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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; 33:534-542. [PMID: 38520669 DOI: 10.1111/ajad.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Brinzo PN, Martins SS. Racial/ethnic trends in opioid and polysubstance opioid overdose mortality in adolescents and young adults, 1999-2020. Addict Behav 2024; 156:108065. [PMID: 38772226 PMCID: PMC11179956 DOI: 10.1016/j.addbeh.2024.108065] [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: 11/27/2023] [Revised: 04/21/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES Previous reports have described variations in opioid overdose mortalities among different race/ethnicity groups. We have analyzed racial/ethnicity trends in opioid and polysubstance opioid overdose mortalities in adolescents and young adults to further characterize differences and potential sub-epidemics within this specific population. METHODS We used mortality data from the U.S. Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death file from 1999 to 2020. Drug overdose mortalities were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Joinpoint regression was used to examine mortality rates for all opioids, opioids with a stimulant, opioids with benzodiazepines, and opioids with alcohol among racial/ethnic groups (non-Hispanic white, non-Hispanic Black, Hispanic, non-Hispanic other) in adolescents and young adults. RESULTS The Average Annual Percent Change (AAPC) for mortality due to opioid and polysubstance opioid overdose increased for all racial/ethnic groups where data was available for analysis from 1999 to 2020. For mortality due to any opioid and any opioid with a stimulant, the greatest AAPC was seen among non-Hispanic Blacks. CONCLUSIONS Unprecedented increases in mortality due to opioid overdose occurred in the last two decades among adolescents and young adults. Heterogenous trends support the notion that the previously defined opioid overdose epidemic "waves" may not accurately depict the effects of the crisis in all race/ethnicity groups. Additionally, alarming increases in opioid-stimulant overdose mortality starting in 2012 further characterize the interrelated effects of the third and fourth waves.
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Affiliation(s)
- Paige N Brinzo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York NY, USA.
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York NY, USA
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Banks DE, Paschke M, Ghonasgi R, Thompson VLS. Benefits and challenges of geographic information systems (GIS) for data-driven outreach in black communities experiencing overdose disparities: results of a stakeholder focus group. BMC Public Health 2024; 24:2103. [PMID: 39098915 PMCID: PMC11299267 DOI: 10.1186/s12889-024-19541-3] [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: 03/05/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Black individuals in the U.S. face increasing racial disparities in drug overdose related to social determinants of health, including place-based features. Mobile outreach efforts work to mitigate social determinants by servicing geographic areas with low drug treatment and overdose prevention access but are often limited by convenience-based targets. Geographic information systems (GIS) are often used to characterize and visualize the overdose crisis and could be translated to community to guide mobile outreach services. The current study examines the initial acceptability and appropriateness of GIS to facilitate data-driven outreach for reducing overdose inequities facing Black individuals. METHODS We convened a focus group of stakeholders (N = 8) in leadership roles at organizations conducting mobile outreach in predominantly Black neighborhoods of St. Louis, MO. Organizations represented provided adult mental health and substance use treatment or harm reduction services. Participants were prompted to discuss current outreach strategies and provided feedback on preliminary GIS-derived maps displaying regional overdose epidemiology. A reflexive approach to thematic analysis was used to extract themes. RESULTS Four themes were identified that contextualize the acceptability and utility of an overdose visualization tool to mobile service providers in Black communities. They were: 1) importance of considering broader community context; 2) potential for awareness, engagement, and community collaboration; 3) ensuring data relevance to the affected community; and 4) data manipulation and validity concerns. CONCLUSIONS There are several perceived benefits of using GIS to map overdose among mobile providers serving Black communities that are overburdened by the overdose crisis but under resourced. Perceived potential benefits included informing location-based targets for services as well as improving awareness of the overdose crisis and facilitating collaboration, advocacy, and resource allocation. However, as GIS-enabled visualization of drug overdose grows in science, public health, and community settings, stakeholders must consider concerns undermining community trust and benefits, particularly for Black communities facing historical inequities and ongoing disparities.
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Affiliation(s)
- Devin E Banks
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA.
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA.
| | - Maria Paschke
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Rashmi Ghonasgi
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
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Rouhani S, Luo L, Byregowda H, Weaver N, Park JN. Epidemiology of drug arrests in the United States: Evidence from the national survey on drug use and health, 2015-2019. Prev Med 2024; 185:108058. [PMID: 38969022 DOI: 10.1016/j.ypmed.2024.108058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Following changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S. METHODS Serial cross-sectional data from the National Survey on Drug Use and Health (2015-2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression. RESULTS Past-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals [aOR 1.92, 95% CI 1.30, 2.84]. CONCLUSION Despite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.
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Affiliation(s)
- Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA; Center for Anti-racism, Social Justice and Public Health, New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Lingzi Luo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Himani Byregowda
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Nicholas Weaver
- Department of Psychology, University of Texas at Austin College of Liberal Arts, 108 E Dean Keeton St, Austin, TX 78712, USA
| | - Ju Nyeong Park
- Division of General Internal Medicine, Brown University Alpert Medical School, 222 Richmond Street, Providence, RI 02903, USA
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Jain L, Kaur J, Ayub S, Ansari D, Ahmed R, Dada AQ, Ahmed S. Fentanyl and xylazine crisis: Crafting coherent strategies for opioid overdose prevention. World J Psychiatry 2024; 14:760-766. [PMID: 38984339 PMCID: PMC11230091 DOI: 10.5498/wjp.v14.i6.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/06/2024] [Accepted: 06/04/2024] [Indexed: 06/19/2024] Open
Abstract
The United States is in the throes of a severe opioid overdose epidemic, primarily fueled by the pervasive use of fentanyl and the emerging threat of xylazine, a veterinary sedative often mixed with fentanyl. The high potency and long duration of fentanyl is compounded by the added risks from xylazine, heightening the lethal danger faced by opioid users. Measures such as enhanced surveillance, public awareness campaigns, and the distribution of fentanyl-xylazine test kits, and naloxone have been undertaken to mitigate this crisis. Fentanyl-related overdose deaths persist despite these efforts, partly due to inconsistent policies across states and resistance towards adopting harm reduction strategies. A multifaceted approach is imperative in effectively combating the opioid overdose epidemic. This approach should include expansion of treatment access, broadening the availability of medications for opioid use disorder, implementation of harm reduction strategies, and enaction of legislative reforms and diminishing stigma associated with opioid use disorder.
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Affiliation(s)
- Lakshit Jain
- Department of Psychiatry, University of Connecticut, Farmington, CT 06032, United States
| | - Jasleen Kaur
- Addiction Services Division, Connecticut Valley Hospital, Middletown, CT 06457, United States
| | - Shahana Ayub
- Department of Psychiatry, Institute of Living, Hartford, CT 06102, United States
| | - Danya Ansari
- Department of Medicine, Islamabad Medical and Dental College, Islamabad 44000, Pakistan
| | - Rizwan Ahmed
- Department of Medicine, Liaquat College of Medicine and Dentistry, Karachi 75290, Pakistan
| | - Abdul Qadir Dada
- Department of Medicine, Trinity School of Medicine, Roswell, GA 30075, United States
| | - Saeed Ahmed
- Addiction Services and Dual Diagnosis Unit, Saint Francis Hospital and Medical Center, Hartford, CT 06105, United States
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Nolen S, Trinidad AJ, Jordan AE, Green TC, Jalali A, Murphy SM, Zang X, Marshall BDL, Schackman BR. Racial/ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City. Harm Reduct J 2023; 20:152. [PMID: 37853481 PMCID: PMC10585909 DOI: 10.1186/s12954-023-00891-x] [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: 05/14/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC). METHODS We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White, and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group. RESULTS Non-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate, and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents. CONCLUSIONS This study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.
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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
| | - Andrew J Trinidad
- Department of Health & Mental Hygiene, Bureau of Alcohol & Drug Use Prevention, Care, & Treatment, 42-09 28Th St, Queens, New York, NY, 11101, USA
| | - Ashly E Jordan
- Department of Health & Mental Hygiene, Bureau of Alcohol & Drug Use Prevention, Care, & Treatment, 42-09 28Th St, Queens, New York, NY, 11101, 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
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
| | - Xiao Zang
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, 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.
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
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Rosen H, Cunningham CO. Time to End Racial Disparities in Buprenorphine Access. Am J Public Health 2023; 113:1083-1085. [PMID: 37590915 PMCID: PMC10484128 DOI: 10.2105/ajph.2023.307388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Henry Rosen
- Henry Rosen is the Chief of Staff at the New York State Office of Addiction Services and Supports, New York, NY. Chinazo O. Cunningham is the Commissioner of the New York State Office of Addiction Services and Supports and is a clinical professor of medicine at the Albert Einstein College of Medicine, New York, NY
| | - Chinazo O Cunningham
- Henry Rosen is the Chief of Staff at the New York State Office of Addiction Services and Supports, New York, NY. Chinazo O. Cunningham is the Commissioner of the New York State Office of Addiction Services and Supports and is a clinical professor of medicine at the Albert Einstein College of Medicine, New York, NY
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Nudy M, Galper K, George DR, Williams BA, Kraschnewski JL, Sinoway L, Brignone E. Association between diseases of despair and atherosclerotic cardiovascular disease among insured adults in the USA: a retrospective cohort study from 2017 to 2021. BMJ Open 2023; 13:e074102. [PMID: 37673458 PMCID: PMC10496711 DOI: 10.1136/bmjopen-2023-074102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVES To assess associations between diseases of despair (DoD) and incident atherosclerotic cardiovascular disease (ASCVD) among insured adults in the USA. DESIGN Retrospective cohort study. SETTING Highmark insurance claims data in the USA from 2017 to 2021. PARTICIPANTS Adults with at least 10 months of continuous insurance enrolment, no record of ASCVD in the 2016 baseline year and no missing data on study variables. PRIMARY AND SECONDARY OUTCOME MEASURES Cox proportional hazard regression was used to calculate crude and adjusted hazard ratios (HR) and 95% confidence intervals (CI) to assess risk of ASCVD (composite of ischaemic cardiomyopathy, non-fatal ischaemic stroke, peripheral arterial disease or non-fatal acute myocardial infarction) by baseline DoD overall, and by the component conditions comprising DoD (alcohol-related disorders, substance-related disorders, suicidality) individually and in combination. RESULTS The DoD-exposed group had an age-adjusted rate of 20.5 ASCVD events per 1000 person-years, compared with 11.7 among the unexposed. In adjusted models, overall DoD was associated with increased risk of incident ASCVD (HR 1.42, 95% CI 1.36 to 1.47). Individually and in combination, component conditions of DoD were associated with higher risk for ASCVD relative to no DoD. Substance-related disorders were associated with 50% higher risk of incident ASCVD (HR 1.5, 95% CI 1.41 to 1.59), alcohol-related disorders and suicidality/intentional self-harm were associated with 33% and 30% higher risk, respectively (HR 1.33, 95% CI 1.26 to 1.41; HR 1.30, 95% CI 1.11 to 1.52). Co-occurring DoD components conferred higher risk still. The highest risk combination was substance-related disorders+suicidality (HR 2.01, 95% CI 1.44 to 2.82). CONCLUSIONS Among this cohort of insured adults, documented DoD was associated with increased ASCVD risk. Further research to understand and address cardiovascular disease prevention in those with DoD could reduce costs, morbidity and mortality. Further examination of overlapping structural factors that may be contributing to concurrent rises in ASCVD and DoD in the USA is needed.
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Affiliation(s)
- Matthew Nudy
- Division of Cardiology, Heart and Vascular Institute, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kathleen Galper
- Advanced Analytics, Highmark Health, Pittsburgh, Pennsylvania, USA
- Highmark Health Research Institute, Highmark Health, Pittsburgh, Pennsylvania, USA
| | - Daniel R George
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Clinical and Translational Science Institute, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Jennifer L Kraschnewski
- Clinical and Translational Science Institute, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lawrence Sinoway
- Division of Cardiology, Heart and Vascular Institute, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Clinical and Translational Science Institute, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Emily Brignone
- Advanced Analytics, Highmark Health, Pittsburgh, Pennsylvania, USA
- Highmark Health Research Institute, Highmark Health, Pittsburgh, Pennsylvania, USA
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Thrul J, Rabinowitz JA, Reboussin BA, Maher BS, Anthony JC, Ialongo NS. Longitudinal associations between age 20 problematic substance use and opioid use disorder incidence at age 30 - findings from an urban cohort. J Psychiatr Res 2023; 160:1-7. [PMID: 36764195 PMCID: PMC10023426 DOI: 10.1016/j.jpsychires.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/15/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
This study used data from a longitudinal prevention study in an urban cohort to examine associations between nicotine dependence, alcohol, and cannabis use disorder and disorder criteria at age 20, with opioid use disorder (OUD) incidence or criteria onset by age 30. The study sample included 1408 participants (57.5% female, 72.5% African American) drawn from two cohorts of participants in a mid-Atlantic region of the U.S. as part of a series of randomized controlled trials of elementary school-based universal prevention interventions. Lifetime cannabis use disorder (CUD), alcohol use disorder (AUD; both DSM-IV), and current nicotine dependence (Fagerstrom Test for Nicotine Dependence, FTND) assessed at age 20 were used to predict (1) DSM-IV lifetime OUD at age 30, and (2) OUD criteria between ages 20 and 30 in multivariable logistic regression models. Covariates for all analyses included sociodemographics (sex, race, and free/reduced-priced lunch status), community disadvantage, and intervention status. Nicotine dependence (FTND≥3) at age 20 predicted age 30 DSM-IV lifetime OUD (aOR = 2.37; 95% CI 1.02,5.54). The number of CUD criteria (aOR = 1.30; 95% CI 1.09,1.57) and nicotine dependence severity scores (aOR = 1.22; 95% CI = 1.05,1.41) at age 20 predicted any OUD criteria between the ages of 20 and 30. Findings are consistent with previous research on opioid use behavior in young adulthood and suggest that nicotine dependence and CUD criteria among urban young people predict onset of OUD and OUD criteria in young adulthood.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Brion S Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James C Anthony
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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King B, Holmes LM, Rishworth A, Patel R. Geographic variations in opioid overdose patterns in Pennsylvania during the COVID-19 pandemic. Health Place 2023; 79:102938. [PMID: 36549235 PMCID: PMC9765327 DOI: 10.1016/j.healthplace.2022.102938] [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: 08/16/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
The convergence of the opioid epidemic and the COVID-19 pandemic has created new health challenges throughout the United States. Since the onset of the pandemic, media attention and scholarly research have drawn attention to the intersections of addiction and COVID-19. However, there remain few empirical studies that examine the direct impacts of the COVID-19 pandemic for opioid overdose patterns. Even fewer have integrated quantitative and qualitative methods to detail the place-specific dynamics shaping opioid overdose and addiction treatment during the COVID-19 pandemic. This article measures and maps change in the age-adjusted rate of opioid-related overdose incidents at the county level from 2018 to 2020. These analyses are combined with interviews conducted since December 2020 with public health providers in the state of Pennsylvania to identify the key factors influencing opioid misuse and transformations in addiction treatment practices.
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Affiliation(s)
- Brian King
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States.
| | - Louisa M. Holmes
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States
| | | | - Ruchi Patel
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States.
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Racial/ethnic residential segregation and the availability of opioid and substance use treatment facilities in US counties, 2009–2019. SSM Popul Health 2022; 20:101289. [DOI: 10.1016/j.ssmph.2022.101289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022] Open
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Pustz J, Srinivasan S, Larochelle MR, Walley AY, Stopka TJ. Relationships between places of residence, injury, and death: Spatial and statistical analysis of fatal opioid overdoses across Massachusetts. Spat Spatiotemporal Epidemiol 2022; 43:100541. [PMID: 36460457 DOI: 10.1016/j.sste.2022.100541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/13/2022] [Accepted: 10/06/2022] [Indexed: 12/15/2022]
Abstract
Understanding the factors associated with where people who use opioids live, where their fatal overdoses occur, and where deaths are recorded can improve our knowledge of local risk environments and inform intervention planning. Through geospatial analyses of death certificate data between 2015 and 2017, we found that a majority of opioid-involved fatal overdoses in Massachusetts occurred at home. Age (adjusted odds ratio [AOR], 1.03; 95% confidence interval [CI], 1.02-1.04), living in a census tract with a higher percentage of crowded households (AOR, 1.04; 95% CI, 1.01-1.08), households without vehicles (AOR, 1.01; 95% CI, 1.00-1.02), and Hispanic ethnicity (AOR, 0.56; 95% CI, 0.42-0.74) were independently associated with fatal overdose at home. Using geographically weighted regression, we identified locations where these associations were stronger and could benefit most from home-based and culturally sensitive overdose prevention efforts, including expanded overdose education and naloxone distribution.
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Affiliation(s)
- Jennifer Pustz
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States
| | - Sumeeta Srinivasan
- Department of Urban and Environmental Policy and Planning, Tufts University, 97 Talbot Avenue, Medford, MA 02155, United States
| | - Marc R Larochelle
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States; Department of Urban and Environmental Policy and Planning, Tufts University, 97 Talbot Avenue, Medford, MA 02155, United States; Department of Community Health, Tufts University, 574 Boston Avenue, Suite 208, Medford, MA 02155, United States; Clinical and Translational Science Institute, 35 Kneeland Street, 7(th) - 11(th) Floors, Boston, MA 02111, United States.
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Le AD, Li Y, Zhu A, Singh J, Xu JY, Srinivasan M, Palaniappan LP, Long J, Gross ER. Effect of race on opioid drug overdose deaths in the United States: an observational cross-sectional study. Br J Anaesth 2022; 129:e66-e68. [PMID: 35787800 PMCID: PMC9583734 DOI: 10.1016/j.bja.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Austin D Le
- Stanford Center for Asian Health Research and Education (CARE), School of Medicine, Stanford University, Stanford, CA, USA
| | - Yuemeng Li
- Stanford Center for Asian Health Research and Education (CARE), School of Medicine, Stanford University, Stanford, CA, USA
| | - Alicia Zhu
- Stanford Center for Asian Health Research and Education (CARE), School of Medicine, Stanford University, Stanford, CA, USA
| | - Jaiveer Singh
- Stanford Center for Asian Health Research and Education (CARE), School of Medicine, Stanford University, Stanford, CA, USA
| | - Jane Y Xu
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education (CARE), School of Medicine, Stanford University, Stanford, CA, USA; Division of Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - Latha P Palaniappan
- Stanford Center for Asian Health Research and Education (CARE), School of Medicine, Stanford University, Stanford, CA, USA; Division of Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jin Long
- Stanford Center for Asian Health Research and Education (CARE), School of Medicine, Stanford University, Stanford, CA, USA; Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Eric R Gross
- Stanford Center for Asian Health Research and Education (CARE), School of Medicine, Stanford University, Stanford, CA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
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14
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Hirchak KA, Amiri S, Kordas G, Oluwoye O, Lyons AJ, Bajet K, Hahn JA, McDonell MG, Campbell ANC, Venner K. Variations in national availability of waivered buprenorphine prescribers by racial and ethnic composition of zip codes. Subst Abuse Treat Prev Policy 2022; 17:41. [PMID: 35614487 PMCID: PMC9131568 DOI: 10.1186/s13011-022-00457-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Opioid overdose remains a public health crisis in diverse communities. Between 2019 and 2020, there was an almost 40% increase in drug fatalities primarily due to opioid analogues of both stimulants and opioids. Medications for opioid use disorder (MOUD; e.g., buprenorphine) are effective, evidence-based treatments that can be delivered in office-based primary care settings. We investigated disparities in the proportion of national prescribers who have obtained a waiver issued to prescribe MOUD by demographic characteristics. METHODS Data for the secondary data analyses were obtained from the Drug Enforcement Administration that maintains data on waivered MOUD prescribers across the US. Proportion of waivered prescribers were examined by ZIP code, race and ethnicity composition, socioeconomic status, insurance, and urban-rural designation using generalized linear mixed effects models. RESULTS Compared with predominantly Non-Hispanic White ZIP codes, other racially and ethnically diverse areas had a higher proportion of waivered buprenorphine prescribers. Differences in prescriber availability between predominant racial group was dependent on rurality based on the interaction found in our fitted model. In metropolitan areas, we found that predominantly Non-Hispanic White ZIP codes had a lower rate of waivered prescribers compared to predominantly Black/African American ZIP codes. CONCLUSIONS Our findings suggest that among AI/AN and Black/African American neighborhoods, availability of waivered prescribers may not be a primary barrier. However, availability of waivered prescribers and prescribing might potentially be an obstacle for Hispanic/Latinx and rural communities. Additional research to determine factors related to improving MOUD availability among diverse communities therefore remains vital to advancing health equity.
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Affiliation(s)
- Katherine A Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Solmaz Amiri
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Gordon Kordas
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA
| | - Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Abram J Lyons
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelsey Bajet
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA
| | - Judith A Hahn
- University of California-San Francisco, San Francisco, CA, USA
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Kamilla Venner
- Center On Alcohol, Substance Use And Addictions, University of New Mexico, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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15
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Lopez AM, Thomann M, Dhatt Z, Ferrera J, Al-Nassir M, Ambrose M, Sullivan S. Understanding Racial Inequities in the Implementation of Harm Reduction Initiatives. Am J Public Health 2022; 112:S173-S181. [PMID: 35349311 PMCID: PMC8965181 DOI: 10.2105/ajph.2022.306767] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To elucidate a structurally oriented theoretical framework that considers legacies of racism, trauma, and social exclusion and to interrogate the "unmet obligations" of the institutionalization of the harm reduction infrastructure to provide equitable protections to Black and Latinx people who use drugs (PWUD) in Maryland. Methods. In 2019, we conducted a rapid ethnographic assessment of and qualitative interviews with PWUD (n = 72) and stakeholders (n = 85) in 5 Maryland counties. We assessed PWUD's experiences, service gaps in as well as barriers and facilitators to accessing services, and the potential to expand harm reduction programs. Results. The unmet obligations we found included enforcement and punitive governance of syringes, naloxone, and other drug use equipment; racism and racialization, social exclusion, and legacies of trauma; and differential implications of harm reduction for populations experiencing racialized criminalization. Conclusions. The implementation of harm reduction policies are a first step, but assessment of structural dynamics are needed for diverse communities with unique histories. This research illuminates a key paradox: progressive policy is implemented, yet the overdose crisis escalates in communities where various forms of racialized exclusions are firmly entrenched. (Am J Public Health. 2022;112(S2):S173-S181. https://doi.org/10.2105/AJPH.2022.306767).
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Affiliation(s)
- Andrea M Lopez
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Matthew Thomann
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Zena Dhatt
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Julieta Ferrera
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Marwa Al-Nassir
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Margaret Ambrose
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Shane Sullivan
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
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16
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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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17
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Pro G, Hayes C, Brown CC, Goree J, Zaller N. Individual and Health Policy Factors Associated With Positive Heroin and Opioid Treatment Response: United States, 2018. Am J Public Health 2022; 112:S66-S76. [PMID: 35143268 PMCID: PMC8842205 DOI: 10.2105/ajph.2021.306503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To identify client- and state-level factors associated with positive treatment response among heroin and opioid treatment episodes in the United States. Methods. We used national data from 46 states using the Treatment Episode Dataset‒Discharges (2018) to identify heroin and opioid treatment episodes (n = 162 846). We defined positive treatment response as a decrease in use between admission and discharge. We used multivariable regression, stratified by race/ethnicity, to identify demographic, pain-related, and state-level factors associated with positive treatment response. Results. Lower community distress was the strongest predictor of better treatment outcomes across all racial/ethnic groups, particularly among White and American Indian/Alaska Native episodes. A primary opioid of heroin was associated with worse outcomes among White and Hispanic episodes. Legislation limiting opioid dispensing was associated with better outcomes among Hispanic episodes. Buprenorphine availability was strongly associated with better outcomes among Black episodes. Conclusions. State-level variables, particularly community distress, had greater associations with positive treatment outcomes than client-level variables. Public Health Implications. Changes in state-level policies and increased resources directed toward areas of high community distress have the potential to improve opioid use disorder treatment and reduce racial/ethnic disparities in treatment outcomes. (Am J Public Health. 2022;112(S1):S66-S76. https://doi.org/10.2105/AJPH.2021.306503).
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Affiliation(s)
- George Pro
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
| | - Corey Hayes
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
| | - Clare C Brown
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
| | - Johnathan Goree
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
| | - Nickolas Zaller
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
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Christopher PP, Stewart C, Manning W, Anderson BJ, Woodruff A, Monteiro J, Stein MD. Risk behaviors among persons civilly committed for opioid use. J Subst Abuse Treat 2022; 132:108493. [PMID: 34098213 PMCID: PMC8627518 DOI: 10.1016/j.jsat.2021.108493] [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: 10/27/2020] [Revised: 01/26/2021] [Accepted: 05/24/2021] [Indexed: 01/03/2023]
Abstract
Despite the growth in civil commitment for persons who use opioids, we know little about the kinds of risk behaviors among those committed. This study examined the behaviors that a judge might use to determine if there is sufficient evidence that an individual's opioid use poses a risk for serious harm. The study recruited participants (n = 121) from three Massachusetts Department of Public Health civil commitment facilities in 2018. We used a list of risk behaviors that courts consider supportive of opioid-related civil commitment. Participants averaged 28 years of age, 56% were male, and 91% met criteria for severe opioid use disorder. Participants endorsed an average of 9 of the 27 risk behaviors. On average, participants endorsed three of the six drug use behaviors representing a danger to themselves, four of eleven behaviors representing an inability to care for or protect themselves (home safety, weight loss), and two of ten behaviors representing a danger to others (driving high or drunk). Participants who reported they were "not at all pleased" to have been civilly committed endorsed significantly (p = .009) fewer behaviors representing a danger to themselves than those who said they were at least "a little pleased." We conclude that the majority of individuals civilly committed for opioid use are engaging in multiple high-risk behaviors that pose a serious risk of harm to themselves.
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Affiliation(s)
- Paul P Christopher
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, United States of America
| | - Catherine Stewart
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
| | - William Manning
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
| | - Bradley J Anderson
- Behavioral Medicine and Addiction Research Unit, Butler Hospital, Providence, RI, United States of America
| | - Alexander Woodruff
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
| | - Jordanna Monteiro
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
| | - Michael D Stein
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America.
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19
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Levander XA, Hoffman KA, McIlveen JW, McCarty D, Terashima JP, Korthuis PT. Rural opioid treatment program patient perspectives on take-home methadone policy changes during COVID-19: a qualitative thematic analysis. Addict Sci Clin Pract 2021; 16:72. [PMID: 34895346 PMCID: PMC8665717 DOI: 10.1186/s13722-021-00281-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In the United States, methadone for opioid use disorder (OUD) is highly regulated. Federal agencies announced guidelines in March 2020 allowing for relaxation of take-home methadone dispensing at opioid treatment programs (OTPs) to improve treatment access and reduce COVID-19 transmission risk during the public health emergency. We explored patient perspectives at three OTPs serving rural communities on how take-home policy changes were received and implemented and how these changes impacted their addiction treatment and recovery. METHODS We completed semi-structured individual qualitative interviews in 2 phases: (1) August-October 2020 and (2) November 2020-January 2021 (total n = 46), anticipating possible policy changes as the pandemic progressed. We interviewed patients with OUD enrolled at 3 rural OTPs in Oregon. Participants received varying take-home methadone allowances following the COVID-19-related policy changes. All interviews were conducted via phone, audio-recorded, and transcribed. We conducted a thematic analysis, iteratively coding transcripts, and deductively and inductively generating codes. RESULTS The 46 participants included 50% women and 89% had Medicaid insurance. Three main themes emerged in the analysis, with no differences between study phases: (1) Adapting to changing OTP policies throughout the pandemic; (2) Recognizing the benefits, and occasional struggles, with increased take-home methadone dosing; and (3) Continuing policies and procedures post-pandemic. Participants described fears and anxieties around ongoing methadone access and safety concerns prior to OTP policy changes, but quickly adapted as protocols soon seemed "natural." The majority of participants acknowledged significant benefits to increased take-homes independent of reducing COVID-19 infection risk including feeling "more like a normal person," improved recovery support, reduced time traveling, and having more time with family and for work. Looking to a post-pandemic future, participants thought some COVID-19-related safety protocols should continue that would reduce risk of other infections, make OTP settings less stressful, and result in more individualized care. CONCLUSIONS As the pandemic progressed, study participants adapted to rapidly changing OTP policies. Participants noted many unanticipated benefits to increased take-home methadone and other COVID-19 protocols including strengthened self-efficacy and recovery and reduced interpersonal conflict, with limited evidence of diversion. Patient perspectives should inform future policies to better address the ongoing overdose epidemic.
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Affiliation(s)
- Ximena A Levander
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Addiction Medicine Section, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code - L475, Portland, OR, 97239-3098, USA.
| | - Kim A Hoffman
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - John W McIlveen
- Oregon Health Authority State Opioid Treatment Authority, Salem, OR, USA
| | - Dennis McCarty
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | | | - P Todd Korthuis
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Addiction Medicine Section, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code - L475, Portland, OR, 97239-3098, USA
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
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20
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Zang X, Macmadu A, Krieger MS, Behrends CN, Green TC, Morgan JR, Murphy SM, Nolen S, Walley AY, Schackman BR, Marshall BDL. Targeting community-based naloxone distribution using opioid overdose death rates: A descriptive analysis of naloxone rescue kits and opioid overdose deaths in Massachusetts and Rhode Island. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103435. [PMID: 34482264 PMCID: PMC8671216 DOI: 10.1016/j.drugpo.2021.103435] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rates of fatal opioid overdose in Massachusetts (MA) and Rhode Island (RI) far exceed the national average. Community-based opioid education and naloxone distribution (OEND) programs are effective public health interventions to prevent overdose deaths. We compared naloxone distribution and opioid overdose death rates in MA and RI to identify priority communities for expanded OEND. METHODS We compared spatial patterns of opioid overdose fatalities and naloxone distribution through OEND programs in MA and RI during 2016 to 2019 using public health department data. The county-level ratio of naloxone kits distributed through OEND programs per opioid overdose death was estimated and mapped to identify potential gaps in naloxone availability across geographic regions and over time. RESULTS From 2016 to 2019, the statewide community-based naloxone distribution to opioid overdose death ratio improved in both states, although more rapidly in RI (from 11.8 in 2016 to 35.6 in 2019) than in MA (from 12.3 to 17.2), driven primarily by elevated and increasing rates of naloxone distribution in RI. We identified some urban/non-urban differences, with higher naloxone distribution relative to opioid overdose deaths in more urban counties, and we observed some counties with high rates of overdose deaths but low rates of naloxone kits distributed through OEND programs. CONCLUSIONS We identified variations in spatial patterns of opioid overdose fatalities and naloxone availability, and these disparities appeared to be widening in some areas over time. Data on the spatial distribution of naloxone distribution and opioid overdose deaths can inform targeted, community-based naloxone distribution strategies that optimize resources to prevent opioid overdose fatalities.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Alexandria Macmadu
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Maxwell S Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Czarina N Behrends
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, United States
| | - Traci C Green
- Institute for Behavioral Health, School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Sean M Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, United States
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, United States
| | - Brandon DL Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
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21
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Hyder A, Lee J, Dundon A, Southerland LT, All D, Hammond G, Miller HJ. Opioid Treatment Deserts: Concept development and application in a US Midwestern urban county. PLoS One 2021; 16:e0250324. [PMID: 33979342 PMCID: PMC8115812 DOI: 10.1371/journal.pone.0250324] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives An Opioid Treatment Desert is an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder. We explored the concept of Opioid Treatment Deserts including racial differences in potential spatial accessibility and applied it to one Midwestern urban county using high resolution spatiotemporal data. Methods We obtained individual-level data from one Emergency Medical Services (EMS) agency (Columbus Fire Department) in Franklin County, Ohio. Opioid overdose events were based on EMS runs where naloxone was administered from 1/1/2013 to 12/31/2017. Potential spatial accessibility was measured as the time (in minutes) it would take an individual, who may decide to seek treatment after an opioid overdose, to travel from where they had the overdose event, which was a proxy measure of their residential location, to the nearest opioid use disorder (OUD) treatment provider that provided medically-assisted treatment (MAT). We estimated accessibility measures overall, by race and by four types of treatment providers (any type of MAT for OUD, Buprenorphine, Methadone, or Naltrexone). Areas were classified as an Opioid Treatment Desert if the estimate travel time to treatment provider (any type of MAT for OUD) was greater than a given threshold. We performed sensitivity analysis using a range of threshold values based on multiple modes of transportation (car and public transit) and using only EMS runs to home/residential location types. Results A total of 6,929 geocoded opioid overdose events based on data from EMS agencies were used in the final analysis. Most events occurred among 26–35 years old (34%), identified as White adults (56%) and male (62%). Median travel times and interquartile range (IQR) to closest treatment provider by car and public transit was 2 minutes (IQR: 3 minutes) and 17 minutes (IQR: 17 minutes), respectively. Several neighborhoods in the study area had limited accessibility to OUD treatment facilities and were classified as Opioid Treatment Deserts. Travel time by public transit for most treatment provider types and by car for Methadone-based treatment was significantly different between individuals who were identified as Black adults and White adults based on their race. Conclusions Disparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio and can be quantified and visualized using local public safety data (e.g., EMS runs). Identification of Opioid Treatment Deserts can aid multiple stakeholders better plan and allocate resources for more equitable access to MAT for OUD and, therefore, reduce the burden of the opioid epidemic while making better use of real-time public safety data to address a public health epidemic that has turned into a public safety crisis.
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Affiliation(s)
- Ayaz Hyder
- Division of Environmental Health, College of Public Health, The Ohio State University, Columbus, OH, United States of America
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH, United States of America
- * E-mail:
| | - Jinhyung Lee
- Department of Geography and Environment, Faculty of Social Science, Western University, Social Science Centre, London, ON, Canada
| | - Ashley Dundon
- Division of Environmental Health, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Lauren T. Southerland
- Department of Emergency Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - David All
- Founder and CEO, Mount Ethos, Seattle, WA, United States of America
| | - Gretchen Hammond
- College of Social Work, The Ohio State University, Columbus, OH, United States of America
| | - Harvey J. Miller
- Center for Urban Regional Analysis, The Ohio State University, Columbus, OH, United States of America
- Department of Geography, The Ohio State University, Columbus, OH, United States of America
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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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Opioid prescribing and health outcomes in opioid-naive patients: Analysis of a statewide health information exchange. J Am Pharm Assoc (2003) 2021; 61:623-631.e3. [PMID: 34045156 DOI: 10.1016/j.japh.2021.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Widespread use of prescription opioids is associated with adverse outcomes. OBJECTIVE To identify factors associated with adverse health outcomes and health care use using a statewide health information exchange. METHODS This is a retrospective cohort study using the Indiana Network for Patient Care. Adult opioid-naive patients who received an opioid prescription between January 2012 and December 2017 were included. The outcomes included (1) a composite outcome of any combination of opioid abuse, dependence, or overdose, (2) all-cause mortality, and (3) health care use. Independent variables included opioid dosage, dispensed amount, days supply, concurrent use of short-acting (SA) and long-acting (LA) opioids, and concurrent use with benzodiazepine or gabapentinoids. Additional variables included patients' age, sex, race, modified Charlson Comorbidity Index score, mental health conditions, and medications for opioid use disorders. Factors associated with composite outcome and mortality were identified using Cox proportional hazards and reported as adjusted hazard ratio (aHR) and 95% CI. Factors associated with health care use were identified using Poisson regression and reported as adjusted incidence rate ratio (aIRR) and 95% CI. RESULTS 1,328,287 opioid prescriptions were identified for 341,722 patients. Opioid-related factors associated with the composite outcome, mortality, and hospitalizations, respectively, included opioid dosage (aHR 1.003 [95% CI 1.001-1.006]; aHR not applicable; aIRR 1.07 [1.06-1.08]), opioid days supply (aHR 1.03 [1.02-1.03]; aHR 1.009 [1.005-1.014]; aIRR 0.94 [0.92-0.96]), concurrent SA/LA opioids (aHR 2.12 [1.78-2.54]; aHR 1.40 [1.14-1.70]; aIRR 1.40 [1.37-1.42]), and use of benzodiazepines/gabapentinoids (aHR 1.68 [1.38-2.04]; aHR 1.23 [1.01-1.51]; aIRR 1.25 [1.23-1.27]). CONCLUSION Many factors are associated with poor health outcomes, especially concurrent use of SA and LA opioids and overlapping prescriptions of opioids with benzodiazepines or gabapentinoids. Identification of factors associated with adverse outcomes may help identify patients at risk for poor outcomes and could inform possible interventions.
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24
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Goss KD, Abramson N, Ioerger M, Reyes AC, Turk MA. A systematic scoping study exploring opioid use across a variety of disability conditions. Disabil Health J 2021; 14:101106. [PMID: 33888430 DOI: 10.1016/j.dhjo.2021.101106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Opioid use experiences among people with disability (PWD) as a group has not been clearly articulated in the current literature, despite links between pain and measures of disability. OBJECTIVE To conduct a systematic search and scoping study examining the characteristics of current literature focused on opioid use among PWD. METHODS Four databases were queried (i.e., Medline, PsycINFO, Embase, and CINAHL) for peer-reviewed, empirical, English-language, journal articles focused on long-term opioid use among PWD. Collected data points included: disability details (specific condition, onset of disability), opioid details (category of opioid use, and specified substance), study details, and design. RESULTS A total of 196 articles were included, with 83.7% published since 2000 largely from the US. The majority of articles (70.4%) focused on the use of opioids as medical treatment, with fewer articles focusing on recreational opioid use or substance use disorders. The majority of included sources (73%) focused on opioid use in acquired conditions; neuropathic pain (21.9%) and attention deficit hyperactivity disorder (20.4%) were the most commonly studied. Differences were observed in the distribution of disability conditions across category of opioid use and study design classification; 73.5% were considered observational in design. CONCLUSIONS The varied representation of disability conditions, and differences across opioid use category and study design classification point to a complicated relationship between opioid use and disability. The present research portfolio would benefit from research matching informational needs of a specific disability area or opioid use category to provide the evidence necessary to advance current knowledge and promote inclusion in national agendas.
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Affiliation(s)
- Katherine D Goss
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, 13210, USA.
| | - Nicholas Abramson
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Michael Ioerger
- College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Alicia C Reyes
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Margaret A Turk
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
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25
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Banks DE, Carpenter RW, Wood CA, Winograd RP. Commentary on Furr-Holden et al. : As opioid overdose deaths accelerate among Black Americans, COVID-19 widens inequities-a critical need to invest in community-based approaches. Addiction 2021; 116:686-687. [PMID: 33417278 PMCID: PMC7878302 DOI: 10.1111/add.15362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has exacerbated racial inequities in fatal opioid overdoses affecting Black Americans. To reduce overdose rates among Black Americans, funding and policy efforts should prioritize local strategies that build community trust, such as grassroots organizations already engaged in outreach, advocacy, and harm reduction services.
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Affiliation(s)
- Devin E Banks
- Department of Psychological Sciences, University of Missouri St Louis, St Louis, MO, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri St Louis, St Louis, MO, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, MO, USA
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26
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Reed MK, Roth AM, Tabb LP, Groves AK, Lankenau SE. "I probably got a minute": Perceptions of fentanyl test strip use among people who use stimulants. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103147. [PMID: 33583679 DOI: 10.1016/j.drugpo.2021.103147] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/30/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fentanyl dominates the heroin supply in many regions of the United States. One harm reduction response has been the distribution of fentanyl test strips to people who use heroin to test for the presence of fentanyl. Reports increasingly indicate that fentanyl contamination is occurring in the illicit stimulant market, but whether people who use stimulants would use fentanyl test strips is unknown. METHODS Between January 2019 and January 2020, fifteen people in Philadelphia, PA who reported stimulant use completed a semi-structured interview with questions about their perceptions of fentanyl and willingness to use fentanyl test strips. Data were coded and analyzed for thematic content using constructs from the Health Belief Model and risk environment theory. RESULTS Participants primarily reported using crack cocaine or crack cocaine/heroin, while some used methamphetamine, powder cocaine, or prescription opioids. All were aware of fentanyl and believed they were susceptible to a fentanyl overdose as stimulant users. Participants perceived benefits of using test strips but reported barriers, such as the unpredictable nature of buying or using drugs and not wanting to delay drug use to test. Structural conditions impeded participant actions to reduce overdose risk if their drugs tested positive for fentanyl. CONCLUSION Fentanyl test strips were a desired harm reduction tool by many participants who used stimulants. In addition to providing access to the strips, programs should tailor overdose prevention education to these clients by acknowledging susceptibility, amplifying benefits, and addressing drug-specific barriers to use of fentanyl test strips.
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Affiliation(s)
- Megan K Reed
- Thomas Jefferson University, Department of Emergency Medicine, 1025 Walnut Street, College Building, Philadelphia, PA 19107, United States.
| | - Alexis M Roth
- Drexel University, Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA 19104, United States
| | - Loni P Tabb
- Drexel University, Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA 19104, United States
| | - Ali K Groves
- Drexel University, Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA 19104, United States
| | - Stephen E Lankenau
- Drexel University, Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA 19104, United States
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27
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Oluwoye O, Kriegel LS, Alcover KC, Hirchak K, Amiri S. Racial and ethnic differences in alcohol-, opioid-, and co-use-related deaths in Washington State from 2011 to 2017. Addict Behav Rep 2020; 12:100316. [PMID: 33364324 PMCID: PMC7752704 DOI: 10.1016/j.abrep.2020.100316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Few studies exist examining alcohol and opioid co-use mortality rates among racially and ethnically diverse communities, presenting a critical gap in understanding the contribution of alcohol on opioid-related deaths and strategies for prevention. The purpose of the study was to assess whether alcohol and opioid-related deaths differ by race/ethnicity subgroups and if there has been an increase in alcohol and opioid-related deaths between 2011 and 2017. DESIGN Secondary data analysis of publicly available alcohol and opioid mortality data among non-Hispanic Whites, Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native individuals in Washington State. MEASUREMENTS The primary outcomes were alcohol-only, opioid-only, and alcohol-opioid co-use mortality, 2011-2017. Alcohol and/or opioid-related deaths were assigned an International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for the underlying or multiple cause of death. FINDINGS Between 2011 and 2017, alcohol-only mortality rates increased among non-Hispanic White (P = 0.003) and Hispanic individuals (P = 0.008). Opioid-only mortality rates increased among American Indian/Alaska Native (P = 0.004) and Hispanic individuals (P = <0.001). American Indian/Alaska Native individuals had the highest alcohol-only, opioid-only, and co-use-related mortality rates when looking at between-group incidence rates. CONCLUSIONS Although the opioid epidemic has been characterized as a public health crisis that predominantly impacts non-Hispanic White individuals, racial and ethnic minorities are increasingly impacted by fatal and non-fatal overdose related to co-occurring substance use. Our findings using data from Washington State, align with existing data and signal a dire need to address alcohol and opioid misuse through targeted interventions to prevent overdose and poisoning, with special considerations for American Indian/Alaska Native communities.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Liat S. Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Karl C. Alcover
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Katherine Hirchak
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Solmaz Amiri
- Department of Nutrition and Exercise Science, Washington State University, Spokane, WA, United States
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28
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Testa A, Lee JG. Trends in Sentencing of Federal Drug Offenders: Findings From U.S. District Courts 2002–2017. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620959071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study uses 16 years (2002–2017) of federal criminal drug sentences from the U.S. Sentencing Commission (USSC) to examine trends in two criminal sentencing outcomes: whether a defendant received a prison sentence and the length of a prison sentence. Logistic and ordinary least squares regression analyses were used to assess criminal sentencing outcomes. Moderation analyses are conducted to assess variation in sentencing for specific drug offenses over time. Results demonstrate that sentencing for federal drug crimes has become less severe over time. However, there is substantial heterogeneity in sentencing across different drug types, with pharmaceutical opioid cases receiving the least leniency over time regarding the incarceration decision and methamphetamine cases experiencing the lowest reduction in the length of prison sentences from 2002 to 2017. Finally, our analysis stratified by race/ethnicity suggested that there is heterogeneity in sentencing outcomes for federal drug offenders, conditional on racial and ethnic background.
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