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Bergeria CL, Huhn AS, Dunn KE. Randomized comparison of two web-based interventions on immediate and 30-day opioid overdose knowledge in three unique risk groups. Prev Med 2019; 128:105718. [PMID: 31078564 PMCID: PMC6842412 DOI: 10.1016/j.ypmed.2019.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND In response to the opioid overdose epidemic, scalable interventions that instruct at-risk populations how to prevent and respond to overdose scenarios are needed. METHOD The following groups of at-risk individuals were recruited online: (1) Acute Pain patients with an opioid prescription, (2) Chronic Pain patients with an opioid prescription, and (3) persons without pain who use Illicit Opioids. Participants were tested on their opioid overdose knowledge using the Brief Opioid Overdose Knowledge (BOOK) questionnaire and randomized to one of two web-based interventions that contained 25 educational content slides. One intervention consisted of embedded questions with corrective feedback (Presentation + Mastery, n = 58), the other did not (Presentation, n = 61). Participants completed the BOOK again at the end of the intervention and 30 days later. Overdose risk behaviors were assessed at baseline and 30-days. RESULTS Relative to baseline, both Presentation and Presentation + Mastery interventions increased total BOOK scores immediately and 30 days later. There was a significant effect of Group on BOOK Knowledge, whereby those with Acute Pain had lower scores across time, regardless of intervention, relative to those with Chronic Pain and Illicit Opioid Use. Compared to baseline, all three groups reported fewer instances of using opioids alone or concurrently with alcohol at the 30-day follow-up. CONCLUSIONS A web-based intervention increased opioid overdose knowledge and decreased overdose risk behavior immediately and at a one-month follow-up, suggesting that this brief, practical, and scalable program could have utility in several populations who are at-risk of opioid overdose.
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Affiliation(s)
- Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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Moving opioid misuse prevention upstream: A pilot study of community pharmacists screening for opioid misuse risk. Res Social Adm Pharm 2019; 15:1032-1036. [DOI: 10.1016/j.sapharm.2018.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/08/2023]
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Abbasi AB, Salisbury-Afshar E, Jovanov D, Berberet C, Arunkumar P, Aks SE, Layden JE, Pho MT. Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History. J Urban Health 2019; 96:38-48. [PMID: 30607879 PMCID: PMC6391294 DOI: 10.1007/s11524-018-00329-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Opioid overprescribing is a major driver of the current opioid overdose epidemic. However, annual opioid prescribing in the USA dropped from 782 to 640 morphine milligram equivalents per capita between 2010 and 2015, while opioid overdose deaths increased by 63%. To better understand the role of prescription opioids and health care utilization prior to opioid-related overdose, we analyzed the death records of decedents who died of an opioid overdose in Illinois in 2016 and linked to any existing controlled substance monitoring program (CSMP) and emergency department (ED) or hospital discharge records. We found that of the 1893 opioid-related overdoses, 573 (30.2%) decedents had not filled an opioid analgesic prescription within the 6 years prior to death. Decedents without an opioid prescription were more likely to be black (33.3% vs 20.2%, p < .001), Hispanic (16.3% vs 8.8%, p < .001), and Chicago residents (46.8% vs 25.6%, p < .001) than decedents with at least one filled opioid prescription. Decedents who did not fill an opioid prescription were less likely to die of an overdose involving prescribed opioids (7.3% vs 19.5%, p < .001) and more likely to fatally overdose on heroin (63% vs 50.4%, p < .001) or fentanyl/fentanyl analogues (50.3% vs 41.8%, p = .001). Between 2012 and the time of death, decedents without an opioid prescription had fewer emergency department admissions (2.5 ± 4.2 vs 10.6 ± 15.8, p < .001), were less likely to receive an opioid use disorder diagnosis (41.3% vs 47.5%, p = .052), and were less likely to be prescribed buprenorphine for opioid use disorder treatment (3.3% vs 8.6%, p < .001). Public health interventions have often focused on opioid prescribing and the use of CSMPs as the core preventive measures to address the opioid crisis. We identified a subset of individuals in Illinois who may not be impacted by such interventions. Additional research is needed to understand what strategies may be successful among high-risk populations that have limited opioid analgesic prescription history and low health care utilization.
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Affiliation(s)
- Ali B Abbasi
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA. .,Illinois Department of Public Health, Chicago, IL, USA.
| | - Elizabeth Salisbury-Afshar
- Center for Multi-System Solutions to the Opioid Epidemic, American Institutes for Research, Chicago, IL, USA
| | - Dejan Jovanov
- Division of Patient Safety and Quality, Illinois Department of Public Health, Chicago, IL, USA
| | - Craig Berberet
- Prescription Monitoring Program, Illinois Department of Human Services, Chicago, IL, USA
| | | | - Steven E Aks
- Department of Emergency Medicine, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Mai T Pho
- Illinois Department of Public Health, Chicago, IL, USA.,Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
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Chang HY, Murimi I, Faul M, Rutkow L, Alexander GC. Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis. Pharmacoepidemiol Drug Saf 2018; 27:422-429. [PMID: 29488663 PMCID: PMC6664298 DOI: 10.1002/pds.4404] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients. METHODS We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012. We identified 3 types of high-risk patients: (1) concomitant users: patients with concomitant use of benzodiazepines and opioids; (2) chronic users: long-term, high-dose, opioid users; and (3) opioid shoppers: patients receiving opioids from multiple sources. We compared changes in opioid prescriptions between Florida and Georgia before and after policy implementation among high-risk/low-risk patients. Our monthly measures included (1) average morphine milligram equivalent per transaction, (2) total opioid volume across all prescriptions, (3) average days supplied per transaction, and (4) total number of opioid prescriptions dispensed. RESULTS Among opioid-receiving individuals in Florida, 6.62% were concomitant users, 1.96% were chronic users, and 0.46% were opioid shoppers. Following policy implementation, Florida's high-risk patients experienced relative reductions in morphine milligram equivalent (opioid shoppers: -1.08 mg/month, 95% confidence interval [CI] -1.62 to -0.54), total opioid volume (chronic users: -4.58 kg/month, CI -5.41 to -3.76), and number of dispensed opioid prescriptions (concomitant users: -640 prescriptions/month, CI -950 to -340). Low-risk patients generally did not experience statistically significantly relative reductions. CONCLUSIONS Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients.
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Affiliation(s)
- Hsien-Yen Chang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Irene Murimi
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Faul
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA
| | - Lainie Rutkow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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Prescription drug monitoring program design and function: A qualitative analysis. Drug Alcohol Depend 2017; 180:395-400. [PMID: 28978492 DOI: 10.1016/j.drugalcdep.2017.08.040] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Opioid-related overdose deaths are a major public health challenge. Forty-nine states have implemented Prescription Drug Monitoring Programs (PDMPs) that collect information about individuals' prescription medications. Little is known about state governments' implementation of PDMPs. We conducted semi-structured interviews with PDMP staff, law enforcement officials, and administrative agency employees to learn about their attitudes and experiences with PDMPs. METHODS From May 2015 to June 2016, we conducted 37 semi-structured interviews with state actors in four states. Questions focused on interviewees' perceptions about PDMP goals, home agency characteristics, and future PDMP initiatives. States were selected purposively. Interviewees were identified through purposive and snowball sampling. RESULTS Interviewees identified key PDMP goals as: improve patient treatment decisions; influence prescribing practices; assist in the identification of "doctor shoppers"; and serve as a tool for law enforcement. Interviewees identified the following characteristics as key for a PDMP's home agency: regulatory and enforcement authority; intra- and inter-agency collaboration; and commitment to data quality and protection. Interviewees identified three promising areas for future PDMP efforts: data sharing and analysis; integration of PDMP data with electronic medical records; and training for current and potential PDMP users. CONCLUSIONS Our findings reveal areas that states may want to prioritize, including improving prescribers' knowledge and use of the PDMP as well as fostering inter-agency collaborations that include PDMP staff. By capitalizing on these opportunities, state governments may improve the effectiveness of their PDMPs, potentially making them more useful tools to curb the morbidity and mortality associated with opioid use disorders.
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Today’s fentanyl crisis: Prohibition’s Iron Law, revisited. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:156-159. [DOI: 10.1016/j.drugpo.2017.05.050] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/28/2017] [Indexed: 01/27/2023]
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Barth KS, Guille C, McCauley J, Brady KT. Targeting practitioners: A review of guidelines, training, and policy in pain management. Drug Alcohol Depend 2017; 173 Suppl 1:S22-S30. [PMID: 28363316 PMCID: PMC5555357 DOI: 10.1016/j.drugalcdep.2016.08.641] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 01/03/2023]
Abstract
This paper reviews the current literature on clinical guidelines, practitioner training, and government/payer policies that have come forth in response to the national rise in prescription opioid overdoses. A review of clinical opioid prescribing guidelines highlights the need for more research on safe and effective treatment options for chronic pain, improved guidance for the best management of post-operative pain, and evaluation of the implementation and impact of guideline recommendations on patient risk and outcomes. Although there is increasing attention to training in pain management in medical schools and medical residency programs, educational opportunities remain highly variable, and the need for additional clinician training in the recognition and treatment of pain as well as opioid use disorder has been recognized. Mandated use of private, federal and state educational and clinical initiatives such as Risk Evaluation and Mitigation Strategies (REMS) and Prescription Drug Monitoring Programs (PDMPs) generally increase utilization of these initiatives, but more research is needed to determine the impact of these initiatives on provider behaviors, treatment access, and patient outcomes. Finally, there is an acute need for more research on safe and effective treatments for chronic pain as well as an increased multi-level focus on improving training and access to evidence-based treatment for opioid use disorder as well as non-pharmacologic and non-interventional chronic pain treatments, so that these guideline-recommended interventions can become mainstream, accessible, first-line interventions for chronic pain and/or opioid use disorders.
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Affiliation(s)
- Kelly S Barth
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Jenna McCauley
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
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Sheridan DC, Laurie A, Hendrickson RG, Fu R, Kea B, Horowitz BZ. Association of Overall Opioid Prescriptions on Adolescent Opioid Abuse. J Emerg Med 2016; 51:485-490. [PMID: 27596964 DOI: 10.1016/j.jemermed.2016.06.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/07/2016] [Accepted: 06/29/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Opioid abuse is a public health epidemic in the United States. Much literature has focused on the prescribing practices of physicians and opioid misuse by adults. However, there are limited data on the effect of opioid prescriptions on adolescent recreational ingestion of these medications. OBJECTIVES The objective of this study was to assess for a relationship between opioid prescribing practices across the United States and adolescent opioid ingestion calls to poison centers. METHODS This was an observational study using the National Poison Data System. The study population consisted of poison center calls regarding adolescents between 2005 and 2010 in the database with a coding of "intentional abuse" and an opioid ingestion. National opioid prescription estimates were generated using nationally representative outpatient and inpatient databases. RESULTS There were 4186 adolescent opioid ingestion calls during the study period. There was a general increase between 2005 and 2010 in both teen opioid abuse calls (617 in 2005 to 782 in 2010) and national opioid prescriptions (approximately 78 million in 2005 to 108 million in 2010). For each opioid prescription increase per 100 persons per year, the annual teen opioid abuse calls increased by 1.8% (95% confidence interval 0.9-2.8%), equivalent to an absolute increase of about 0.04 to 0.05 calls per 100,000 teens annually. CONCLUSIONS There appears to be an association between opioid prescriptions nationally and poison center calls for adolescent opioid ingestions. This is particularly important in this patient population because of impulsivity and early exposure to substance abuse. Providers should be aware of the nonmedical use of opioids by adolescents and educate patients accordingly.
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Affiliation(s)
- David C Sheridan
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | - Amber Laurie
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Robert G Hendrickson
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Oregon Poison Center, Oregon Health and Science University, Portland, Oregon
| | - Rongwei Fu
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Bory Kea
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | - B Zane Horowitz
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Oregon Poison Center, Oregon Health and Science University, Portland, Oregon
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Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY. Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016; 10:300-8. [PMID: 27261669 PMCID: PMC5049966 DOI: 10.1097/adm.0000000000000223] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/07/2016] [Indexed: 01/23/2023]
Abstract
In March of 2015, the United States Department of Health and Human Services identified 3 priority areas to reduce opioid use disorders and overdose, which are as follows: opioid-prescribing practices; expanded use and distribution of naloxone; and expansion of medication-assisted treatment. In this narrative review of overdose prevention and the role of prescribers and pharmacists in distributing naloxone, we address these priority areas and present a clinical scenario within the review involving a pharmacist, a patient with chronic pain and anxiety, and a primary care physician. We also discuss current laws related to naloxone prescribing and dispensing. This review was adapted from the Prescribe to Prevent online continuing medical education module created for prescribers and pharmacists (http://www.opioidprescribing.com/naloxone_module_1-landing).
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Affiliation(s)
- Jamie K Lim
- Clinical Addiction Research and Education Unit (JKL, AYW), Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA; College of Pharmacy (JPB), University of Rhode Island, Kingston, RI; Network for Public Health Law (CSD), St. Paul, MN; Departments of Emergency Medicine and Epidemiology (TCG), Warren Alpert Medical School of Brown University, Providence, RI; and Department of Emergency Medicine (TCG), Boston University School of Medicine, Boston, MA
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Green SL, Pfenning S. Optimizing the Use of State Prescription Drug Monitoring Programs for Public Safety. JOURNAL OF NURSING REGULATION 2015. [DOI: 10.1016/s2155-8256(15)30777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davis CS, Johnston JE, Pierce MW. Overdose Epidemic, Prescription Monitoring Programs, and Public Health: A Review of State Laws. Am J Public Health 2015; 105:e9-e11. [PMID: 26378849 DOI: 10.2105/ajph.2015.302856] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Prescription monitoring programs (PMPs), state-level databases that collect patient-specific prescription information at the time medications are dispensed, have been suggested as tools to address the overdose epidemic. We reviewed all laws in the United States (n = 25) that articulated the purposes PMPs are intended to serve. Attributes related to reducing abuse, misuse, and diversion of prescription medications appeared most commonly. Only 5 purpose statements mentioned the promotion of public health as goals of the PMP, and only 3 listed improving health care. None listed overdose prevention as a goal of the PMP.
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Affiliation(s)
- Corey S Davis
- Corey S. Davis is with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jill E. Johnston is with the Division of Environmental Health, Keck School of Medicine, University of Southern California, Los Angeles. Matthew W. Pierce is an independent consultant based in Washington, DC
| | - Jill E Johnston
- Corey S. Davis is with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jill E. Johnston is with the Division of Environmental Health, Keck School of Medicine, University of Southern California, Los Angeles. Matthew W. Pierce is an independent consultant based in Washington, DC
| | - Matthew W Pierce
- Corey S. Davis is with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jill E. Johnston is with the Division of Environmental Health, Keck School of Medicine, University of Southern California, Los Angeles. Matthew W. Pierce is an independent consultant based in Washington, DC
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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].
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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
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