estimate between-person and within-person associations between time-varying covariates and opioid risk behavior, mixed-effects regression was used on the 145-person subsample of veterans completing the baseline and at least three follow-up assessments. RESULTS The level of each time-varying covariate at the average of study time (between-person effect) was positively related to ORBS for pain severity and interference, suicidal ideation, and depression. Deviations from individuals' personal trajectories (within-person effect) were positively related to ORBS for pain severity and interference, suicidal ideation, and depression. CONCLUSIONS US military veterans endure physical and mental health challenges elevating risk for opioid-related overdose. When pain severity, pain interference, suicidal ideation and depression were higher than usual, opioid risk behavior was higher. Conversely, when these health issues were less of a problem than usual, opioid risk behavior was lower. Assessing the physical and mental health of opioid-using veterans over time may support the development and implementation of interventions to reduce behaviors that increase the likelihood of overdose.
Collapse
Affiliation(s)
- Charles M. Cleland
- Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012,Department of Population Health, New York University School
of Medicine, 180 Madison Avenue, New York, NY, 10016
| | - Alex S. Bennett
- College of Global Public Health, New York University, 665
Broadway, 11th Floor, New York, NY, 10012,Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
| | - Luther Elliott
- College of Global Public Health, New York University, 665
Broadway, 11th Floor, New York, NY, 10012,Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
| | - Andrew Rosenblum
- National Development and Research Institutes/USA, New York,
NY, 10010
| | - Peter C. Britton
- VA Center of Excellence for Suicide Prevention, Canandaigua
VA Medical Center, 400 Fort Hill Avenue Canandaigua, NY, USA 14424,Department of Psychiatry, University of Rochester, USA
Rochester, NY
| | - Brett Wolfson-Stofko
- Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
| |
Collapse
|
22
|
Bennett AS, Watford JA, Elliott L, Wolfson-Stofko B, Guarino H. Military veterans' overdose risk behavior: Demographic and biopsychosocial influences. Addict Behav 2019; 99:106036. [PMID: 31494452 PMCID: PMC6791780 DOI: 10.1016/j.addbeh.2019.106036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND U.S. military veterans face many biopsychosocial (BPS) challenges post-service that may elevate risk for opioid-related overdose including physical pain, mental health concerns and social stressors. Some veterans use opioids to manage pain and cope with social readjustment. This study assessed associations between BPS factors and recent engagement in overdose risk behavior in a community sample of post-9/11 veterans who used opioids in New York City. METHODS Participants (n = 218) were recruited through convenience sampling and completed a baseline assessment including a validated Opioid Risk Behavior Scale (ORBS) that measured past-30-day engagement in 22 opioid-related overdose risk behaviors. Analyses examined associations between ORBS scores and hypothesized demographic, biological/physical, psychological and social predictors. Incident rate ratios estimated the expected relative difference in ORBS score associated with each predictor. RESULTS Participants reported an average of 4.72 overdose risk behaviors in the past 30 days. Significant independent predictors of higher ORBS score, after adjustment for demographics and current prescription medications, were past-30-day: depression symptoms; unsheltered or living in a homeless shelter (vs. private housing); history of mental health treatment; experiencing stressful life events; average pain severity; and pain interference. CONCLUSION Veterans face myriad BPS challenges and, while drug-related overdose risks are well understood, findings suggest that other factors-including mental health, pain and stressful life events-may also be associated with overdose risk among opioid-using veterans. The larger challenges veterans face should be considered in the context of BPS forms of pain management when tailoring and delivering overdose prevention interventions.
Collapse
Affiliation(s)
- Alex S Bennett
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11th Fl., New York, NY 10012, United States of America.
| | - J Alexander Watford
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Department of Applied Psychology, Steinhardt School of Culture, Education, and Human Development, New York University, 82 Washington Square E, New York, NY 10003, United States of America
| | - Luther Elliott
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11th Fl., New York, NY 10012, United States of America
| | - Brett Wolfson-Stofko
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11th Fl., New York, NY 10012, United States of America
| | - Honoria Guarino
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11th Fl., New York, NY 10012, United States of America
| |
Collapse
|
23
|
Abstract
OBJECTIVES Unintentional opioid overdose deaths are a public health crisis, and naloxone is the most effective harm reduction tool to curb many of these deaths. There is growing evidence that take-home naloxone can prevent opioid overdose in targeted populations. The goal of this study is to measure the opioid overdose reversal rate with take-home naloxone among participants with a diagnosis of opioid use disorder (OUD) in an opioid treatment program (OTP) setting. METHODS Patients enrolled in an outpatient OTP program were eligible for this prospective cohort study between April 4, 2016 and July 4, 2016. Two hundred forty-four study participants received overdose education, instruction on how to use naloxone, and were provided with 2 doses of a take-home naloxone auto-injector kit. They were subsequently followed for 3 months. RESULTS Thirty-one study participants reported overdose reversals using naloxone auto-injector kits on 38 community members. All overdose reversals were heroin-related. Eighty-seven per cent of the community members reversed with naloxone were friends or relatives of the study participants. CONCLUSIONS This study validates that naloxone is not commonly used on the index study participant, but is often used on a secondary target among people who inject drugs. The large number of overdose reversals reported in this prospective study suggests that this novel model for naloxone use may be replicated at other OTP settings to reduce opioid overdose deaths.
Collapse
|
24
|
Rudolph AE, Young AM, Havens JR. Using Network and Spatial Data to Better Target Overdose Prevention Strategies in Rural Appalachia. J Urban Health 2019; 96:27-37. [PMID: 30465260 PMCID: PMC6391296 DOI: 10.1007/s11524-018-00328-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This analysis uses network and spatial data to identify optimal individuals to target with overdose prevention interventions in rural Appalachia. Five hundred and three rural persons who use drugs were recruited to participate in the Social Networks among Appalachian People Study (2008-2010). Interviewer-administered surveys collected information on demographic characteristics, risk behaviors (including overdose history), network members, and residential addresses. We restricted the sample to individuals with at least one confirmed relationship to another study participant (N = 463). Using dyadic analyses (N = 1428 relationships), we identified relationship-level correlates of relationships with network members who have previously overdosed. We then examined individual- and network-level factors associated with (1) having at least one first-degree alter (i.e., network member) with a prior overdose and (2) each additional network member with a prior overdose (N = 463 study participants). Overall, 28% of the sample had previously overdosed and 57% were one-degree away from someone who previously overdosed. Relationships with those who had overdosed were characterized by closer residential proximity. Those with at least one network member who previously overdosed were more geographically central and occupied more central network positions. Further, the number of network members with an overdose history increased with decreasing distance to the town center, increasing network centrality, and prior enrollment in an alcohol detox program. Because fatal overdoses can be prevented through bystander intervention, these findings suggest that strategies that target more central individuals (both geographically and based on their network positions) and those who have previously enrolled in alcohol detox programs with overdose prevention training and naloxone may optimize intervention reach and have the potential to curb overdose fatalities in this region.
Collapse
Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA. .,Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, 19122, USA.
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.,Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
25
|
Kelly BC, Vuolo M. Social network ties to nightlife and healthcare professionals and prescription drug misuse among young adults. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 66:48-56. [PMID: 30703607 DOI: 10.1016/j.drugpo.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nightlife scenes have been characterized as risk environments where social ecology and network ties facilitate substance use. In contrast to other substances, the prescription drug problem also has been shaped by the healthcare system. How network ties to professionals in these domains are associated with prescription drug misuse remains a key area of study. METHODS We analyzed a sample of 404 young adults who misuse prescription drugs, recruited from nightlife venues primarily via time-space sampling. We evaluated nine types of network ties via friends and family (5 nightlife professions and 4 healthcare professions) as well as total ties in each occupational domain and their relationship to three different outcomes - frequency of misuse, escalation to non-oral use, and substance-related problems. Negative binomial, logistic, and linear regression methods were employed. We then examined mechanisms by which these network associations may operate. RESULTS Ties to party promoters (p < .05) and bouncers (p < .01) were positively associated with all three outcomes. A single outcome each was associated with ties to DJs (problems, p < .01), musicians (frequency, p < .05), and bartenders (escalation, p < .05). The total number of network ties in the nightlife domain was positively associated with all three outcomes, with each additional tie increasing frequency (20.3%, p < .001), odds of escalation (OR = 42.9%, p < .01), and problems (12.5%, p < .01). The number of sources, peer norm context, and social bonding were explanatory mechanisms for all three outcomes for nightlife networks. Specific occupational ties and the total number of ties to healthcare professionals were not associated with any outcome. CONCLUSION Embeddedness in nightlife networks is related to patterns of prescription drug misuse, and some of this association can be explained by multiple mechanisms of social networks. By contrast, ties to healthcare professionals are not associated with patterns of misuse among such young adults.
Collapse
Affiliation(s)
- Brian C Kelly
- Purdue University, Dept. of Sociology, 700 W State St., West Lafayette, IN, 47907, United States.
| | - Mike Vuolo
- The Ohio State University, Dept. of Sociology, United States
| |
Collapse
|
26
|
Push and Pull: Migration Patterns and Links to Harm Reduction Services Among People Who Use Drugs. CANADIAN JOURNAL OF ADDICTION 2018. [DOI: 10.1097/cxa.0000000000000018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Friedman SR, Williams L, Young AM, Teubl J, Paraskevis D, Kostaki E, Latkin C, German D, Mateu-Gelabert P, Guarino H, Vasylyeva TI, Skaathun B, Schneider J, Korobchuk A, Smyrnov P, Nikolopoulos G. Network Research Experiences in New York and Eastern Europe: Lessons for the Southern US in Understanding HIV Transmission Dynamics. Curr HIV/AIDS Rep 2018; 15:283-292. [PMID: 29905915 PMCID: PMC6010197 DOI: 10.1007/s11904-018-0403-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE This paper presents an overview of different kinds of risk and social network methods and the kinds of research questions each can address. RECENT FINDINGS It also reviews what network research has discovered about how network characteristics are associated with HIV and other infections, risk behaviors, preventive behaviors, and care, and discusses some ways in which network-based public health interventions have been conducted. Based on this, risk and social network research and interventions seem both feasible and valuable for addressing the many public health and social problems raised by the widespread use of opioids in the US South.
Collapse
Affiliation(s)
- Samuel R Friedman
- National Development and Research Institutes, Inc., New York, NY, USA.
| | - Leslie Williams
- National Development and Research Institutes, Inc., New York, NY, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Jennifer Teubl
- National Development and Research Institutes, Inc., New York, NY, USA
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Carl Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Honoria Guarino
- National Development and Research Institutes, Inc., New York, NY, USA
| | | | - Britt Skaathun
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA
| | - John Schneider
- Department of Medicine and Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | | | | | | |
Collapse
|
28
|
Pharmaceutical opioid overdose deaths and the presence of witnesses. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:8-13. [PMID: 29433040 DOI: 10.1016/j.drugpo.2017.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/29/2017] [Accepted: 12/18/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND In the past two decades, rates of pharmaceutical opioid use and harms resulting from their use (including death) have risen. The present study identified a series of fatal opioid overdoses where there was evidence that witnesses had noted symptoms consistent with overdose, and examined associated contextual factors. METHODS A retrospective review was undertaken utilising the Coroners Court of Victoria's Overdose Deaths Register for pharmaceutical opioid overdose deaths between 2011 and 2013. Information on the source of pharmaceutical opioids, co-contributing drugs, history of drug dependence, and mental illness was extracted and coded. RESULTS Pharmaceutical opioids were involved in 587 deaths, and within these, 125 cases (21%) were witnessed. The majority of these witnessed deaths (77.6%) occurred at the deceased's residence, with the witness being a partner or unrelated acquaintance who did not realise the significance of what they were witnessing. The most common contributing pharmaceutical opioids were methadone (49.6%), codeine (32.0%), and oxycodone (19.2%), with the source more often prescribed than diverted. Co-contributing drugs were involved in 110 cases, with the most common being benzodiazepines. Evidence of current dependence and mental illness was found in 53.6% of cases. CONCLUSION Most pharmaceutical opioid overdose deaths with a witness present occurred in the deceased's home, with symptoms of overdose being noted, but not acted upon. These findings support the trialling of education and/or naloxone to partners and family members of people who use pharmaceutical opioids in order to reduce overdose deaths.
Collapse
|
29
|
Heavey SC, Chang YP, Vest BM, Collins RL, Wieczorek W, Homish GG. ‘I have it just in case’ — Naloxone access and changes in opioid use behaviours. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 51:27-35. [DOI: 10.1016/j.drugpo.2017.09.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/29/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022]
|
30
|
Carrà G, Crocamo C, Borrelli P, Tabacchi T, Bartoli F, Popa I, Montomoli C, Clerici M. Area-Level Deprivation and Adverse Consequences in People With Substance Use Disorders: Findings From the Psychiatric and Addictive Dual Disorder in Italy (PADDI) Study. Subst Use Misuse 2017; 52:451-458. [PMID: 27849429 DOI: 10.1080/10826084.2016.1240696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Environmental factors may operate with individual ones to influence the risk of substance use. Research has focused on severe adverse consequences influenced by contextual variables. However, the literature on community level factors influencing substance use behaviors is relatively limited across Europe so far. OBJECTIVE We capitalized on data from a National survey, exploring individual and contextual characteristics, to study adverse consequences among people with substance use disorders. METHODS The impact of area-level deprivation on nonfatal overdose, hepatitis C or B infections, and major involvement with the criminal justice system, was explored. Logistic regression models with cluster-robust errors, modeling subject-level and area-level effects, were used. RESULTS Living in deprived and intermediate areas, as compared with affluent ones, was associated with greater likelihood of both nonfatal overdose and jail sentences longer than 6 months, though not of active viral hepatitis. CONCLUSIONS Area-level deprivation may play an important role in determining adverse consequences in people with substance use disorders, also after controlling for individual-level characteristics. More research is needed to understand the aspects of social and physical environments that matter for drug outcomes before effective policy and research interventions can be developed.
Collapse
Affiliation(s)
- Giuseppe Carrà
- a Division of Psychiatry , University College London , London , United Kingdom.,b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
| | - Cristina Crocamo
- b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy.,c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy
| | - Paola Borrelli
- c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy
| | - Tommaso Tabacchi
- b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
| | - Francesco Bartoli
- b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
| | - Ioana Popa
- c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy
| | - Cristina Montomoli
- c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy
| | - Massimo Clerici
- b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
| |
Collapse
|
31
|
Rowe C, Santos GM, Raymond HF, Coffin PO. Social mixing and correlates of injection frequency among opioid use partnerships. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 41:80-88. [PMID: 28113118 DOI: 10.1016/j.drugpo.2016.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND As resources are deployed to address the opioid overdose epidemic in the USA, it is essential that we understand the correlates of more frequent opioid injections-which has been associated not only with HIV and HCV transmission, but also with overdose risk-to inform the development and targeting of effective intervention strategies like overdose prevention and naloxone distribution programs. However, no studies have explored how characteristics of opioid use partnerships may be associated within injection frequency with opioid partnerships. METHODS Using baseline data from a trial of a behavioural intervention to reduce overdose among opioid users in San Francisco, CA, we calculated assortativity among opioid use partnerships by race, gender, participant-reported HIV- and HCV-status, and opioids used using Newman's assortativity coefficient (NC). Multivariable generalized estimating equations linear regression was used to examine associations between individual- and partnership-level characteristics and injection frequency within opioid use partnerships. RESULTS Opioid use partnerships (n=134) reported by study participants (n=55) were assortative by race (NC=0.42, 95%CI=0.33-0.50) and participant-reported HCV-status (NC=0.42, 95%CI=0.31-0.52). In multivariable analyses, there were more monthly injections among sexual/romantic partnerships (β=114.4, 95%CI=60.2-168.7, p<0.001), racially concordant partnerships reported by white study participants (β=71.4, 95%CI=0.3-142.5, p=0.049), racially discordant partnerships reported by African American study participants (β=105.7, 95%CI=1.0-210.5, p=0.048), and partnerships in which either member had witnessed the other experience an overdose (β=81.8, 95%CI=38.9-124.6, p<0.001). CONCLUSION Social segregation by race and HCV-status should potentially be considered in efforts to reach networks of opioid users. Due to higher injection frequency and greater likelihood of witnessing their partners experience an overdose, individuals in sexual/romantic opioid use partnerships, white individuals in racially homogenous partnerships, and African American individuals in heterogeneous partnerships may warrant focused attention as part of peer- and network-based overdose prevention efforts, as well as broader HIV/HCV prevention strategies. Developing and targeting overdose prevention education programs that provide information on risk factors and ways to identify overdose, as well as effective responses, including naloxone use and rescue breathing, for more frequently injecting networks may help reduce opioid morbidity and mortality in these most at risk groups.
Collapse
Affiliation(s)
- Christopher Rowe
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Henry F Raymond
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Phillip O Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| |
Collapse
|
32
|
Shakya HB, Christakis NA, Fowler JH. An exploratory comparison of name generator content: Data from rural India. SOCIAL NETWORKS 2017; 48:157-168. [PMID: 28845086 PMCID: PMC5571897 DOI: 10.1016/j.socnet.2016.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since the 1970s sociologists have explored the best means for measuring social networks, although few name generator analyses have used sociocentric data or data from developing countries, partly because sociocentric studies in developing countries have been scant. Here, we analyze 12 different name generators used in a sociocentric network study conducted in 75 villages in rural Karnataka, India. Having unusual sociocentric data from a non-Western context allowed us to extend previous name generator research through the unique analyses of network structural measures, an extensive consideration of homophily, and investigation of status difference between egos and alters. We found that domestic interaction questions generated networks that were highly clustered and highly centralized. Similarity between respondents and their nominated contacts was strongest for gender, caste, and religion. We also found that domestic interaction name generators yielded the most homogeneous ties, while advice questions yielded the most heterogeneous. Participants were generally more likely to nominate those of higher social status, although certain questions, such as who participants talk to uncovered more egalitarian relationships, while other name generators elicited the names of social contacts distinctly higher or lower in status than the respondent. Some questions also seemed to uncover networks that were specific to the cultural context, suggesting that network researchers should balance local relevance with global generalizability when choosing name generators.
Collapse
Affiliation(s)
- Holly B. Shakya
- School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, United States
- Yale Institute for Network Science, PO Box 208263, New Haven, CT 06520, United States
| | | | - James H. Fowler
- School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, United States
- Political Science Department, University of California San Diego, SSB 301, 9500 Gilman Dr., La Jolla, CA 92093, United States
| |
Collapse
|
33
|
Haglund M, Ang A, Mooney L, Gonzales R, Chudzynski J, Cooper CB, Dolezal BA, Gitlin M, Rawson RA. Predictors of depression outcomes among abstinent methamphetamine-dependent individuals exposed to an exercise intervention. Am J Addict 2016; 24:246-251. [PMID: 25907813 DOI: 10.1111/ajad.12175] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/20/2014] [Accepted: 10/12/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This paper expands on a study investigating depression outcomes in response to an 8-week exercise intervention among methamphetamine (MA) dependent individuals in early recovery. METHODS A total of 135 MA-dependent individuals enrolled in residential treatment were randomly assigned to either a structured exercise intervention or a structured health education control group. Both groups were similar in format: 60-minute sessions, offered three times a week over an 8-week study period. RESULTS Results showed that at the 8-week trial endpoint, participants randomized to the exercise intervention showed significantly greater reduction in depression symptom scores than participants randomized to the health education group, and that participants who attended the greatest number of exercise sessions derived the greatest benefit. This paper further analyzes study data to uncover individual predictors of depression response to exercise and finds that among participants randomized to exercise treatment, individuals with the most severe medical, psychiatric, and addiction disease burden at baseline showed the most significant improvement in depressive symptoms by study endpoint. CONCLUSIONS Our findings suggest that exercise in moderate dose is effective at treating depressive symptoms in individuals in early recovery from addiction, and furthermore, that treatment with exercise appears to be particularly beneficial to individuals who suffer from severe medical, psychiatric, and addictive disorders.
Collapse
Affiliation(s)
- Margaret Haglund
- Adult Division of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Alfonso Ang
- Integrated Substance Abuse Programs, Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Larissa Mooney
- Addiction Medicine Clinic, Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Rachel Gonzales
- Azusa Pacific University, Azusa, California, and Integrated Substance Abuse Programs, Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Joy Chudzynski
- Integrated Substance Abuse Programs, Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Christopher B Cooper
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Brett A Dolezal
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Michael Gitlin
- Adult Division of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Richard A Rawson
- Integrated Substance Abuse Programs, Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, California
| |
Collapse
|
34
|
Abstract
BACKGROUND Fatal opioid overdose is a significant public health concern in the United States. One approach to reducing fatalities is expanding overdose response education to broader audiences. This study examined responses to a web-based overdose education tool. METHODS The results of 422 anonymous surveys submitted on www.stopoverdose.org were analyzed for participant demographics, knowledge of opioid overdose recognition and response, and knowledge of Washington's Good Samaritan overdose law. Characteristics, knowledge, and planned behavior of respondents with professional versus personal interest in overdose education were compared. RESULTS Most respondents were age 35 or older (57%) and female (65%). The mean score on the knowledge quiz for overdose recognition and response items was 16.2 out of 18, and 1.5 out of 2 possible points for items concerning the law. Respondents indicating professional interest were significantly more likely to be 35 or older (p = .001) and to have received prior overdose education (p < .001), but less likely to know someone at risk for opioid overdose (p < .001) or report planning to obtain take-home naloxone (p < .001). No significant differences were found in overdose knowledge scores between groups. CONCLUSIONS Online training may be effective among individuals with professional and personal interest in overdose, as general knowledge scores of overdose response were high among both groups. Lower scores reflecting knowledge of the law suggest that the web-based training may not have adequately presented this information. Overall, results suggest that a web-based platform may be a promising approach to basic overdose education.
Collapse
Affiliation(s)
- Stephanie S Roe
- a Social Development Research Group , University of Washington , Seattle , Washington , USA
| | - Caleb J Banta-Green
- b Alcohol and Drug Abuse Institute , University of Washington , Seattle , Washington , USA
| |
Collapse
|
35
|
Davis CS, Green TC, Zaller ND. Addressing the overdose epidemic requires timely access to data to guide interventions. Drug Alcohol Rev 2015; 35:383-6. [PMID: 26382016 DOI: 10.1111/dar.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/06/2015] [Indexed: 11/26/2022]
Abstract
Fatal opioid overdose, the leading cause of injury death in the USA, is regularly described as an epidemic. The response to the overdose crisis, however, has largely failed to utilise many of the public health tools that have proven effective in combating epidemics. Chief among these is the systematic and timely use of data by public health officials to track outbreaks and effectively target interventions. This failure is particularly acute regarding data from prescription monitoring programmes, which are routinely used by clinicians and law enforcement agents, but often unavailable to health officials. We argue for a shift in emphasis and resources towards an evidence-based public health approach to data use for overdose prevention. [Davis CS, Green TC, Zaller ND. Addressing the overdose epidemic requires timely access to data to guide interventions. Drug Alcohol Rev 2016;35:383-386].
Collapse
Affiliation(s)
| | - Traci C Green
- Boston Medical Center Injury Center, Department of Emergency Medicine, Boston University School of Medicine, Boston, USA.,Emergency Medicine and Epidemiology, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Nickolas D Zaller
- Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
36
|
Wagner KD, Liu L, Davidson PJ, Cuevas-Mota J, Armenta RF, Garfein RS. Association between non-fatal opioid overdose and encounters with healthcare and criminal justice systems: Identifying opportunities for intervention. Drug Alcohol Depend 2015; 153:215-20. [PMID: 26091751 PMCID: PMC4512661 DOI: 10.1016/j.drugalcdep.2015.05.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Accidental overdose, driven largely by opioids, is a leading cause of death among people who inject drugs (PWIDs). We conducted secondary analysis of data from a cohort of PWIDs to identify venues where high-risk PWID could be targeted by overdose education/naloxone distribution (OEND) programs. METHODS 573 PWIDs completed a quantitative survey between June, 2012 and January, 2014, which was analyzed using multivariable logistic regression. The dependent variable was a dichotomous indicator of experiencing a heroin/opioid-related overdose in the past six months. Independent variables included: demographics, drug use behavior, and encounters with two venues - the health care and criminal justice systems - that could serve as potential venues for OEND programs. RESULTS Almost half (41.5%) reported ever experiencing a heroin/opioid overdose, and 45 (7.9%) reported experiencing at least one heroin/opioid overdose in the past six months. In the final multivariable model, receiving care in a hospital in the past six months (Adjusted Odds Ratio [AdjOR] 4.08, 95% Confidence Interval [C.I.] 2.07, 8.04, p<0.001) and being arrested for drug possession in the past six months (AdjOR 5.17, 95% C.I. 2.37, 11.24, p<0.001) were associated with experiencing an opioid overdose in the past six months. CONCLUSIONS Identifying venues outside of those that traditionally target services to PWIDs (i.e., syringe exchange programs) will be critical to implementing OEND interventions at a scale sufficient to address the growing epidemic of heroin/opioid related deaths. Clinical settings, such as hospitals, and drug-related encounters with law enforcement officers are promising venues for the expansion of OEND programs.
Collapse
Affiliation(s)
- Karla D. Wagner
- School of Community Health Sciences, University of Nevada, Reno; 1664 N. Virginia St. MC 0274; Reno, NV 89557
| | - Lin Liu
- Division of Biostatistics & Bioinformatics, Department of Family Medicine and Public Health, University of California School of Medicine; 9500 Gilman Drive MC 0717; La Jolla, CA 92093
| | - Peter J. Davidson
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine; 9500 Gilman Drive MC 0507; La Jolla, CA 92093
| | - Jazmine Cuevas-Mota
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine; 9500 Gilman Drive MC 0507; La Jolla, CA 92093
| | - Richard F. Armenta
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine; 9500 Gilman Drive MC 0507; La Jolla, CA 92093
| | - Richard S. Garfein
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine; 9500 Gilman Drive MC 0507; La Jolla, CA 92093
| |
Collapse
|
37
|
Green TC, Ray M, Bowman SE, McKenzie M, Rich JD. Two cases of intranasal naloxone self-administration in opioid overdose. Subst Abus 2015; 35:129-32. [PMID: 24821348 DOI: 10.1080/08897077.2013.825691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Overdose is a leading cause of death for former prisoners, exacting its greatest toll during the first 2 weeks post release. Protective effects have been observed with training individuals at high risk of overdose and prescribing them naloxone, an opioid antagonist that reverses the effects of the opioid-induced respiratory depression that causes death. CASES The authors report 2 people with opiate use histories who self-administered intranasal naloxone to treat their own heroin overdoses following release from prison. Patient A is a 34-year-old male, who reported having experienced an overdose on heroin the day after he was released from incarceration. Patient B is a 29-year-old female, who reported an overdose on her first injection of heroin, 17 days post release from incarceration. Both patients self-administered the medication but were assisted at some point during the injury by a witness whom they had personally instructed in how to prepare and administer the medication. Neither patient experienced withdrawal symptoms following exposure to naloxone. DISCUSSION Self-administration of naloxone should not be a goal of overdose death prevention training. A safer, more reliable approach is to prescribe naloxone to at-risk patients and train and also equip members of their household and social or drug-using networks in overdose prevention and response.
Collapse
Affiliation(s)
- Traci C Green
- a Department of General Emergency Medicine, Rhode Island Hospital , Providence , Rhode Island , USA
| | | | | | | | | |
Collapse
|
38
|
Davis CS, Pierce M, Dasgupta N. Evolution and convergence of state laws governing controlled substance prescription monitoring programs, 1998-2011. Am J Public Health 2014; 104:1389-95. [PMID: 24922132 DOI: 10.2105/ajph.2014.301923] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to collect and characterize all laws governing the operation of prescription monitoring programs (PMPs), state-level databases that collect patient-specific prescription information, which have been suggested as a tool for reducing prescription drug overdose fatalities. METHODS We utilized a structured legal research protocol to systematically identify, review, and code all PMP statutes and regulations effective from 1998 through 2011. These laws were then abstracted along eleven domains, including reporting provisions, data sharing, and data access. RESULTS PMP characteristics vary greatly among states and across time. We observed an increase in the types and frequency of data required to be reported, the types of individuals permitted to access PMP data, and the percentage of PMPs authorized to proactively identify outlier prescribers and patients. As of 2011, 10 states required PMPs to report suspicious activity to law enforcement, while only 3 required reporting to the patient's physician. None required linkage to drug treatment or required all prescribers to review PMP data before prescribing. Few explicitly address data retention. CONCLUSIONS State PMP laws are heterogeneous and evolving. Future studies of PMP effectiveness should take these variations into account.
Collapse
Affiliation(s)
- Corey S Davis
- Corey S. Davis is with the Network for Public Health Law, Southeastern Region, Carrboro, North Carolina. Matthew Pierce is with the Health Law and Justice Program, American University Washington College of Law, Washington, DC. Nabarun Dasgupta is with the Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | | | | |
Collapse
|
39
|
Howell JL, Koudenburg N, Loschelder DD, Weston D, Fransen K, De Dominicis S, Gallagher S, Haslam SA. Happy but unhealthy: The relationship between social ties and health in an emerging network. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2014. [DOI: 10.1002/ejsp.2030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
40
|
Moore C, Lloyd G, Oretti R, Russell I, Snooks H. Paramedic-supplied 'Take Home' Naloxone: protocol for cluster randomised feasibility study. BMJ Open 2014; 4:e004712. [PMID: 24650810 PMCID: PMC3963087 DOI: 10.1136/bmjopen-2013-004712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION 'Take Home' Naloxone (THN) kits for use by peers in the event of an opioid overdose may reduce further overdose and deaths, but distribution through Drugs Services may not reach those at highest risk. Attendance by paramedics at emergency calls for patients who have suffered an overdose presents an opportunity to distribute THN kits. In this feasibility study we will assess the acceptability of this intervention, and gather data to inform definitive trial planning. METHODS AND ANALYSIS Cluster randomised trial with staggered allocation of paramedics (clusters) to groups. We will invite paramedics in an urban area of south Wales, UK to take part. We will randomly allocate those that accept to training sessions during the first 4 months of the trial. Patients attended by paramedics who have been trained and issued THN kits will fall into the intervention group. Patients attended by paramedics following usual practice (until they receive their training and THN kits) will fall into the control group. We will gather data about processes and outcomes of care: numbers of patients eligible for intervention, offered and accepted THN, attended emergency department, suffered further overdose, died within 3 months and about follow-up rates: numbers of patients consented, completed (postal or telephone) questionnaire. We will gather qualitative data about acceptability to patients and paramedics through interviews and focus groups. ETHICS AND DISSEMINATION Ethical approval for this study was granted on 7 December 2011, by South East Wales Research Ethics Committee, Panel C. Results of this study will be reported through peer-reviewed scientific journals, conference presentations and internal organisational report. We will also seek to report our findings through local and national substance misuse networks and publications. TRIAL REGISTRATION NUMBER ISRCTN98216498.
Collapse
Affiliation(s)
- Chris Moore
- Medical and Clinical Services Directorate, Welsh Ambulance Services NHS Trust, Blackweir Ambulance Station, Cardiff, UK
| | - Gregory Lloyd
- Operational Services, Welsh Ambulance Services NHS Trust, Blackweir Ambulance Station, Cardiff, UK
| | - Rossana Oretti
- Cardiff Addictions Unit, Cardiff & Vale University Health Board, Cardiff Royal Infirmary, Cardiff, UK
| | - Ian Russell
- West Wales Organisation for Rigorous Trials in Health (WWORTH), Institute of Life Science, College of Medicine, Singleton Park, Swansea, UK
| | - Helen Snooks
- Thematic Research Network for Emergency, Unscheduled and Trauma care (TRUST), Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, UK
| |
Collapse
|
41
|
Cerdá M, Ransome Y, Keyes KM, Koenen KC, Tardiff K, Vlahov D, Galea S. Revisiting the role of the urban environment in substance use: the case of analgesic overdose fatalities. Am J Public Health 2013; 103:2252-60. [PMID: 24134362 PMCID: PMC3828967 DOI: 10.2105/ajph.2013.301347] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether neighborhood social characteristics (income distribution and family fragmentation) and physical characteristics (clean sidewalks and dilapidated housing) were associated with the risk of fatalities caused by analgesic overdose. METHODS In a case-control study, we compared 447 unintentional analgesic opioid overdose fatalities (cases) with 3436 unintentional nonoverdose fatalities and 2530 heroin overdose fatalities (controls) occurring in 59 New York City neighborhoods between 2000 and 2006. RESULTS Analgesic overdose fatalities were less likely than nonoverdose unintentional fatalities to have occurred in higher-income neighborhoods (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.70, 0.96) and more likely to have occurred in fragmented neighborhoods (OR = 1.35; 95% CI = 1.05, 1.72). They were more likely than heroin overdose fatalities to have occurred in higher-income (OR = 1.31; 95% CI = 1.12, 1.54) and less fragmented (OR = 0.71; 95% CI = 0.55, 0.92) neighborhoods. CONCLUSIONS Analgesic overdose fatalities exhibit spatial patterns that are distinct from those of heroin and nonoverdose unintentional fatalities. Whereas analgesic fatalities typically occur in lower-income, more fragmented neighborhoods than nonoverdose fatalities, they tend to occur in higher-income, less unequal, and less fragmented neighborhoods than heroin fatalities.
Collapse
Affiliation(s)
- Magdalena Cerdá
- Magdalena Cerdá, Katherine M. Keyes, Karestan C. Koenen and Sandro Galea are with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Yusuf Ransome is with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health. Kenneth Tardiff is with the Department of Psychiatry, Weill Cornell Medical College, New York, NY. David Vlahov is with the School of Nursing, University of California, San Francisco
| | | | | | | | | | | | | |
Collapse
|
42
|
Hall MT, Leukefeld CG, Havens JR. Factors associated with high-frequency illicit methadone use among rural Appalachian drug users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 39:241-6. [PMID: 23841864 DOI: 10.3109/00952990.2013.805761] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In recent years there has been a sharp increase in the use of illicit methadone as well as methadone-related overdose deaths. OBJECTIVE The purpose of this study was to describe factors associated with low- and high-frequency methadone use in a cohort of rural Appalachian drug users. METHODS Interviews assessing sociodemographics, illicit drug use and drug treatment, psychiatric disorders, health and sociometric drug network characteristics were conducted with 503 rural drug users between 2008 and 2010. A two-level mixed effects regression model was utilized to differentiate low- (one use per month or less in the past six months) versus high-frequency (daily or weekly use in the past six months) illicit methadone users. RESULTS The lifetime prevalence of illicit methadone use in this population was 94.7% (n = 476) and slightly less than half (46.3%) were high-frequency users. In the mixed effects regression model, initiating illicit methadone use at a younger age was associated with high-frequency illicit methadone use. Taking a prescribed medication for a physical problem, undergoing additional weeks of outpatient drug free treatment, daily OxyContin® use in the past month, and having fewer ties and second-order connections in the drug network reduced the odds of high-frequency illicit methadone use. CONCLUSIONS Rates of illicit methadone use and high-frequency illicit methadone use among this sample of rural drug users were considerably higher than those previously reported in the literature. Health practitioners in rural areas should routinely screen for illicit opioid use, including methadone.
Collapse
Affiliation(s)
- Martin T Hall
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA.
| | | | | |
Collapse
|
43
|
Pabayo R, Alcantara C, Kawachi I, Wood E, Kerr T. The role of depression and social support in non-fatal drug overdose among a cohort of injection drug users in a Canadian setting. Drug Alcohol Depend 2013; 132:603-9. [PMID: 23647731 PMCID: PMC3770831 DOI: 10.1016/j.drugalcdep.2013.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Non-fatal overdose remains a significant source of morbidity among people who inject drugs (IDU). Although depression and social support are important in shaping the health of IDU, little is known about the relationship between these factors and overdose. Therefore, we sought to determine whether depressive symptoms and social support predicted non-fatal overdose among IDU in a Canadian setting. METHODS Data were derived from three prospective cohorts of people who use drugs: the Vancouver Injection Drug Users Study (VIDUS), the ACCESS Cohort, and the At-Risk Youth Study (ARYS). Multilevel modeling was used to determine if depression and social support were significant predictors of non-fatal overdose across time. Analyses were stratified by sex. RESULTS There were 1931 participants included in this analysis, including 653 (33.8%) females and 69 (3.6%) youth 20 years old or younger. Depressed men (adjusted odds ratio [AOR]=1.53, 95% confidence intervals [CI]=1.25, 1.87) and women (adjusted odds ratio [AOR]=2.23, 95% confidence intervals [CI]=1.65, 3.00) were more likely to experience a non-fatal overdose. Further, among women, those who reported having 3 or more persons they could rely upon for social support were less likely to experience a non-fatal overdose (AOR=0.54, 95% CI 0.31, 0.93). CONCLUSION Although depression was a significant predictor of non-fatal drug overdose, social support was a significant predictor among women only. Possible strategies to prevent non-fatal overdose may include identifying IDU experiencing severe depressive symptoms and providing targeted mental health treatments and mobilizing interpersonal social support among IDU, especially among women.
Collapse
Affiliation(s)
- Roman Pabayo
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Carmela Alcantara
- Department of Medicine, Columbia University Medical Center, 622 West 168 Street, PH-9, Room 9-319, New York, NY, USA, 10032
| | - Ichiro Kawachi
- Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, USA, 02115
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6,School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6,School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| |
Collapse
|
44
|
Wagner KD, Davidson PJ, Iverson E, Washburn R, Burke E, Kral AH, McNeeley M, Jackson Bloom J, Lankenau SE. "I felt like a superhero": the experience of responding to drug overdose among individuals trained in overdose prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:157-65. [PMID: 23932166 DOI: 10.1016/j.drugpo.2013.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/01/2013] [Accepted: 07/07/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Overdose prevention programs (OPPs) train people who inject drugs and other community members to prevent, recognise and respond to opioid overdose. However, little is known about the experience of taking up the role of an "overdose responder" for the participants. METHODS We present findings from qualitative interviews with 30 participants from two OPPs in Los Angeles, CA, USA from 2010 to 2011 who had responded to at least one overdose since being trained in overdose prevention and response. RESULTS Being trained by an OPP and responding to overdoses had both positive and negative effects for trained "responders". Positive effects include an increased sense of control and confidence, feelings of heroism and pride, and a recognition and appreciation of one's expertise. Negative effects include a sense of burden, regret, fear, and anger, which sometimes led to cutting social ties, but might also be mitigated by the increased empowerment associated with the positive effects. CONCLUSION Findings suggest that becoming an overdose responder can involve taking up a new social role that has positive effects, but also confers some stress that may require additional support. OPPs should provide flexible opportunities for social support to individuals making the transition to this new and critical social role. Equipping individuals with the skills, technology, and support they need to respond to drug overdose has the potential to confer both individual and community-wide benefits.
Collapse
Affiliation(s)
- Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA 92093-0507, USA.
| | - Peter J Davidson
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA 92093-0507, USA
| | - Ellen Iverson
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS 2, Los Angeles, CA 90027, USA
| | - Rachel Washburn
- Department of Sociology, Loyola Marymount University, One LMU Drive, Suite 4314, Los Angeles, CA 90045-2659, USA
| | - Emily Burke
- Department of Community Health and Prevention, Drexel University School of Public Health, 1505 Race Street, Bellet Building, Philadelphia, PA 19102-1192, USA
| | - Alex H Kral
- Urban Health Program, RTI International, San Francisco Regional Office, 114 Sansome Street, Suite 500, San Francisco, CA 94104, USA
| | - Miles McNeeley
- Community, Health Outcomes and Intervention Research Program, The Saban Research Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 30, Los Angeles, CA 90027, USA
| | - Jennifer Jackson Bloom
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS 2, Los Angeles, CA 90027, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Drexel University School of Public Health, 1505 Race Street, Bellet Building, Philadelphia, PA 19102-1192, USA
| |
Collapse
|
45
|
Kapadia F, Siconolfi DE, Barton S, Olivieri B, Lombardo L, Halkitis PN. Social support network characteristics and sexual risk taking among a racially/ethnically diverse sample of young, urban men who have sex with men. AIDS Behav 2013; 17:1819-28. [PMID: 23553346 PMCID: PMC3761803 DOI: 10.1007/s10461-013-0468-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Associations between social support network characteristics and sexual risk among racially/ethnically diverse young men who have sex with men (YMSM) were examined using egocentric network data from a prospective cohort study of YMSM (n = 501) recruited in New York City. Bivariate and multivariable logistic regression analyses examined associations between social support network characteristics and sexual risk taking behaviors in Black, Hispanic/Latino, and White YMSM. Bivariate analyses indicated key differences in network size, composition, communication frequency and average relationship duration by race/ethnicity. In multivariable analyses, controlling for individual level sociodemographic, psychosocial and relationship factors, having a sexual partner in one's social support network was associated with unprotected sexual behavior for both Hispanic/Latino (AOR = 3.90) and White YMSM (AOR = 4.93). Further examination of key network characteristics across racial/ethnic groups are warranted in order to better understand the extant mechanisms for provision of HIV prevention programming to racially/ethnically diverse YMSM at risk for HIV.
Collapse
Affiliation(s)
- F Kapadia
- Center for Health, Identity, Behavior and Prevention Studies, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10016, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Shakya HB, Christakis NA, Fowler JH. Parental influence on substance use in adolescent social networks. ACTA ACUST UNITED AC 2013; 166:1132-9. [PMID: 23045157 DOI: 10.1001/archpediatrics.2012.1372] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the relationship between the parenting style of an adolescent's peers' parents and an adolescent's substance use. DESIGN Longitudinal survey. SETTING Adolescents across the United States were interviewed at school and at home. PARTICIPANTS Nationally representative sample of adolescents in the United States. MAIN EXPOSURE Authoritative vs neglectful parenting style of adolescent's parents and adolescent's friends' parents and adolescent substance use. MAIN OUTCOME MEASURES Adolescent alcohol abuse, smoking, marijuana use, and binge drinking. RESULTS If an adolescent had a friend whose mother was authoritative, that adolescent was 40% (95% CI, 12%-58%) less likely to drink to the point of drunkenness, 38% (95% CI, 5%-59%) less likely to binge drink, 39% (95% CI, 12%-58%) less likely to smoke cigarettes, and 43% (95% CI, 1%-67%) less likely to use marijuana than an adolescent whose friend's mother was neglectful, controlling for the parenting style of the adolescent's own mother, school-level fixed effects, and demographics. These results were only partially mediated by peer substance use. CONCLUSIONS Social network influences may extend beyond the homogeneous dimensions of own peer or own parent to include extradyadic influences of the wider network. The value of parenting interventions should be reassessed to take into account these spillover effects in the greater network.
Collapse
Affiliation(s)
- Holly B Shakya
- Department of Medicine, School of Medicine, University of California, San Diego, USA.
| | | | | |
Collapse
|
47
|
Rudolph AE, Linton S, Dyer TP, Latkin C. Individual, network, and neighborhood correlates of exchange sex among female non-injection drug users in Baltimore, MD (2005-2007). AIDS Behav 2013; 17:598-611. [PMID: 22983502 DOI: 10.1007/s10461-012-0305-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The "HIV risk environment" has been characterized as a dynamic interplay between structural and network factors. However, most HIV prevention research has not examined the independent and combined impact of network and structural factors. We aimed to identify individual, network, and neighborhood correlates of exchange sex (≥1 exchange sex partner, past 90 days) among female non-injection drug users (NIDUs). We used baseline data from 417 NIDUs enrolled in a randomized HIV prevention trial in Baltimore (2005-2007). Surveys ascertained demographic variables, drug/sex risk behaviors, neighborhood perceptions, and social/sexual network characteristics. Correlates of exchange sex were identified with descriptive statistics and log-binomial regression. Our findings suggest that sex and drug relationships among female NIDUs are interlinked and may be difficult to modify without altering social norms. Strengthening ties that provide social support but not drug support and reducing ties that provide both drug and social support may facilitate reductions in individual-level HIV-risk behaviors.
Collapse
Affiliation(s)
- Abby E Rudolph
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, 92093-0507, USA.
| | | | | | | |
Collapse
|
48
|
Silva K, Schrager SM, Kecojevic A, Lankenau SE. Factors associated with history of non-fatal overdose among young nonmedical users of prescription drugs. Drug Alcohol Depend 2013; 128:104-10. [PMID: 22974490 PMCID: PMC4184803 DOI: 10.1016/j.drugalcdep.2012.08.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/09/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The current study examines the prevalence and correlates of lifetime non-fatal overdose (OD) involving the nonmedical use of prescription opioids and tranquilizers among a sample of high-risk young adults in New York, NY and Los Angeles, CA. METHODS Data were derived from a cross-sectional study of 16-25 year old nonmedical users of prescription drugs (n=596). Unadjusted associations between OD history and socio-demographic and drug use variables were investigated in bivariate logistic regression models. Multivariate logistic regression models identified correlates of non-fatal OD. RESULTS Lifetime prevalence of non-fatal overdose involving prescription opioids and/or tranquilizers was 23.6%. Factors associated with increased risk of non-fatal overdose included lower social class while growing up (OR: 1.81, 95% CI: [1.15, 2.83], p<0.01), having ever received care at a psychiatric hospital (OR: 1.79, 95% CI: [1.12, 2.85], p<0.05), ever witnessing a family member OD on drugs (OR: 1.59, 95% CI: [1.02, 2.50], p<0.05), being prescribed tranquilizers (OR: 2.07, 95% CI: [1.29, 4.27], p<0.01), ever snorting or sniffing opioids (OR: 2.51, 95% CI: [1.48, 4.27], p<0.001), injecting tranquilizers (OR: 3.09, 95% CI: [1.61, 5.93], p<0.001), and past 90-day injection drug use (OR: 1.68, 95% CI: [1.03, 2.74], p<0.05). Participants who reported past 90-day stimulant misuse had lower odds of reporting OD compared to those who were not recent stimulant users (OR: 0.60, 95% CI: [0.38-0.96], p<0.05). CONCLUSIONS This study documents the high prevalence of experiencing non-fatal overdose among young nonmedical users of prescription drugs. Results could inform overdose prevention efforts throughout the U.S.
Collapse
Affiliation(s)
- Karol Silva
- Drexel University, School of Public Health, Department of Community Health and Prevention, 1505 Race Street, 11th Floor, Philadelphia, PA 19102, USA.
| | - Sheree M. Schrager
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, 5000 Sunset Boulevard, 7th Floor, Los Angeles, CA 90027, USA
| | - Aleksandar Kecojevic
- Drexel University, School of Public Health, Department of Community Health and Prevention, 1505 Race Street, 11th Floor, Philadelphia, PA 19102, USA
| | - Stephen E. Lankenau
- Drexel University, School of Public Health, Department of Community Health and Prevention, 1505 Race Street, 11th Floor, Philadelphia, PA 19102, USA
| |
Collapse
|
49
|
Wagner KD, Iverson E, Wong CF, Jackson-Bloom J, McNeeley M, Davidson PJ, McCarty C, Kral AH, Lankenau SE. Personal social network factors associated with overdose prevention training participation. Subst Use Misuse 2013; 48:21-30. [PMID: 22988840 PMCID: PMC3698974 DOI: 10.3109/10826084.2012.720335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We investigated social network factors associated with participation in overdose prevention training among injection drug users (IDUs). From 2008 to 2010, 106 IDUs who had witnessed an overdose in the past year from two syringe exchange programs in Los Angeles provided data on overdose prevention training status (trained vs. untrained), social networks, history of overdose, and demographics. In multivariate logistic regression, naming at least one network member who had been trained in overdose prevention was significantly associated with being trained (Adjusted Odds Ratio 3.25, 95% Confidence Interval 1.09, 9.68). Using social network approaches may help increase training participation. Limitations are noted.
Collapse
Affiliation(s)
- Karla D. Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego; 9500 Gilman Drive MC 0507, San Diego, CA 92093-0507
| | - Ellen Iverson
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California; 4650 Sunset Blvd., MS 2, Los Angeles, CA 90027
| | - Carolyn F. Wong
- Community, Health Outcomes and Intervention Research Program, The Saban Research Institute, Children’s Hospital Los Angeles; 4650 Sunset Blvd., MS 30, Los Angeles, CA 90027 and Department of Pediatrics, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California
| | - Jennifer Jackson-Bloom
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California; 4650 Sunset Blvd., MS 2, Los Angeles, CA 90027
| | - Miles McNeeley
- Community, Health Outcomes and Intervention Research Program, The Saban Research Institute, Children’s Hospital Los Angeles; 4650 Sunset Blvd., MS 30, Los Angeles, CA 90027
| | - Peter J. Davidson
- Division of Global Public Health, Department of Medicine, University of California San Diego; 9500 Gilman Drive MC 0507, San Diego, CA 92093-0507
| | - Christopher McCarty
- Bureau of Economic and Business Research; Health Services Research, Management and Policy; University of Florida; PO Box 117145, Gainesville, FL 32611-7145
| | - Alex H. Kral
- Urban Health Program, RTI International, San Francisco Regional Office; 114 Sansome St., Suite 500; San Francisco, CA 94104 and Department of Family and Community Medicine, University of California San Francisco
| | - Stephen E. Lankenau
- Department of Community Health and Prevention, Drexel University School of Public Health; 1505 Race Street, Bellet Building, Philadelphia, PA 19102-1192
| |
Collapse
|
50
|
Bohnert ASB, Tracy M, Galea S. Characteristics of drug users who witness many overdoses: implications for overdose prevention. Drug Alcohol Depend 2012; 120:168-73. [PMID: 21839588 PMCID: PMC3229655 DOI: 10.1016/j.drugalcdep.2011.07.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Programs to improve response of drug users when witnessing an overdose can reduce overdose mortality. Characteristics of drug users may be associated with the number of overdoses ever witnessed. This information could inform overdose prevention programs. METHODS Participants in New York City, who were age 18 and older with heroin and/or cocaine use in the past two months, were administered structured interviews (n=1184). Survey topics included overdose response, drug use behavior, treatment history, and demographic information. RESULTS In a multivariable negative binomial regression model, those persons who were male (IRR [Incidence Rate Ratio]=1.7, CI [95% Confidence Interval]=1.4,2.2), had experienced homelessness (IRR=1.9, CI=1.4,2.6), had used heroin (IRR=2.0, CI=1.3,3.2), had overdosed themselves (IRR=1.9, CI=1.6,2.4), or had attended Narcotics Anonymous (IRR=1.3, CI=1.1,1.6) witnessed a greater count of overdoses in their lifetime. Those persons who have witnessed more overdoses were less likely to have sought medical assistance (OR [Odds Ratio]=0.7) and more likely to report counter-productive or ineffective actions (ORs between 1.9 and 2.4) at the last overdose they witnessed compared to persons who had only ever witnessed one or two overdoses. CONCLUSIONS Persons at high risk for overdose are likely to witness more overdoses. Persons who had witnessed more overdoses were more likely to report taking ineffective action at the last overdose witnessed. Individuals who have witnessed many overdoses are likely key targets of overdose response training.
Collapse
Affiliation(s)
- Amy S B Bohnert
- VA National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, United States.
| | | | | |
Collapse
|