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Ezell JM, Pho MT, Ajayi BP, Simek E, Shetty N, Goddard-Eckrich DA, Bluthenthal RN. Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model. Drug Alcohol Rev 2024; 43:1143-1159. [PMID: 38646735 DOI: 10.1111/dar.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
ISSUES To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. APPROACH Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. KEY FINDINGS Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. IMPLICATIONS There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. CONCLUSION There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, USA
| | - Babatunde P Ajayi
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Elinor Simek
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Netra Shetty
- University of California Berkeley, Berkeley, USA
| | | | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Gray AC, Neitzke-Spruill L, Hughes C, O'Connell DJ, Anderson TL. Opioid-stimulant trends in overdose toxicology by race, ethnicity, & gender: An analysis in Delaware, 2013-2019. J Ethn Subst Abuse 2024; 23:471-500. [PMID: 35973048 DOI: 10.1080/15332640.2022.2109790] [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] [Indexed: 10/15/2022]
Abstract
Recent upticks of stimulant presence in overdose deaths suggest the opioid epidemic is morphing, which raises questions about what drugs are involved and who is impacted. We investigate annual and growth rate trends in combined opioid-stimulant overdose toxicology between 2013 and 2019 for White, Black, and Hispanic male and female decedents in Delaware. During these years, toxicology shifted to illegal drugs for all with fentanyl leading the increase and opioid-cocaine combinations rising substantially. While combined opioid-cocaine toxicology grew among Black and Hispanic Delawareans, White males continue to report the highest rates overall. These findings depart from historical patterns and may challenge existing opioid epidemic policies.
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Affiliation(s)
| | | | | | - Daniel J O'Connell
- Center for Drug and Health Studies, University of Delaware, Newark, Delaware
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Watson DP, Swartz JA, Magee LA, Bray BC, Phalen P, Medcalf S, McGuire AB. Latent class analysis of emergency department patients engaged in telehealth peer recovery support services and associations of identified classes with post-discharge outcomes. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209282. [PMID: 38135121 PMCID: PMC11060927 DOI: 10.1016/j.josat.2023.209282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/23/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND People with substance use disorders (SUDs) frequently use emergency department (ED) services. Despite evidence demonstrating that post-discharge SUD treatment linkage effectively reduces the number of ED re-presentations, relatively few hospitals have implemented interventions to identify and connect patients with SUDs to appropriate care. ED-based peer recovery support specialist (PRSS) interventions have emerged as a promising approach for hospitals, but more research is needed to understand the extent to which these interventions meet the needs of patients who present to the ED for different reasons and with various underlying concerns. METHOD A retrospective cohort analysis used data from a telehealth PRSS program in 15 EDs within one Indiana hospital system. The study included 2950 ED patients who engaged with telehealth PRSS services between September 2018 and September 2021. Latent class analysis identified patterns of patient characteristics associated with post-discharge PRSS engagement and ED re-presentations. Covariate predictors and distal outcomes were assessed to examine the associations between class membership, demographic factors, and patient outcomes. RESULTS The study team selected a six-class model as the best fit for the data. Class 1, representing patients with opioid use disorder and mental health diagnoses who presented to the ED for an opioid overdose, was used as the reference class for all other statistical tests. Multinomial logistic regression analysis demonstrated significant associations between covariate predictors, outcomes, and class membership. Regression results also demonstrate PRSSs had greater success contacting patients with prior year ED use and patients with a successful post-discharge PRSS contact were less likely to re-present to the ED. CONCLUSION Results highlight the heterogeneity of patients with SUDs and emphasize the need for tailored interventions to address patient-specific needs more effectively. They also provide support for the perceived utility of PRSS engagement for ED patients.
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Affiliation(s)
- Dennis P Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W. Walton Street, Chicago, IL 60610, USA.
| | - James A Swartz
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 W. Harrison Street, Chicago, IL 60607, USA
| | - Lauren A Magee
- Paul H. O'Neill School of Environmental and Public Affairs, Indiana University - Purdue University Indianapolis, 801 W. Michigan Street, Indianapolis, IN 46202, USA
| | - Bethany C Bray
- Institute for Health Research and Policy, The University of Illinois at Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA
| | - Peter Phalen
- Division of Psychiatric Services Research, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Spencer Medcalf
- Indiana University Health, 950 N Meridian Street, Suite 900, Indianapolis, IN 46204, USA
| | - Alan B McGuire
- Indiana University Richard M. Fairbanks School of Public Health, Department of Social and Behavioral Sciences, 1050 Wishard Boulevard, Indianapolis, IN 46202, USA; Richard L. Roudebush VAMC, Health Services Research and Development, 1481 W. 10(th) Street (11H) Room C8108, Indianapolis, IN 46202, USA
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Jones AA, Waghmare SA, Segel JE, Harrison ED, Apsley HB, Santos-Lozada AR. Regional differences in fatal drug overdose deaths among Black and White individuals in the United States, 2012-2021. Am J Addict 2024. [PMID: 38520669 DOI: 10.1111/ajad.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/22/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The current study examines regional differences in Black/White fatal drug overdoses. METHODS Black/White overdose mortality data (2012-2021; N = 537,085) were retrieved from CDC WONDER. We used death counts and corresponding Census Bureau population estimates by the decedent's age and race/ethnicity to calculate mortality rate ratios. RESULTS From 2012 to 2021, there were 537,085 reported overdose deaths among White (85%) and Black (15%) individuals in the United States. In the South, Black individuals had lower fatal drug overdose deaths than their same-aged White counterparts. In the Northeast, Midwest, and West regions, Black individuals had around 10%-60% lower likelihood of overdoses among younger ages (15-24, 25-34, 35-44) but about 60%-300% higher likelihood of overdoses among older adults (55-64). Increases in overdose deaths during the pandemic (2020-2021) led to changes in Black/White overdose death patterns, whereas Black individuals of all ages in the Midwest and West regions had approximately 15%-425% higher likelihood of fatal overdoses than their same-aged White counterparts. Sex-stratified analysis suggests that Black females in the South had overdose death rates around 50% lower than same-aged White females, and overdose deaths were relatively equal for Black and White females in the Midwest-patterns not seen among males. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The findings indicate that the Black/White overdose mortality gap changed after the COVID-19 pandemic across all regions and age cohorts, with state and regional variations in magnitude. Behavioral interventions and policies to curb drug overdose deaths among populations most impacted should consider regional, sex, and age-related differences.
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Affiliation(s)
- Abenaa A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
- Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shashim A Waghmare
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Joel E Segel
- Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric D Harrison
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Hannah B Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alexis R Santos-Lozada
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
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Shearer RD, Segel JE, Howell BA, Jones AA, Khatri UG, da Silva DT, Vest N, Winkelman TN. Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources-United States, 2010-2019. Med Care 2024; 62:151-160. [PMID: 38180005 PMCID: PMC10922552 DOI: 10.1097/mlr.0000000000001969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources. OBJECTIVE To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances. RESEARCH DESIGN We conducted a longitudinal, cross-sectional analysis comparing trends. SUBJECTS We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files. MEASURES We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019. RESULTS Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. CONCLUSIONS Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.
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Affiliation(s)
- Riley D. Shearer
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joel E. Segel
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA
| | - Benjamin A. Howell
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA
| | - Utsha G. Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Teixeira da Silva
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Noel Vest
- Department of Anesthesia Stanford university School of Medicine, Stanford, CA
| | - Tyler N.A. Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN
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Jones AA, Schneider KE, Tobin KE, O'Sullivan D, Latkin CA. Daily opioid and stimulant co-use and nonfatal overdoses in the context of social disadvantage: Findings on marginalized populations. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 151:208986. [PMID: 36822268 PMCID: PMC10313799 DOI: 10.1016/j.josat.2023.208986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Opioids and stimulants are increasingly implicated in overdose deaths, particularly among minoritized groups. We examined daily opioid and cocaine co-use, nonfatal overdoses, and naloxone carrying among minoritized people who inject drugs (PWID). METHODS The study derived data from 499 PWID in Baltimore City, MD, recruited using street-based outreach between 2016 and 2019. Participants reported overdoses; sociodemographic characteristics; and use of nonmedical prescription opioids, heroin, cocaine, and naloxone. RESULTS Among the participants, the mean age was 46, 34 % were female, 64 % self-identified as Black, and 53 % experienced recent homelessness. Black PWID, compared to White PWID, were as likely to use opioids and cocaine daily but were 61 % less likely to have naloxone. After controlling for sociodemographic characteristics, women (aOR:1.88, 95%CI: 1.14, 3.11), persons experiencing homelessness (aOR:3.07, 95%CI: 1.79, 5.24), and those who experienced a recent overdose (aOR:2.14, 95%CI: 1.29, 3.58) were significantly more likely to use opioids and any form of cocaine every day. In a subanalysis of only female PWID, females engaged in sex work (aOR:2.27, 95%CI: 1.02, 5.07) and females experiencing recent homelessness (aOR:5.82, 95%CI: 2.50, 13.52) were significantly more likely to use opioids and cocaine daily. Furthermore, females (aOR:1.69, 95%CI:1.03, 2.77), persons experiencing homelessness (aOR:1.94, 95%CI:1.16, 3.24), and those with higher educational attainment (aOR:2.06, 95%CI:1.09, 3.91) were more likely to often/always carry naloxone, while Black PWID were less likely to have naloxone (aOR:0.39, 95%CI:0.22, 0.69). CONCLUSIONS These findings highlight the need for targeted naloxone distribution and other harm-reduction interventions among minoritized groups in urban areas.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, USA.
| | - K E Schneider
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
| | - K E Tobin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
| | - D O'Sullivan
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, USA
| | - C A Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
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Victor G, Ray B, Del Pozo B, Jaffe K, King A, Huynh P. Buprenorphine and opioid analgesics: Dispensation and discontinuity among accidental overdose fatalities in the Indianapolis metropolitan area, 2016-2021. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209053. [PMID: 37105266 PMCID: PMC10330395 DOI: 10.1016/j.josat.2023.209053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/28/2022] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND This study describes overall trends and sociodemographic disparities in buprenorphine and opioid analgesic uptake and prescribing patterns prior to fatal overdose events. METHODS We examined toxicology data from all accidental overdose deaths from 2016 to 2021 (N = 2682) in a large metropolitan area. These data were linked at the individual-level with a prescription drug monitoring program (PDMP). RESULTS Fewer than half of all deaths had any kind of PDMP record (39.9 %, n = 1070). Among those with a buprenorphine prescription, 10.6 % (n = 35) of decedents had a buprenorphine dispensation within 7 days of their death, while the majority (64.7 %, n = 214) were dispensed buprenorphine more than 30 days prior to death. Evidence existed of racial disparities among those with any buprenorphine uptake, whereby Black individuals (7.3 %, n = 24) had significantly fewer any dispensations compared to White individuals (92.7 %, n = 307). Among those with an opioid analgesic prescription, about 12.2 % (n = 90) were dispensed within 7 days of death, with the majority (68.5 %, n = 506) occurring more than 30 days prior to death. Like buprenorphine dispensations, Black individuals were prescribed a significantly smaller proportion of opioid analgesics (21.9 %, n = 162) versus White individuals (77.7 %, n = 574). Buprenorphine was detected in 78.5 % of deaths where fentanyl was present in the toxicology record, significantly greater when compared to opioid analgesics (57.5 %). CONCLUSION Consistent with prior research, our findings suggest prescription opioid analgesics may protect against fatal overdoses. Access to buprenorphine treatment did not keep pace with the rising lethality of the overdose crisis, and in recent years, a smaller percentage of the people at risk of fatal overdose availed themselves of MOUD preceding their death.
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Affiliation(s)
- Grant Victor
- School of Social Work, Rutgers, The State University of New Jersey, 120 Albany St, New Brunswick, NJ 08901, United States of America.
| | - Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States of America
| | - Brandon Del Pozo
- Miriam Hospital/Warren Alpert Medical School of Brown University, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Road Bldg. 14, G016, Ann Arbor, MI 48109, United States of America
| | - Andy King
- School of Emergency Medicine, Wayne State University, 4201 St. Antoine, University Health Center - 6G, Detroit, MI 48201, United States of America
| | - Philip Huynh
- Center for Behavioral Health and Justice, Wayne State University, Detroit, MI 48208, United States of America
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Pamplin JR, King C, Cooper C, Bennett AS, Elliott L, Davis CS, Rouhani S, Townsend TN. Pathways to racial disparities in the effects of Good Samaritan Laws: A mixed methods pilot study. Drug Alcohol Depend 2023; 249:110823. [PMID: 37336006 DOI: 10.1016/j.drugalcdep.2023.110823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Drug overdose deaths continue to rise, and considerable racial inequities have emerged. Overdose Good Samaritan laws (GSLs) are intended to encourage overdose witnesses to seek emergency assistance. However, evidence of their effectiveness is mixed, and little is known regarding racial disparities in their implementation. This study examined GSL impact by assessing racial differences in awareness of and trust in New York state's GSL. METHODS Using a sequential mixed methods design, Black and white participants were recruited from an existing longitudinal cohort study of people who use illicit opioids in New York City to participate in a quantitative survey and qualitative interviews. Racially stratified survey responses were analyzed using chi-squared tests, Fisher exact tests, or t-tests. Qualitative interviews were analyzed using a hybrid inductive-deductive approach. RESULTS Participants (n=128) were 56% male and predominantly aged 50 years or older. Most met criteria for severe opioid use disorder (81%). Fifty-seven percent reported that the New York GSL makes them more likely to call 911 even though 42% reported not trusting law enforcement to abide by the GSL; neither differed by race. Black people were less likely to have heard of the GSL (36.1% vs 60%) and were less likely to have accurate information regarding its protections (40.4% vs 49.6%). CONCLUSIONS Though GSLs may reduce negative impacts of the criminalization of people who use drugs, their implementation may exacerbate existing racial disparities. Resources should be directed towards harm reduction strategies that do not rely on trust in law enforcement.
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Affiliation(s)
- John R Pamplin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.
| | - Carla King
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, New York, NY, United States
| | - Claire Cooper
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Alex S Bennett
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States; Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, New York, NY, United States; Center for Anti-racism, Social Justice & Public Health, School of Global Public Health, New York University, New York, NY, United States
| | - Luther Elliott
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States; Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, New York, NY, United States
| | - Corey S Davis
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Network for Public Health Law, Edina, MN, United States
| | - Saba Rouhani
- Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, New York, NY, United States; Center for Anti-racism, Social Justice & Public Health, School of Global Public Health, New York University, New York, NY, United States; Department of Epidemiology, School of Global Public Health, New York University, New York, NY, United States
| | - Tarlise N Townsend
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Rory Meyers College of Nursing, New York University, New York, NY, United States
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Ray B, Christian K, Bailey T, Alton M, Proctor A, Haggerty J, Lowder E, Aalsma MC. Antecedents of fatal overdose in an adult cohort identified through administrative record linkage in Indiana, 2015-2022. Drug Alcohol Depend 2023; 247:109891. [PMID: 37120921 DOI: 10.1016/j.drugalcdep.2023.109891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The United States continues to experience unprecedented rates of overdose mortality and need to identify effective policies or practices that can be implemented. This study aims to measure the prevalence, frequency, timing, and rate of touchpoints that occurred prior to a fatal overdose where communities might intervene. METHODS In collaboration with Indiana state government, we conducted record-linkage of statewide administrative datasets to vital records (January 1, 2015, through August 26, 2022) to identify touchpoints (jail booking, prison release, prescription medication dispensation, emergency department visits, and emergency medical services). We examined touchpoints within 12-months prior to a fatal overdose among an adult cohort and explored variation over time and by demographic characteristics. RESULTS Over the 92-month study period there were 13,882 overdose deaths (89.3% accidental poisonings, X40-X44) in our adult cohort that were record-linked to multiple administrative datasets and revealed nearly two-thirds (64.7%; n=8980) experienced an emergency department visit, the most prevalent touchpoint followed by prescription medication dispensation, emergency medical services responses, jail booking, and prison release. However, with approximately 1 out of every 100 returning citizens dying from drug overdose within 12-months of release, prison release had the highest touchpoint rate followed by emergency medical services responses, jail booking, emergency department visits, and prescription medication dispensation. CONCLUSION Record-linking administrative data from routine practice to vital records from overdose mortality is a viable means of identifying where resources should be situated to reduce fatal overdose, with potential to evaluate the effectiveness of overdose prevention efforts.
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Affiliation(s)
- Bradley Ray
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC27709, United States.
| | - Kaitlyn Christian
- Indiana Management Performance Hub, 100 North Senate Avenue, Room N855, Indianapolis, IN46204, United States
| | - Timothy Bailey
- Indiana Management Performance Hub, 100 North Senate Avenue, Room N855, Indianapolis, IN46204, United States
| | - Madison Alton
- Indiana Division of Mental Health and Addiction, 402 West Washington Street W353, Indiana, IN46204, United States
| | - Alison Proctor
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC27709, United States
| | - John Haggerty
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC27709, United States
| | - Evan Lowder
- Department of Criminology, Law and Society, George Mason University, 4400 University Drive, 4F4, Fairfax, VA22030, United States
| | - Matthew C Aalsma
- Department of Pediatrics, Indiana University School of Medicine, 340 W. 10th StreetIndianapolisIN46202, United States
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10
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Khan MR, Hoff L, Elliott L, Scheidell JD, Pamplin JR, Townsend TN, Irvine NM, Bennett AS. Racial/ethnic disparities in opioid overdose prevention: comparison of the naloxone care cascade in White, Latinx, and Black people who use opioids in New York City. Harm Reduct J 2023; 20:24. [PMID: 36841763 PMCID: PMC9959933 DOI: 10.1186/s12954-023-00736-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/12/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Drug overdose mortality is rising precipitously among Black people who use drugs. In NYC, the overdose mortality rate is now highest in Black (38.2 per 100,000) followed by the Latinx (33.6 per 100,000) and white (32.7 per 100,000) residents. Improved understanding of access to harm reduction including naloxone across racial/ethnic groups is warranted. METHODS Using data from an ongoing study of people who use illicit opioids in NYC (N = 575), we quantified racial/ethnic differences in the naloxone care cascade. RESULTS We observed gaps across the cascade overall in the cohort, including in naloxone training (66%), current possession (53%) daily access during using and non-using days (21%), 100% access during opioid use (20%), and complete protection (having naloxone and someone who could administer it present during 100% of opioid use events; 12%). Naloxone coverage was greater in white (training: 79%, possession: 62%, daily access: 33%, access during use: 27%, and complete protection: 13%, respectively) and Latinx (training: 67%, possession: 54%, daily access: 22%, access during use: 24%, and complete protection: 16%, respectively) versus Black (training: 59%, possession: 48%, daily access:13%, access during use: 12%, and complete protection: 8%, respectively) participants. Black participants, versus white participants, had disproportionately low odds of naloxone training (OR 0.40, 95% CI 0.22-0.72). Among participants aged 51 years or older, Black race (versus white, the referent) was strongly associated with lower levels of being trained in naloxone use (OR 0.20, 95% CI 0.07-0.63) and having 100% naloxone access during use (OR 0.34, 95% CI 0.13-0.91). Compared to white women, Black women had 0.27 times the odds of being trained in naloxone use (95% CI 0.10-0.72). CONCLUSIONS There is insufficient protection by naloxone during opioid use, with disproportionately low access among Black people who use drugs, and a heightened disparity among older Black people and Black women.
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Affiliation(s)
- Maria R. Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - Lee Hoff
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Luther Elliott
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY USA
| | - Joy D. Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - John R. Pamplin
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY USA
| | - Tarlise N. Townsend
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - Natalia M. Irvine
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Alex S. Bennett
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Center for Anti-Racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, NY USA
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11
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Post-overdose follow-up in the community with peer recovery specialists: the Lake Superior Diversion and Substance Use Response Team. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100139. [PMID: 36994366 PMCID: PMC10040321 DOI: 10.1016/j.dadr.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023]
Abstract
Background As the overdose epidemic continues to worsen, nonfatal overdose calls for service represent a critical touchpoint for intervention. While most studies have focused on law enforcement led post-overdose follow-up, the current study describes the programmatic characteristics and outcomes of a non-law enforcement post overdose program comprised of peer specialists embedded within a local police department. Methods We examined information on 341 follow-up responses occurring over a 16-month study period using administrative data. We assessed programmatic characteristics including demographic information on clients, referral source, engagement type, and goal completion. Results The results indicate that over 60% of client referrals ended in the goal of in-person contact. Of those, about 80% went on to complete an engagement goal with the peer specialist. We found no significant variation in client demographics and referral source or follow-up engagement (in-person or not); however, client referrals from law enforcement first responders, the most common source, are significantly less likely to result in an in-person contact, though, if contact is made, similarly likely to complete an engagement goal. Conclusions Post overdose response programs that do not involve law enforcement are exceedingly rare. Given that some research has shown that police involvement in post overdose response can have unexpected, associated harms, it is important to assess the effectiveness of post overdose programs that do not involve the police. Findings here suggest that this type of program is successful at locating and engaging community members into recovery support services who have experienced an overdose.
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12
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Febres-Cordero S, Smith DJ, Wulkan AZ, Béliveau AJ, Gish A, Zine S, Fugitt L, Giordano NA. It's what the community demands: Results of community-based emergency opioid overdose trainings. Public Health Nurs 2023; 40:44-53. [PMID: 36377302 DOI: 10.1111/phn.13151] [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: 04/19/2022] [Revised: 09/23/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In response to a surge of drug overdoses involving polysubstance use among Atlanta service industry workers that resulted in the deaths of five people in the Atlanta area in the summer of 2021, a local community of harm reductionists and nurses organized opioid education and naloxone distribution (OEND) training sessions specifically customized for service industry workers in Atlanta. After the sessions, the nurses and harm reductionists asked attendants to participate in a study concerning their response to overdoses. The reason nurses and harm reductionists conducted the study was to determine the efficacy of OEND training adapted for those working in the service industries as well as to evaluate and possibly modify the training sessions for future use. This pre-post study examined if and how participants' knowledge and attitudes toward an opioid-involved overdose changed after engaging with the OEND training. If the study determined that the sessions were successful in teaching service industry workers how to mitigate the immediate and devastating effects of overdose, we recommend expanding and implementing both adaptable training sessions like the OEND training referenced, as well as accompanying studies to improve the training sessions' effectiveness. DESIGN The pre-post study used convenience sampling to recruit participants in emergent OEND training. Participants completed an abbreviated version the Opioid Overdose Attitudes Scale (OOAS) which measured how, and to what degree, they changed their attitudes towards overdoses and their responses to them. Participants also completed an abbreviated version of the Opioid Overdose Knowledge Scale (OOKS) which measured how effectively the OEND increased their knowledge when it came to properly responding to an overdose, which included implementing naloxone as part of immediate rehabilitation treatment. Paired nonparametric tests assessed changes in participants' OOAS/OOKS scores. RESULTS A total of 161 individuals attended, and 72 consented to be in the study. The sample predominately consisted of white (76.4%) and female (66.7%) adults whose age averaged 34.3 years. Attitude and knowledge score improvements were statistically significant: approximately 11 points (p < .001) and 3 points (p < .001), respectively. CONCLUSIONS This rapidly implemented training was associated with improving attitudes and knowledge about responding to an opioid-involved overdose. We recommend expanding the scope of studies like these in order to develop and examine effective, dynamic, and targeted OEND training tailored towards specific community groups and situations, such as polysubstance overdose among service industry workers. As the opioid epidemic worsens, it is critical to equip community members themselves with the skills and tools to recognize and respond to opioid overdoses as a frontline prevention to overdose deaths.
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Affiliation(s)
| | - Daniel J Smith
- M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | | | | | - Andy Gish
- Atlanta Harm Reduction Coalition, Atlanta, Georgia.,Georgia Overdose Prevention, Atlanta, Georgia
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13
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Linas BP, Morgan JR, Murphy SM, Walley AY, Schackman BR, Marshall BDL. Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts. Drug Alcohol Depend 2022; 241:109668. [PMID: 36309001 PMCID: PMC9833886 DOI: 10.1016/j.drugalcdep.2022.109668] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. METHODS We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and "other" (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. RESULTS From 2016-2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. CONCLUSION We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA; The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI 02906, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA.
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14
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Cano M, Sparks CS. Drug overdose mortality by race/ethnicity across US-born and immigrant populations. Drug Alcohol Depend 2022; 232:109309. [PMID: 35077954 DOI: 10.1016/j.drugalcdep.2022.109309] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The present study examined racial/ethnic differences in US drug overdose mortality among US-born and foreign-born men and women. METHODS In this cross-sectional analysis of 2010-2019 data from the National Center for Health Statistics, Bayesian hierarchical models predicted drug overdose mortality based on the interaction of race/ethnicity, nativity, and sex, adjusting for age, for 518,553 drug overdose deaths among individuals ages 15-74 identified as Non-Hispanic (NH) White, NH Black, Hispanic, or NH Asian/Pacific Islander (PI). Rate ratios with 95% Highest Posterior Density Intervals (HPDIs) were examined by race/ethnicity and nativity. RESULTS In the US-born population, 2017-2019 estimated overdose mortality rates were higher for NH Black than NH White men (ratio 1.48 [95% HPDI 1.28-1.72]), similar between NH Black and NH White women (ratio 1.03 [95% HPDI 0.89-1.20]), similar between Hispanic and NH White men (ratio 0.96 [95% HPDI 0.82-1.10]), and lower for NH Asian/PI than NH White men and women. In the foreign-born population, both for men and women, estimated overdose mortality rates were lower in every racial/ethnic group relative to the NH White group. For men and women of all racial/ethnic groups examined, estimated overdose mortality rates were higher in US-born than foreign-born subpopulations, yet the extent of this nativity differential was least pronounced in the NH White group. CONCLUSIONS In the US-born population, NH Black men experienced the highest recent rates of overdose mortality; in the foreign-born population, the highest rates of overdose mortality were observed among NH White men and women.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, The University of Texas at San Antonio, 501W. César E. Chávez Blvd., San Antonio, TX 78207, USA.
| | - Corey S Sparks
- Department of Demography, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
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15
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Association between law enforcement seizures of illicit drugs and drug overdose deaths involving cocaine and methamphetamine, Ohio, 2014-2019. Drug Alcohol Depend 2022; 232:109341. [PMID: 35134733 DOI: 10.1016/j.drugalcdep.2022.109341] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The United States continues to experience a crisis of mounting opioid overdose deaths involving cocaine and methamphetamine (hereafter illicit stimulants). Law enforcement drug seizure data present a unique opportunity to examine the association between illicit-stimulant-involved overdose deaths (ISODs) and the illicit drug supply. Our objective is to better understand correlations between illicit drug market trends and increases in ISODs in Ohio in 2014-2019. METHODS This observational study analyzes the universe of ISODs and drug seizures in Ohio from 2014 to 2019. We use graphs and descriptive statistics to characterize trends over time and estimate a time series model of their association. ISODs were summed to yield monthly statewide counts of seizures containing methamphetamine, cocaine, illicitly manufactured fentanyl (IMF), and other non-IMF opioids (e.g., heroin). All rates were calculated per 100,000 persons. RESULTS Roughly 80% of ISODs in Ohio from 2014 to 2019 involved an opioid, with IMF co-occurring in 90% of ISODs by 2019. Methamphetamine and cocaine seizures containing IMF were associated with 0.439 (p < .01) and 0.457 (p < .01) additional deaths per 100,000 persons per month, respectively. IMF seizures not containing cocaine nor methamphetamine were also associated with additional ISODs (0.119, p < .01) and seizures of illicit stimulants not containing IMF were not associated with ISODs. CONCLUSIONS The number of ISODs was extremely high when IMF was co-involved and relatively low without IMF involvement. By demonstrating how supply-side trends correspond with ISOD rates, the current study bolsters the analytical utility of law enforcement seizures and complements growing literature in the field.
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Victor G, Zettner C, Huynh P, Ray B, Sightes E. Jail and overdose: assessing the community impact of incarceration on overdose. Addiction 2022; 117:433-441. [PMID: 34251065 DOI: 10.1111/add.15640] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/23/2021] [Accepted: 06/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Incarceration produces a specific public health threat for drug overdose, and correctional settings do not offer medication for opioid use disorder. This study examined the overall impact of jail incarceration on overdose, the specific hazard for those booked on a syringe-related charge and the proportion of all overdose decedents in the community who were in the jail prior to death. DESIGN AND SETTING A cohort study of fatal overdose outcomes among a sample of individuals booked into and released from jail between 1 January 2017 and 31 December 2019. Marion County, IN, USA. PARTICIPANTS All individuals released from one county jail between 1 January 2017 and 31 December 2017 and decedents who died within the county from an accidental fatal overdose between January 2017 and December 2019. MEASUREMENTS AND FINDINGS Using information on all jail booking events, including charge type, during a 5-year period (January 2015-December 2019), we looked at the hazard of accidental fatal overdose post-release, controlling for age, sex and race. Of all overdose deaths in the county, 21% (n = 237) had been in the county jail within 2 years prior to their death. Each prior booking increased the hazard of mortality by approximately 20% [hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.15, 1.28], while the presence of a syringe charge at most recent booking prior to release more than tripled the hazard of mortality (HR = 3.55, 95% CI = 2.55, 4.93). CONCLUSIONS In Marion County, IN, USA, there appears to be an association between increased risk of fatal drug overdose and both syringe-related arrests and repeat jail bookings.
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Affiliation(s)
- Grant Victor
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Catherine Zettner
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Philip Huynh
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Bradley Ray
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Emily Sightes
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
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17
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Developing a cascade of care for opioid use disorder among individuals in jail. J Subst Abuse Treat 2022; 138:108751. [DOI: 10.1016/j.jsat.2022.108751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 12/30/2022]
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Sawyer JL, Shrestha S, Pustz JC, Gottlieb R, Nichols D, Van Handel M, Lingwall C, Stopka TJ. Characterizing opioid-involved overdose risk in local communities: An opioid overdose vulnerability assessment across Indiana, 2017. Prev Med Rep 2021; 24:101538. [PMID: 34976612 PMCID: PMC8683947 DOI: 10.1016/j.pmedr.2021.101538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/22/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022] Open
Abstract
The objective of this initiative was to conduct a comprehensive opioid overdose vulnerability assessment in Indiana and evaluate spatial accessibility to opioid use disorder treatment, harm reduction services, and opioid response programs. We compiled 2017 county-level (n = 92) data on opioid-related and socioeconomic indicators from publicly available state and federal sources. First, we assessed the spatial distribution of opioid-related indicators in a geographic information system (GIS). Next, we used a novel regression-weighted ranking approach with mean standardized covariates and an opioid-involved overdose mortality outcome to calculate county-level vulnerability scores. Finally, we examined accessibility to opioid use disorder treatment services and opioid response programs at the census tract-level (n = 1511) using two-step floating catchment area analysis. Opioid-related emergency department visit rate, opioid-related arrest rate, chronic hepatitis C virus infection rate, opioid prescription rate, unemployment rate, and percent of female-led households were independently and positively associated with opioid-involved overdose mortality (p < 0.05). We identified high-risk counties across the rural-urban continuum and primarily in east central Indiana. We found that only one of the 19 most vulnerable counties was in the top quintile for treatment services and had naloxone provider accessibility in all of its census tracts. Findings from our vulnerability assessment provide local-level context and evidence to support and inform future public health policies and targeted interventions in Indiana in areas with high opioid overdose vulnerability and low service accessibility. Our approach can be replicated in other state and local public health jurisdictions to assess opioid-involved public health vulnerabilities.
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Affiliation(s)
- Jared L. Sawyer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, United States
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, United States
| | - Jennifer C. Pustz
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, United States
| | | | | | | | - Cailyn Lingwall
- Council of State and Territorial Epidemiologists, United States
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, United States
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Jones AA, Park JN, Allen ST, Schneider KE, Weir BW, Hunt D, Sherman SG. Racial differences in overdose training, naloxone possession, and naloxone administration among clients and nonclients of a syringe services program. J Subst Abuse Treat 2021; 129:108412. [PMID: 34080560 PMCID: PMC8565096 DOI: 10.1016/j.jsat.2021.108412] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/08/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate racial (Black/White) differences in overdose response training and take-home naloxone (THN) possession and administration among clients and nonclients of the Baltimore syringe service program (SSP). METHODS The study derived data from a cross-sectional survey of 263 (183 SSP clients, 80 nonclients) people who inject drugs (PWID). The study recruited SSP clients using targeted sampling and recruited nonclients through peer referral from April to November 2016. RESULTS In our sample, 61% of the participants were Black, 42% were between the ages of 18 and 44, and 70% were males. SSP clients, regardless of race, were more likely to have received overdose response training than Black nonclients (Black clients AOR: 3.85, 95% CI: 1.88, 7.92; White clients AOR: 2.73, 95% CI: 1.29, 5.75). The study found no significant differences in overdose response training between Black and White nonclients. SSP clients and White nonclients were more likely to possess THN than Black nonclients (Black clients: AOR: 4.21, 95% CI: 2.00, 8.87; White clients: AOR: 3.54, 95% CI: 1.56, 8.04; White nonclients AOR: 4.49, 95% CI: 1.50,13.47). CONCLUSION SSP clients were more likely to receive overdose response training than their nonclient peers who they referred to the study, illustrating the utility of SSPs in reaching PWID at high risk of overdose. We also observed that Black PWID, who did not access services at the SSP, were the least likely to possess THN, suggesting the need to employ outreach targeting Black PWID who do not access this central harm reduction intervention.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, 105 Health and Human Development Building, University Park, PA 16802, USA.
| | - J N Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - S T Allen
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - K E Schneider
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - B W Weir
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - D Hunt
- Baltimore City Health Department, 100 N. Holliday St, Baltimore, MD 21202, USA
| | - S G Sherman
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
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Lockwood TLE, Huynh P, Richard A, Sightes E, Bailey K, Ray B, Lieberman M. Community overdose surveillance: Comparing substances collected from the death scene investigation to toxicology results. Drug Alcohol Depend 2021; 224:108722. [PMID: 33932743 PMCID: PMC8180509 DOI: 10.1016/j.drugalcdep.2021.108722] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent overdose trends are characterized by increased toxicological detection of stimulants with opioids, yet it is unclear whether these substances are mixed prior to consumption or purposefully used simultaneously. METHODS Postmortem toxicology data were collected in Marion County, Indiana, from 45 fatal overdose cases involving heroin, fentanyl, methamphetamine, or cocaine. Substances found by death scene investigators at the scene of the fatal overdose (57 samples) were tested using high-pressure liquid chromatography mass-spectrometry (LC-MS) technology. We compared toxicology and LC-MS results to understand whether substances contributing to overdose were found in combination or separately at the scene of the overdose. RESULTS Comparing toxicology reports with LC-MS results from substances found at the scene of overdose deaths involving opioids and stimulants reveal that deaths are largely the result of the co-use of opioids and stimulants, rather than use of stimulants combined with opioids. CONCLUSIONS Collecting and testing physical samples from fatal overdose scenes and comparing these to post-mortem toxicology results is a new way to examine polydrug use patterns. This community overdose surveillance method can be used to improve overdose prevention and response efforts.
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Affiliation(s)
- Tracy-Lynn E Lockwood
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, 46556, United States
| | - Philip Huynh
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, 48202, United States
| | - Alex Richard
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, 46556, United States
| | - Emily Sightes
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, 48202, United States
| | - Katie Bailey
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, 48202, United States
| | - Bradley Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, 48202, United States
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, 46556, United States.
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21
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Mohler G, Mishra S, Ray B, Magee L, Huynh P, Canada M, O’Donnell D, Flaxman S. A modified two-process Knox test for investigating the relationship between law enforcement opioid seizures and overdoses. Proc Math Phys Eng Sci 2021. [DOI: 10.1098/rspa.2021.0195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Recent research has shown an association between monthly law enforcement drug seizure events and accidental drug overdose deaths using cross-sectional data in a single state, whereby increased seizures correlated with more deaths. In this study, we conduct statistical analysis of street-level data on law enforcement drug seizures, along with street-level data on fatal and non-fatal overdose events, to determine possible micro-level causal associations between opioid-related drug seizures and overdoses. For this purpose, we introduce a novel, modified two-process Knox test that controls for self-excitation to measure clustering of overdoses nearby in space and time following law enforcement seizures. We observe a small, but statistically significant (
p
< 0.001), effect of 17.7 excess non-fatal overdoses per 1000 law enforcement seizures within three weeks and 250 m of a seizure. We discuss the potential causal mechanism for this association along with policy implications.
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Affiliation(s)
- G. Mohler
- Department of Computer Science, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - S. Mishra
- School of Public Health, Imperial College London, London, UK
| | - B. Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, USA
| | - L. Magee
- O’Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - P. Huynh
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, USA
| | - M. Canada
- Indiana High Intensity Drug Trafficking Areas, Office of National Drug Control Policy, Indianapolis, IN, USA
| | - D. O’Donnell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S. Flaxman
- Department of Mathematics, Imperial College London, London, UK
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22
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Wu ZH, Yong Q, Walker JM, Grady JJ, Laurencin CT. Fentanyl, Heroin, and Cocaine Overdose Fatalities are Shifting to the Black Community: An Analysis of the State of Connecticut. J Racial Ethn Health Disparities 2021; 9:722-730. [PMID: 33977509 DOI: 10.1007/s40615-021-01007-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/04/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Historically, Blacks and Hispanics have had lower opioid-involved overdose death rates in Connecticut (CT). We examined if a shift has taken place where rates of Black fatal overdoses have now surpassed Whites in the state. METHODS Drug overdose fatality rates were calculated by number of deaths per year per 100,000 population from 2012 to 2019 in Connecticut. Measures were by race (White, Hispanic, Black, and Asian or Pacific Islander), age groups, and types of drugs, including fentanyl, heroin, cocaine, and other opioids. Poisson regression was used to test the interactions (race × age); joinpoint regression analysis was used to evaluate trend lines of fatality rate by racial/ethnic group within each age group with a significance level of p < 0.05. RESULTS Drug overdose fatality rates in CT from 2012 to 2019 showed a significant increase for all races combined, estimated 3.6 deaths per 100,000 population per year. For Whites, overdose deaths were 4.6 per year from 2012 to 2017 with no change from 2017 to 2019. The overdose fatality rate for Hispanics was 3.0 and for Asian or Pacific Islanders 0.6 per year from 2012 to 2019. For Blacks, the death rates were statistically flat between 2012 and 2014; however, from 2015 to 2019, this group saw the largest average increase of 6.0 overdose deaths per 100,000 population each year. By 2019, the overdose fatality rate was higher in Blacks than in Whites, (39 vs. 38 per 100,000, respectively). Further, Blacks ages 50 years and over reported the highest overdose fatality rates among all race/age groups, an increase of 8.5 deaths per 100,000 population since 2014. CONCLUSIONS AND RELEVANCE Connecticut is a microcosm of the opioid overdose trend in the New England region of our country. The majority of overdose deaths in CT involved illicit drugs, fentanyl, heroin, and cocaine, rather than prescription drugs. Blacks 50-years-old and over showed the fastest growing overdose death rates. Opioid deaths are now shifting to the Black community, creating an urgent public health crisis.
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Affiliation(s)
- Z Helen Wu
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA.,Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Qiao Yong
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA.,Department of Statistics, University of Connecticut, Storrs, CT, 06269, USA
| | - Joanne M Walker
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - James J Grady
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA.,Department of Population Health Science, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA. .,Department of Materials Science & Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT, USA.
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23
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Watson DP, Weathers T, McGuire A, Cohen A, Huynh P, Bowes C, O’Donnell D, Brucker K, Gupta S. Evaluation of an emergency department-based opioid overdose survivor intervention: Difference-in-difference analysis of electronic health record data to assess key outcomes. Drug Alcohol Depend 2021; 221:108595. [PMID: 33610095 PMCID: PMC8026710 DOI: 10.1016/j.drugalcdep.2021.108595] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years, a number of emergency department (ED)-based interventions have been developed to provide supports and/or treatment linkage for people who use opioids. However, there is limited research supporting the effectiveness of the majority of these interventions. Project POINT is an ED-based intervention aimed at providing opioid overdose survivors with naloxone and recovery supports and connecting them to evidence-based medications for opioid use disorder (MOUD). An evaluation of POINT was conducted. METHODS A difference-in-difference analysis of electronic health record data was completed to understand the difference in outcomes for patients admitted to the ED when a POINT staff member was working versus times when they were not. The observation window was January 1, 2012 to July 6, 2019, which included N = 1462 unique individuals, of which 802 were in the POINT arm. Outcomes of focus include MOUD opioid prescriptions dispensed, active non-MOUD opioid prescriptions dispensed, naloxone access, and drug poisonings. RESULTS The POINT arm had a significant increase in MOUD prescriptions dispensed, non-MOUD prescriptions dispensed, and naloxone access (all p-values < 0.001). There was no significant effect related to subsequent drug poisoning-related hospital admissions. CONCLUSIONS The results support the assertion that POINT is meeting its two primary goals related to increasing naloxone access and connecting patients to MOUD. Generalization of these results is limited; however, the evaluation contributes to a nascent area of research and can serve a foundation for future work.
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Affiliation(s)
- Dennis P. Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W. Walton St., Chicago, IL 60610
| | - Tess Weathers
- Indiana University Richard M. Fairbanks School of Public Health, Department of Social and Behavioral Sciences, 1050 Wishard Blvd., Indianapolis, IN, 46202, United States.
| | - Alan McGuire
- Richard L. Roudebush VAMC, Health Services Research and Development, 1481 W. 10th St (11H) Rm. C8108, Indianapolis, IN, 46202, United States; Indiana University Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., Indianapolis, IN, 46202, United States.
| | - Alex Cohen
- GiveWell, 1714 Franklin Street, Oakland, CA, 94612, United States.
| | - Philip Huynh
- Wayne State University, School of Social Work, Center for Behavioral Health and Justice, 5201 Cass Avenue Suite 226, Detroit, MI, 48202, United States.
| | - Clay Bowes
- Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, United States.
| | - Daniel O’Donnell
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Ave., Indianapolis, IN 46202
| | | | - Sumedha Gupta
- Department of Economics, Indiana University Purdue University Indianapolis, United States.
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24
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Victor GA, Bailey K, Ray B. Buprenorphine Treatment Intake and Critical Encounters following a Nonfatal Opioid Overdose. Subst Use Misuse 2021; 56:988-996. [PMID: 33749520 DOI: 10.1080/10826084.2021.1901933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Individuals with prior opioid-related overdose events have an increased risk for opioid-related mortality. Buprenorphine is a partial agonist that has shown to be an effective medication for opioid use disorder (MOUD). Yet, few studies have investigated whether buprenorphine reduces the risk of opioid-related mortality following a nonfatal opioid-related overdose. METHODS A retrospective study was conducted on all overdose cases in Indiana between January 1, 2017 and December 31, 2017. Data were linked from multiple administrative sources. Cases were linked to vital records to assess mortality. Bivariate analyses were conducted to assess group differences between survivors and decedents. A series of multiple logistic regression models were used to determine main and interaction effects of opioid-related mortality. RESULTS Among the 10,195 nonfatal overdoses, 2.4% (247) resulted in a subsequent fatal overdose. Overdose decedents were on average 36.4 years-old, 66.8% male, 91.1% White, and 83.8% did not receive a buprenorphine dispensation. Incremental increases in the number of buprenorphine dispensations decreased the likelihood of fatal overdose by 94% (95% CI = 0.88-0.98, p = .001). Incremental increases in arrest encounters were found to significantly increase the likelihood of a fatal overdose (AOR = 2.16; 95% CI = 1.13-3.55). Arrest encounters were a significant moderator of the relationship between buprenorphine uptake effectiveness and drug-related mortality. CONCLUSIONS Analysis of linked data provided details of risk and protective factors of fatal overdose. Buprenorphine reduced the risk of death; however, criminal justice involvement remains an area of attention for diversion and overdose death prevention interventions.
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Affiliation(s)
- Grant A Victor
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Katie Bailey
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Brad Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, Michigan, USA
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25
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Glober N, Mohler G, Huynh P, Arkins T, O'Donnell D, Carter J, Ray B. Impact of COVID-19 Pandemic on Drug Overdoses in Indianapolis. J Urban Health 2020; 97:802-807. [PMID: 33005988 PMCID: PMC7529089 DOI: 10.1007/s11524-020-00484-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
We described the change in drug overdoses during the COVID-19 pandemic in one urban emergency medical services (EMS) system. Data was collected from Marion County, Indiana (Indianapolis), including EMS calls for service (CFS) for suspected overdose, CFS in which naloxone was administered, and fatal overdose data from the County Coroner's Office. With two sample t tests and ARIMA time series forecasting, we showed changes in the daily rates of calls (all EMS CFS, overdose CFS, and CFS in which naloxone was administered) before and after the stay-at-home order in Indianapolis. We further showed differences in the weekly rate of overdose deaths. Overdose CFS and EMS naloxone administration showed an increase with the social isolation of the Indiana stay-at-home order, but a continued increase after the stay-at-home order was terminated. Despite a mild 4% increase in all EMS CFS, overdose CFS increased 43% and CFS with naloxone administration increased 61% after the stay-at-home order. Deaths from drug overdoses increased by 47%. There was no change in distribution of age, race/ethnicity, or zip code of those who overdosed after the stay-at-home order was issued. We hope this data informs policy-makers preparing for future COVID-19 responses and other disaster responses.
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Affiliation(s)
| | | | | | - Tom Arkins
- Indiana University, Indianapolis, IN, USA
| | | | | | - Brad Ray
- Wayne State University, Detroit, MI, USA
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26
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Blondino CT, Gormley MA, Taylor DDH, Lowery E, Clifford JS, Burkart B, Graves WC, Lu J, Prom-Wormley EC. The Influence of Co-Occurring Substance Use on the Effectiveness of Opiate Treatment Programs According to Intervention Type. Epidemiol Rev 2020; 42:57-78. [PMID: 32944731 DOI: 10.1093/epirev/mxaa005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
This systematic review describes the influence of co-occurring substance use on the effectiveness of opiate treatment programs. MEDLINE/PubMed, Embase, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from database inception to November 28, 2018, to identify eligible opioid treatment studies in the United States that assessed the relationship between co-occurring substance use and treatment outcome (i.e., opioid abstinence and treatment retention). A total of 34 eligible studies were included. Overall, co-occurring substance use was associated with negative treatment outcomes regardless of intervention type. However, patterns varied by substance and intervention type. In particular, co-occurring use of cocaine or marijuana with opioids was associated with reduced treatment retention and opioid abstinence regardless of intervention type. Co-occurring use of amphetamines, compared with no use or reduced use of amphetamines, decreased treatment retention. Co-occurring use of alcohol was both positively and negatively associated with treatment outcomes. One study reported a significant positive association between sedative use and opioid abstinence. Generally, findings suggest that combined interventions reported better health outcomes compared with pharmacological or behavioral intervention studies alone. The findings of this review emphasize the need to comprehensively study and address co-occurring substance use to improve opiate treatment programs.
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