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Bettano A, Jones K, Fillo KT, Ficks R, Bernson D. Opioid-related incident severity and emergency medical service naloxone administration by sex in Massachusetts, 2013-2019. Subst Abus 2021; 43:479-485. [PMID: 34283708 DOI: 10.1080/08897077.2021.1949661] [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: 10/20/2022]
Abstract
BACKGROUND A Cross-sectional study of all emergency ambulance runs reported by licensed Emergency Medical Services (EMS) providers between 2013 and 2019 was undertaken to determine if the sex of a patient experiencing opioid-related symptoms had an impact on their odds of receiving naloxone from EMS. Methods: All runs within Massachusetts for individuals 11 years and older with a reported sex between 2013 and 2019 (n = 5,533,704 runs) were included. Covariates modeled were patient age, year of the incident, and county of the incident. Runs were separated into those that were opioid-related versus not; opioid-related runs were further subdivided into five severity categories including dead on arrival, acute opioid overdose, opioid intoxicated, opioid withdrawal, and other opioid-related incident. Results: Among opioid-related runs, women had 24% lower odds (95% CI 0.68-0.86) of appearing in the dead on arrival category and 20% lower odds (95% CI 0.78-0.82) of appearing in the acute opioid overdose category than men. Among acute opioid overdoses, runs where patient symptoms met Massachusetts EMS guidelines for naloxone administration, women had 18% lower odds (95% CI 0.76-0.89) of receiving naloxone than men. Conclusions: Sex-related differences persist in the odds of naloxone administration by EMS providers when controlling for symptom presentation.
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Affiliation(s)
- Amy Bettano
- Special Analytic Projects, Office of Population Health, Massachusetts Department of Public Health, Boston, MA, USA
| | - Katarina Jones
- Division of Quality Improvement, Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, MA, USA
| | - Katherine T Fillo
- Division of Quality Improvement, Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, MA, USA
| | - Ridgely Ficks
- Division of Quality Improvement, Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, MA, USA
| | - Dana Bernson
- Special Analytic Projects, Office of Population Health, Massachusetts Department of Public Health, Boston, MA, USA
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2
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Peppin JF, Pergolizzi JV, Dahan A, Raffa RB. Are opioid receptor antagonists adequate for "Opioid" overdose in a changing reality? J Clin Pharm Ther 2021; 46:861-866. [PMID: 33913179 DOI: 10.1111/jcpt.13320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Deaths due to opioid-induced respiratory depression (OIRD) continue to rise despite intense regulatory and professional actions. COVID-19 has only worsened this situation.1 An opioid receptor antagonist (ORA) such as naloxone is the most common intervention for OIRD. However, with increasing overdose from highly potent illicit opioids and polysubstance abuse, appraisal of the adequacy of ORA seems warranted and timely. COMMENT OIRD results from the binding of an excess number of agonist molecules to opioid receptors. Mechanistically, it makes sense to reverse this by displacing agonist molecules by administering an ORA. But realistically, the trend to higher-potency agonists and polysubstance abuse diminishes the effectiveness of this approach. We are left facing a crisis without a solution. WHAT IS NEW AND CONCLUSION For the increasingly common OIRD from highly potent illicit agonists and polysubstance overdose, ORAs are correspondingly less effective. Alternatives are needed-soon.
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Affiliation(s)
- John F Peppin
- Marian University College of Osteopathic Medicine (Clinical Adjunct Professor), Indianapolis, IN, USA.,Clinical Professor Internal Medicine, Pikeville University, College of Osteopathic Medicine, Pikeville, USA
| | - Joseph V Pergolizzi
- Enalare Therapeutics Inc, Naples, FL, USA.,Neumentum Inc., Summit, NJ, USA.,NEMA Research Inc., Naples, FL, USA
| | - Albert Dahan
- Leiden University Medical Center, Leiden, The Netherlands
| | - Robert B Raffa
- Enalare Therapeutics Inc, Naples, FL, USA.,Neumentum Inc., Summit, NJ, USA.,University of Arizona College of Pharmacy (Adjunct Professor), Tucson, AZ, USA.,Temple University School of Pharmacy (Professor emeritus), Philadelphia, PA, USA
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3
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Wagner K, Zhong Y, Teshale E, White K, Winstanley EL, Hettema J, Thornton K, Bisztray B, Fiuty P, Page K. Hepatitis C virus infection and polysubstance use among young adult people who inject drugs in a rural county of New Mexico. Drug Alcohol Depend 2021; 220:108527. [PMID: 33465605 PMCID: PMC7889731 DOI: 10.1016/j.drugalcdep.2021.108527] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/06/2020] [Accepted: 12/27/2020] [Indexed: 01/07/2023]
Abstract
AIMS We assessed prevalence and correlates for hepatitis C virus (HCV) infection in young adult people who inject drugs (PWID) in rural New Mexico, where opioid use has been historically problematic. METHODS Participants were 18-29 years old with self-reported injection drug use in the past 90 days. We conducted testing for HCV antibodies (anti-HCV) and HCV ribonucleic acid (RNA) and assessed sociodemographic and risk exposures. We provided counseling and referrals to prevention services and drug treatment. We estimated prevalence ratios (PR) to assess bivariate associations with HCV infection; and adjusted PRs using modified Poisson regression methods. RESULTS Among 256 participants tested for anti-HCV, 156 (60.9 %) had been exposed (anti-HCV positive), and of 230 tested for both anti-HCV and HCV RNA, 103 (44.8 %) had current infection (RNA-positive). The majority (87.6 %) of participants were Hispanic. Almost all (96.1 %) had ever injected heroin; 52.4 % and 52.0 % had ever injected methamphetamine or cocaine, respectively. Polysubstance injecting (heroin and any other drug) was associated with significantly higher prevalence of HCV infection (76.0 %) compared to injecting only heroin (24.0 %) (PR: 3.17 (95 % CI:1.93, 5.23)). Years of injecting, history of non-fatal opioid-involved overdose, polysubstance injecting, and stable housing were independently associated with HCV infection. CONCLUSIONS HCV is highly prevalent among young adult PWID in rural NM. The high reported prevalence of polysubstance injecting and its association with HCV infection should be considered in prevention planning.
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Affiliation(s)
- Katherine Wagner
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131 USA
| | - Yuna Zhong
- Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kirsten White
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131 USA
| | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Jennifer Hettema
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Karla Thornton
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131 USA,ECHO Institute University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Birgitta Bisztray
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131 USA
| | | | - Kimberly Page
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131, USA.
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4
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Shupp R, Loveridge S, Skidmore M, Green B, Albrecht D. Recognition and stigma of prescription drug abuse disorder: personal and community determinants. BMC Public Health 2020; 20:977. [PMID: 32571263 PMCID: PMC7310116 DOI: 10.1186/s12889-020-09063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/05/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prescription drug abuse (PDA) disorders continue to contribute to the current American opioid crisis. Within this context, our study seeks to improve understanding about stigma associated with, and symptom recognition of, prescription drug abuse. AIMS Model the stigma and symptom recognition of PDA in the general population. METHODS A randomized, nation-wide, online, vignette-focused survey of the general public (N = 631) was implemented with an oversample for rural counties. Logit estimation was used for analysis, with regional and county-level sociodemographic variables as controls. RESULTS Individual respondents that self-identify as having or having had "a prescription drug abuse issue" were less likely to correctly identify the condition and were 4 times more likely to exhibit stigma. Male respondents were approximately half as likely to correctly identify PDA as female respondents while older respondents (55+) were more likely to correctly identify PDA, relative to those aged 35-54. Being both male and younger was associated with slightly more stigma, in that they were less likely to disagree with the stigma statement. CONCLUSIONS In light of the continued risks that individuals with PDA behaviors face in potentially transitioning to illicit opioid use, the findings of this survey suggested a continued need for public education and outreach. Of particular note is the perspective of those who have self-identified with the condition, as this population faces the largest risks of adverse health outcomes from illicit drug use within the survey respondents.
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Affiliation(s)
- Robert Shupp
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI 48824 USA
| | - Scott Loveridge
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI 48824 USA
| | - Mark Skidmore
- Department of Agricultural, Food and Resource Economics & Economics, Michigan State University, East Lansing, MI 48824 USA
| | - Brandn Green
- JG Research & Evaluation, 2103 Bridger Drive, Suite 1, Bozeman, MT 59715 USA
| | - Don Albrecht
- Western Rural Development Center, Utah State University, 4880 Old Main Hill, Logan, UT 84322 USA
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5
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Fink BC, Uyttebrouck O, Larson RS. An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:249-258. [PMID: 32631181 DOI: 10.1177/1073110520935336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death.
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Affiliation(s)
- Brandi C Fink
- Brandi Fink, Ph.D., is a licensed clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of New Mexico Health Sciences. Dr. Fink's research focuses on identifying novel neurophysiological intervention targets to improve outcomes for patients with a variety of substance use related problems. Her clinical work focuses on the treatment of substance use disorders. Olivier Uyttebrouck is a Senior Scientific Writer for the University of New Mexico Health Sciences. Richard Larson, M.D., Ph.D., is the Executive Vice Chancellor, Vice Chancellor for Research, and Professor of Pathology at the University of New Mexico Health Sciences. As an established scholar and leader, Dr. Larson oversees an array of activities and programs at a $2.2 billion academic health center. These activities have spanned operational, clinical, educational and research missions
| | - Olivier Uyttebrouck
- Brandi Fink, Ph.D., is a licensed clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of New Mexico Health Sciences. Dr. Fink's research focuses on identifying novel neurophysiological intervention targets to improve outcomes for patients with a variety of substance use related problems. Her clinical work focuses on the treatment of substance use disorders. Olivier Uyttebrouck is a Senior Scientific Writer for the University of New Mexico Health Sciences. Richard Larson, M.D., Ph.D., is the Executive Vice Chancellor, Vice Chancellor for Research, and Professor of Pathology at the University of New Mexico Health Sciences. As an established scholar and leader, Dr. Larson oversees an array of activities and programs at a $2.2 billion academic health center. These activities have spanned operational, clinical, educational and research missions
| | - Richard S Larson
- Brandi Fink, Ph.D., is a licensed clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of New Mexico Health Sciences. Dr. Fink's research focuses on identifying novel neurophysiological intervention targets to improve outcomes for patients with a variety of substance use related problems. Her clinical work focuses on the treatment of substance use disorders. Olivier Uyttebrouck is a Senior Scientific Writer for the University of New Mexico Health Sciences. Richard Larson, M.D., Ph.D., is the Executive Vice Chancellor, Vice Chancellor for Research, and Professor of Pathology at the University of New Mexico Health Sciences. As an established scholar and leader, Dr. Larson oversees an array of activities and programs at a $2.2 billion academic health center. These activities have spanned operational, clinical, educational and research missions
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6
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Manetti F, Scopetti M, Santurro A, Consoloni L, D'Errico S. Widespread septic embolization in injection drug use mitro-aortic infective endocarditis as a remote cause of death. Int J Legal Med 2020; 134:1345-1351. [PMID: 32367331 DOI: 10.1007/s00414-020-02309-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/22/2020] [Indexed: 01/09/2023]
Abstract
Injection drug use-related infective endocarditis (IDU-IE) assumes peculiar epidemiological, pathogenetic, and prognostic characteristics that allow to consider it a distinct nosological entity, as well as a current problem of considerable social weight. Incidence is reasonably underestimated because diagnosis is often accidental in postmortem examination when drug-related death is suspected. In many cases, postmortem toxicological examinations are negative for acute drug abuse, and findings of infective endocarditis became relevant in the explanation of the mechanism of death. Extracardiac involvement of infective endocarditis is rarely reported as fatal. Fragmentation and embolization of bacterial vegetations can be associated with parenchymal infarcts, systemic spread of the infectious process by formation of an abscess. A case of septic shock as a consequence of the constant bacteremia determined by the continuous proliferation and release of bacteria into the circulation is presented in an injection drug user with left-sided endocarditis and widespread septic embolization. Authors reviewed forensic and medical literature and promote epidemiological value of medical and forensic autopsy. Extracardiac involvement of infective endocarditis may represent a remote and alternative cause of death in injection drug users, and an early diagnosis can be relevant for prognosis. Postmortem examination still represents a valuable opportunity of learning for clinicians and improving diagnostic accuracy with injection drug users. A call for changing of attitudes and practice toward autopsy is finally demanded.
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Affiliation(s)
- Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Lara Consoloni
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy.
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7
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Acharya M, Chopra D, Hayes CJ, Teeter B, Martin BC. Cost-Effectiveness of Intranasal Naloxone Distribution to High-Risk Prescription Opioid Users. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:451-460. [PMID: 32327162 DOI: 10.1016/j.jval.2019.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/16/2019] [Accepted: 12/18/2019] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To determine the cost-effectiveness of pharmacy-based intranasal naloxone distribution to high-risk prescription opioid (RxO) users. METHODS We developed a Markov model with an attached tree for pharmacy-based naloxone distribution to high-risk RxO users using 2 approaches: one-time and biannual follow-up distribution. The Markov structure had 6 health states: high-risk RxO use, low-risk RxO use, no RxO use, illicit opioid use, no illicit opioid use, and death. The tree modeled the probability of an overdose happening, the overdose being witnessed, naloxone being available, and the overdose resulting in death. High-risk RxO users were defined as individuals with prescription opioid doses greater than or equal to 90 morphine milligram equivalents (MME) per day. We used a monthly cycle length, lifetime horizon, and US healthcare perspective. Costs (2018) and quality-adjusted life-years (QALYs) were discounted 3% annually. Microsimulation was performed with 100 000 individual trials. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS One-time distribution of naloxone prevented 14 additional overdose deaths per 100 000 persons, with an incremental cost-effectiveness ratio (ICER) of $56 699 per QALY. Biannual follow-up distribution led to 107 additional lives being saved with an ICER of $84 799 per QALY compared with one-time distribution. Probabilistic sensitivity analyses showed that a biannual follow-up approach would be cost-effective 50% of the time at a willingness-to-pay (WTP) threshold of $100 000 per QALY. Naloxone effectiveness and proportion of overdoses witnessed were the 2 most influential parameters for biannual distribution. CONCLUSION Both one-time and biannual follow-up naloxone distribution in community pharmacies would modestly reduce opioid overdose deaths and be cost-effective at a WTP of $100 000 per QALY.
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Affiliation(s)
- Mahip Acharya
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Divyan Chopra
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin Teeter
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bradley C Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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8
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Abstract
This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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9
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Kim HK, Connors NJ, Mazer-Amirshahi ME. The role of take-home naloxone in the epidemic of opioid overdose involving illicitly manufactured fentanyl and its analogs. Expert Opin Drug Saf 2019; 18:465-475. [DOI: 10.1080/14740338.2019.1613372] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Hong K. Kim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicholas J. Connors
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Maryann E. Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- School of Medicine, Georgetown University, Washington, DC, USA
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10
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Dragovich A, Brason F, Beltran T, McCoart A, Plunkett AR. The feasibility of employing a home healthcare model for education and treatment of opioid overdose using a naloxone auto-injector in a private practice pain medicine clinic. Curr Med Res Opin 2018; 34:2137-2141. [PMID: 29667452 DOI: 10.1080/03007995.2018.1466698] [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] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to determine if employing a home healthcare model for education and treatment of opioid overdose using the Evzio (Naloxone) auto-injector in a private practice pain clinic. METHODS A prospective survey was used to determine the feasibility of integrating a naloxone auto-injector within the patient's home with a home care training model. Twenty moderate or high-risk patients were enrolled from the chronic pain clinic. Patients who were moderate or high risk completed an evaluation survey. The naloxone auto-injector was dispensed to all patients meeting criteria. The treating provider after prescribing the naloxone auto-injector then consulted home health per standard clinical practice. All patients had home health consulted to perform overdose identification and rescue training. A Cochran's Q test was conducted to examine differences in patient knowledge pre- and post-training. The post training test was done 2-4 weeks later. RESULTS Forty subjects enrolled after meeting inclusion/exclusion criteria. Twenty withdrew because their insurance declined coverage for the naloxone auto-injector. Those completing home health showed a statistically significant difference in their ability to correctly identify the steps needed to effectively respond to an overdose (p = .03). DISCUSSION Preliminary evidence would suggest training on overdose symptom recognition and proper use of prescription naloxone for treatment in the home setting by home health staff would prove more beneficial than the clinic setting, but feasibility was hindered by unaffordable costs related to insurance coverage limitations.
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Affiliation(s)
| | - Fred Brason
- b Project Lazarus , Moravian Falls , NC , USA
| | - Thomas Beltran
- c Womack Army Medical Center, Department of Clinical Investigation , Fort Bragg , NC , USA
| | - Amy McCoart
- d Henry M Jackson Foundation , Varina , NC , USA
| | - Anthony R Plunkett
- e Womack Army Medical Center, Department of Anesthesiology , Fort Bragg , NC , USA
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11
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Mattson CL, O’Donnell J, Kariisa M, Seth P, Scholl L, Gladden RM. Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016-June 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:945-951. [PMID: 30161105 PMCID: PMC6124818 DOI: 10.15585/mmwr.mm6734a2] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In 2016, 63,632 drug overdose deaths occurred in the United States, 42,249 (66.4%) of which involved opioids (1). The development of prevention programs are hampered by a lack of timely data on specific substances contributing to and circumstances associated with fatal overdoses. This report describes opioid overdose deaths (referred to as opioid deaths) for decedents testing positive for prescription opioids (e.g., oxycodone and hydrocodone), illicit opioids (e.g., heroin, illicitly manufactured fentanyl, and fentanyl analogs), or both prescription and illicit opioids, and describes circumstances surrounding the overdoses, in 11 states participating in CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program.* During July 2016–June 2017, among 11,884 opioid overdose deaths, 17.4% of decedents tested positive for prescription opioids only, 58.7% for illicit opioids only, and 18.5% for both prescription and illicit opioids (type of opioid could not be classified in 649 [5.5%] deaths). Approximately one in 10 decedents had been released from an institutional setting in the month preceding the fatal overdose. Bystanders were reportedly present in approximately 40% of deaths; however, naloxone was rarely administered by a layperson. Enhanced surveillance data from 11 states provided more complete information on the substances involved in and circumstances surrounding opioid overdose deaths. Consistent with other emerging evidence and recommendations,† these data suggest prevention efforts should prioritize naloxone distribution to persons misusing opioids or using high dosage prescription opioids and to their family members and friends. In addition, these data suggest a need to expand treatment and support for persons who have experienced a nonfatal overdose and to expand treatment in detention facilities and upon release.
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12
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Hendy HM, Black P, Can SH, Fleischut A, Aksen D. Opioid Abuse as Maladaptive Coping to Life Stressors in U.S. Adults. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618783454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Threat Appraisal and Coping Theory suggests that when individuals face life stressors, especially if they have poor self-esteem, they may rely on maladaptive coping behaviors that ease distress but worsen their condition over time. The present study compared five life stressors (health, money, work, family, romance) for their association with opioid use, then examined poor self-esteem as a mediator of these associations. Study participants included 1,047 U.S. adults gathered in a quota sample by SurveyMonkey (54.3% women; 53.3% 45+ years of age; 76.7% White; 60.2% with US$50,000 or higher income; 11.1% using opioids). Participants completed online surveys to report demographics, five life stressors, self-esteem, and indications of opioid use as measured with the PROMIS Questionnaire. Pearson correlation found poor self-esteem associated with high opioid use; multiple regression found health, family, and romance stressors associated with high opioid use ( R2 = .089); and multiple regression found health, money, family, and romance stressors associated with poor self-esteem ( R2 = .283). Then, bootstrapping mediational analyses examined the sequence of HIGH LIFE STRESSORS → POOR SELF-ESTEEM → HIGH OPIOID USE, finding that poor self-esteem was a significant mediator between each life stressor (health, money, family, romance) and increased risk for opioid use. The present sample included mostly individuals with a White ethnic identity and high incomes, so future research should examine these patterns with more diverse samples. In addition, the amount of opioids consumed, present motivations for use, the sequence of events leading to present use, exposure to substance-abuse treatment, and where individuals presently are on the use-recovery process could moderate associations found between life stressors and opioid use.
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Affiliation(s)
| | | | - S. Hakan Can
- Penn State Schuylkill, Schuylkill Haven, PA, USA
| | | | - Damla Aksen
- State University of New York, Binghamton, NY, USA
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13
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Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, Holtzman D. Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014. Am J Public Health 2018; 108:175-181. [PMID: 29267061 PMCID: PMC5846578 DOI: 10.2105/ajph.2017.304132] [Citation(s) in RCA: 485] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare US trends in rates of injection drug use (IDU), specifically opioid injection, with national trends in the incidence of acute HCV infection to assess whether these events correlated over time. METHODS We calculated the annual incidence rate and demographic and risk characteristics of reported cases of acute HCV infection using surveillance data from 2004 to 2014 and the annual percentage of admissions to substance use disorder treatment facilities reporting IDU for the same time period by type of drug injected and demographic characteristics. We then tested for trends. RESULTS The annual incidence rate of acute HCV infection increased more than 2-fold (from 0.3 to 0.7 cases/100 000) from 2004 to 2014, with significant increases among select demographic subgroups. Admissions for substance use disorder attributed to injection of heroin and prescription opioid analgesics increased significantly, with an almost 4-fold increase in prescription opioid analgesic injection. Significant increases in opioid injection mirrored those for reported cases of acute HCV infection among demographic subgroups. CONCLUSIONS These findings strongly suggest that the national increase in acute HCV infection is related to the country's opioid epidemic and associated increases in IDU.
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Affiliation(s)
- Jon E Zibbell
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Alice K Asher
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Rajiv C Patel
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Ben Kupronis
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Kashif Iqbal
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - John W Ward
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Deborah Holtzman
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
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Jakubowski A, Kunins HV, Huxley-Reicher Z, Siegler A. Knowledge of the 911 Good Samaritan Law and 911-calling behavior of overdose witnesses. Subst Abus 2017; 39:233-238. [DOI: 10.1080/08897077.2017.1387213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andrea Jakubowski
- New York City Department of Health and Mental Hygiene, Long Island City, New York, United States
| | - Hillary V. Kunins
- New York City Department of Health and Mental Hygiene, Long Island City, New York, United States
| | - Zina Huxley-Reicher
- New York City Department of Health and Mental Hygiene, Long Island City, New York, United States
| | - Anne Siegler
- New York City Department of Health and Mental Hygiene, Long Island City, New York, United States
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