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Onohuean H, Oosthuizen F. Multinational appraisal of the epidemiological distribution of opioid fatalities: a systematic review and meta-analysis. Front Psychiatry 2024; 14:1290461. [PMID: 38250280 PMCID: PMC10796457 DOI: 10.3389/fpsyt.2023.1290461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024] Open
Abstract
Background The global or multinational scientific evidence on the distribution of opioid fatality is unknown. Hence, the current study collects epidemiological characteristics to shed light on the ongoing global or multinational opioid crisis and to promote the development of public health prevention/management strategies. Method All documents on PRISMA standards were retrieved via electronic databases. Results Among the 47 articles relevant to our studies, which depict a total population size of 10,191 individuals, the prevalence of opioid fatal overdose was 15,022 (14.74%). Among the 47 articles, 14 of them reported the gender of the participants, with 22,125 (15.79%) male individuals and 7,235 (5.17%) female individuals, and the age distribution of the participants that was most affected by the overdose was as follows: 29,272 (31.13%) belonged to the 18-34-year-old age group and 25,316 (26.92%) belonged to the less than 18-year-old age group. Eighteen studies qualified for the meta-analysis of the multinational prevalence of fatal opioid overdose, depicting an overall pooled prevalence estimate of 19.66%, with 95% CIs (0.13-0.29), I2 = 99.76% determined using the random-effects model, and Q statistic of 7198.77 (p < 0.0001). The Egger test models of publication bias revealed an insubstantial level of bias (p = 0.015). The subgroup analysis of the study design (cohort or other) revealed that others have the highest prevalence estimate of 34.37, 95% CIs (0.1600-0.5901), I2 = 97.04%, and a sample size of less than 1,000 shows the highest prevalence of 34.66, 95% CIs (0.2039-0.5234), I2 = 97.82%, compared to that of more than 1,000 with a prevalence of 12.28, 95% CIs (0.0675-0.2131), I2 = 99.85%. The meta-regression analysis revealed that sample size (less-than or greater-than 1,000), (p = 0.0098; R2 = 3.83%) is significantly associated with the observed heterogeneity. Conclusion Research-based findings of fatal opioid overdose are grossly lacking in middle- and low-income nations. We established that there is a need for opioid fatality surveillance systems in developing nations.
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Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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2
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Roxburgh A, Livingston M, Dietze P, Nielsen S, Cogger S, Bartlett M, Day C, Latimer J, Jauncey M, Clark N. The impact of COVID-19 public health measures on attendance and overdose at supervised injecting facilities in Australia. Public Health 2023; 224:90-97. [PMID: 37742585 DOI: 10.1016/j.puhe.2023.08.019] [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: 04/28/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic disrupted service provision of harm reduction and drug treatment services for people who inject drugs in many countries. The two supervised injecting facilities (SIFs) in Sydney and Melbourne were differentially impacted by the pandemic, requiring local procedural changes in each service. We aimed to examine the impact of pandemic responses (including restrictions on movement, known as 'lockdowns') on service use and key parameters such as client reports of drug injected and recorded overdose rates. STUDY DESIGN Time series analysis of weekly client visits and monthly overdoses occurring at each service. METHODS Administrative client data from the two SIFs (Sydney data from 1 January 2018 to 30 April 2022; Melbourne data from 1 July 2018 to 30 April 2022) were examined using interrupted time series analyses with lockdown dates in each state entered as interruption terms. We analysed weekly SIF visits overall and by drug type, and monthly rates of opioid overdose at each service. RESULTS Lockdowns resulted in decreased visits to both services. The number of weekly client visits decreased during the first national lockdown for both the Sydney (trend change = -57.9; 95% CI [-109.4, -6.4]) and Melbourne SIF (near sig trend change = -54.8 [-110.8, 1.05]). Trends in visit numbers increased after lockdowns were lifted in each city; however, visits in Sydney have not returned to the numbers recorded prior to the pandemic. Visits to the Melbourne SIF related to heroin use declined at each lockdown (trend 1 = -42.7 [-81.5, -3.9]; trend 2 = -56.1 [-94.6, -17.7]; trend 3 = -33.8 [-67.4, -0.2]); heroin visits to the Sydney SIF declined during the first lockdown and remained low (trend = -55.6 [-82.8, -28.3]). Methamphetamine visits to the Sydney SIF fluctuated, surpassing heroin visits at several timepoints. Rates of monthly opioid overdoses at both services declined immediately following the start of the first lockdown (Sydney = -16.6 [-26.1, -6.8]; Melbourne = -6.4 [-8.7, -4.1]), with increasing trends recorded at the end of the final lockdown in each jurisdiction (Sydney = 2.8 [0.6, 5.0]; Melbourne = 1.3 [0.72, 3.2]). CONCLUSIONS Public health restrictions related to the COVID-19 pandemic were associated with reduced client visits to, and overdoses in, Australian SIFs. Variations were noted in the drugs injected, likely reflecting changes in local drug markets. Shifts to other drugs during these periods were evident: methamphetamine in Sydney; co-injection of heroin and diphenhydramine in Melbourne.
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Affiliation(s)
- A Roxburgh
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia.
| | - M Livingston
- National Drug Research Institute, Curtin University, Perth, Australia
| | - P Dietze
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - S Nielsen
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - S Cogger
- North Richmond Community Health Medically Supervised Injecting Room, Melbourne Australia
| | - M Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - C Day
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - J Latimer
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - M Jauncey
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - N Clark
- North Richmond Community Health Medically Supervised Injecting Room, Melbourne Australia; Addiction Medicine, Royal Melbourne Hospital, Melbourne, Australia
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Tas B, Lawn W, Traykova EV, Evans RAS, Murvai B, Walker H, Strang J. A scoping review of mHealth technologies for opioid overdose prevention, detection and response. Drug Alcohol Rev 2023; 42:748-764. [PMID: 36933892 DOI: 10.1111/dar.13645] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/20/2023]
Abstract
ISSUES Opioid overdose kills over 100,000 people each year globally. Mobile health (mHealth) technologies and devices, including wearables, with the capacity to prevent, detect or respond to opioid overdose exist in early form, or could be re-purposed or designed. These technologies may particularly help those who use alone. For technologies to be successful, they must be effective and acceptable to the at-risk population. The aim of this scoping review is to identify published studies on mHealth technologies that attempt to prevent, detect or respond to opioid overdose. APPROACH A systematic scoping review of literature was conducted up to October 2022. APA PsychInfo, Embase, Web of Science and Medline databases were searched. INCLUSION CRITERIA articles had to report on (i) mHealth technologies that deal with (ii) opioid (iii) overdose. KEY FINDINGS A total of 348 records were identified, with 14 studies eligible for this review across four domains: (i) technologies that require intervention/response from others (four); (ii) devices that use biometric data to detect overdose (five); (iii) devices that automatically respond to an overdose with administration of an antidote (three); (iv) acceptability/willingness to use overdose-related technologies/devices (five). IMPLICATIONS There are multiple routes in which these technologies may be deployed, but several factors impact acceptability (e.g., discretion or size) and accuracy of detection (e.g., sensitive parameter/threshold with low false positive rate). CONCLUSION mHealth technologies for opioid overdose may play a crucial role in responding to the ongoing global opioid crises. This scoping review identifies vital research that will determine the future success of these technologies.
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Affiliation(s)
- Basak Tas
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elena V Traykova
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca A S Evans
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Barbara Murvai
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hollie Walker
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Werb D, Scheim AI, Soipe A, Aeby S, Rammohan I, Fischer B, Hadland SE, Marshall BDL. Health harms of non-medical prescription opioid use: A systematic review. Drug Alcohol Rev 2022; 41:941-952. [PMID: 35437841 PMCID: PMC9064965 DOI: 10.1111/dar.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
ISSUES Non-medical prescription opioid use (NMPOU) contributes substantially to the global burden of morbidity. However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken. APPROACH We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD-10 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence-Based Medicine 'Levels of Evidence' scale to assess study quality. KEY FINDINGS Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self-harm and 1 study assessing its association with assault (<1%). IMPLICATIONS A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non-fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self-harm, suicidal ideation and assault. DISCUSSION AND CONCLUSIONS Findings may inform the prevention of harms associated with NMPOU, although higher-quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.
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Affiliation(s)
- Dan Werb
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Ayden I Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ayorinde Soipe
- Department of Epidemiology, Brown University School of Public Health, Providence, USA.,Division of Nephrology, Department of Medicine, State University of New York, New York, USA
| | - Samantha Aeby
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada.,Department of Psychiatry, Federal University of Sao Paulo, São Paulo, Brazil
| | - Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, USA.,Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
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5
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Padwa H, Bass B, Urada D. Homelessness and publicly funded substance use disorder treatment in California, 2016-2019: Analysis of treatment needs, level of care placement, and outcomes. J Subst Abuse Treat 2021; 137:108711. [PMID: 35012791 DOI: 10.1016/j.jsat.2021.108711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Both homelessness and substance use have increased in recent years. People experiencing homelessness (PEH) are at increased risk for health problems and early mortality, both of which can be exacerbated by substance use disorders (SUD). Specialty SUD treatment is likely needed to address substance use among PEH, and more than 232,000 PEH received treatment from U.S. publicly funded SUD programs in 2015. The objective of this paper is to develop a better understanding of the SUD services that PEH receive in publicly funded treatment programs by (1) describing the characteristics and needs of the PEH population served in publicly funded SUD treatment programs, compared to non-PEH populations; (2) determining if differences exist in treatment placement (level of care) for PEH and non-PEH; and (3) gauging how successful programs are in treating PEH compared to non-PEH. METHODS Observational study using a two-way fixed effect model to determine associations among homelessness, retention, and outcomes among Medicaid beneficiaries receiving SUD treatment in California from 2016 to 2019 (n = 638,953). The study team used ordinary least squares (OLS) regression to measure the degree to which homelessness was associated with baseline characteristics, SUD services received, and treatment outcomes. RESULTS PEH were significantly more likely than non-PEH to be having methamphetamine or heroin as their primary substance. PEH had greater frequency of primary substance use prior to entering treatment, greater ER and hospital utilization, more criminal justice involvement, and greater prevalence of mental health diagnoses and unemployment. PEH were 9.82% more likely than non-PEH to receive residential treatment and 7.11% less likely than non-PEH to receive treatment intensive outpatient modalities. Homelessness was associated with an 11.90% decrease in retention, and a 19.40% decrease in successful discharge status. These trends were consistent across outpatient, intensive outpatient, and residential modalities. CONCLUSIONS Developing SUD treatment capacity and housing supports can improve treatment outcomes for PEH. Potential strategies to improve SUD services for PEH include providing more contingency management, opioid pharmacotherapies, programming designed to treat individuals with co-occurring mental health disorders, and resources for housing options that can support PEH in their recovery.
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Affiliation(s)
- Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America.
| | - Brittany Bass
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America
| | - Darren Urada
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America
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Wares JR, Dong J, Gevertz JL, Radunskaya A, Vine K, Wiebe D, Solomon S. Predicting the impact of placing an overdose prevention site in Philadelphia: a mathematical modeling approach. Harm Reduct J 2021; 18:110. [PMID: 34717657 PMCID: PMC8556858 DOI: 10.1186/s12954-021-00559-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites—commonly known as safe injection facilities—in proximity of locations with the highest rates of overdose. As urban centers in the USA are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to assess the magnitude of the effect that these services might have on public health. Methods We developed a mathematical model to describe the movement of people who used opioids to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and treatment/recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia and ran simulations to describe the effect of placing a site in the Kensington neighborhood. Results In Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in White opioid users being more likely to benefit from the site’s services. Overdoses that occur onsite can be reversed. Our results predict that for every 30 stations in the overdose prevention site, 6 per year of these would have resulted in fatalities if they had occurred outside of the overdose prevention site. Additionally, we estimate that fatalities will decrease further when referrals from the OPS to treatment are considered. Conclusions Mathematical modeling was used to predict the impact of placing an overdose prevention site in the Kensington neighborhood of Philadelphia. To fully understand the impact of site placement, both direct and indirect effects must be included in the analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact. Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an overdose prevention site in a particular location.
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Affiliation(s)
- Joanna R Wares
- Department of Mathematics and Computer Science, University of Richmond, 204 Jepson Hall, 221 Richmond Way, Richmond, VA, 23173, USA.
| | - Jing Dong
- Department of Mathematics and Computer Science, University of Richmond, 204 Jepson Hall, 221 Richmond Way, Richmond, VA, 23173, USA
| | - Jana L Gevertz
- Department of Mathematics and Statistics, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Ami Radunskaya
- Department of Mathematics and Statistics, Pomona College, Claremont, CA, 91711, USA
| | - Kendra Vine
- Division of Substance Use Prevention and Harm Reduction, Department of Public Health, Philadelphia, PA, 19109, USA
| | - Doug Wiebe
- Penn Injury Science Center, Department of Biostatistics, Informatics and Epidemiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sara Solomon
- Penn Injury Science Center, Department of Biostatistics, Informatics and Epidemiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Prevalence and correlates of multiple non-fatal opioid overdoses among people who inject drugs who utilise needle syringe programs in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103245. [PMID: 33840562 DOI: 10.1016/j.drugpo.2021.103245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Non-fatal overdose (NFOD) is a major cause of morbidity among people who inject drugs (PWID) and multiple NFOD is associated with increased risk of fatal overdose. Despite this, few studies have examined the prevalence and correlates of drug-specific multiple NFOD. The current study aimed to determine the prevalence and correlates of recent multiple non-fatal opioid overdose (NFOOD) among PWID who access needle syringe programs (NSPs) in Australia. METHODS The Australian Needle and Syringe Program Survey is conducted annually and was conducted at 46 sites across Australia in 2019. Participation involves completion of a self-administered questionnaire and a capillary dried blood spot for HIV and hepatitis C virus testing. In 2019, respondents who reported a minimum of one NFOOD in the previous 12 months (recent NFOOD) were asked to complete supplementary questions regarding their last NFOOD. Bivariate and multivariate logistic regression were used to determine factors independently associated with multiple recent NFOOD. RESULTS A total of 222 respondents reported recent NFOOD. Respondents were predominantly male (59%), one third (39%) were aged less than 39 years and 73% reported last injecting heroin at their last NFOOD. One in two respondents (48%, n = 107) reported multiple opioid overdoses (median 3, interquartile range 2-5). The odds of reporting multiple NFOOD were higher among respondents who reported injecting in a public location at their last NFOOD (adjusted odds ratio [AOR] 2.10, 95% CI 1.14-3.90, p = 0.018) and benzodiazepine use in the 12 h prior to NFOOD (AOR 2.74, 95% CI 1.50-4.99, p = 0.001). CONCLUSIONS Multiple NFOOD was prevalent among PWID who utilised NSPs who reported recent NFOOD. Public injecting and benzodiazepine use were associated with increased risk of multiple NFOOD, and there is a need for interventions specifically targeting PWID who report these high risk injecting practices.
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Chakravarthy K, Goel A, Jeha GM, Kaye AD, Christo PJ. Review of the Current State of Urine Drug Testing in Chronic Pain: Still Effective as a Clinical Tool and Curbing Abuse, or an Arcane Test? Curr Pain Headache Rep 2021; 25:12. [PMID: 33598816 DOI: 10.1007/s11916-020-00918-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Therapeutic use, misuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain remain a major concern for physicians, the government, payers, and patients. The challenge remains finding effective diagnostic tools that can be clinically validated to eliminate or substantially reduce the abuse of controlled prescription drugs, while still assuring the proper treatment of those patients in pain. Urine drug testing still remains an important means of adherence monitoring, but questions arise as to its relevance and effectiveness. This review examines the role of UDT, determines its utility in current clinical practice, and investigates its relevance in current chronic pain management. RECENT FINDINGS A review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature was searched from year 2000 to present examining the relevance and role of UDT in monitoring chronic opioid therapy along with reliability and accuracy, appropriate use, overuse, misuse, and abuse. There are only a limited number of reviews and investigations on UDT, despite the fact that clinicians who prescribe controlled medications for chronic states commonly are expected to utilize UDT. Therefore, despite highly prevalent use, there is a limited publication base from which to draw in this present study. Regardless of experience or training background, physicians and healthcare providers can much more adequately assess opioid therapy with the aid of UDT, which often requires confirmatory testing by a laboratory for clinical and therapeutic prescribing decisions. It has become a strongly recommended aspect of pain care with controlled substances locally, regionally, and nationally. Incorporating UDT for all patients in whom chronic opioid therapy is undertaken is consistent with state and national guidelines and best practice strategies. Practice standards vary as to the frequency of UDT locally, regionally, and nationally, however.
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Affiliation(s)
- Krishnan Chakravarthy
- VA San Diego Healthcare System, UC San Diego School of Medicine, La Jolla, CA, USA. .,Department of Anesthesiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Aneesh Goel
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, 550 North Broadway, Suite 301, Baltimore, MD, 21205, USA
| | - George M Jeha
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alan David Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Departments of Anesthesiology and Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Paul J Christo
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, 550 North Broadway, Suite 301, Baltimore, MD, 21205, USA.
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9
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Tas B, Jolley CJ, Kalk NJ, van der Waal R, Bell J, Strang J. Heroin-induced respiratory depression and the influence of dose variation: within-subject between-session changes following dose reduction. Addiction 2020; 115:1954-1959. [PMID: 32057141 DOI: 10.1111/add.15014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 12/23/2019] [Accepted: 02/07/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Globally, more than 100 000 people die annually from opioid overdose. Opportunities to study physiological events in at-risk individuals are limited. This study examined variation of opioid dose and impact on respiratory depression in a chronic injecting heroin user at separate time-points during his long-term diamorphine maintenance treatment. DESIGN A single-subject study over 5 years during which participant underwent experimental studies on diamorphine-induced respiratory depression, at changing maintenance doses. SETTING A clinical research facility. Participant Male subject on long-term injectable diamorphine (pharmaceutical heroin) maintenance treatment for heroin addiction. MEASUREMENTS Physiological measures of oxygen saturation (SpO2 ), end-tidal carbon dioxide (ETCO2 ) and respiratory rate (RR) were used to indicate severity of respiratory depression. FINDINGS (1) After diamorphine injection, respiratory regulation became abnormal, with prolonged apnoea exceeding 20 sec (maximum 56 sec), elevated ETCO2 (maximum 6.9%) and hypoxaemia (minimum SpO2 80%). (2) Abnormalities were greater with highest diamorphine dose: average SpO2 was 89.3% after 100 mg diamorphine versus 93.6% and 92.8% for the two 30-mg doses. (3) However, long apnoeic pauses and high levels of ETCO2 % were also present after lower doses. CONCLUSIONS With marked inter-session variability, these findings corroborate observations of inconsistent relationships between opioid dose and overdose risk.
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Affiliation(s)
- Basak Tas
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Caroline J Jolley
- King's College London, Centre for Human and Applied Physiological Sciences, London, UK
| | - Nicola J Kalk
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | - James Bell
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - John Strang
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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10
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Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain. PLoS One 2020; 15:e0232538. [PMID: 32365132 PMCID: PMC7197848 DOI: 10.1371/journal.pone.0232538] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
Background After decades of increased opioid pain reliever prescribing, providers are rapidly reducing prescribing. We hypothesized that reduced access to prescribed opioid pain relievers among patients previously reliant upon opioid pain relievers would result in increased illicit opioid use. Methods and findings We conducted a retrospective cohort study among 602 publicly insured primary care patients who had been prescribed opioids for chronic non-cancer pain for at least three consecutive months in San Francisco, recruited through convenience sampling. We conducted a historical reconstruction interview and medical chart abstraction focused on illicit substance use and opioid pain reliever prescriptions, respectively, from 2012 through the interview date in 2017–2018. We used a nested-cohort design, in which patients were classified, based on opioid pain reliever dose change, into a series of nested cohorts starting with each follow-up quarter. Using continuation-ratio models, we estimated associations between opioid prescription discontinuation or 30% increase or decrease in dose, relative to no change, and subsequent frequency of heroin and non-prescribed opioid pain reliever use, separately. Models controlled for demographics, clinical and behavioral characteristics, and past use of heroin or non-prescribed opioid pain relievers. A total of 56,372 and 56,484 participant-quarter observations were included from the 597 and 598 participants available for analyses of heroin and non-prescribed opioid pain reliever outcomes, respectively. Participants discontinued from prescribed opioids were more likely to use heroin (Adjusted Odds Ratio (AOR) = 1.57, 95% CI: 1.25–1.97) and non-prescribed opioid pain relievers (AOR = 1.75, 1.45–2.11) more frequently in subsequent quarters compared to participants with unchanged opioid prescriptions. Participants whose opioid pain reliever dose increased were more likely to use heroin more frequently (AOR = 1.67, 1.32–2.12). Results held throughout sensitivity analyses. The main limitations were the observational nature of results and limited generalizability beyond safety-net settings. Conclusions Discontinuation of prescribed opioid pain relievers was associated with more frequent non-prescribed opioid pain reliever and heroin use; increased dose was also associated with more frequent heroin use. Clinicians should be aware of these risks in determining pain management approaches.
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11
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Roxburgh A, Hall WD, Gisev N, Degenhardt L. Characteristics and circumstances of heroin and pharmaceutical opioid overdose deaths: Comparison across opioids. Drug Alcohol Depend 2019; 205:107533. [PMID: 31704378 DOI: 10.1016/j.drugalcdep.2019.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although much is known about the correlates of heroin overdose, less is known about pharmaceutical opioid (PO) overdose. This study aimed to examine correlates of opioid overdose deaths by opioid and compare correlates between opioids. METHODS Analysis of opioid overdose deaths in Australia between 2000-2015, extracted from the National Coronial Information System (NCIS). The NCIS is an online database of deaths reportable to the coroner, and contains coroner's findings, autopsy and toxicology reports. Deaths were categorized into mutually exclusive groups: 1) Heroin deaths; and 2) PO deaths (excluding heroin). PO deaths were examined by individual opioid. RESULTS There were 10,795 opioid overdose deaths over the study period. Relative to deaths occurring in major cities, deaths in regional/remote areas had 15.2 (95 % CI: 11.5-20.2) times the risk of being attributed to pharmaceutical fentanyl than heroin. Relative to deaths among people without a recorded history of chronic pain, deaths among people with a recorded history of chronic pain had a 1.9-10.7-fold increased risk of the death being attributed to POs than heroin. Deaths among people with a recorded history of substance use problems where the opioid was injected prior to death had 7.2 and 1.7 times the risk of being attributed to methadone and pharmaceutical fentanyl (respectively) than heroin. CONCLUSIONS Findings suggest the need to: educate PO consumers about the risks of overdose at the time of prescribing; increase coverage and engagement in opioid dependence treatment (particularly in regional/remote areas); and increase uptake of take-home naloxone to reduce opioid overdose mortality.
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Affiliation(s)
- Amanda Roxburgh
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Wayne D Hall
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia; University of Queensland Clinical Centre for Research, University of Queensland, Brisbane, QLD, 4072, Australia; University of Queensland Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, 4006, Australia; National Addiction Centre, Kings College London, WC2R 2LS, United Kingdom
| | - Natasa Gisev
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia; School of Population and Global Health, University of Melbourne, VIC, 3010, Australia
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12
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Harms associated with extramedical use of prescription opioid analgesics in Australia: A scoping review. Res Social Adm Pharm 2019; 15:925-935. [DOI: 10.1016/j.sapharm.2018.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/02/2018] [Indexed: 01/01/2023]
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13
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DelVillano S, de Groh M, Morrison H, Do MT. At-a-glance - Supervised Injection Services: a community-based response to the opioid crisis in the City of Ottawa, Canada. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2019; 39:112-115. [PMID: 30869474 DOI: 10.24095/hpcdp.39.3.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In response to the current opioid crisis in Canada, establishing safe injection services (SIS) in high risk communities has become more prevalent. In November 2017, The Trailer opened in Ottawa, Canada and tracks client use, overdose treatment and overdoses reversed. We analyzed data collected between November 2017 and August 2018. During peak hours, demand for services consistently exceeded The Trailer's capacity. Overdoses treated and reversed in this facility increased substantially during this period. Results suggest The Trailer provided an important though not optimal (due to space restrictions) harm reduction service to this high-risk community.
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Affiliation(s)
| | | | | | - Minh T Do
- Health Canada, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
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14
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"Beyond Safer Injecting"-Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112032. [PMID: 31181648 PMCID: PMC6603933 DOI: 10.3390/ijerph16112032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022]
Abstract
Health and social issues in aging populations of people who inject drugs (PWID) tend to aggregate, despite risky injecting practices decreasing with age. Identifying needs and avenues of support is becoming increasingly important. We described the health and social situation among clients of a long-running supervised injecting facility (SIF) in Sydney, Australia. An interviewer-administered survey (n = 182) assessed current housing status, employment, physical and mental health, incarceration history, drug use, engagement in drug treatment, health service utilization, and willingness to accept support. Results were compared to the information provided at initial visit. Up to half of the participants transitioned between lower- and higher-risk health and social indicators over time. Willingness to accept support was greatest amongst those with higher self-perceived need. Support for mental health was a low priority, despite the high self-reporting of mental health issues. SIF clients are open to support for health and social issues, despite ongoing active drug use. Lower-threshold services such as SIFs are well-positioned to recognize and respond to deteriorating health and social issues for PWID. Facilitating care and treatment remains a challenge when the services to which people are being referred are higher-threshold with a more rigid approach.
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15
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Belackova V, Salmon AM, Day CA, Ritter A, Shanahan M, Hedrich D, Kerr T, Jauncey M. Drug consumption rooms: A systematic review of evaluation methodologies. Drug Alcohol Rev 2019; 38:406-422. [PMID: 30938025 DOI: 10.1111/dar.12919] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 01/27/2023]
Abstract
ISSUES Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. APPROACH Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. KEY FINDINGS Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. IMPLICATIONS Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. CONCLUSIONS Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.
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Affiliation(s)
| | - Allison M Salmon
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Carolyn A Day
- Central Clinical School, Addiction Medicine, University of Sydney, Royal Prince Albert Hospital, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, UNSW Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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16
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Mallow PJ, Sathe N, Topmiller M, Chubinski J, Carr D, Christopher R. Estimating the Prevalence of Opioid use Disorder in the Cincinnati Region using Probabilistic Multiplier Methods and Model Averaging. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2019; 6:61-69. [PMID: 32685580 PMCID: PMC7299446 DOI: 10.36469/9729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Opioid use disorder (OUD) and its consequences have strained the resources of health, social, and criminal justice services in the Cincinnati region. However, understanding of the potential number of people suffering from OUD is limited. Little robust and reliable information quantifies the prevalence and there is often great variation between individual estimates of prevalence. In other fields such as meteorology, finance, sports, and politics, model averaging is commonly employed to improve estimates and forecasts. The objective of this study was to apply a model averaging approach to estimate the number of individuals with OUD in the Cincinnati region. METHODS Three individual probabilistic simulation models were developed to estimate the number of OUD individuals in the Cincinnati Core Based Statistical Area (CBSA). The models used counts of overdose deaths, non-fatal overdoses, and treatment admissions as benchmark data. A systematic literature review was performed to obtain the multiplier data for each model. The three models were averaged to generate single estimate and confidence band of the prevalence of OUD. RESULTS This study estimated 15 067 (SE 1556) individuals with OUD in the Cincinnati CBSA (2 165 139 total population). Based on these results, we estimate the prevalence of OUD to be between 13 507 (0.62% of population) and 16 620 (0.77% of population). CONCLUSIONS The method proposed herein has been shown in diverse fields to mitigate some of the uncertainty associated with reliance on a single model. Further, the simplicity of the method described is easily replicable by community health centers, first-responders, and social services to estimate capacity needs supported by OUD estimates for the region they serve.
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Affiliation(s)
| | | | - Michael Topmiller
- HealthLandscape, Cincinnati, OH
- American Academy of Family Physicians, Cincinnati, OH
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17
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Power J, Salmon AM, Latimer J, Jauncey M, Day CA. Overdose Risk and Client Characteristics Associated With the Injection of Buprenorphine at a Medically Supervised Injecting Center in Sydney, Australia. Subst Use Misuse 2019; 54:1646-1653. [PMID: 30973286 DOI: 10.1080/10826084.2019.1600147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Buprenorphine and buprenorphine/naloxone (BNX) were developed to improve the safety profile of opioid substitution treatment (OST) and reduce diversion and injection, yet continue to be injected, despite the risk of harm. Previous studies examining injection of these substances have relied on self-reported injection and overdose. Using data from the Uniting Medically Supervised Injecting Center (MSIC) in Sydney, this study aimed to assess the overdose risk associated with the use of buprenorphine and BNX and identify factors associated with injecting. Methods: Client data routinely collected from MSIC, a drug consumption room where clients can legally inject drugs under supervision, was used. Odds ratios (OR) to assess the risk of overdose and their associated 95% confidence intervals (95%CI) were calculated and compared to other substances. Univariate analysis using χ-square and multivariate logistic regressions were used to determine characteristics associated with buprenorphine and BNX injection. Results: Data from 1,020,782 injections by 15,832 individuals were analyzed. Risk of overdose was low for buprenorphine compared to other substances (OR 0.16; 95%CI: 0.07-0.19) and no overdoses occurred when BNX was injected. Injection of both buprenorphine and BNX was associated with male gender, homelessness, no income/reliance upon government payments, and prior imprisonment. Conclusions: Buprenorphine and BNX continue to be injected, albeit in small numbers. This is the first study to report on injection and overdose risk using direct observation, and has confirmed the lower overdose risk. MSIC clients who inject buprenorphine and BNX tend to be marginalized and may benefit from targeted harm reduction measures.
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Affiliation(s)
- Joseph Power
- a The Sydney Central Clinical School, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Allison M Salmon
- b Uniting Medically Supervised Injecting Centre , Kings Cross , NSW , Australia
| | - Julie Latimer
- b Uniting Medically Supervised Injecting Centre , Kings Cross , NSW , Australia
| | - Marianne Jauncey
- a The Sydney Central Clinical School, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia.,b Uniting Medically Supervised Injecting Centre , Kings Cross , NSW , Australia
| | - Carolyn A Day
- a The Sydney Central Clinical School, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia.,b Uniting Medically Supervised Injecting Centre , Kings Cross , NSW , Australia
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18
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Ray BR, Lowder EM, Kivisto AJ, Phalen P, Gil H. EMS naloxone administration as non-fatal opioid overdose surveillance: 6-year outcomes in Marion County, Indiana. Addiction 2018; 113:2271-2279. [PMID: 30255531 DOI: 10.1111/add.14426] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/13/2018] [Accepted: 08/20/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS Despite rising rates of opioid overdose in the United States, few studies have examined the frequency of non-fatal overdose events or mortality outcomes following resuscitation. Given the widespread use of naloxone to respond to overdose-related deaths, naloxone administration may provide a useful marker of overdose events to identify high-risk users at heightened risk of mortality. We used naloxone administration by emergency medical services as a proxy measure of non-fatal overdose to examine repeat events and mortality outcomes during a 6-year period. METHODS We conducted a retrospective investigation of all cases in Marion County, Indiana between January 2011 and December 2016 where emergency medical services used naloxone to resuscitate a patient. Cases were linked to vital records to assess mortality and cause of death during the same time-period. We used Cox regression survival analysis to assess whether repeat non-fatal overdose events during the study period were associated with the hazard of mortality, both overall and by cause of death. RESULTS Of 4726 patients administered naloxone, 9.4% (n = 444) died an average of 354 days [standard deviation (SD) = 412.09, range = 1-1980] following resuscitation. Decedents who died of drug-related causes (34.7%, n = 154) were younger and more likely to have had repeat non-fatal overdose events. Patients with repeat non-fatal overdose events (13.4%, n = 632) had a ×2.07 [95% confidence interval (CI) = 1.59, 2.71] higher hazard of all-cause mortality and a ×3.06 (95% CI = 2.13, 4.40) higher hazard of drug-related mortality. CONCLUSIONS Among US emergency medical service patients administered naloxone for opioid overdose, those with repeat non-fatal opioid overdose events are at a much higher risk of mortality, particularly drug-related mortality, than those without repeat events.
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Affiliation(s)
- Bradley R Ray
- School of Public and Environmental Affairs, Indiana University, Purdue University Indianapolis, Indianapolis, IN, USA
| | - Evan M Lowder
- School of Public and Environmental Affairs, Indiana University, Purdue University Indianapolis, Indianapolis, IN, USA
| | - Aaron J Kivisto
- School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, USA
| | - Peter Phalen
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Harold Gil
- Marion County Public Health Department, Indianapolis, IN, USA
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19
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May T, Bennett T, Holloway K. RETRACTED: The impact of medically supervised injection centres on drug-related harms: a meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:98-107. [PMID: 30077946 DOI: 10.1016/j.drugpo.2018.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/22/2018] [Accepted: 06/15/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Tom May
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
| | - Trevor Bennett
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
| | - Katy Holloway
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
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20
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Stam NC, Pilgrim JL, Drummer OH, Smith K, Gerostamoulos D. Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment. Clin Toxicol (Phila) 2018; 56:1135-1142. [DOI: 10.1080/15563650.2018.1478093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nathan C. Stam
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | | | - Olaf H. Drummer
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Victorian Institute of Forensic Medicine, Melbourne, Australia
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21
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Palis H, Marchand K, Karamouzian M, MacDonald S, Harrison S, Guh D, Lock K, Brissette S, Anis AH, Krausz M, Marsh DC, Schechter MT, Oviedo-Joekes E. The association between nicotine dependence and physical health among people receiving injectable diacetylmorphine or hydromorphone for the treatment of chronic opioid use disorder. Addict Behav Rep 2018; 7:82-89. [PMID: 29892701 PMCID: PMC5993889 DOI: 10.1016/j.abrep.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 03/25/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION People with chronic opioid use disorder often present to treatment with individual and structural vulnerabilities and remain at risk of reporting adverse health outcomes. This risk is greatly compounded by tobacco smoking, which is highly prevalent among people with chronic opioid use disorder. Despite the known burden of tobacco smoking on health, the relationship between nicotine dependence and health has not been studied among those receiving injectable opioid agonist treatment. As such, the present study aims to explore the association between nicotine dependence and physical health among participants of the Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME) at baseline and six-months. METHODS SALOME was a double-blind phase III clinical trial testing the non-inferiority of injectable hydromorphone to injectable diacetylmorphine for chronic opioid use disorder. Participants reporting tobacco smoking were included in a linear regression analysis of physical health at baseline (before receiving treatment) and at six-months. RESULTS At baseline, nicotine dependence score, lifetime history of emotional, physical, or sexual abuse and prior month safe injection site access were independently and significantly associated with physical health. At six-months nicotine dependence score was the only variable that maintained this significant and independent association with physical health. CONCLUSIONS Findings indicate that after six-months, the injectable treatment effectively brought equity to patients' physical health status, yet the association with nicotine dependence remained. Findings could inform whether the provision of treatment for nicotine dependence should be made a priority in settings where injectable opioid agonist treatment is delivered to achieve improvements in overall physical health in this population.
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Affiliation(s)
- Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway, Kerman, Iran
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Suzanne Brissette
- Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, CHUM Montréal, Montréal, QC H2X 3J4, Canada
| | - Aslam H. Anis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - David C. Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada
| | - Martin T. Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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Jauncey M, Livingston M, Salmon AM, Dietze P. The impact of OxyContin reformulation at the Sydney Medically Supervised Injecting Centre: Pros and cons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:17-22. [DOI: 10.1016/j.drugpo.2017.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
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