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Filteau MR, Green B, Kim F, McBride KA. 'It's the same thing as giving them CPR training': rural first responders' perspectives on naloxone. Harm Reduct J 2022; 19:111. [PMID: 36192736 PMCID: PMC9531424 DOI: 10.1186/s12954-022-00688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
The Substance Abuse and Mental Health Services Administration's (SAMHSA) Harm Reduction grant program expanded access to several harm reduction strategies to mitigate opioid overdose fatalities, including expanding access to naloxone. Interviews with first responders in a frontier and remote (FAR) state were conducted to understand their job responsibilities in relation to overdose response and prevention and their perceptions of training laypersons to administer naloxone. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, and members of harm reduction-focused community organizations. The study finds widespread support for increasing access to naloxone and training laypersons in naloxone administration throughout Montana, due to rural first responders' inability to meet the needs of residents and an overall lack of resources to address addiction and the effects of fentanyl. Participants from harm reduction-focused community organizations convey support for training lay persons, but also illuminate that real and perceived cultural opposition to harm reduction strategies could reduce the likelihood that laypeople enroll in naloxone training. This study adds to the literature because it focuses on first responders in a FAR area that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area's overall lack of access to medications for opioid use disorder or other treatment services. Expanding harm reduction approaches, like increasing access and training laypersons to administer naloxone, might be FAR residents' best chance for surviving an opioid overdose.
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Affiliation(s)
| | | | - Frances Kim
- JG Research and Evaluation, Bozeman, MT, USA
| | - Ki-Ai McBride
- Montana Department of Health and Human Services, Behavioral Health and Disabilities Disorders Division, Helena, MT, USA
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2
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Townsend TN, Hamilton LK, Rivera-Aguirre A, Davis CS, Pamplin JR, Kline D, Rudolph KE, Cerdá M. Use of an Inverted Synthetic Control Method to Estimate Effects of Recent Drug Overdose Good Samaritan Laws, Overall and by Black/White Race/Ethnicity. Am J Epidemiol 2022; 191:1783-1791. [PMID: 35872589 PMCID: PMC9989361 DOI: 10.1093/aje/kwac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 01/29/2023] Open
Abstract
Overdose Good Samaritan laws (GSLs) aim to reduce mortality by providing limited legal protections when a bystander to a possible drug overdose summons help. Most research into the impact of these laws is dated or potentially confounded by coenacted naloxone access laws. Lack of awareness and trust in GSL protections, as well as fear of police involvement and legal repercussions, remain key deterrents to help-seeking. These barriers may be unequally distributed by race/ethnicity due to racist policing and drug policies, potentially producing racial/ethnic disparities in the effectiveness of GSLs for reducing overdose mortality. We used 2015-2019 vital statistics data to estimate the effect of recent GSLs on overdose mortality, overall (8 states) and by Black/White race/ethnicity (4 states). Given GSLs' near ubiquity, few unexposed states were available for comparison. Therefore, we generated an "inverted" synthetic control method (SCM) to compare overdose mortality in new-GSL states with that in states that had GSLs throughout the analytical period. The estimated relationships between GSLs and overdose mortality, both overall and stratified by Black/White race/ethnicity, were consistent with chance. An absence of effect could result from insufficient protection provided by the laws, insufficient awareness of them, and/or reticence to summon help not addressable by legal protections. The inverted SCM may be useful for evaluating other widespread policies.
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Affiliation(s)
| | | | | | | | | | | | | | - Magdalena Cerdá
- Correspondence to Dr. Magdalena Cerdá, Department of Population Health, Center for Opioid Epidemiology and Policy, 180 Madison Avenue, New York, NY 10016 (e-mail: )
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Pourtaher E, Payne ER, Fera N, Rowe K, Leung SYJ, Stancliff S, Hammer M, Vinehout J, Dailey MW. Naloxone administration by law enforcement officers in New York State (2015-2020). Harm Reduct J 2022; 19:102. [PMID: 36123614 PMCID: PMC9483860 DOI: 10.1186/s12954-022-00682-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has amplified the need for wide deployment of effective harm reduction strategies in preventing opioid overdose mortality. Placing naloxone in the hands of key responders, including law enforcement officers who are often first on the scene of a suspected overdose, is one such strategy. New York State (NYS) was one of the first states to implement a statewide law enforcement naloxone administration program. This article provides an overview of the law enforcement administration of naloxone in NYS between 2015 and 2020 and highlights key characteristics of over 9000 opioid overdose reversal events. METHODS Data in naloxone usage report forms completed by police officers were compiled and analyzed. Data included 9133 naloxone administration reports by 5835 unique officers located in 60 counties across NYS. Descriptive statistics were used to examine attributes of the aided individuals, including differences between fatal and non-fatal incidents. Additional descriptive analyses were conducted for incidents in which law enforcement officers arrived first at the scene of suspected overdose. Comparisons were made to examine year-over-year trends in administration as naloxone formulations were changed. Quantitative analysis was supplemented by content analysis of officers' notes (n = 2192). RESULTS In 85.9% of cases, law enforcement officers arrived at the scene of a suspected overdose prior to emergency medical services (EMS) personnel. These officers assessed the likelihood of an opioid overdose having occurred based on the aided person's breathing status and other information obtained on the scene. They administered an average of 2 doses of naloxone to aided individuals. In 36.8% of cases, they reported additional administration of naloxone by other responders including EMS, fire departments, and laypersons. Data indicated the aided survived the suspected overdose in 87.4% of cases. CONCLUSIONS With appropriate training, law enforcement personnel were able to recognize opioid overdoses and prevent fatalities by administering naloxone and carrying out time-sensitive medical interventions. These officers provided life-saving services to aided individuals alongside other responders including EMS, fire departments, and bystanders. Further expansion of law enforcement naloxone administration nationally and internationally could help decrease opioid overdose mortality.
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Affiliation(s)
- Elham Pourtaher
- New York State Department of Health, AIDS Institute, New York, USA.
| | - Emily R Payne
- New York State Department of Health, AIDS Institute, New York, USA
| | - Nicole Fera
- New York State Department of Health, AIDS Institute, New York, USA
| | - Kirsten Rowe
- New York State Department of Health, AIDS Institute, New York, USA
| | | | - Sharon Stancliff
- New York State Department of Health, AIDS Institute, New York, USA
| | - Mark Hammer
- New York State Department of Health, AIDS Institute, New York, USA
| | - Joshua Vinehout
- New York State Division of Criminal Justice Services, Albany, USA
| | - Michael W Dailey
- Department of Emergency Medicine, Albany Medical College, Albany, USA
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4
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Andraka-Christou B, Nguyen T, Harris S, Atkins DN, Totaram R, Golan O, Koval A, Madeira J. Harm Reduction Policy Support among Students at Two U.S. Universities. Subst Use Misuse 2022; 57:1185-1195. [PMID: 35491710 DOI: 10.1080/10826084.2022.2069265] [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: 10/18/2022]
Abstract
Background: The U.S. is undergoing an opioid overdose crisis. Harm reduction (HR) policies are associated with decreased overdose deaths and incidence of communicable diseases, yet legality of HR policies differs across U.S. jurisdictions. College student perceptions of HR policies are underexplored, even though their voting behavior has increased in recent years. We sought to compare their support of different HR policies and to explore relationships between demographic characteristics and support for HR policies. Methods: We collected cross-sectional, convenience sample survey data from undergraduate students at two large public universities, one in the Midwest and one in the Southeast, during Fall 2018/Spring 2019. We analyzed data using descriptive statistics and logistic regressions. Results: The final sample included 1,263 respondents. Good Samaritan laws (n = 833, 66%) and naloxone distribution (n = 476, 37.7%) were most commonly supported, while heroin maintenance treatment (n = 232, 18.4%) and heroin decriminalization (n = 208, 16.5%) were least supported. Democrat/liberal or less religious/spiritual respondents supported HR policies more than their Republican/conservative or religious/spiritual counterparts. Midwestern students were more likely to support syringe services programs. Conclusion: HR education initiatives could target religious and/or Republican/conservative students, as they have lower HR support. Among HR policies, Good Samaritan policies may be easiest to pass in college communities.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA.,Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida, USA
| | - Thuy Nguyen
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Shana Harris
- Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida, USA.,Department of Anthropology, University of Central Florida, Orlando, Florida, USA
| | - Danielle N Atkins
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Olivia Golan
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Andriy Koval
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Jody Madeira
- Maurer School of Law, Indiana University-Bloomington, Bloomington, Indiana, USA
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5
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Carroll JJ, Mital S, Wolff J, Noonan RK, Martinez P, Podolsky MC, Killorin JC, Green TC. Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose. Drug Alcohol Depend 2020; 217:108257. [PMID: 32947173 PMCID: PMC7475730 DOI: 10.1016/j.drugalcdep.2020.108257] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rates of fatal overdose (OD) from synthetic opioids rose nearly 60 % from 2016 to 2018. 911 Good Samaritan Laws (GSLs) are an evidenced-based strategy for preventing OD fatality. This study describes patrol officers' knowledge of their state's GSL, experience with OD response, and their perspectives on strategies to prevent and respond to opioid OD. METHODS An electronic survey assessed officers' knowledge of state GSLs and experiences responding to OD. Descriptive statistics and hierarchical linear modeling were generated to examine differences in knowledge, preparedness, and endorsement of OD response efforts by experience with OD response. RESULTS 2,829 officers responded to the survey. Among those who had responded to an OD call in the past six months (n = 1,946), 37 % reported administering naloxone on scene and 36 % reported making an arrest. Most (91 %) correctly reported whether their state had a GSL in effect. Only 26 % correctly reported whether that law provides limited immunity from arrest. Fifteen percent of officers who had responded to an OD work in departments that do not carry naloxone. Compared with officers who had not responded to any OD calls, those who reported responding OD calls at least monthly and at least weekly, were significantly less likely to endorse OD response efforts. CONCLUSION Officers who respond to OD calls are generally receiving training and naloxone supplies to respond, but knowledge gaps and additional training needs persist. Additional training and strategies to relieve compassion fatigue among those who have more experience with OD response efforts may be indicated.
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Affiliation(s)
- Jennifer J. Carroll
- Department of Sociology & Anthropology, Elon University, Elon, NC, United States,Department of Medicine, Brown University, Providence, RI, United States,Corresponding author at: Elon University, 100 Campus Drive, 2035 Campus Box, Elon, NC, United States
| | - Sasha Mital
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - Jessica Wolff
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - Rita K. Noonan
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - Pedro Martinez
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - Melissa C. Podolsky
- National Center for Injury Control and Prevention, Centers for Disease Control & Prevention, Atlanta, GA, United States
| | - John C. Killorin
- Atlanta-Carolinas High Intensity Drug Trafficking Areas, Peachtree Corners, GA, United States
| | - Traci C. Green
- Heller School for Social Policy and Development, Brandeis University, Waltham, MA, United States,Departments of Emergency Medicine and Epidemiology, Brown University, Providence, RI, United States
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Ansari B, Tote KM, Rosenberg ES, Martin EG. A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018. Public Health Rep 2020; 135:100S-127S. [PMID: 32735190 PMCID: PMC7407056 DOI: 10.1177/0033354920922975] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES In the United States, rising rates of overdose deaths and recent outbreaks of hepatitis C virus and HIV infection are associated with injection drug use. We updated a 2014 review of systems-level opioid policy interventions by focusing on evidence published during 2014-2018 and new and expanded opioid policies. METHODS We searched the MEDLINE database, consistent with the 2014 review. We included articles that provided original empirical evidence on the effects of systems-level interventions on opioid use, overdose, or death; were from the United States or Canada; had a clear comparison group; and were published from January 1, 2014, through July 19, 2018. Two raters screened articles and extracted full-text data for qualitative synthesis of consistent or contradictory findings across studies. Given the rapidly evolving field, the review was supplemented with a search of additional articles through November 17, 2019, to assess consistency of more recent findings. RESULTS The keyword search yielded 535 studies, 66 of which met inclusion criteria. The most studied interventions were prescription drug monitoring programs (PDMPs) (59.1%), and the least studied interventions were clinical guideline changes (7.6%). The most common outcome was opioid use (77.3%). Few articles evaluated combination interventions (18.2%). Study findings included the following: PDMP effectiveness depends on policy design, with robust PDMPs needed for impact; health insurer and pharmacy benefit management strategies, pill-mill laws, pain clinic regulations, and patient/health care provider educational interventions reduced inappropriate prescribing; and marijuana laws led to a decrease in adverse opioid-related outcomes. Naloxone distribution programs were understudied, and evidence of their effectiveness was mixed. In the evidence published after our search's 4-year window, findings on opioid guidelines and education were consistent and findings for other policies differed. CONCLUSIONS Although robust PDMPs and marijuana laws are promising, they do not target all outcomes, and multipronged interventions are needed. Future research should address marijuana laws, harm-reduction interventions, health insurer policies, patient/health care provider education, and the effects of simultaneous interventions on opioid-related outcomes.
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Affiliation(s)
- Bahareh Ansari
- Department of Information Science, University at Albany–State University of New York, Albany, NY, USA
| | - Katherine M. Tote
- Department of Epidemiology and Biostatistics, University at Albany–State University of New York, Albany, NY, USA
- Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany–State University of New York, Albany, NY, USA
- Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA
| | - Erika G. Martin
- Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA
- Department of Public Administration and Policy, University at Albany–State University of New York, Albany, NY, USA
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Schuler MS, Heins SE, Smart R, Griffin BA, Powell D, Stuart EA, Pardo B, Smucker S, Patrick SW, Pacula RL, Stein BD. The state of the science in opioid policy research. Drug Alcohol Depend 2020; 214:108137. [PMID: 32652376 PMCID: PMC7423757 DOI: 10.1016/j.drugalcdep.2020.108137] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Characterize the state of the science in opioid policy research based on a literature review of opioid policy studies. METHODS We conducted a scoping review of studies evaluating the impact of U.S. state-level and federal-level policies on opioid-related outcomes published in 2005-2018. We characterized: 1) state and federal policies evaluated, 2) opioid-related outcomes examined, and 3) study design and analytic methods (summarized overall and by policy category). RESULTS In total, 145 studies were reviewed (79 % state-level policies, 21 % federal-level policies) and classified with respect to 8 distinct policy categories and 7 outcome categories. The majority of studies evaluated policies related to prescription opioids (prescription drug monitoring programs (PDMPs), opioid prescribing policies, federal regulation of prescription opioids, pain clinic laws) and considered policy impacts with respect to proximal outcomes (e.g., opioid prescribing behaviors). In total, only 29 (20 % of studies) met each of three key criteria for rigorous design: analysis of longitudinal data with a comparison group design, adjustment for difference between policy-enacting and comparison states, and adjustment for potentially confounding co-occurring policies. These more rigorous studies were predominately published in 2017-2018 and primarily evaluated PDMPs, marijuana laws, treatment-related policies, and overdose prevention policies. CONCLUSIONS Our results indicated that study design rigor varied notably across policy categories, highlighting the need for broader adoption of rigorous methods in the opioid policy field. More evaluation studies are needed regarding overdose prevention policies and policies related to treatment access. Greater examination of distal outcomes and potential unintended consequences are also warranted.
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Affiliation(s)
- Megan S Schuler
- RAND Corporation, 20 Park Plaza #920, Boston, MA, 02216, USA.
| | - Sara E Heins
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Beth Ann Griffin
- RAND Corporation, 1200 S Hayes Street, Arlington, VA, 22202, USA
| | - David Powell
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Bryce Pardo
- RAND Corporation, 1200 S Hayes Street, Arlington, VA, 22202, USA
| | - Sierra Smucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Stephen W Patrick
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center 2200 Children's Way, 11111 Doctors' Office Tower, Nashville, TN, 37232, USA
| | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Verna and Peter Dauterive Hall, Los Angeles, CA, 90089, USA
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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The effectiveness of drug-related Good Samaritan laws: A review of the literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:102773. [PMID: 32467017 DOI: 10.1016/j.drugpo.2020.102773] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/30/2019] [Accepted: 04/18/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The United States (US) and Canada are in the midst of an opioid overdose epidemic. Many people who use illicit drugs (PWUD) do not call an emergency number 911 at the scene of an overdose due to fear of arrest. In the US and Canada, when an individual calls 911, both emergency medical services (EMS) and police are notified to attend the overdose event. In response, many settings in North America have introduced drug-related 'Good Samaritan' laws (GSLs) that aim to encourage PWUD to call 911 by providing legal immunity (mainly protections from drugs possessed for personal use) to those at the scene of the overdose. However, little is known about the effectiveness of these laws in increasing calls to 911. METHODS We conducted a literature review of the published literature between 2005 and 2019 to examine the effectiveness of GSLs. Searches were referenced using keywords that included: "good samaritan", "overdose", "emergency services", and "drug use". RESULTS Among 68 articles identified, after eligibility screening, 12 publications were deemed to meet the inclusion criteria. These publications were largely quantitative observational studies (9/12), with a minority (3/12) being qualitative in design. Two major themes emerged: "knowledge of GSLs and calling EMS" and "overdose-related hospital admissions and mortality assessment". CONCLUSION At this time, the current body of evidence regarding the effectiveness of GSLs in increasing calls to EMS and reducing drug-related harms is limited and mixed. Studies show that PWUD have low levels of knowledge regarding GSLs while some evidence suggests their effectiveness in increasing calls to EMS at the scene of an overdose. Given the current overdose crisis, further investigation is warranted to establish the effectiveness of these laws in reducing drug-related harms.
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MAURI AMANDAI, TOWNSEND TARLISEN, HAFFAJEE REBECCAL. The Association of State Opioid Misuse Prevention Policies With Patient- and Provider-Related Outcomes: A Scoping Review. Milbank Q 2020; 98:57-105. [PMID: 31800142 PMCID: PMC7077777 DOI: 10.1111/1468-0009.12436] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Policy Points This scoping review reveals a growing literature on the effects of certain state opioid misuse prevention policies, but persistent gaps in evidence on other prevalent state policies remain. Policymakers interested in reducing the volume and dosage of opioids prescribed and dispensed can consider adopting robust prescription drug monitoring programs with mandatory access provisions and drug supply management policies, such as prior authorization policies for high-risk prescription opioids. Further research should concentrate on potential unintended consequences of opioid misuse prevention policies, differential policy effects across populations, interventions that have not received sufficient evaluation (eg, Good Samaritan laws, naloxone access laws), and patient-related outcomes. CONTEXT In the midst of an opioid crisis in the United States, an influx of state opioid misuse prevention policies has provided new opportunities to generate evidence of policy effectiveness that can inform policy decisions. We conducted a scoping review to synthesize the available evidence on the effectiveness of US state interventions to improve patient and provider outcomes related to opioid misuse and addiction. METHODS We searched six online databases to identify evaluations of state opioid policies. Eligible studies examined legislative and administrative policy interventions that evaluated (a) prescribing and dispensing, (b) patient behavior, or (c) patient health. FINDINGS Seventy-one articles met our inclusion criteria, including 41 studies published between 2016 and 2018. These articles evaluated nine types of state policies targeting opioid misuse. While prescription drug monitoring programs (PDMPs) have received considerable attention in the literature, far fewer studies addressed other types of state policy. Overall, evidence quality is very low for the majority of policies due to a small number of evaluations. Of interventions that have been the subject of considerable research, promising means of reducing the volume and dosages of opioids prescribed and dispensed include drug supply management policies and robust PDMPs. Due to low study number and quality, evidence is insufficient to draw conclusions regarding interventions targeting patient behavior and health outcomes, including naloxone access laws and Good Samaritan laws. CONCLUSIONS Recent research has improved the evidence base on several state interventions targeting opioid misuse. Specifically, moderate evidence suggests that drug supply management policies and robust PDMPs reduce opioid prescribing. Despite the increase in rigorous evaluations, evidence remains limited for the majority of policies, particularly those targeting patient health-related outcomes.
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Affiliation(s)
- AMANDA I. MAURI
- University of Michigan School of Public Health
- Injury Prevention CenterUniversity of Michigan Medical School
| | - TARLISE N. TOWNSEND
- University of Michigan School of Public Health
- Injury Prevention CenterUniversity of Michigan Medical School
- University of Michigan Department of Sociology
| | - REBECCA L. HAFFAJEE
- University of Michigan School of Public Health
- Injury Prevention CenterUniversity of Michigan Medical School
- RAND Corporation
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Mahgoub N, O'Connell K, Gevint K. An Inpatient Service Approach to Facing the Opioid Crisis. Psychiatr Serv 2019; 70:532-533. [PMID: 31154964 DOI: 10.1176/appi.ps.201800481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nahla Mahgoub
- Department of Psychiatry, Weill Cornell Medicine, New York (Mahgoub); Gracie Square Hospital, New York (all authors)
| | - Kathryn O'Connell
- Department of Psychiatry, Weill Cornell Medicine, New York (Mahgoub); Gracie Square Hospital, New York (all authors)
| | - Kimberly Gevint
- Department of Psychiatry, Weill Cornell Medicine, New York (Mahgoub); Gracie Square Hospital, New York (all authors)
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