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Cochran G, Smid MC, Krans EE, Yu Z, Carlston K, White A, Abdulla W, Baylis J, Charron E, Okifugi A, Gordon AJ, Lundahl B, Silipigni J, Seliski N, Haaland B, Tarter R. Patient navigation for pregnant individuals with opioid use disorder: Results of a randomized multi-site pilot trial. Addiction 2024; 119:544-556. [PMID: 37859587 DOI: 10.1111/add.16364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND AND AIMS Patient navigation (PN) may benefit pregnant individuals with opioid use disorder (OUD) by improving treatment adherence. We examined participant enrollment, session delivery and assessment feasibility for a PN intervention among pregnant participants and compared PN preliminary effectiveness for OUD treatment engagement with participants in usual care (UC). DESIGN This study was a pilot single-blinded multi-site randomized trial. SETTING Two academic medical centers in Pennsylvania (n = 57) and Utah (n = 45), United States participated. PARTICIPANTS One hundred and two pregnant adult participants unestablished (fewer than 6 weeks) on medication for OUD (MOUD) were randomized to PN (n = 53) or UC (n = 49). INTERVENTION PN was composed of 10 prenatal sessions (delivered after baseline but before the prenatal assessments) and four postnatal sessions (delivered before the 2- and 6-month postpartum assessments) focused upon OUD treatment and physical/mental health needs. UC involved brief case management. MEASUREMENTS Feasibility assessments included consent, session delivery and assessment rates. Mixed-effect models for intent-to-treat (ITT) and per protocol (PP, received six or more sessions) populations were estimated to compare outcomes of MOUD use, secondary outcomes of substance use disorder (SUD) treatment attendance and non-prescribed opioid use, and exploratory outcome of overdose at baseline, predelivery and 2 and 6 months postpartum. FINDINGS We consented 87% (106 of 122) of the proposed target, delivered ~60% of sessions delivered and completed ≥ 75% assessments. PN ITT and PP had better MOUD adherence, SUD treatment attendance, non-prescribed opioid use and overdose outcomes than UC. Notable changes included good evidence for greater percentage change in days for PN PP MOUD use from baseline to 2 months postpartum [PN = 28.0 versus UC = -10.9, 95% confidence interval (CI) = 9.7, 62.1] and some evidence for baseline to 6 months postpartum (PN = 45.4 versus UC = 23.4, 95% CI = -0.7, 48.2). PN PP percentage change in days for SUD treatment attendance also showed good evidence for improvements from baseline to prenatal assessment (PN = 7.4 versus UC = -21.3, 95% CI = 3.3, 53.5). PN compared to UC participants reported fewer overdoses at 2 months (PN = 11.9%/UC = 16.1%) and at 6 months postpartum (PN = 3.8%/UC = 6.2%). CONCLUSIONS Patient navigation appears to be associated with improvements in opioid use disorder treatment engagement and overdoses during pregnancy. This pilot trial shows the feasibility of the intervention and a future large-scale trial.
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Affiliation(s)
- Gerald Cochran
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC, Pittsburgh, PA, USA
| | - Ziji Yu
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristi Carlston
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ashley White
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Walitta Abdulla
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC, Pittsburgh, PA, USA
| | - Jacob Baylis
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elizabeth Charron
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Akiko Okifugi
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Adam J Gordon
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Brad Lundahl
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - John Silipigni
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Natasha Seliski
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ralph Tarter
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
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Clingan SE, Woodruff SI, Gaines TL, Davidson PJ. Detoxification, 12-step meeting attendance, and non-fatal opioid overdoses among a suburban/exurban population with opioid use disorder. J Addict Dis 2023; 41:266-273. [PMID: 35950698 PMCID: PMC9918603 DOI: 10.1080/10550887.2022.2108287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Drug overdoses are the leading cause of injury death in the United States with an estimated 105,752 individuals dying from an overdose in the United States in a 12-month period ending October 2021. Given that people who have opioid use disorder (OUD) are at an increased risk of death, it is crucial to assess risk factors associated with opioid overdose to improve interventions. OBJECTIVES We examine factors associated with non-fatal overdose among a suburban/exurban population with OUD in Southern California. METHODS Participants were recruited by convenience sampling (n = 355) and were interviewed between November 2017 to August 2018. Participants were eligible for the study if they had a history of pharmaceutical opioid use. RESULTS A total of 198 (55.8%) participants reported at least one overdose in their lifetime. A total of 229 participants identified as male, 124 identified as female, and 2 identified as non-binary. When controlling for demographic factors, non-oral opioid administration at first opioid use (AOR 2.82, 95% CI 1.52-5.22), having a history of methadone detoxification, (AOR 2.23, 95% CI 1.27-3.91), history of buprenorphine detoxification (AOR 1.77, 95% CI 1.02-3.07), and history of 12 step attendance (AOR 1.89, 95% CI 1.12-3.20) were found to be independently and positively associated with lifetime opioid overdose. CONCLUSIONS Detoxification with buprenorphine and methadone was found to be associated with having a non-fatal opioid overdose. Buprenorphine and methadone should not be prescribed as a detoxification medication as long-term use of medication for OUD results in better outcomes than medication that is used short-term.
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Affiliation(s)
- Sarah E. Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Susan I. Woodruff
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4119
| | - Tommi L. Gaines
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093
| | - Peter J. Davidson
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093
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Brandt L, Hu MC, Liu Y, Castillo F, Odom GJ, Balise RR, Feaster DJ, Nunes EV, Luo SX. Risk of Experiencing an Overdose Event for Patients Undergoing Treatment With Medication for Opioid Use Disorder. Am J Psychiatry 2023; 180:386-394. [PMID: 36891640 DOI: 10.1176/appi.ajp.20220312] [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] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Overdose risk during a course of treatment with medication for opioid use disorder (MOUD) has not been clearly delineated. The authors sought to address this gap by leveraging a new data set from three large pragmatic clinical trials of MOUD. METHODS Adverse event logs, including overdose events, from the three trials (N=2,199) were harmonized, and the overall risk of having an overdose event in the 24 weeks after randomization was compared for each study arm (one methadone, one naltrexone, and three buprenorphine groups), using survival analysis with time-dependent Cox proportional hazard models. RESULTS By week 24, 39 participants had ≥1 overdose event. The observed frequency of having an overdose event was 15 (5.30%) among 283 patients assigned to naltrexone, eight (1.51%) among 529 patients assigned to methadone, and 16 (1.15%) among 1,387 patients assigned to buprenorphine. Notably, 27.9% of patients assigned to extended-release naltrexone never initiated the medication, and their overdose rate was 8.9% (7/79), compared with 3.9% (8/204) among those who initiated naltrexone. Controlling for sociodemographic and time-varying medication adherence variables and baseline substance use, a proportional hazard model did not show a significant effect of naltrexone assignment. Significantly higher probabilities of experiencing an overdose event were observed among patients with baseline benzodiazepine use (hazard ratio=3.36, 95% CI=1.76, 6.42) and those who either were never inducted on their assigned study medication (hazard ratio=6.64, 95% CI=2.12, 19.54) or stopped their medication after initial induction (hazard ratio=4.04, 95% CI=1.54, 10.65). CONCLUSIONS Among patients with opioid use disorder seeking medication treatment, the risk of overdose events over the next 24 weeks is elevated among those who fail to initiate or discontinue medication and those who report benzodiazepine use at baseline.
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Affiliation(s)
- Laura Brandt
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
| | - Mei-Chen Hu
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
| | - Ying Liu
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
| | - Felipe Castillo
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
| | - Gabriel J Odom
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
| | - Raymond R Balise
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
| | - Daniel J Feaster
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
| | - Edward V Nunes
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
| | - Sean X Luo
- Department of Psychology, City College of New York, New York (Brandt); Division on Substance Use Disorders, New York State Psychiatric Institute, New York (Castillo, Nunes, Luo); Department of Psychiatry, Columbia University Irving Medical Center, New York (Hu, Liu, Nunes, Luo); Department of Biostatistics, Florida International University, Miami (Odom); Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami (Balise, Feaster)
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Schneider KE, Allen ST, Winiker AK, White RH, O’Rourke A, Sherman SG, Grieb SM. Overdose Experiences among People Who Inject Drugs in West Virginia: Personal Loss, Psychological Distress, Naloxone, and Fentanyl. Subst Use Misuse 2022; 58:22-26. [PMID: 36371695 PMCID: PMC10124002 DOI: 10.1080/10826084.2022.2136489] [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] [Indexed: 11/15/2022]
Abstract
Background: As overdose remains a major public health concern in the United States, it is important to understand the experiences people who inject drugs (PWID) have with overdose. Past experiences during such emergencies are an important determinant of future behavior, including help seeking, which can be lifesaving. Methods: We explored experiences with overdose, using data from 21 in-depth interviews collected from PWID in a rural county in West Virginia (Cabell County). We used an iterative, modified constant comparison approach to synthesize resulting interview data. Results: Participants reported pervasive experiences with overdose, including through their own personal overdose experiences, witnessing others overdose, and losing loved ones to overdose fatalities. Experiencing emotional distress when witnessing an overdose was common among our participants. Many participants reported regularly carrying naloxone and using it to reverse overdoses. Multiple participants described believing the myth that people grow immune to naloxone over time. Concerns about the presence of fentanyl in drugs were also common, with many participants attributing their own and others' overdoses to fentanyl. Conclusions: Our findings have important implications for naloxone access and education, as well as policies and practices to encourage help seeking during overdose events among rural PWID. Participant concerns about fentanyl in the drug supply highlight the need for access to drug checking technologies.
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Affiliation(s)
- Kristin E. Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Allison O’Rourke
- DC Center for AIDS Research, Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington, DC 20052, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Suzanne M. Grieb
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
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Domzaridou E, Carr MJ, Webb RT, Millar T, Ashcroft DM. Non-fatal overdose risk during and after opioid agonist treatment: A primary care cohort study with linked hospitalisation and mortality records. Lancet Reg Health Eur 2022; 22:100489. [PMID: 36034051 PMCID: PMC9399254 DOI: 10.1016/j.lanepe.2022.100489] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The initiation and cessation of opioid agonist treatment (OAT) have both been associated with elevated risk of fatal overdose. We examined risk of non-fatal overdose during OAT initiation and cessation and specifically between methadone versus buprenorphine recipients. Methods We utilised primary care electronic health records from the Clinical Practice Research Datalink to delineate a study cohort of adults aged 18-64 who were prescribed OAT between Jan 1, 1998 and Dec 31, 2017. These records were linked to hospitalisation, mortality records and patient neighbourhood and practice-level Index of Multiple Deprivation quintiles. With inverse probability treatment weights applied and negative binomial regression models we estimated incidence rate ratios for hospital admissions among patients who experienced multiple overdoses. Findings A total of 20898 patients were prescribed methadone or buprenorphine over 83856 person-years of follow-up. Compared with periods in treatment, patients not in treatment were 51% more likely to experience a non-fatal overdose that required hospitalisation (weighted rate ratio, wRR 1·51; 95% CI 1·42, 1·60), especially during the four weeks of OAT initiation (5·59; 5·31, 5·89) and following cessation (13·39; 12·78, 14·03). The wRR of overdose during (0·37; 0·34, 0·39) and after treatment (0·36; 0·34, 0·38) favoured buprenorphine compared to methadone. Interpretation OAT is associated with decreased non-fatal overdose risk. Buprenorphine may act more protectively than methadone, especially during the first four weeks of treatment. Funding National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).
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Affiliation(s)
- Eleni Domzaridou
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Corresponding author at: Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester M13 9PL, UK.
| | - Matthew J. Carr
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Roger T. Webb
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, UK
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Tim Millar
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Darren M. Ashcroft
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
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Kelty E, Pyle A, Preen DB. Opioid poisoning during pregnancy: prevalence, characteristics, and neonatal outcomes. Arch Womens Ment Health 2022; 25:957-963. [PMID: 35984500 PMCID: PMC9492584 DOI: 10.1007/s00737-022-01260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Abstract
While it has been postulated that opioid poisoning during pregnancy may cause adverse maternal and neonatal outcomes, the harm associated with opioid poisoning during pregnancy has not been robustly examined. Pregnant women admitted to hospital or presenting to the emergency department (ED) in Western Australia (WA) with a diagnosis of opioid poisoning were identified by linking state midwifery records with hospital and ED administrative data. Maternal and neonatal outcomes were compared with opioid poisoning that occurred in the 12 months prior to conception or the 12 months following birth. Between 2003 and 2018, 57 neonates were born to women who had experienced opioid poisoning during pregnancy (14.1 per 100,000 births) in WA. The incidence of opioid poisoning in the year prior to pregnancy (IRR: 3.04, 95%CI: 2.30, 4.02) and the year following pregnancy (IRR: 1.96, 95%CI: 1.46, 2.64) was significantly higher than during pregnancy. Opioid poisoning during pregnancy was less likely to involve multiple substances and be intentional (rather than accidental). Neonatal conditions associated with in utero hypoxia were significantly less common in neonates born to women who experience opioid poisoning prior to pregnancy compared with during pregnancy (OR: 0.17, 95%CI: 0.04, 0.80). Opioid poisoning in pregnancy was not associated with an increased risk of other serious adverse neonatal outcomes. Opioid poisoning during pregnancy is uncommon and less likely to be intentional and involve multiple substances. Opioid poisoning during pregnancy is likely associated with an increased risk of conditions associated with in utero hypoxia.
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Affiliation(s)
- Erin Kelty
- The School of Population and Global Health, the University of Western Australia, 35 Stirling Highway, Crawley, WA, Australia.
| | - Anwyn Pyle
- The Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - David B Preen
- The School of Population and Global Health, the University of Western Australia, 35 Stirling Highway, Crawley, WA, Australia
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Lin Q, Kolak M, Watts B, Anselin L, Pollack H, Schneider J, Taylor B. Individual, interpersonal, and neighborhood measures associated with opioid use stigma: Evidence from a nationally representative survey. Soc Sci Med 2022; 305:115034. [PMID: 35636049 PMCID: PMC9288898 DOI: 10.1016/j.socscimed.2022.115034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022]
Abstract
Despite growing awareness of opioid use disorder (OUD), fatal overdoses and downstream health conditions (e. g., hepatitis C and HIV) continue to rise in some populations. Various interrelated structural forces, together with social and economic determinants, contribute to this ongoing crisis; among these, access to medications for opioid use disorder (MOUD) and stigma towards people with OUD remain understudied. We combined data on methadone, buprenorphine, and naltrexone providers from SAMHSA’s 2019 directory, additional naltrexone providers from Vivitrol’s location finder service, with a nationally representative survey called “The AmeriSpeak survey on stigma toward people with OUD.” Integrating the social-ecological framework, we focus on individual characteristics, personal and family members’ experience with OUD, and spatial access to MOUD at the community level. We use nationally representative survey data from 3008 respondents who completed their survey in 2020. Recognizing that stigma is a multifaceted construct, we also examine how the process varies for different types of stigma, specifically perceived dangerousness and untrustworthiness, as well as social distancing measures under different scenarios. We found a significant association between stigma and spatial access to MOUD — more resources are related to weaker stigma. Respondents had a stronger stigma towards people experiencing current OUD (versus past OUD), and they were more concerned about OUD if the person would marry into their family (versus being their coworkers). Additionally, respondents’ age, sex, education, and personal experience with OUD were also associated with their stigma, and the association can vary depending on the specific type of stigma. Overall, stigma towards people with OUD was associated with both personal experiences and environmental measures.
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Affiliation(s)
- Qinyun Lin
- Center for Spatial Data Science, University of Chicago, USA.
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, USA
| | | | - Luc Anselin
- Center for Spatial Data Science, University of Chicago, USA
| | - Harold Pollack
- School of Social Service Administration, University of Chicago, USA
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Jones NR, Hickman M, Nielsen S, Larney S, Dobbins T, Ali R, Degenhardt L. The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001-2018: Findings from the OATS retrospective linkage study. Drug Alcohol Depend 2022; 236:109464. [PMID: 35523111 DOI: 10.1016/j.drugalcdep.2022.109464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND There are critical periods of mortality risk at onset and cessation of opioid agonist treatment. We aim to determine whether non-fatal overdose followed the same pattern as fatal overdose, comparing the first 4 weeks of treatment and treatment cessation and the remainder time off treatment, with the remainder treatment time, to determine intervention markers. METHODS Retrospective cohort study of people with a history of opioid agonist treatment using linked New South Wales data. The incidence of non-fatal overdose hospitalization; emergency department presentation; and fatal overdose from national death records were compared. Rates were calculated using generalized estimating equations adjusting for demographics, year, and recent health and incarceration events. RESULTS The remainder time in OAT had the lowest incidence of overdose for all outcomes and is the reference level for the adjusted incident rate ratios (aIRR). Fatal overdose was lowest in treatment and highest in the first four weeks out of treatment, aIRR of 12.83 (95% CI 10.0-16.4). Whereas the highest overdose rate for non-fatal opioid overdose was in the first four weeks in treatment, aIRR of 3.11 (95% CI 2.19-4.42). CONCLUSIONS Retention on opioid agonist treatment is protective against drug related overdose. There is elevated risk of non-fatal overdose at treatment initiation that is not evident for fatal overdose, but the first month of treatment cessation is a critical period for both non-fatal and fatal overdose. These findings emphasize the importance of treatment retention and interventions for polysubstance overdose at cessation.
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Affiliation(s)
- Nicola R Jones
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS2 8DZ, UK
| | - Suzanne Nielsen
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, Université de Montréal and Centre de Recherche du, Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052, Australia; School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - Robert Ali
- School of Medicine, The University of Adelaide, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052, Australia.
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Lee JD, Nunes EV, Novo P, May J, Matthews A, Van Veldhuisen P, Lindblad R, Liu D, Rotrosen J. Commentary on Ajazi et al (2021) Re-analysis of the X:BOT Trial. J Addict Med 2022; 16:382-385. [PMID: 35960212 PMCID: PMC9375053 DOI: 10.1097/adm.0000000000000930] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Joshua D Lee
- From the New York University Grossman School of Medicine, New York (JDL, PN, JR); New York State Psychiatric Institute and Columbia University Irving Medical Center, New York (EVN); EMMES Inc, Bethesda, MD (JM, AM, PVV, RL); and National Institute on Drug Abuse (DL)
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10
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Spreen LA, Dittmar EN, Quirk KC, Smith MA. Buprenorphine initiation strategies for opioid use disorder and pain management: A systematic review. Pharmacotherapy 2022; 42:411-427. [PMID: 35302671 PMCID: PMC9310825 DOI: 10.1002/phar.2676] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 12/17/2022]
Abstract
Buprenorphine possesses many unique attributes that make it a practical agent for adults and adolescents with opioid use disorder (OUD) and/or acute or chronic pain. Sublingual buprenorphine has been the standard of care for treating OUD, but its use in pain management is not as clearly defined. Current practice guidelines recommend a period of mild‐to‐moderate withdrawal from opioids before transitioning to buprenorphine due to its ability to displace full agonists from the μ‐opioid receptor. However, this strategy can lead to negative physical and psychological outcomes for patients. Novel initiation strategies suggest that concomitant administration of small doses of buprenorphine with opioids can avoid the unwanted withdrawal associated with buprenorphine initiation. We aim to systematically review the buprenorphine initiation strategies that have emerged in the last decade. Embase, PubMed, and Cochrane Databases were searched for relevant literature. Studies were included if they were published in the English language and described the transition to buprenorphine from opioids. Data were collected from each study and synthesized using descriptive statistics. This review included 7 observational studies, 1 feasibility study, and 39 case reports/series which included 924 patients. The strategies utilized between the literature included traditional initiation (47.9%), microdosing with various buprenorphine formulations (16%), and miscellaneous methods (36.1%). Traditional initiation and microdosing initiation were compared in the data synthesis and analysis; miscellaneous methods were omitted given the high variability between methods. Overall, 95.6% of patients in the traditional initiation group and 96% of patients in the microdosing group successfully rotated to sublingual buprenorphine. Initiation regimens can vary widely depending on patient‐specific factors and buprenorphine formulation. A variety of buprenorphine transition strategies are published in the literature, many of which were effective for patients with OUD, pain, or both.
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Affiliation(s)
- Lauren A Spreen
- Department of Pharmacy Services, University of Michigan Health, Ann Arbor, Michigan, USA.,University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Emma N Dittmar
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Kyle C Quirk
- Department of Palliative Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael A Smith
- Department of Pharmacy Services, University of Michigan Health, Ann Arbor, Michigan, USA.,University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
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11
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Joudrey PJ, Kolak M, Lin Q, Paykin S, Anguiano V, Wang EA. Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder. JAMA Netw Open 2022; 5:e227028. [PMID: 35438757 PMCID: PMC9020217 DOI: 10.1001/jamanetworkopen.2022.7028] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community's ability to respond to natural disasters and infectious disease outbreaks is associated with MOUD access. OBJECTIVE To examine the association of community vulnerability to disasters and pandemics with geographic access to each of the 3 MOUDs and whether this association differs by urban, suburban, or rural classification. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of zip code tabulation areas (ZCTAs) in the continental United States excluding Washington, DC, conducted a geospatial analysis of 2020 treatment location data. EXPOSURES Social vulnerability index (US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics). MAIN OUTCOMES AND MEASURES Drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each treatment type (buprenorphine, methadone, and extended-release naltrexone). RESULTS Among 32 604 ZCTAs within the continental US, 170 within Washington, DC, and 20 without an urban-rural classification were excluded, resulting in a final sample of 32 434 ZCTAs. Greater social vulnerability was correlated with longer drive times for methadone (correlation, 0.10; 95% CI, 0.09 to 0.11), but it was not correlated with access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (correlation, -0.10; 95% CI, -0.12 to -0.08) but vulnerability was not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (correlation, 0.22; 95% CI, 0.20 to 0.24) and extended-release naltrexone (correlation, 0.15; 95% CI, 0.13 to 0.17). CONCLUSIONS AND RELEVANCE In this study, communities with greater vulnerability did not have greater geographic access to MOUD, and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access regardless of vulnerability status. Future disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths.
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Affiliation(s)
- Paul J. Joudrey
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marynia Kolak
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Qinyun Lin
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Susan Paykin
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Vidal Anguiano
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Emily A. Wang
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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12
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Cochran G, Cole ES, Sharbaugh M, Nagy D, Gordon AJ, Gellad WF, Pringle J, Bear T, Warwick J, Drake C, Chang CCH, DiDomenico E, Kelley D, Donohue J. Provider and Patient-panel Characteristics Associated With Initial Adoption and Sustained Prescribing of Medication for Opioid Use Disorder. J Addict Med 2022; 16:e87-e96. [PMID: 33973921 DOI: 10.1097/adm.0000000000000859] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Limited information is available regarding provider- and patient panel-level factors associated with primary care provider (PCP) adoption/prescribing of medication for opioid use disorder (MOUD). METHODS We assessed a retrospective cohort from 2015 to 2018 within the Pennsylvania Medicaid Program. Participants included PCPs who were Medicaid providers, with no history of MOUD provision, and who treated ≥10 Medicaid enrollees annually. We assessed initial MOUD adoption, defined as an index buprenorphine/buprenorphine-naloxone or oral/extended release naltrexone fill and sustained prescribing, defined as ≥1 MOUD prescription(s) for 3 consecutive quarters from the PCP. Independent variables included provider- and patient panel-level characteristics. RESULTS We identified 113 rural and 782 urban PCPs who engaged in initial adoption and 36 rural and 288 urban PCPs who engaged in sustained prescribing. Rural/urban PCPs who issued increasingly larger numbers of antidepressant and antipsychotic medication prescriptions had greater odds of initial adoption and sustained prescribing (P < 0.05) compared to those that did not prescribe these medications. Further, each additional patient out of 100 with opioid use disorder diagnosed before MOUD adoption increased the adjusted odds for initial adoption 2% to 4% (95% confidence interval [CI] = 1.01-1.08) and sustained prescribing by 4% to 7% (95% CI = 1.01-1.08). New Medicaid providers in rural areas were 2.52 (95% CI = 1.04-6.11) and in urban areas were 2.66 (95% CI = 1.94, 3.64) more likely to engage in initial MOUD adoption compared to established PCPs. CONCLUSIONS MOUD prescribing adoption was concentrated among PCPs prescribing mental health medications, caring for those with OUD, and new Medicaid providers. These results should be leveraged to test/implement interventions targeting MOUD adoption among PCPs.
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Affiliation(s)
- Gerald Cochran
- Department of Internal Medicine, University of Utah, City, UT (GC, AJG), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (ESC, MS, DN, TB, CD, JD), School of Medicine, University of Pittsburgh, Pittsburgh, PA (WFG, C-CH), Program Evaluation Research Unit, University of Pittsburgh, Pittsburgh, PA (JP, JW), School of Pharmacy, University of Pittsburgh, Pittsburgh, PA (JP), Pennsylvania Department of Drug and Alcohol Programs, Harrisburg, PA (ED), Pennsylvania Department of Human Services, Harrisburg, PA (DK)
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13
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Wilson M, Brumwell A, Stowe MJ, Shelly S, Scheibe A. Personal experience and awareness of opioid overdose occurrence among peers and willingness to administer naloxone in South Africa: findings from a three-city pilot survey of homeless people who use drugs. Harm Reduct J 2022; 19:17. [PMID: 35148779 PMCID: PMC8832761 DOI: 10.1186/s12954-021-00561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Drug overdoses occur when the amount of drug or combination of drugs consumed is toxic and negatively affects physiological functioning. Opioid overdoses are responsible for the majority of overdose deaths worldwide. Naloxone is a safe, fast-acting opioid antagonist that can reverse an opioid overdose, and as such, it should be a critical component of community-based responses to opioid overdose. However, the burden of drug overdose deaths remains unquantified in South Africa, and both knowledge about and access to naloxone is generally poor. The objective of this study was to describe the experiences of overdose, knowledge of responses to overdose events, and willingness to call emergency medical services in response to overdose among people who use drugs in Cape Town, Durban, and Pretoria (South Africa). Methods We used convenience sampling to select people who use drugs accessing harm reduction services for this cross-sectional survey from March to July 2019. Participants completed an interviewer-administered survey, assessing selected socio-demographic characteristics, experiences of overdose among respondents and their peers, knowledge about naloxone and comfort in different overdose responses. Data, collected on paper-based tools, were analysed using descriptive statistics and categorised by city. Results Sixty-six participants participated in the study. The median age was 31, and most (77%) of the respondents were male. Forty-one per cent of the respondents were homeless. Heroin was the most commonly used drug (79%), and 82% of participants used drugs daily. Overall, 38% (25/66) reported overdosing in the past year. Most (76%, 50/66) knew at least one person who had ever experienced an overdose, and a total of 106 overdose events in peers were reported. Most participants (64%, 42/66) had not heard of naloxone, but once described to them, 73% (48/66) felt comfortable to carry it. More than two-thirds (68%, 45/66) felt they would phone for medical assistance if they witnessed an overdose. Conclusion Drug overdose was common among participants in these cities. Without interventions, high overdose-related morbidity and mortality is likely to occur in these contexts. Increased awareness of actions to undertake in response to an overdose (calling for medical assistance, using naloxone) and access to naloxone are urgently required in these cities. Additional data are needed to better understand the nature of overdose in South Africa to inform policy and responses.
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Affiliation(s)
- Michael Wilson
- Advance Access and Delivery South Africa, 112 Stamfordhill Road, Greyville, Durban, 4001, South Africa. .,Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | | | - M J Stowe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,South African Network of People Who Use Drugs (SANPUD), Cape Town, South Africa
| | - Shaun Shelly
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Andrew Scheibe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,TB HIV Care, Cape Town, South Africa.,Urban Futures Centre, Faculty of Engineering, Durban University of Technology, Durban, South Africa
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14
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Padmanathan P, Forbes H, Redaniel MT, Gunnell D, Lewer D, Moran P, Watson B, Degenhardt L, Hickman M. Self-harm and suicide during and after opioid agonist treatment among primary care patients in England: a cohort study. Lancet Psychiatry 2022; 9:151-159. [PMID: 34921800 DOI: 10.1016/s2215-0366(21)00392-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The first 4 weeks after initiation and cessation of opioid agonist treatment for opioid dependence are associated with an increased risk of all-cause mortality and overdose. We aimed to investigate whether the rate of self-harm and suicide among people who were prescribed opioid agonist treatment differs during initiation, cessation, and the remainder of time on and off treatment. METHODS We did a retrospective cohort study and used health-care records from UK Clinical Practice Research Datalink, linked to mortality and hospital admission data, for adults (age 18-75 years at cohort entry) who were prescribed opioid agonist treatment at least once in primary care in England between Jan 2, 1998, and Nov 30, 2018. We estimated rates and adjusted risk ratios (aRRs) of hospital admissions for self-harm and death by suicide, comparing time during and after treatment, as well as comparing stable periods of time on treatment with treatment initiation, cessation, and the remaining time off treatment. FINDINGS Between Jan 2, 1998, and Nov 30, 2018, 8070 patients (5594 [69·3%] men and 2476 [30·7%] women) received 17 004 episodes of opioid agonist treatment over 40 599 person-years. Patients were mostly of White ethnicity (7006 [86·8%] patients). 807 episodes of self-harm (1·99 per 100 person-years) and 46 suicides (0·11 per 100 person-years) occurred during the study period. The overall age-standardised and sex-standardised mortality ratio for suicide was 7·5 times (95% CI 5·5-10·0) higher in the study cohort than in the general population. Opioid agonist treatment was associated with a reduced risk of self-harm (aRR in periods off treatment 1·50 [95% CI 1·21-1·88]), but was not significantly associated with suicide risk (aRR in periods off treatment 1·21 [0·64-2·28]). Risk of self-harm (aRR 2·60 [95% CI 1·83-3·70]) and suicide (4·68 [1·63-13·42]) were both elevated in the first 4 weeks after stopping opioid agonist treatment compared with stable periods on treatment. INTERPRETATION Stable periods of opioid agonist treatment are associated with reduced risk of self-harm, emphasising the importance of improving retention of patients in treatment. The first month following cessation of opioid agonist treatment is a period of increased risk of suicide and self-harm, during which additional psychosocial support is required. FUNDING Medical Research Council.
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Affiliation(s)
- Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Specialist Drug and Alcohol Service, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK.
| | - Harriet Forbes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Applied Research Collaboration West, Bristol, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals, Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Dan Lewer
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Paul Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Applied Research Collaboration West, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals, Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Ben Watson
- Bristol Specialist Drug and Alcohol Service, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals, Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
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15
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Armoon B, Higgs P, Mohammadi R. Mental health status, health service utilization, drug use behaviors associated with non-fatal overdose among people who use illicit drugs: A meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2019331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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16
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Armoon B, Mohammadi R, Fattah Moghaddam L, Gonabadi-Nezhad L. Type of drug use and risky determinants associated with fatal overdose among people who use drugs: a meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2019329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Leila Gonabadi-Nezhad
- Department of Psychiatry, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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17
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Ripperger M, Lotspeich SC, Wilimitis D, Fry CE, Roberts A, Lenert M, Cherry C, Latham S, Robinson K, Chen Q, McPheeters ML, Tyndall B, Walsh CG. Ensemble learning to predict opioid-related overdose using statewide prescription drug monitoring program and hospital discharge data in the state of Tennessee. J Am Med Inform Assoc 2021; 29:22-32. [PMID: 34665246 PMCID: PMC8714265 DOI: 10.1093/jamia/ocab218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective To develop and validate algorithms for predicting 30-day fatal and nonfatal opioid-related overdose using statewide data sources including prescription drug monitoring program data, Hospital Discharge Data System data, and Tennessee (TN) vital records. Current overdose prevention efforts in TN rely on descriptive and retrospective analyses without prognostication. Materials and Methods Study data included 3 041 668 TN patients with 71 479 191 controlled substance prescriptions from 2012 to 2017. Statewide data and socioeconomic indicators were used to train, ensemble, and calibrate 10 nonparametric “weak learner” models. Validation was performed using area under the receiver operating curve (AUROC), area under the precision recall curve, risk concentration, and Spiegelhalter z-test statistic. Results Within 30 days, 2574 fatal overdoses occurred after 4912 prescriptions (0.0069%) and 8455 nonfatal overdoses occurred after 19 460 prescriptions (0.027%). Discrimination and calibration improved after ensembling (AUROC: 0.79–0.83; Spiegelhalter P value: 0–.12). Risk concentration captured 47–52% of cases in the top quantiles of predicted probabilities. Discussion Partitioning and ensembling enabled all study data to be used given computational limits and helped mediate case imbalance. Predicting risk at the prescription level can aggregate risk to the patient, provider, pharmacy, county, and regional levels. Implementing these models into Tennessee Department of Health systems might enable more granular risk quantification. Prospective validation with more recent data is needed. Conclusion Predicting opioid-related overdose risk at statewide scales remains difficult and models like these, which required a partnership between an academic institution and state health agency to develop, may complement traditional epidemiological methods of risk identification and inform public health decisions.
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Affiliation(s)
- Michael Ripperger
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah C Lotspeich
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Drew Wilimitis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie E Fry
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Allison Roberts
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Matthew Lenert
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charlotte Cherry
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Sanura Latham
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Katelyn Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Qingxia Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa L McPheeters
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ben Tyndall
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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18
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Dahlman D, Ohlsson H, Edwards AC, Sundquist J, Håkansson A, Sundquist K. Socioeconomic correlates of incident and fatal opioid overdose among Swedish people with opioid use disorder. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:73. [PMID: 34565405 PMCID: PMC8474855 DOI: 10.1186/s13011-021-00409-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
Background Opioid overdose (OD) and opioid OD death are major health threats to people with opioid use disorder (OUD). Socioeconomic factors are underexplored potential determinants of opioid OD. In this study, we assessed socioeconomic and other factors and their associations with incident and fatal opioid OD, in a cohort consisting of 22,079 individuals with OUD. Methods We performed a retrospective, longitudinal study based on Swedish national register data for the period January 2005–December 2017. We used Cox proportional hazard models to investigate the risk of incident and fatal opioid OD as a function of several individual, parental and neighborhood covariates. Results Univariate analysis showed that several covariates were associated with incident and fatal opioid OD. In the multivariate analysis, incident opioid OD was associated with educational attainment (Hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94–0.97), having received social welfare (HR 1.31; 95% CI 1.22–1.39), and criminal conviction (HR 1.53; 95% CI 1.42–1.65). Fatal opioid OD was also associated with criminal conviction (HR 1.93; 95% CI 1.61–2.32). Conclusion Individuals with low education and receipt of social welfare had higher risks of incident opioid OD and individuals with criminal conviction were identified as a risk group for both incident and fatal opioid OD. Our findings should raise attention among health prevention policy makers in general, and among decision-makers within the criminal justice system and social services in particular. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00409-3.
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Affiliation(s)
- Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden. .,Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden. .,Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden
| | - Alexis C Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
| | - Anders Håkansson
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.,Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
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19
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Mullin S, Zola J, Lee R, Hu J, MacKenzie B, Brickman A, Anaya G, Sinha S, Li A, Elkin PL. Longitudinal K-means approaches to clustering and analyzing EHR opioid use trajectories for clinical subtypes. J Biomed Inform 2021; 122:103889. [PMID: 34411708 PMCID: PMC9035269 DOI: 10.1016/j.jbi.2021.103889] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/26/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Identification of patient subtypes from retrospective Electronic Health Record (EHR) data is fraught with inherent modeling issues, such as missing data and variable length time intervals, and the results obtained are highly dependent on data pre-processing strategies. As we move towards personalized medicine, assessing accurate patient subtypes will be a key factor in creating patient specific treatment plans. Partitioning longitudinal trajectories from irregularly spaced and variable length time intervals is a well-established, but open problem. In this work, we present and compare k-means approaches for subtyping opioid use trajectories from EHR data. We then interpret the resulting subtypes using decision trees, examining how each subtype is influenced by opioid medication features and patient diagnoses, procedures, and demographics. Finally, we discuss how the subtypes can be incorporated in static machine learning models as features in predicting opioid overdose and adverse events. The proposed methods are general, and can be extended to other EHR prescription dosage trajectories.
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Affiliation(s)
- Sarah Mullin
- University at Buffalo, The State University of New York, United States.
| | - Jaroslaw Zola
- University at Buffalo, The State University of New York, United States
| | - Robert Lee
- University at Buffalo, The State University of New York, United States; Department of Veterans Affairs, WNY VA, United States
| | - Jinwei Hu
- University at Buffalo, The State University of New York, United States
| | - Brianne MacKenzie
- University at Buffalo, The State University of New York, United States
| | - Arlen Brickman
- University at Buffalo, The State University of New York, United States
| | - Gabriel Anaya
- University at Buffalo, The State University of New York, United States
| | - Shyamashree Sinha
- University at Buffalo, The State University of New York, United States
| | - Angie Li
- University at Buffalo, The State University of New York, United States
| | - Peter L Elkin
- University at Buffalo, The State University of New York, United States; Department of Veterans Affairs, WNY VA, United States; Faculty of Engineering, University of Southern Denmark, Denmark
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20
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Franchitto N. Buprenorphine exposures in adolescents and adults: A 10-year experience of a French Poison Control Center. Fundam Clin Pharmacol 2021; 35:762-763. [PMID: 34250651 DOI: 10.1111/fcp.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nicolas Franchitto
- University Service of Addictology CHU Purpan, Toulouse, France.,UMR 1027, University of Toulouse, UPS, Inserm, Toulouse, France
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21
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Potru S, Tang YL. Chronic Pain, Opioid Use Disorder, and Clinical Management Among Older Adults. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:294-302. [PMID: 34690595 PMCID: PMC8475938 DOI: 10.1176/appi.focus.20210002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Because of unique factors related to physiological changes and altered metabolism in advanced age, special attention is needed concerning chronic pain, opioid use, and opioid use disorder among older adults. Clinicians need to follow the most updated clinical guidelines regarding opioid prescribing. Routine screening and awareness are the keys to identifying opioid use disorder. Comprehensive assessments often require both pain assessment (including functional status) and substance use assessment, including the use of urine toxicological testing and structured, validated screening tools and instruments. Comprehensive, interdisciplinary efforts are critical in managing the care of older adults with chronic pain and opioid use disorder. A collaborative approach that includes substance abuse treatment and pain management (including pain subspecialty care) is often recommended. Medications for opioid use disorder have been extensively studied and have the most convincing evidence to date, and psychosocial treatments may be beneficial in some circumstances.
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Affiliation(s)
- Sudheer Potru
- Department of Anesthesiology (Potru) and Department of Psychiatry and Behavioral Sciences (Tang), both at Emory University, Atlanta; Department of Anesthesiology (Potru) and Substance Abuse Treatment Program (Tang), both at Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Yi-Lang Tang
- Department of Anesthesiology (Potru) and Department of Psychiatry and Behavioral Sciences (Tang), both at Emory University, Atlanta; Department of Anesthesiology (Potru) and Substance Abuse Treatment Program (Tang), both at Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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22
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Rapid Transition From Methadone to Buprenorphine Utilizing a Micro-dosing Protocol in the Outpatient Veteran Affairs Setting. J Addict Med 2021; 14:e271-e273. [PMID: 32011408 DOI: 10.1097/adm.0000000000000618] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Alternative transition protocols from methadone to buprenorphine in the treatment of opioid use disorder (OUD) are needed to reduce the risk of precipitated withdrawal and opioid use during induction. METHODS Case report (n = 1). RESULTS One patient with OUD underwent a rapid microinduction outpatient protocol that did not cause precipitated withdrawal or require preceding taper before cessation of methadone. The induction was carried out safely in the outpatient setting. CONCLUSIONS This report provides a patient-centered approach demonstrating feasibility and cost-effectiveness of rapid transition to buprenorphine in the US outpatient psychiatry setting. Barriers to adherence to opioid agonist therapy may be reduced using this protocol.
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23
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Bharat C, Hickman M, Barbieri S, Degenhardt L. Big data and predictive modelling for the opioid crisis: existing research and future potential. Lancet Digit Health 2021; 3:e397-e407. [PMID: 34045004 DOI: 10.1016/s2589-7500(21)00058-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/21/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
A need exists to accurately estimate overdose risk and improve understanding of how to deliver treatments and interventions in people with opioid use disorder in a way that reduces such risk. We consider opportunities for predictive analytics and routinely collected administrative data to evaluate how overdose could be reduced among people with opioid use disorder. Specifically, we summarise global trends in opioid use and overdoses; describe the use of big data in research into opioid overdose; consider the potential for predictive modelling, including machine learning, for prevention and monitoring of opioid overdoses; and outline the challenges and risks relating to the use of big data and machine learning in reducing harms that are related to opioid use. Future research for improving the coverage and provision of existing interventions, treatments, and resources for opioid use disorder requires collaboration of multiple agencies. Predictive modelling could transport the concept of stratified medicine to public health through novel methods, such as predictive modelling and emulated trials for evaluating diagnoses and prognoses of opioid use disorder, predicting treatment response, and providing targeted treatment recommendations.
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Affiliation(s)
- Chrianna Bharat
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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24
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De Aquino JP, Parida S, Sofuoglu M. The Pharmacology of Buprenorphine Microinduction for Opioid Use Disorder. Clin Drug Investig 2021; 41:425-436. [PMID: 33818748 PMCID: PMC8020374 DOI: 10.1007/s40261-021-01032-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/25/2022]
Abstract
Although expanding the availability of buprenorphine—a first-line pharmacotherapy for opioid-use disorder (OUD)—has increased the capacity of healthcare systems to offer treatment, starting this medication is fraught with significant barriers. Standard induction regimens require persons with OUD to taper and discontinue full opioid agonists and experience opioid withdrawal prior to the first dose of buprenorphine. Further, emerging evidence indicates that precipitated withdrawal during induction may impact long-term treatment outcomes. Microinduction is a novel approach that, by harnessing buprenorphine’s unique pharmacological profile, may allow circumventing the needed for prolonged opioid tapers, and reduce the risk of precipitated withdrawal—holding promise to enhance treatment access. In this review, we examine the pharmacological basis for microinduction and appraise the evidence of this approach to improve clinical outcomes among persons with OUD. First, we highlight the potential dose-dependent effects of buprenorphine on two key neuroadaptations at the mu-opioid receptor (MOR)—resensitization and upregulation. We then focus on how microinduction may reverse these chronic MOR neuroadaptations, allowing the maintenance of an adequate opioid tone, and thereby potentially circumventing opioid withdrawal. Second, we describe the clinical evidence available, derived from observational reports and open-label studies, examining the potential efficacy of microinduction. Despite significant heterogeneity—exemplified by variable buprenorphine formulations, daily doses, and schedules of administration—these data provide preliminary support for the feasibility of microinduction. Finally, we provide new mechanistic, methodological, and clinical insights to guide future translational research, as well as randomized, placebo-controlled clinical trials in this compelling agenda of pharmacotherapy development.
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Affiliation(s)
- Joao P De Aquino
- VA Connecticut Healthcare System, 950 Campbell Avenue, 151D, West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA.
| | - Suprit Parida
- VA Connecticut Healthcare System, 950 Campbell Avenue, 151D, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, 950 Campbell Avenue, 151D, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA
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25
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Cole ES, Drake C, DiDomenico E, Sharbaugh M, Kim JY, Nagy D, Cochran G, Gordon AJ, Gellad WF, Pringle J, Warwick J, Chang CCH, Kmiec J, Kelley D, Donohue JM. Patterns of clinic switching and continuity of medication for opioid use disorder in a Medicaid-enrolled population. Drug Alcohol Depend 2021; 221:108633. [PMID: 33631544 PMCID: PMC8931627 DOI: 10.1016/j.drugalcdep.2021.108633] [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: 08/14/2020] [Revised: 01/14/2021] [Accepted: 02/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many persons with opioid use disorder (OUD) initiate medication for opioid use disorder (MOUD) with one clinic and switch to another clinic during their course of treatment. These switches may occur for referrals or for unplanned reasons. It is unknown, however, what effect switching MOUD clinics has on continuity of MOUD treatment or on overdoses. OBJECTIVE To examine patterns of switching MOUD clinics and its association with the proportion of days covered (PDC) by MOUD, and opioid-related overdose. DESIGN Cross-sectional retrospective analysis of Pennsylvania Medicaid claims data. MAIN MEASURES MOUD clinic switches (i.e., filling a MOUD prescription from a prescriber located in a different clinic than the previous prescriber), PDC, and opioid-related overdose. RESULTS Among 14,107 enrollees, 43.2 % switched clinics for MOUD at least once during the 270 day period. In multivariate regression results, enrollees who were Non-Hispanic black (IRR = 1.43; 95 % CI = 1.24-1.65; p < 0.001), had previous methadone use (IRR = 1.32; 95 % CI = 1.13-1.55; p < 0.001), and a higher total number of office visits (IRR = 1.01; CI = 1.01-1.01; p < 0.001) had more switches. The number of clinic switches was positively associated with PDC (OR = 1.12; 95 % CI = 1.10-1.13). In secondary analyses, we found that switches for only one MOUD fill were associated with lower PDC (OR = 0.97; 95 % CI = 0.95-0.99), while switches for more than one MOUD fill were associated with higher PDC (OR = 1.40; 95 % CI = 1.36-1.44). We did not observe a relationship between opioid-related overdose and clinic switches. CONCLUSIONS Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions, insofar as it is related to overdose and PDC.
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Affiliation(s)
- Evan S Cole
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States.
| | - Coleman Drake
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States
| | - Ellen DiDomenico
- Pennsylvania Department of Drug and Alcohol Programs 2601 N 3rd St, Harrisburg, PA, 17110, United States
| | - Michael Sharbaugh
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States
| | - Joo Yeon Kim
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States
| | - Dylan Nagy
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States
| | - Gerald Cochran
- University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, 295 Chipeta Way, Salt Lake City, UT, 84132, United States
| | - Adam J Gordon
- University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, 295 Chipeta Way, Salt Lake City, UT, 84132, United States
| | - Walid F Gellad
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States; University of Pittsburgh School of Medicine, Division of General Internal Medicine, UPMC Montefiore Hospital, Suite W933, Pittsburgh, PA, 15213, United States
| | - Janice Pringle
- University of Pittsburgh School of Pharmacy, Program Evaluation and Research Unit 5607 Baum Blvd, Pittsburgh, PA, 15206, United States
| | - Jack Warwick
- University of Pittsburgh School of Pharmacy, Program Evaluation and Research Unit 5607 Baum Blvd, Pittsburgh, PA, 15206, United States
| | - Chung-Chou H Chang
- University of Pittsburgh School of Medicine, Division of General Internal Medicine, UPMC Montefiore Hospital, Suite W933, Pittsburgh, PA, 15213, United States
| | - Julie Kmiec
- University of Pittsburgh, Department of Psychiatry, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA, 15213, United States
| | - David Kelley
- Pennsylvania Department of Human Services, 625 Forster St, Harrisburg, PA, 17120, United States
| | - Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States
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26
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Krsak M, Montague BT, Trowbridge P, Johnson SC, Binswanger IA. Opioid Use and Chronic Infections: The Value of Addressing the Syndemic in Correctional Settings Via Telemedicine Guidance and Broader Use of Long-Acting Medications. J Infect Dis 2021; 222:S486-S493. [PMID: 32877543 DOI: 10.1093/infdis/jiaa001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the United States, we are experiencing linked epidemics (a syndemic) of substance use disorders (SUDs) and infections associated with drug use, including unsafe injecting and unsafe sex in exchange for drugs or money. Current drug laws, together with risk-taking behavior among persons with SUDs, contribute to disproportionately high prevalences of these conditions in correctional settings. Detection and treatment of diseases with a high impact on public health are best addressed in the settings where such conditions are most prevalent (ie, jails and prisons for SUDs and chronic infections). The effectiveness, safety, cost of care. and public health impact of these conditions can be improved by means of broader screening and expanded access to specialty consultations through telemedicine/telehealth, along with broader use of long-acting medications for the treatment of human immunodeficiency virus and SUDs. Expanding telemedicine/telehealth, first for specialties which do not require advanced technology (eg, infectious diseases, addictions), can eventually lead to further advancements in correctional healthcare.
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Affiliation(s)
- Martin Krsak
- Division of Infectious Diseases, University of Colorado School of Medicine, Colorado, USA
| | - Brian T Montague
- Division of Infectious Diseases, University of Colorado School of Medicine, Colorado, USA
| | - Paul Trowbridge
- Spectrum Health Center for Integrative Medicine, Grand Rapids, Michigan, USA
| | - Steven C Johnson
- Division of Infectious Diseases, University of Colorado School of Medicine, Colorado, USA
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,Colorado Permanente Medical Group, Denver, Colorado, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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27
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Jain P, McKinnell K, Marino R, Vunnava P, Liles-Burden MA, Desai A, Wenten M, Fratantonio J, Akerman SC, Sullivan MA, Bloomgren G. Evaluation of Opioid Overdose Reports in Patients Treated with Extended-Release Naltrexone: Postmarketing Data from 2006 to 2018. Drug Saf 2021; 44:351-359. [PMID: 33258068 PMCID: PMC7892734 DOI: 10.1007/s40264-020-01020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 10/26/2022]
Abstract
INTRODUCTION After treatment with naltrexone extended-release injectable suspension (XR-NTX), a µ-opioid receptor antagonist, opioid tolerance is reduced from pretreatment baseline. Patients may be vulnerable to opioid overdose if they attempt to override the blockade during treatment, at the end of a dosing interval, after missing a dose, or after discontinuing treatment. OBJECTIVE We analyzed postmarketing data to characterize reporting rates of opioid overdose during treatment with and after discontinuation of XR-NTX. METHODS Postmarketing adverse event reports within the XR-NTX safety database, received 2006-2018, for patients treated with XR-NTX for any indication were reviewed for opioid overdose cases. Assessable cases were categorized by timing of the event from the last dose of XR-NTX (latency): ≤28 days (on treatment), 29-56 days, and >56 days from last dose of XR-NTX. Within each latency group, cases were further classified as serious and, of those, cases that had a fatal outcome. RESULTS During the 12-year period, an estimated 495,602 patients received XR-NTX. Opioid overdose was reported in 161 cases; of these, 66 contained sufficient information to determine latency. Reporting rates of opioid overdose per 10,000 patients treated were similar among latency groups: 0.54 for ≤28 days (0.24 fatal), 0.34 for 29-56 days (0.16 fatal), and 0.44 for >56 days (0.40 fatal) from the last dose of XR-NTX. CONCLUSIONS Over the 12-year period, the reporting rates of opioid overdose were similar during treatment with or after discontinuation of XR-NTX and <10/10,000 patients exposed. Our findings are limited by the nature of spontaneously reported safety data.
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Affiliation(s)
- Priya Jain
- Alkermes, Inc., 852 Winter Street, Waltham, MA, 02451, USA
| | | | - Rose Marino
- Alkermes, Inc., 852 Winter Street, Waltham, MA, 02451, USA
| | | | | | - Avani Desai
- Alkermes, Inc., 852 Winter Street, Waltham, MA, 02451, USA
| | - Madé Wenten
- Alkermes, Inc., 852 Winter Street, Waltham, MA, 02451, USA
| | | | | | - Maria A Sullivan
- Alkermes, Inc., 852 Winter Street, Waltham, MA, 02451, USA
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gary Bloomgren
- Alkermes, Inc., 852 Winter Street, Waltham, MA, 02451, USA.
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28
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Jones NR, Hickman M, Larney S, Nielsen S, Ali R, Murphy T, Dobbins T, Fiellin DA, Degenhardt L. Hospitalisations for non-fatal overdose among people with a history of opioid dependence in New South Wales, Australia, 2001-2018: Findings from the OATS retrospective cohort study. Drug Alcohol Depend 2021; 218:108354. [PMID: 33121866 DOI: 10.1016/j.drugalcdep.2020.108354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To examine, among a cohort of opioid dependent people with a history of opioid agonist treatment (OAT), the frequency and incidence rates of non-fatal overdose (NFOD) hospital separations over time, by age and sex. METHODS Retrospective cohort study of people with a history of OAT using state-wide linked New South Wales (NSW) data. The incidence of NFOD hospital separations involving an opioid, sedative, stimulant or alcohol was defined according to the singular or combination of poisoning/toxic effect using ICD-10-AM codes. Crude incidence rates were calculated by gender, age group and calendar year. RESULTS There were 31.8 (31.3-32.3) NFOD per 1,000 person-years (PY). Opioid NFOD incidence was higher in women than men: incidence rate ratio (IRR) 1.11 per 1,000PY; 95 %CI: [1.06-1.17]; women had higher sedative NFOD rates than men, IRR 1.27 per 1,000PY [1.21-1.34]. Participants ≤25 years, 26-30yrs, and 31-35yrs had higher incidence of opioid NFOD compared to 46+yrs, with IRRs of: 1.45 per 1,000PY; [1.32-1.59]; 1.20 per 1,000PY; [1.11-1.30] and 1.22 per 1,000PY; [1.13-1.32], respectively. Between 2006-7 and 2016-17, the cohort accounted for 19 % of NSW opioid NFOD episodes, 12 % of sedative, 14 % of stimulant and 5 % of acute alcohol-related NFOD. CONCLUSIONS Hospital stays due to NFOD are a relatively frequent occurrence among opioid-dependent people. There are clear differences in rates and substances involved by sex, age and over time. Evidence-based interventions that prevent overdose among people who are opioid dependent need to be delivered to scale, including widespread community provision of naloxone.
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Affiliation(s)
- Nicola R Jones
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia.
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS2 8DZ, UK.
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia; Department of Family Medicine and Emergency Medicine, Université de Montréal and Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada.
| | - Suzanne Nielsen
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Melbourne, Australia.
| | - Robert Ali
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia; School of Medicine, The University of Adelaide, Australia.
| | - Thomas Murphy
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia.
| | - Timothy Dobbins
- School of Public Health and Community Medicine, UNSW Sydney, Australia.
| | - David A Fiellin
- Yale Schools of Medicine and Public Health, New Haven, CT, USA.
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia.
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29
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Mariottini C, Kriikku P, Ojanperä I. Concomitant drugs with buprenorphine user deaths. Drug Alcohol Depend 2021; 218:108345. [PMID: 33127184 DOI: 10.1016/j.drugalcdep.2020.108345] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Buprenorphine is abused in several countries notwithstanding its benefits as an analgesic and as an opioid agonist treatment medication. Benzodiazepines and alcohol have previously been associated with buprenorphine toxicity. This study elucidates the role of emerging concomitant drugs in different groups of buprenorphine user deaths. METHODS All cases in the Finnish national post-mortem toxicology database from 2016-2019 in which buprenorphine or norbuprenorphine was a laboratory finding in any post-mortem specimen and age at death of 15-64 years were investigated for cause and manner of death, concurrent drug and alcohol findings, age, and gender. RESULTS There were 792 deaths with a buprenorphine finding, of which buprenorphine was implicated in poisoning without other opioids in 271 cases (34 %). In this group of buprenorphine poisoning deaths, concomitant benzodiazepines were found in 94 % (clonazepam 53 %), illicit drugs in 63 %, gabapentinoids in 50 % (pregabalin 41 %), alcohol in 41 %, antidepressants in 32 %, and antipsychotics in 28 % of cases; only three deaths showed no benzodiazepines, alcohol, or gabapentinoids. Polydrug use was common regardless of the cause of death. In the age group 15 to 24 years, concomitant use of benzodiazepines and illicit drugs, and buprenorphine poisoning were more prevalent than in the age group 25-64 years. CONCLUSIONS The unprecedentedly high concomitant use of benzodiazepines in buprenorphine user deaths obscures other possible pharmacological risk factors for buprenorphine poisoning that could be relevant for prevention. Higher mortality in the younger age group suggests particularly unsafe drug use patterns that should be addressed.
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Affiliation(s)
- Claudia Mariottini
- Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014 Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Pirkko Kriikku
- Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014 Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Ilkka Ojanperä
- Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014 Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.
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30
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Cochran G, Bruneau J, Cox N, Gordon AJ. Medication treatment for opioid use disorder and community pharmacy: Expanding care during a national epidemic and global pandemic. Subst Abus 2020; 41:269-274. [PMID: 32697171 DOI: 10.1080/08897077.2020.1787300] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are effective strategies for treatment of opioid use disorder (OUD) and reducing overdose risk. MOUD treatment rates continue to be low across the US, and currently, some evidence suggests access to evidence-based treatment is becoming increasingly difficult for those with OUD as a result of the 2019 novel corona virus (COVID-19). A major underutilized source to address these serious challenges in the US is community pharmacy given the specialized training of pharmacists, high levels of consumer trust, and general availability for accessing these service settings. Canadian, Australian, and European pharmacists have made important contributions to the treatment and care of those with OUD over the past decades. Unfortunately, US pharmacists are not permitted to prescribe MOUD and are only currently allowed to dispense methadone for the treatment of pain, not OUD. US policymakers, regulators, and practitioners must work to facilitate this advancement of community pharmacy-based through research, education, practice, and industry. Advancing community pharmacy-based MOUD for leading clinical management of OUD and dispensation of treatment medications will afford the US a critical innovation for addressing the opioid epidemic, fallout from COVID-19, and getting individuals the care they need.
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Affiliation(s)
- Gerald Cochran
- Greater Intermountain Node, a NIH NIDA Clinical Trial Network node and Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Julie Bruneau
- Department of family medicine and emergency medicine, Université de Montréal, Montréal, Canada
| | - Nicholas Cox
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Adam J Gordon
- Greater Intermountain Node, a NIH NIDA Clinical Trial Network node and Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS Center), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
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31
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Wightman RS, Perrone J, Scagos R, Krieger M, Nelson LS, Marshall BDL. Opioid Overdose Deaths with Buprenorphine Detected in Postmortem Toxicology: a Retrospective Analysis. J Med Toxicol 2020; 17:10-15. [PMID: 32648229 DOI: 10.1007/s13181-020-00795-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/14/2020] [Accepted: 06/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Buprenorphine is a unique μ-opioid receptor partial agonist with avid receptor binding, nominal euphoric reward, and a ceiling effect on sedation and respiratory depression. Despite a pharmacologic profile that enhances safety, cases of fatal opioid overdose with buprenorphine on postmortem toxicology are reported, but details of these cases in the literature are limited. METHODS A retrospective review of opioid-involved drug overdose fatalities in Rhode Island (RI) from 2016 to 2018 using the RI Department of Health State Unintentional Drug Overdose Reporting System (SUDORS) database. Deaths with buprenorphine on toxicology testing versus opioid-involved overdose deaths without buprenorphine were compared to assess the type and number of co-exposures. RESULTS Of 534 opioid-involved deaths, 29 (5.4%) included buprenorphine and/or norbuprenorphine on toxicology. Most frequent co-exposures are as follows: fentanyl (75.9%), norfentanyl (72.4%), cocaine (41.4%), benzoylecgonine (41.4%), cannabinoids (31.0%), ethanol (31.0%), levamisole (31.0%), and free morphine (31.0%). An average number of co-exposures for fatalities with buprenorphine were 9.24 versus 6.68 in those without buprenorphine. In one case buprenorphine was the only drug listed to cause death; all other fatalities with buprenorphine on toxicology reported additional drugs contributing to death. CONCLUSION Decedents with buprenorphine detected on toxicology testing commonly had documented polysubstance use. Although data are limited, buprenorphine may provide some risk mitigation against full agonist opioid overdose including fentanyl. Further work should explore the use of postmortem concentrations of buprenorphine, norbuprenorphine, and other opioid metabolites to determine the role of buprenorphine in fatal overdose pharmacology.
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Affiliation(s)
- Rachel S Wightman
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, 55 Claverick St, Providence, RI, 02903, USA.
| | - Jeanmarie Perrone
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Ground Silverstein, Rm. 260 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Rachel Scagos
- Rhode Island Department of Health, 3 Capitol Hill, Cannon Building, Providence, RI, 02908, USA
| | - Maxwell Krieger
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA
| | - Lewis S Nelson
- Rutgers New Jersey School of Medicine, Medical Science Building, 185 South Orange Avenue, Newark, NJ, 07103, 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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Gicquelais RE, Jannausch M, Bohnert AS, Thomas L, Sen S, Fernandez AC. Links between suicidal intent, polysubstance use, and medical treatment after non-fatal opioid overdose. Drug Alcohol Depend 2020; 212:108041. [PMID: 32470753 PMCID: PMC7336718 DOI: 10.1016/j.drugalcdep.2020.108041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Suicidal thinking during non-fatal overdose may elevate risk for future completed suicide or intentional overdose. Long-term outcomes following an intentional non-fatal overdose may be improved through specific intervention and prevention responses beyond those designed for unintentional overdoses, yet little research has assessed suicidal intent during overdoses or defined characteristics that differentiate these events from unintentional overdoses. METHODS Patients with a history of opioid overdose (n = 274) receiving residential addiction treatment in the Midwestern United States completed self-report surveys to classify their most recent opioid overdose as unintentional, actively suicidal (wanted to die), or passively suicidal (didn't care about the risks). We characterized correlates of intent using descriptive statistics and prevalence ratios. We also examined how intent related to thoughts of self-harm at the time of addiction treatment. RESULTS Of opioid overdoses, 51 % involved suicidal intent (44 % passive and 7 % active). Active suicidal intent was positively associated with hospitalization. Active/passive intent (vs. no intent, aPR: 2.2, 95 % CI: 1.4-3.5) and use of ≥5 substances (vs. 1 substance, aPR: 3.6, 95 % CI: 1.2-10.6) at the last opioid overdose were associated with having thoughts of self-harm or suicide in the 2 weeks before survey completion in adjusted models. Participants who reported active/passive intent more commonly used cocaine or crack (27 %) with opioids during their last overdose relative to unintentional overdoses (16 %). CONCLUSIONS Over half of opioid overdoses among individuals in addiction treatment involved some degree of suicidal thinking. Identifying patients most at risk will facilitate better targeting of suicide prevention and monitoring services.
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Affiliation(s)
- Rachel E. Gicquelais
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA,Corresponding author at: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E7133A, Baltimore, MD, 21205, USA.
| | - Mary Jannausch
- Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Amy S.B. Bohnert
- Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI 48105, USA,Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA,Department of Anesthesiology, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Laura Thomas
- Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI 48105, USA,Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA,Molecular and Behavioral Neuroscience Institute, University of Michigan, 205 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Anne C. Fernandez
- Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
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Kelty E, Hulse G, Joyce D, Preen DB. Impact of Pharmacological Treatments for Opioid Use Disorder on Mortality. CNS Drugs 2020; 34:629-642. [PMID: 32215842 DOI: 10.1007/s40263-020-00719-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of pharmacological treatments for opioid use disorders, including methadone, buprenorphine and naltrexone has been associated with a reduction in mortality compared with illicit opioid use. However, these treatments can also contribute significantly to the risk of death. The opioid agonists methadone and buprenorphine achieve clinical efficacy in patients with an opioid use disorder through suppressing craving and diminishing the effectiveness of illicit opioid doses, while the antagonist naltrexone blocks the action of opioids. Pharmacological differences between opioid pharmacotherapies then create different temporal patterns of protection and mortality risk, different risks of relapse to illicit opioid use, and variations in direct and indirect toxicity, which are revealed in clinical and epidemiological studies. Induction onto methadone and the cessation of oral naltrexone treatment are associated with an elevated risk of opioid poisoning, which is not apparent in patients treated with buprenorphine or sustained-release naltrexone. Beyond drug-related mortality, these pharmacotherapies can impact a participant's risk of death. Buprenorphine may also have some advantages over methadone in patients with depressive disorders or cardiovascular abnormalities. Naltrexone, which is also commonly prescribed to manage problem alcohol use, may reduce deaths in chronic co-alcohol users. Understanding these pharmacologically driven patterns then guides the judicious choice of drug and dosing schedule and the proactive risk management that is crucial to minimising the risk of death in treatment.
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Affiliation(s)
- Erin Kelty
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.
| | - Gary Hulse
- Division of Psychiatry, Medical School, The University of Western Australia, Perth, WA, Australia.,Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - David Joyce
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia
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Kahn LS, Wozniak M, Vest BM, Moore C. “Narcan encounters:” overdose and naloxone rescue experiences among people who use opioids. Subst Abus 2020; 43:113-126. [DOI: 10.1080/08897077.2020.1748165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Linda S. Kahn
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, New York, USA
| | - Monika Wozniak
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, New York, USA
| | - Bonnie M. Vest
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, New York, USA
| | - Cheryll Moore
- Erie County Department of Health, University at Buffalo, Buffalo, New York, USA
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Yeh ST, Ng YY, Wu SC. Association of psychiatric and physical illnesses with suicide in older adults in Taiwan. J Affect Disord 2020; 264:425-429. [PMID: 31767216 DOI: 10.1016/j.jad.2019.11.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 09/17/2019] [Accepted: 11/12/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to investigate the association of psychiatric and physical illnesses with suicide in older adults in Taiwan. METHODS A nationwide database in Taiwan was used for this matched case-control study. Elderly participants with and without intentional self-harm from 2010 to 2012 were matched by propensity score by calendar year, gender, age, and area of residence. Psychiatric and physical illnesses were identified by tracing back 1 year from the date of death in suicide and from July 1 of the previous year to June 30 of the observational year in the controls. Associations between illnesses and the risk of suicide was assessed by conditional logistic regression analysis. RESULTS 2,528 older adults who died by suicide were studied, and the crude suicide mortality rate was 33.7 per 100,000. The risk of suicide in older adults with depression (AOR = 9.06, 95% CI = 6.07-13.52), cancer (AOR = 8.51, 95% CI = 5.39-13.45) and schizophrenia (AOR = 7.34, 95% CI = 2.65-20.33), were significantly higher than control group. Other illnesses, such as bipolar disorder, chronic obstructive pulmonary disease, stroke, chronic kidney disease, hypertension, and diabetes mellitus (AOR = 3.63, 2.41, 1.94, 1.73, 1.68, 1.45, respectively), showed lower risk but still significantly higher in older adults with suicide. CONCLUSIONS Psychiatric and physical illnesses, especially depression, cancer, and schizophrenia, were found to be independently associated with suicide in older adults. The result of this study can help clinicians to identify older adults at risk of suicide and open avenues for prevention.
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Affiliation(s)
- Shin-Ting Yeh
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Yee-Yung Ng
- Department of Medicine, School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
| | - Shiao-Chi Wu
- Institute of Health & Welfare Policy, National Yang-Ming University, 155, Sec. 2, Li-Nong Street, Taipei, Taiwan 112, Republic of China.
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Abstract
This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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Daly C, Griffin E, Corcoran P, Webb RT, Ashcroft DM, Perry IJ, Arensman E. A national case fatality study of drugs taken in intentional overdose. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102609. [PMID: 31884324 DOI: 10.1016/j.drugpo.2019.102609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intentional drug overdose (IDO) has been linked with marked increases in premature mortality risk due to suicide, accidents and other causes, yet little is known about how case fatality risk varies according to the type of drug/s taken. This study aimed to examine the incidence of IDO, to identify the predictors of fatal IDO and to establish which drugs are linked with greater risk of a fatal outcome. METHODS Data from the National Self-Harm Registry, and the National Drug-Related Deaths Index, 2007-2014, were used to calculate incidence, examine overdose characteristics and estimate case fatality risk ratios. RESULTS We examined 63,831 non-fatal and 364 fatal IDOs (incidence: 148.8 and 1.01 per 100,000 respectively). Compared to non-fatal IDOs, fatal cases were more often male (55.2% vs. 42.0%), older in age (median 44 vs. 35 years), and more frequently involved multiple drugs (78.3% vs. 48.5%). Tricyclic antidepressants were associated with a 15-fold increased risk of death and opioids a 12-fold increased risk, relative to the reference category (non-opioid analgesics). While the risk of fatal outcome was higher for males than females, the elevation in risk was greater in females when tricyclic antidepressants or opioids were taken. CONCLUSION Male gender, increasing age and multiple drug use were associated with fatal IDO outcome. Tricyclic antidepressants and opioids were associated with a significantly increased risk of death following intentional overdose. Clinicians need to consider the case fatality risk of drugs when determining treatment for patients at risk of or those who have previously harmed themselves.
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Affiliation(s)
- Caroline Daly
- National Suicide Research Foundation, Room 4.28, Western Gateway Building, Western Road, Cork, Ireland.
| | - Eve Griffin
- National Suicide Research Foundation, Room 4.28, Western Gateway Building, Western Road, Cork, Ireland; School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Room 4.28, Western Gateway Building, Western Road, Cork, Ireland; School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom; Division of Psychology & Mental Health, Centre for Mental Health and Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom; Division of Pharmacy & Optometry, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Ivan J Perry
- School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, Room 4.28, Western Gateway Building, Western Road, Cork, Ireland; School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland; Australian Institute for Suicide Research and Prevention, Room 1.48 Psychology Building (M24), Griffith University Messines Ridge Road, Mount Gravatt, Queensland 4122, Australia
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Kelty E, Hulse G, Joyce D. A comparison of blood toxicology in fatalities involving alcohol and other drugs in patients with an opioid use disorder treated with methadone, buprenorphine, and implant naltrexone. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 46:241-250. [DOI: 10.1080/00952990.2019.1698587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Erin Kelty
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia
| | - Gary Hulse
- Division of Psychiatry, University of Western Australia, Crawley, Western Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
| | - David Joyce
- School of Medicine, University of Western Australia, Crawley, Western Australia
- School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia
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Attenuation of antidepressant and antisuicidal effects of ketamine by opioid receptor antagonism. Mol Psychiatry 2019; 24:1779-1786. [PMID: 31467392 DOI: 10.1038/s41380-019-0503-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/30/2019] [Accepted: 05/17/2019] [Indexed: 12/12/2022]
Abstract
We recently reported that naltrexone blocks antidepressant effects of ketamine in humans, indicating that antidepressant effects of ketamine require opioid receptor activation. However, it is unknown if opioid receptors are also involved in ketamine's antisuicidality effects. Here, in a secondary analysis of our recent clinical trial, we test whether naltrexone attenuates antisuicidality effects of ketamine. Participants were pretreated with naltrexone or placebo prior to intravenous ketamine in a double-blinded crossover design. Suicidality was measured with the Hamilton Depression Rating Scale item 3, Montgomery-Åsberg Depression Rating Scale item 10, and Columbia Suicide Severity Rating Scale. In the 12 participants who completed naltrexone and placebo conditions, naltrexone attenuated the antisuicidality effects of ketamine on all three suicidality scales/subscales (linear mixed model, fixed pretreatment effect, p < 0.01). Results indicate that opioid receptor activation plays a significant role in the antisuicidality effects of ketamine.
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Darke S, Farrell M, Duflou J, Larance B, Lappin J. Circumstances of death of opioid users being treated with naltrexone. Addiction 2019; 114:2000-2007. [PMID: 31278812 DOI: 10.1111/add.14729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/16/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Naltrexone is an opioid antagonist used as a maintenance drug for the treatment of opioid dependence and in opioid withdrawal regimens. The current study aimed to: (1) determine the clinical characteristics and circumstances of death of people undergoing naltrexone treatment for opioid dependence; and (2) determine the blood toxicology of cases including naltrexone concentrations, the presence of other drugs and a comparison of morphine concentrations in the presence and absence of naltrexone. DESIGN Retrospective study of all deaths among people undergoing naltrexone treatment for opioid dependence retrieved from the National Coronial Information System, 2000-17. SETTING Australia-wide. CASES Seventy-four cases, with a mean age of 32.5 years; 81.1% male. MEASUREMENTS Information was collected on demographics, manner of death, naltrexone treatment history, toxicology and major organ pathology. FINDINGS Death was attributed to opioid toxicity in 86.5% of cases: accidental (79.7%), deliberate (6.8%). In 55.4% of all cases the decedent was maintained on oral naltrexone and 32.4% had a recent naltrexone implant. In five cases the decedent was undergoing opioid detoxification. Among those screened for naltrexone, naltrexone was present in the blood or urine of 52.5% (15.8% of oral maintenance cases, 85.7% of implant cases). Fourteen cases were known to have died from opioid toxicity with naltrexone present in their blood or urine. The median blood naltrexone concentrations were within the reported therapeutic range. CONCLUSIONS The primary cause of death among people undergoing naltrexone treatment for opioid dependence in Australia from 2000 to 2017 was opioid toxicity, the majority of cases having been maintained on oral naltrexone. Cases in which naltrexone was not detected indicate the importance of treatment compliance. Deaths due to opioid toxicity where naltrexone was present indicates the possibility of overdose while naltrexone medication is maintained.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,School of Psychology, University of Wollongong, NSW, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,School of Psychiatry, University of New South Wales, NSW, Australia
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Prevalence and factors associated with continual opioid use among patients attending methadone clinic at Mwananyamala Hospital, Dar Es Salaam, Tanzania. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2019. [DOI: 10.1016/j.fsir.2019.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Premkumar A, Grobman WA, Terplan M, Miller ES. Methadone, Buprenorphine, or Detoxification for Management of Perinatal Opioid Use Disorder: A Cost-Effectiveness Analysis. Obstet Gynecol 2019; 134:921-931. [PMID: 31599845 PMCID: PMC6870188 DOI: 10.1097/aog.0000000000003503] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To estimate whether methadone, buprenorphine, or detoxification treatment is the most cost-effective approach to the management of opioid use disorder (OUD) during pregnancy. METHODS We created a decision analytic model that compared the cost effectiveness (eg, the marginal cost of the strategy in U.S. dollars divided by the marginal effectiveness of the strategy, measured in quality-adjusted life-years [QALYs]) of initiation of methadone, buprenorphine, or detoxification in treatment of OUD during pregnancy. Probabilities, costs, and utilities were estimated from the existing literature. Incremental cost-effective ratios for each strategy were calculated, and a ratio of $100,000 per QALY was used to define cost effectiveness. One-way sensitivity analyses and a Monte Carlo probabilistic sensitivity analysis were performed. RESULTS Under base assumptions, initiation of buprenorphine was more effective at a lower cost than either methadone or detoxification and thus was the dominant strategy. Buprenorphine was no longer cost effective if the cost of methadone was 8% less than the base-case estimate ($1,646/month) or if the overall costs of detoxification were 121% less than the base-case estimate for the detoxification cost multiplier, which was used to increase the values of both inpatient and outpatient management of detoxification by a factor of 2. Monte Carlo analyses revealed that buprenorphine was the cost-effective strategy in 70.5% of the simulations. Direct comparison of buprenorphine with methadone demonstrated that buprenorphine was below the incremental cost-effective ratio in 95.1% of simulations; direct comparison between buprenorphine and detoxification demonstrated that buprenorphine was below the incremental cost-effective ratio in 45% of simulations. CONCLUSION Under most circumstances, we estimate that buprenorphine is the cost-effective strategy when compared with either methadone or detoxification as treatment for OUD during pregnancy. Nonetheless, the fact that buprenorphine was not the cost-effective strategy in almost one out of three of simulations suggests that the robustness of our model may be limited and that further evaluation of the cost-effective approach to the management of OUD during pregnancy is needed.
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Affiliation(s)
- Ashish Premkumar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Mishka Terplan
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Virginia Commonwealth School of Medicine, Richmond, VA USA
| | - Emily S. Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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St Marie B, Broglio K. Managing Pain in the Setting of Opioid Use Disorder. Pain Manag Nurs 2019; 21:26-34. [PMID: 31648905 DOI: 10.1016/j.pmn.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/27/2019] [Accepted: 08/03/2019] [Indexed: 12/11/2022]
Abstract
SPECIFIC CLINICAL ISSUE Healthcare providers are challenged with managing pain and minimizing morbidity and mortality associated with opioid use disorder. MAJOR PRACTICE RECOMMENDATIONS BASED ON BEST EVIDENCE The purpose of this article is to guide acute and ambulatory care clinicians in managing pain in patients with opioid use disorder. Included in this article is a review of medications used for opioid use disorder, a discussion of the management of patients with active opioid use disorder and acute or chronic pain, and a discussion of the management of acute and chronic pain in people in recovery both on and off medications for opioid use disorder.
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Affiliation(s)
| | - Kathleen Broglio
- Section of Palliative Medicine, Geisel School of Medicine at Dartmouth, Collaboratory for Implementation Sciences at Dartmouth, Lebanon, New Hampshire
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44
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Court personnel attitudes towards medication-assisted treatment: A state-wide survey. J Subst Abuse Treat 2019; 104:72-82. [DOI: 10.1016/j.jsat.2019.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 01/21/2023]
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45
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Vorspan F, Hjelmström P, Simon N, Benyamina A, Dervaux A, Brousse G, Jamain T, Kosim M, Rolland B. What place for prolonged-release buprenorphine depot-formulation Buvidal® in the treatment arsenal of opioid dependence? Insights from the French experience on buprenorphine. Expert Opin Drug Deliv 2019; 16:907-914. [PMID: 31364884 DOI: 10.1080/17425247.2019.1649252] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Since the 1990s, opioid maintenance treatments (OMTs), i.e. mostly methadone and buprenorphine, have represented the therapeutic cornerstone of opioid dependence. In France, the public health strategy on opioid dependence, identified here as the 'French model', has consisted of offering a facilitated access to buprenorphine, to reach a large treatment coverage and reduce opioid-related mortality. Areas covered: Recently, a new formulation of subcutaneous buprenorphine depot (Buvidal®) has been approved in Europe for treatment of opioid dependence. The place of Buvidal® among the pre-existing arsenal of OMTs is discussed in the light of the pharmacological specificities of this new formulation, and with the particular standpoint of the French model on opioid dependence. Expert opinion: Buvidal® could constitute a promising treatment option mainly in case of: 1) OMT initiation, including in non-specialized addiction medicine care; 2) Discharge from prison or hospital; Diversion/misuse of 3) buprenorphine or 4) methadone; 5) Clinically stabilized patients wishing to avoid daily oral taking of the medication. As such, this new formulation should be highly accessible, which will require specific pathways through care as the product is intended to be administered by a healthcare professional.
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Affiliation(s)
- Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique - Hôpitaux de Paris , Paris , France.,Faculté de Médecine, Université Paris Diderot et INSERM UMRS 1144, Université Paris Descartes, Université Paris Diderot , Paris , France
| | | | - Nicolas Simon
- INSERM, IRD, SESSTIM, Hop Sainte Marguerite, Service de Pharmacologie Clinique, CAP, Aix Marseille Univ , Marseille , France
| | - Amine Benyamina
- CESP, centre d'enseignement, de recherche et de traitement des addictions, université Paris Sud , Villejuif , France
| | - Alain Dervaux
- Service de Psychiatrie et Addictologie de liaison, CHU Sud , Amiens Cedex , France.,Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247 , Amiens , France
| | - Georges Brousse
- EA NPsy-Sydo, université Clermont-Auvergne , Clermont-Ferrand , France
| | | | - Margaux Kosim
- Consultations de médecine-Alcoologie PASS, Groupe Hospitalier Pitié Salpêtrière , Paris , France.,Camurus SAS , Paris , France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier , Bron , France.,Université de Lyon, UCBL1, INSERM, INSERM U1028, CNRS UMR 5292, CRNL , Bron , France
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46
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Bech AB, Clausen T, Waal H, Šaltytė Benth J, Skeie I. Mortality and causes of death among patients with opioid use disorder receiving opioid agonist treatment: a national register study. BMC Health Serv Res 2019; 19:440. [PMID: 31266495 PMCID: PMC6604272 DOI: 10.1186/s12913-019-4282-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/19/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Mortality rates and causes of death among individuals in opioid agonist treatment (OAT) vary according to several factors such as geographical region, age, gender, subpopulations, drug culture and OAT status. Patients in OAT are ageing due to effective OAT as well as demographic changes, which has implications for morbidity and mortality. Norway has one of the oldest OAT populations in Europe. Because of the varying mortality rates and causes of death in different subgroups and countries, research gaps still exist. The aims of this study were to describe the causes of death among OAT patients in Norway, to estimate all-cause and cause-specific crude mortality rates (CMRs) during OAT and to explore characteristics associated with drug-induced cause of death compared with other causes of death during OAT. METHODS This was a national, observational register study. Data from the Norwegian Cause of Death Registry and the Norwegian Patient Registry were combined with data from medical records. We included all patients in the Norwegian OAT programme who died not more than 5 days after the last intake of OAT medication, between 1 January 2014 and 31 December 2015. RESULTS In the 2-year observation period, 200 (1.4%) of the OAT patients died. A forensic or medical autopsy was performed in 63% of the cases. The mean age at the time of death was 48.9 years (standard deviation 8.4), and 74% were men. Somatic disease was the most common cause of death (45%), followed by drug-induced death (42%), and violent death (12%). In general, CMRs increased with age, and they were higher in men and in patients taking methadone compared with buprenorphine. Increasing somatic comorbidity, measured by the Charlson comorbidity index, reduced the odds of dying of a drug-induced cause of death compared with other causes of death. CONCLUSIONS Both somatic and drug-induced causes of death were common during OAT. Improved treatment and follow-up of chronic diseases, especially in patients aged > 40 years, and continuous measures to reduce drug-induced deaths appear to be essential to reduce future morbidity and mortality burdens in this population.
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Affiliation(s)
- Anne Berit Bech
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, P.O. Box 104, N-2381, Brumunddal, Norway. .,Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway
| | - Helge Waal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Sognsvannsveien 21, Bygg 6, P.O. Box 4959 Nydalen, N-0424, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway
| | - Ivar Skeie
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,Regional Psychiatric Centre Gjøvik, Innlandet Hospital Trust, Kyrre Grepps gate 11, N-2819, Gjøvik, Norway
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Lee JD, Kunoe N. Extended-release opioid antagonists and HIV treatment. Lancet HIV 2019; 6:e206-e207. [PMID: 30880164 DOI: 10.1016/s2352-3018(19)30040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/06/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Joshua D Lee
- Department of Population Health, NYU School of Medicine, New York, NY 10016, USA; Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Nikolaj Kunoe
- Department of Population Health, NYU School of Medicine, New York, NY 10016, USA; Lovisenberg Diaconal Hospital, Oslo, Norway
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Potential Risk Window for Opioid Overdose Related to Treatment with Extended-Release Injectable Naltrexone. Drug Saf 2018; 41:979-980. [PMID: 30073490 DOI: 10.1007/s40264-018-0705-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Silverman B, Bloomgren G, Jain P, Marcopul K, Silveira A, Fratantonio J, Sullivan M, Akerman S. Comment on "Review of Case Narratives from Fatal Overdoses Associated with Injectable Naltrexone for Opioid Dependence". Drug Saf 2018; 41:991-993. [PMID: 29956220 PMCID: PMC6153963 DOI: 10.1007/s40264-018-0691-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | | | | | | | - Maria Sullivan
- Alkermes, Inc, Waltham, MA USA
- Clinical Psychiatry, Columbia University, New York, NY USA
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50
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Kidorf M, Solazzo S, Yan H, Brooner RK. Psychiatric and Substance Use Comorbidity in Treatment-Seeking Injection Opioid Users Referred From Syringe Exchange. J Dual Diagn 2018; 14:193-200. [PMID: 30332349 DOI: 10.1080/15504263.2018.1510148] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The present study evaluated rates of co-occurring current psychiatric and substance use disorders in a sample of opioid-dependent treatment-seeking injection drug users referred from syringe exchange. METHODS Participants (N = 208) completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-R to assess current (within the past year) psychiatric and substance use disorders and the two most commonly diagnosed personality disorders (antisocial and borderline personality disorders). RESULTS Forty-eight percent of the sample had a current Axis I psychiatric disorder, and 67% had a co-occurring current substance use disorder. Posttraumatic stress disorder (21%), major depression (17%), and bipolar I (12%) were the most prevalent Axis I psychiatric disorders, and cocaine use disorder (53%) was the most commonly co-occurring substance use disorder. Women were more likely to have diagnoses of most anxiety disorders and less likely to have diagnoses of alcohol use disorder or antisocial personality disorder. The presence of a personality disorder was associated with higher rates of cocaine and sedative use disorder. CONCLUSIONS Findings suggest the importance of evaluating and treating co-occurring psychiatric and substance use disorders in the treatment of injection drug users with opioid dependence.
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Affiliation(s)
- Michael Kidorf
- a Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Stephanie Solazzo
- a Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Haijuan Yan
- a Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Robert K Brooner
- a Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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