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Kozak Z, Urquhart GJ, Rouhani S, Allen ST, Park JN, Sherman SG. Factors associated with daily use of benzodiazepines/tranquilizers and opioids among people who use drugs. Am J Addict 2024; 33:83-91. [PMID: 37717256 DOI: 10.1111/ajad.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Co-use of benzodiazepines and opioids significantly increases fatal overdose risk, yet few studies have examined co-use of these drugs when obtained both with and without a prescription. We examined associations of daily co-use of prescribed benzodiazepines/tranquilizers (BZD/TRQ) and prescribed and nonprescribed opioids among people who use street opioids (PWUO). METHODS PWUO (N = 417) were recruited from Baltimore City and neighboring Anne Arundel County, Maryland, and surveyed on sociodemographic characteristics, structural vulnerabilities, healthcare access and utilization, substance use, and overdose experiences. Multivariable logistic regression was used to identify factors associated with self-reported co-use. RESULTS Participants were 46 years old on average, and predominantly Black (74%) males (62%). Daily co-use was reported by 22%. In multivariable analyses, odds of co-use were significantly higher among participants who did not have a high school degree/GED (adjusted odds ratio [aOR]: 1.71, 95% confidence interval [CI]: 1.02-2.88), endorsed receiving mental health treatment in the past 6 months (aOR: 2.13, 95% CI: 1.28-3.56), reported daily use of powdered cocaine (aOR: 3.57, 95% CI: 1.98-6.45), and synthetic cannabinoids (aOR: 3.11, 95% CI: 1.40-6.93). Odds of co-use were significantly lower among Black participants compared to white participants (aOR: 0.39, 95% CI: 0.19-0.82). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Clinicians working with PWUO or who prescribe BZDs or opioids should screen patients who use cocaine or synthetic cannabinoids, have low level of educational attainment, or recently accessed mental health services, as these patients may be at higher risk for daily co-use of BZD/TRQ and opioids, and therefore lethal overdose.
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Affiliation(s)
- Zofia Kozak
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Glenna J Urquhart
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, New York University School of Global Public Health, New York, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju N Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- The Warren Alpert Medical School, Brown University, Providence, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Piros HI, Bauman A, Clark CB. An exploration of the link between narcissism, masochism, and crime in a post-incarcerated sample. J Natl Med Assoc 2023; 115:488-495. [PMID: 37541903 DOI: 10.1016/j.jnma.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/20/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
This study examined the relationship between narcissism, masochism, and violent criminal justice involvement. Current interventions used with offender populations target traits such as antisocial personality but typically ignore narcissism and masochism. Understanding the connection between violent crime, narcissism, and masochism can help us develop a more indepth understanding of which personality features contribute to an increased proclivity towards criminal action. The participants (N = 494) were post-incarcerated individuals. To assess individuals' degree of narcissistic and masochistic thinking, the Narcissistic Personality Inventory and the underserving self-image subscale of the Self-Defeating Interpersonal Style Scale were administered via a Qualtrics survey. Basic demographic information, psychopathy, intelligence, and personality were also measured and controlled for in the analyses. A logistic regression indicated that high levels masochistic thinking were associated with violent criminal justice involvement, even when relevant covariates were controlled for. High levels of narcissism were not found to exhibit a statically significant relationship with violent criminal justice involvement when psychopathy was controlled for. These findings suggest that masochistic characteristics may be a potential target for treatment in rehabilitating offenders.
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Affiliation(s)
- Hannah I Piros
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS 67260, United States
| | - Amy Bauman
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS 67260, United States
| | - C Brendan Clark
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS 67260, United States.
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3
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Moore J, Renn T, Veeh C. The metropolitan context of substance use and substance use disorders among US adults on probation or parole supervision. Subst Abus 2021; 43:161-170. [PMID: 33848449 DOI: 10.1080/08897077.2021.1903651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rates of substance use and substance use disorders are higher among adults on probation or parole supervision compared to the general population. Substance use is a risk factor of not adhering to supervision requirements, which may result in revocation and incarceration. Examining associations of metropolitan area status with substance use and substance use disorders may identify specific substance use behaviors that can be targeted in community corrections prevention and treatment services. The present study examined associations of metropolitan area residency with substance use and substance use disorders among adults on probation or parole supervision. Methods: Data came from the 2015 to 2018 National Survey on Drug Use and Health ([NSDUH]; N = 4266 adults on parole or probation). Multivariable logistic regression was run for substance-specific models for each of the two outcomes of past-year use and substance use disorder. Results: Nonmetropolitan residency was associated with higher odds of methamphetamine use and lower odds of cocaine use. Nonmetropolitan residency was associated with higher odds of methamphetamine use disorder and lower odds of opioid use disorder and cocaine use disorder. Conclusions: Study findings highlight the differences of substance use and substance use disorders between levels of metropolitan areas for those on probation or parole. Findings suggest that cocaine use should be emphasized in clinical services in large metropolitan areas, whereas methamphetamine use may be prioritized in nonmetropolitan areas. Further study is needed to investigate the interface of substance use behaviors and community corrections outcomes across metropolitan and nonmetropolitan areas.
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Affiliation(s)
- John Moore
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Tanya Renn
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Christopher Veeh
- School of Social Work, The University of Iowa, Iowa City, IA, USA
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4
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Crummy EA, Donckels EA, Baskin BM, Bentzley BS, Ferguson SM. The impact of cocaine and heroin drug history on motivation and cue sensitivity in a rat model of polydrug abuse. Psychopharmacology (Berl) 2020; 237:55-68. [PMID: 31463541 PMCID: PMC7458349 DOI: 10.1007/s00213-019-05349-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/09/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE Comorbid use of heroin and cocaine is highly prevalent among drug users and can greatly increase addiction risk. Nonetheless, little is known regarding how a multi-drug history impacts motivation and cue responsivity to individual drugs. OBJECTIVE We used behavioral-economic procedures to examine motivation to maintain drug consumption and tests of drug-seeking to drug-associated cues to assess sensitivity to heroin and cocaine-associated cues in rats that had a self-administration history of heroin, cocaine, or both drugs. RESULTS Unexpectedly, we found that groups with a polydrug history of heroin and cocaine did not have higher levels of motivation or cue-induced reinstatement of drug-seeking for either cocaine or heroin compared to single drug groups. Nonetheless, we did find drug-specific differences in both economic price and cue sensitivity. Specifically, demand elasticity was lower for cocaine compared to heroin in animals with a single drug history, but not with polydrug groups. In addition, cocaine demand was predictive of the degree of cue-induced reinstatement of drug-seeking for cocaine following extinction, whereas heroin demand was predictive of the degree of reactivity to a heroin-associated cue. Furthermore, although cue reactivity following the initial self-administration phase did not differ across cues and drug history, reactivity to both heroin and cocaine cues was greater during subsequent heroin use compared to cocaine use, and this enhanced reactivity to heroin cues persisted during forced abstinence. CONCLUSIONS These results indicate that there is a greater motivation to maintain cocaine consumption, but higher sensitivity to drug-associated cues with a history of heroin use, suggesting that cocaine and heroin may drive continued drug use through different behavioral processes.
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Affiliation(s)
- Elizabeth A. Crummy
- Neuroscience Graduate Program, University of Washington, Seattle, WA, USA,Center for Integrative Brain Research, Seattle Children’s Research Institute, 1900 Ninth Ave., Seattle, WA 98101, USA
| | - Elizabeth A. Donckels
- Center for Integrative Brain Research, Seattle Children’s Research Institute, 1900 Ninth Ave., Seattle, WA 98101, USA
| | - Britahny M. Baskin
- Neuroscience Graduate Program, University of Washington, Seattle, WA, USA,Center for Integrative Brain Research, Seattle Children’s Research Institute, 1900 Ninth Ave., Seattle, WA 98101, USA
| | - Brandon S. Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Susan M. Ferguson
- Neuroscience Graduate Program, University of Washington, Seattle, WA, USA,Center for Integrative Brain Research, Seattle Children’s Research Institute, 1900 Ninth Ave., Seattle, WA 98101, USA,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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5
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El-Bassel N, Davis A, Mandavia A, Goddard-Eckrich D, Hunt T, Marotta P, Chang M, Wu E, Gilbert L. Men in Community Correction Programs and Their Female Primary Sex Partners: Latent Class Analysis to Identify the Relationship of Clusters of Drug Use and Sexual Behaviors and HIV Risks. J Urban Health 2019; 96:411-428. [PMID: 29948784 PMCID: PMC6565788 DOI: 10.1007/s11524-018-0265-3] [Citation(s) in RCA: 5] [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: 11/26/2022]
Abstract
Existing research indicates that justice-involved individuals use a variety of different drugs and polysubstance use is common. Research shows that different typologies of drug users, such as polydrug users versus users of a single drug, have differing types of individual-, structural-, and neighborhood-level risk characteristics. However, little research has been conducted on how different typologies of drug use are associated with HIV risks among individuals in community corrections and their intimate sex partners. This paper examines the different types of drug use typologies among men in community correction programs and their female primary sex partners. We used latent class analysis to identify typologies of drug use among men in community correction programs in New York City and among their female primary sex partners. We also examined the associations between drug use typologies with sexual and drug use behaviors that increase the risk of HIV acquisition. The final analysis included a total of 1167 participants (822 male participants and 345 of their female primary sex partners). Latent class analyses identified three identical typologies of drug use for both men and their female primary sex partners: (1) polydrug use, (2) mild polydrug users with severe alcohol and marijuana use, and (3) alcohol and marijuana users. Men and women who were classified as polydrug users and mild polydrug users, compared to those who were classified as alcohol and marijuana users, tended to be older and non-Hispanic Caucasians. Polydrug users and mild polydrug users were also more likely to have risky sex partners and higher rates of criminal justice involvement. There is a need to provide HIV and drug use treatment and linkage to service and care for men in community correction programs, especially polydrug users. Community correction programs could be the venue to provide better access by reaching out to this high HIV risk key population with increased rates of drug use and multiple sex partners.
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Affiliation(s)
- Nabila El-Bassel
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA.
| | - Alissa Davis
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Amar Mandavia
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Dawn Goddard-Eckrich
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Timothy Hunt
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Phillip Marotta
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Mingway Chang
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Elwin Wu
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Louisa Gilbert
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
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Joudrey PJ, Khan MR, Wang EA, Scheidell JD, Edelman EJ, McInnes DK, Fox AD. A conceptual model for understanding post-release opioid-related overdose risk. Addict Sci Clin Pract 2019; 14:17. [PMID: 30982468 PMCID: PMC6463640 DOI: 10.1186/s13722-019-0145-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/26/2019] [Indexed: 12/28/2022] Open
Abstract
Post-release opioid-related overdose mortality is the leading cause of death among people released from jails or prisons (PRJP). Informed by the proximate determinants framework, this paper presents the Post-Release Opioid-Related Overdose Risk Model. It explores the underlying, intermediate, proximate and biological determinants which contribute to risk of post-release opioid-related overdose mortality. PRJP share the underlying exposure of incarceration and the increased prevalence of several moderators (chronic pain, HIV infection, trauma, race, and suicidality) of the risk of opioid-related overdose. Intermediate determinants following release from the criminal justice system include disruption of social networks, interruptions in medical care, poverty, and stigma which exacerbate underlying, and highly prevalent, substance use and mental health disorders. Subsequent proximate determinants include interruptions in substance use treatment, including access to medications for opioid use disorder, polypharmacy, polydrug use, insufficient naloxone access, and a return to solitary opioid use. This leads to the final biological determinant of reduced respiratory tolerance and finally opioid-related overdose mortality. Mitigating the risk of opioid-related overdose mortality among PRJP will require improved coordination across criminal justice, health, and community organizations to reduce barriers to social services, ensure access to health insurance, and reduce interruptions in care continuity and reduce stigma. Healthcare services and harm reduction strategies, such as safe injection sites, should be tailored to the needs of PRJP. Expanding access to opioid agonist therapy and naloxone around the post-release period could reduce overdose deaths. Programs are also needed to divert individuals with substance use disorder away from the criminal justice system and into treatment and social services, preventing incarceration exposure.
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Affiliation(s)
- Paul J Joudrey
- VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Ave, West Haven, CT, 06516, USA.
- National Clinician Scholars Program, Yale School of Medicine, 333 Cedar Street, Sterling Hall of Medicine IE-68, PO Box 208088, New Haven, CT, 06520, USA.
| | - Maria R Khan
- Department of Population Health, New York University, 227 East 30th Street, New York, NY, 10016, USA
| | - Emily A Wang
- Department of Internal Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, USA
| | - Joy D Scheidell
- Department of Population Health, New York University, 227 East 30th Street, New York, NY, 10016, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, USA
| | - D Keith McInnes
- Department of Veterans Affairs, Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers VA Hospital, Bedford, MA, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Aaron D Fox
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA
- Montefiore Medical Center, Bronx, NY, 10467, USA
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Transnational trends in prescription drug misuse among women: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:56-73. [DOI: 10.1016/j.drugpo.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 09/14/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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8
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Lorvick J, Browne EN, Lambdin BH, Comfort M. Polydrug use patterns, risk behavior and unmet healthcare need in a community-based sample of women who use cocaine, heroin or methamphetamine. Addict Behav 2018; 85:94-99. [PMID: 29883856 DOI: 10.1016/j.addbeh.2018.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/05/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of multiple illicit drugs (polydrug use) is associated with health-related harms and elevated risk of drug overdose. Polydrug use in common among women who use 'hard' drugs, such as cocaine, heroin or methamphetamine. METHODS Quantitative data collection was conducted with a community-recruited sample of 624 women who used heroin, methamphetamine or cocaine in Oakland, CA during 2014-2015. We conducted latent class analysis to classify polydrug use patterns. We assessed associations between classes of polydrug use and infectious disease risk behaviors, health care utilization and unmet health care need. RESULTS We identified four distinct classes of drug use: (1) predominantly crack (52% of women); (2) powder cocaine & non-heroin opioids (8%); (3) moderate polydrug use (25%); (4) heavy polydrug use (15%). Odds of sexual risk, injection drug use and unmet healthcare need were twice as high in the heavy polydrug use class as the predominantly crack class (p > 0.01 for each outcome). The rate of binge drinking (as days per month) was also significantly higher in the heavy polydrug class (p = 0.01). The moderate polydrug use class had higher odds of injection drug use and drug treatment participation, compared to the mainly crack class (p < 0.001 for each outcome). There were no differences between classes in health insurance or health care utilization. DISCUSSION Reduction of polydrug use could be an effective harm reduction strategy to address sexual and injection risk among women. The use of both opioids and stimulants in three of the four classes suggests that multi-modal substance abuse treatment approaches may be most appropriate.
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Affiliation(s)
- Jennifer Lorvick
- RTI International, Behavioral and Urban Health Program, United States.
| | - Erica N Browne
- RTI International, Women's Global Health Imperative, United States
| | - Barrot H Lambdin
- RTI International, Behavioral and Urban Health Program, United States; University of Washington, United States
| | - Megan Comfort
- RTI International, Behavioral and Urban Health Program, United States; University of California, San Francisco, United States
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9
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Sedative hypnotics overdose: Epidemiology, diagnosis and management. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2018. [DOI: 10.1016/j.injms.2018.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Bouvier BA, Waye KM, Elston B, Hadland SE, Green TC, Marshall BDL. Prevalence and correlates of benzodiazepine use and misuse among young adults who use prescription opioids non-medically. Drug Alcohol Depend 2018; 183:73-77. [PMID: 29241103 PMCID: PMC5803376 DOI: 10.1016/j.drugalcdep.2017.10.023] [Citation(s) in RCA: 20] [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: 08/21/2017] [Revised: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Benzodiazepine use dramatically increases the risk of unintentional overdose among people who use opioids non-medically. However, little is known about the patterns of co-occurring benzodiazepine and opioid use among young adults in the United States. METHODS The Rhode Island Young Adult Prescription Drug Study (RAPiDS) was a cross-sectional study from January 2015-February 2016. RAPiDS recruited 200 young adults aged 18-29 who reported past 30-day non-medical prescription opioid (NMPO) use. Using Wilcoxon rank sum test and Fisher's exact test, we examined correlates associated with regular prescribed and non-medical use (defined as at least monthly) of benzodiazepines among NMPO users in Rhode Island. RESULTS Among participants, 171 (85.5%) reported lifetime benzodiazepine use and 125 (62.5%) reported regular benzodiazepine use. Nearly all (n=121, 96.8%) reported non-medical use and 43 (34.4%) reported prescribed use. Compared to the 75 participants who did not regularly use benzodiazepines, participants who reported regular use were more likely to be white (66.3% vs. 58.0%, p=0.03), have ever been incarcerated (52.8% vs. 37.3%, p=0.04), and have ever been diagnosed with a psychiatric disorder (bipolar: 29.6% vs. 16.0%, p=0.04; anxiety: 56.8 vs. 36.0%, p=0.01). Although the association was marginally significant, accidental overdose was higher among those who were prescribed the benzodiazepine they used most frequently compared to those who were not (41.9% vs. 24.4%, p=0.06). CONCLUSION Benzodiazepine use and misuse are highly prevalent among young adult NMPO users. Harm reduction and prevention programs for this population are urgently needed.
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Affiliation(s)
- Benjamin A Bouvier
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Katherine M Waye
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Scott E Hadland
- Boston Medical Center, Department of Pediatrics, 850 Harrison Avenue, Boston, MA, 02118, USA; Boston University School of Medicine, Department of Pediatrics, Division of General Pediatrics, 88 East Newton Street, Vose Hall Room 322, Boston, MA, 02118, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA; Boston Medical Center Injury Prevention Center and Boston University School of Medicine, Department of Emergency Medicine, 771 Albany Street, Room 1332, Boston, MA, 02118, USA; The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Pardo D, Miller L, Chiulli D. Implementation of a pharmacy consult to reduce co-prescribing of opioids and benzodiazepines in a Veteran population. Subst Abus 2017; 38:157-160. [PMID: 28166464 DOI: 10.1080/08897077.2017.1290011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The dangers of co-administration of opioid pain relievers (OPRs) and benzodiazepines (BZDs) are well documented. The combination of OPRs and BZDs make up the majority of medications involved in prescription drug-related overdose and are often used concomitantly. This pattern is consistent among the veteran population where mental health illness and substance abuse are prominent. The Veterans Health Administration implemented the Opioid Safety Initiative (OSI) aimed at improving patient safety surrounding OPRs. In alignment with OSI, the study facility implemented a prior authorization pharmacy consult in an effort to reduce OPR and BZD co-prescribing and optimize patient safety. The purpose of this article is to report the frequency of co-prescribing before and after implementation of the consult. Secondary aims include reporting the emergency room visits and hospitalizations, prescribers' actions in the setting of disapproved consults, patient characteristics associated with co-prescribing, and frequency of co-prescribing without a consult. METHODS This was a single-center, retrospective chart review study. Microsoft Structured Query Language server database and Veterans Health Information Systems and Technology Architecture were used to extract data and identify study patients. The Computerized Patient Record System was used to collect patient data. Microsoft Access and Excel were utilized to organize, query, and analyze the extracted data. RESULTS There was a 34.6% reduction in patients on chronic OPR therapy co-prescribed a BZD, and the total number of overdose-related events decreased after implementation of the consult. In the event of disapproved consults, pharmacists' evidence-based recommendations were implemented 63% of the time. Patients for whom co-prescribing consults were placed were more likely to have mental health diagnoses. CONCLUSIONS Following implementation of a pharmacy consult, there was a reduction in co-prescribing and overdose-related events at the study facility.
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Affiliation(s)
- Deborah Pardo
- a Veterans Affairs Palo Alto Health Care System (VAPAHCS) , Palo Alto , California , USA
| | - Lacey Miller
- a Veterans Affairs Palo Alto Health Care System (VAPAHCS) , Palo Alto , California , USA
| | - Dana Chiulli
- a Veterans Affairs Palo Alto Health Care System (VAPAHCS) , Palo Alto , California , USA
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Peacock A, Bruno R, Larance B, Lintzeris N, Nielsen S, Ali R, Dobbins T, Degenhardt L. Same-day use of opioids and other central nervous system depressants amongst people who tamper with pharmaceutical opioids: A retrospective 7-day diary study. Drug Alcohol Depend 2016; 166:125-33. [PMID: 27430400 DOI: 10.1016/j.drugalcdep.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/27/2016] [Accepted: 07/03/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims were to determine: (i) quantity and frequency of same-day use of opioids with benzodiazepines and/or alcohol amongst people who regularly tamper with pharmaceutical opioids; and (ii) socio-demographic, mental health, harms and treatment profile associated with same-day use of high doses. METHOD The cohort (n=437) completed a retrospective 7-day diary detailing opioid, benzodiazepine, and alcohol intake. Oral morphine equivalent (OME) units and diazepam equivalent units (DEU) were calculated, with >200mg OME, >40mg DEU and >4 standard alcoholic drinks (each 10g alcohol) considered a "high dose". RESULTS One-half (47%) exclusively consumed opioids without benzodiazepines/alcohol; 26% had days of opioid use with and without benzodiazepines/alcohol; and 26% always used opioids and benzodiazepines/alcohol. Same-day use of opioids with benzodiazepines/alcohol typically occurred on 1-3days in the past week. Six in ten (61%) participants reported high dose opioid use on at least one day; one in five (20%) reported high dose opioid and high dose benzodiazepine/alcohol use on at least one day. The latter group were more likely to use prescribed opioid substitution therapy, often alongside diverted pharmaceutical opioids. Socio-demographic and clinical profiles did not vary according to high dose opioid, alcohol and benzodiazepine use, and there was no association with harms. CONCLUSIONS Same-day use of opioids with benzodiazepines/alcohol, and high dose combinations, are common amongst people who tamper with pharmaceutical opioids. Assessment of concomitant benzodiazepine/alcohol use during opioid therapy, implementation of real-time prescription monitoring systems, and research to clarify upper safe limits for polydrug depressant use, are potential implications.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, University of Tasmania, Tasmania, Australia.
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, University of Tasmania, Tasmania, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Nick Lintzeris
- Sydney Medical School, Sydney University, New South Wales, Australia; Drug and Alcohol Services, South East Sydney Local Health District, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; Drug and Alcohol Services, South East Sydney Local Health District, New South Wales, Australia
| | - Robert Ali
- University of Adelaide, South Australia, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Merlin JS, Tamhane A, Starrels JL, Kertesz S, Saag M, Cropsey K. Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV. AIDS Behav 2016; 20:687-98. [PMID: 26487298 DOI: 10.1007/s10461-015-1178-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Opioids are often prescribed for chronic pain, and opioid risks such as overdose and death are heightened when opioids are co-prescribed with other sedating medications. We investigated factors associated with chronic opioid prescription, alone and in combination with benzodiazepines and muscle relaxants, in a clinical cohort of individuals with HIV. We used multivariable logistic regression models to determine participant clinical and demographic characteristics that are associated with chronic prescription of opioids or chronic co-prescription of opioids with sedating medications. Among 1474 participants, chronic prescription of opioids occurred in 253 individuals (17.2 %), and chronic co-prescription occurred in 90 individuals (6.1 %). Age >50, public insurance as compared to private insurance, and symptoms of depression and anxiety were significantly associated with chronic opioid prescription and chronic co-prescription. Our findings raise concern that opioid prescription and co-prescription of sedating medications occurs disproportionately in patients for whom use is riskier.
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Affiliation(s)
- Jessica S Merlin
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, BBRB 222, 1530 3rd Ave S, Birmingham, AL, 35294-2170, USA.
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Ashutosh Tamhane
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, BBRB 222, 1530 3rd Ave S, Birmingham, AL, 35294-2170, USA
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stefan Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Saag
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, BBRB 222, 1530 3rd Ave S, Birmingham, AL, 35294-2170, USA
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
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