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Heyman GM, Ryu E, Brownell H. Evidence that intergenerational income mobility is the strongest predictor of drug overdose deaths in U. S. Midwest counties. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 132:104558. [PMID: 39226770 DOI: 10.1016/j.drugpo.2024.104558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/23/2024] [Accepted: 08/08/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Our goal in this report was to quantify the degree to which opioid prescription rates and socioeconomic correlates of income inequality predicted overdose deaths in the 1055 U.S. Midwest counties. The study follows up a state-level analysis which reported that opioid prescription rates, social capital and unemployment explained much of the variance in opioid overdose death rates (Heyman, McVicar, & Brownell, 2019). METHODS We created a data set that included drug overdose death rates, opioid prescription rates, and correlates of income inequality. Given that the variables of interest varied at the state and county level, multilevel regression was our statistical approach. RESULTS From 2006 to 2021, Midwest overdose drug deaths increased according to an exponential equation that closely approximated the equation that describes the increases in overdose deaths for the entire U.S. from 1978 to 2016 (e.g., Jalal et al., 2018). Retail opioid prescription sales increased from 2006 to 2012, but then declined so that by 2017 they were lower than in 2006. The regression analyses revealed that intergenerational income mobility was the strongest predictor of overdose deaths. The other consistently statistically significant predictors were opioid prescription rates, social capital, and unemployment rates. Together these predictors, plus pupil teacher ratios, single parent families, and attending college accounted for approximately 47 % of the variance in overdose death rates each year. In keeping with the decline in opioid prescription rates, the explanatory power of opioid prescription rates weakened over the course of the study. CONCLUSIONS Overdose deaths increased at a constant exponential rate for the years that it was possible to apply our regression model. This occurred even though access to legal opioids decreased. What remained invariant was the predictive strength of intergenerational income mobility; each year it was the predictor that explained the most variance in overdose deaths.
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Affiliation(s)
- Gene M Heyman
- Department of Psychology & Neuroscience, Boston College, Chestnut Hill, MA, 02467, USA.
| | - Ehri Ryu
- Department of Psychology & Neuroscience, Boston College, Chestnut Hill, MA, 02467, USA
| | - Hiram Brownell
- Department of Psychology & Neuroscience, Boston College, Chestnut Hill, MA, 02467, USA
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Ciccarone D. Bending the Overdose Curve - Still Not Enough. N Engl J Med 2024; 391:1052-1053. [PMID: 39293092 DOI: 10.1056/nejme2406359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Affiliation(s)
- Daniel Ciccarone
- From Family and Community Medicine, University of California San Francisco, San Francisco
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Lambrette G. [Mental health, an ecosystem issue]. Soins Psychiatr 2024; 45:40-42. [PMID: 38218622 DOI: 10.1016/j.spsy.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
The question of mental health can be approached using the three-dimensional model. In the light of the biological, environmental and circumstantial ingredients characterizing it, a critical analysis of both diagnosis and treatment can be proposed. The environment, like the individual, is both a factor and a player in psychological suffering. Treating one as well as the other is therefore the challenge of an ecosystemic approach.
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Affiliation(s)
- Grégory Lambrette
- Quai 57-Suchtberondungsstell arcus asbl, 55 avenue de la Gare, L-1611 Luxembourg.
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Tatar M, Faraji MR, Keyes K, Wilson FA, Jalali MS. Social vulnerability predictors of drug poisoning mortality: A machine learning analysis in the United States. Am J Addict 2023; 32:539-546. [PMID: 37344967 DOI: 10.1111/ajad.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/16/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Drug poisoning is a leading cause of unintentional deaths in the United States. Despite the growing literature, there are a few recent analyses of a wide range of community-level social vulnerability features contributing to drug poisoning mortality. Current studies on this topic face three limitations: often studying a limited subset of vulnerability features, focusing on small sample sizes, or solely including local data. To address this gap, we conducted a national-level analysis to study the impacts of several social vulnerability features in predicting drug mortality rates in the United States. METHODS We used machine learning to investigate the role of 16 social vulnerability features in predicting drug mortality rates for US counties in 2014, 2016, and 2018-the most recent available data. We estimated each vulnerability feature's gain relative contribution in predicting drug poisoning mortality. RESULTS Among all social vulnerability features, the percentage of noninstitutionalized persons with a disability is the most influential predictor, with a gain relative contribution of 18.6%, followed by population density and the percentage of minority residents (13.3% and 13%, respectively). Percentages of households with no available vehicles, mobile homes, and persons without a high school diploma are the following features with gain relative contributions of 6.3%, 5.8%, and 5.1%, respectively. CONCLUSION AND SCIENTIFIC SIGNIFICANCE We identified social vulnerability features that are most predictive of drug poisoning mortality. Public health interventions and policies targeting vulnerable communities may increase the resilience of these communities and mitigate the overdose death and drug misuse crisis.
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Affiliation(s)
- Moosa Tatar
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohammad R Faraji
- Department of Computer Science and Information Technology, Institute for Advanced Studies in Basic Sciences, Zanjan, Iran
| | - Katherine Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, Massachusetts, USA
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Applying network analysis to investigate substance use symptoms associated with drug overdose. Drug Alcohol Depend 2022; 234:109408. [PMID: 35306394 PMCID: PMC9018556 DOI: 10.1016/j.drugalcdep.2022.109408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/17/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Drug overdose deaths have been increasing over the last several decades. While single substance classes, such as opioids, have been implicated in this rise, less is known about the contributions of polysubstance use (PSU) and other combinations of specific substances and symptoms that may be a risk factor for drug overdose. METHODS Symptoms of alcohol, cannabis, and other drug use disorders, as well as co-substance use indicators, were assessed and then examined via network analysis in a sample of young adults (N = 1540). Features of the estimated symptom network were investigated, including topology and node centrality, as well as bridge centrality, which further examines node centrality while accounting for the nodes belonging to discrete communities. RESULTS Individual symptoms were more strongly associated with other symptoms within the same substance class than across substance classes. Tolerance and withdrawal symptoms were the most central items in the network. However, when accounting for symptoms belonging to discrete substance classes, drug overdose emerged as a strong bridge symptom, among others. CONCLUSIONS As a strong bridge symptom, drug overdose had many connections with a variety of substances and symptoms, which might suggest that risk for drug overdose may be a function of overall substance use severity. Altogether, examining alcohol and substance use symptoms using a network analytic framework provided novel insights into the role PSU might play in conferring risk for drug overdose.
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Lam T, Hayman J, Berecki‐Gisolf J, Sanfilippo P, Lubman DI, Nielsen S. Pharmaceutical opioid poisonings in Victoria, Australia: Rates and characteristics of a decade of emergency department presentations among nine pharmaceutical opioids. Addiction 2022; 117:623-636. [PMID: 34338377 PMCID: PMC9292229 DOI: 10.1111/add.15653] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Pharmaceutical opioids are a significant contributor to the global 'opioid crisis', yet few studies have comprehensively distinguished between opioid types. We measured whether a range of common pharmaceutical opioids varied in their contribution to the rates and characteristics of harm in a population-wide indicator of non-fatal overdose. DESIGN Retrospective observational study of emergency department (ED) patient care records in the Victorian Emergency Minimum Data set (VEMD), July 2009 to June 2019. SETTING Victoria, Australia. CASES ED presentations for non-fatal overdose related to pharmaceutical opioid use (n = 5403), where the specific pharmaceutical opioid was documented. MEASUREMENTS We compared harms across the nine individual pharmaceutical opioids most commonly sold, and considered where multiple opioids contributed to the overdose. We calculated supply-adjusted rates of ED presentations using Poisson regression and used multinomial logistic regression to compare demographic and clinical characteristics of presentations among nine distinct pharmaceutical opioids and a 10th category where multiple opioids were documented for the presentation. FINDINGS There were wide differences, up to 27-fold, between supply-adjusted rates of overdose. When considering presentations with sole opioids, the highest supply-adjusted overdose rates [per 100 000 oral morphine equivalents (OME); 95% confidence interval (CI)] were for codeine (OME = 0.078, 95% CI = 0.073-0.08) and oxycodone (OME =0.029, 95% CI = 0.027-0.030) and the lowest were for tapentadol (OME = 0.004, 95% CI = 0.003-0.006) and fentanyl (OME = 0.003, 95% CI = 0.002-0.004). These rates appeared related to availability rather than opioid potency. Most (62%) poisonings involved females. Codeine, oxycodone and tramadol were associated with younger presentations (respectively, 59.5%, 41.7% and 49.8% of presentations were 12-34 years old), and intentional self-harm (respectively 65.2%, 50.6%, and 52.8% of presentations). Relative to morphine, fentanyl [ 0.32 relative risk ratio (RRR)] and methadone ( 0.58 RRR) presentations were less likely to be coded as self-harm. Relative to morphine-buprenorphine, codeine, oxycodone and tramadol presentations were significantly more likely to be associated with the less urgent triage categories (respectively 2.18, 1.80, 1.52, 1.65 RRR). CONCLUSIONS In Victoria, Australia, rates and characteristics of emergency department presentations for pharmaceutical opioids show distinct variations by opioid type.
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Affiliation(s)
- Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVICAustralia
| | - Jane Hayman
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVICAustralia,Victorian Injury Surveillance Unit, Monash University Accident Research CentreMonash UniversityClaytonVICAustralia
| | - Janneke Berecki‐Gisolf
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVICAustralia,Victorian Injury Surveillance Unit, Monash University Accident Research CentreMonash UniversityClaytonVICAustralia
| | - Paul Sanfilippo
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVICAustralia,Turning PointEastern HealthRichmondVICAustralia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVICAustralia,Turning PointEastern HealthRichmondVICAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVICAustralia,Turning PointEastern HealthRichmondVICAustralia
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Opioid Consumption in Chronic Pain Patients: Role of Perceived Injustice and Other Psychological and Socioeconomic Factors. J Clin Med 2022; 11:jcm11030647. [PMID: 35160101 PMCID: PMC8837077 DOI: 10.3390/jcm11030647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Chronic pain is a complex biopsychosocial phenomenon. Lifestyle, behavioral, socioeconomic, and psychosocial factors such as depression and perceived injustice are often associated with the development of chronic pain and vice versa. We sought to examine the interaction of these factors with opioid intake. METHODS At our institution, 164 patients with chronic pain undergoing an interdisciplinary assessment within a three-month period participated in the study and completed the Injustice Experience Questionnaire (IEQ). Data regarding opioid intake, pain levels, pain diagnosis, depression, anxiety, stress, quality of life, pain-related disability, habitual well-being, occupational status, and ongoing workers compensation litigation were extracted from the patients' charts. RESULTS Approximately one-fourth of the patients used opioids. The IEQ total was significantly higher in patients using Schedule III opioids. Depression, but not the anxiety and stress scores, were significantly higher in patients using opioids. There were no significant differences regarding pain-related disability, habitual well-being, and the coded psychosocial diagnoses. In the patient group without opioids, the percentage of employed persons was significantly higher but there were no significant differences regarding work leave, pension application, or professional education. CONCLUSIONS Opioid use appears to be more closely related to psychological factors and single social determinants of pain than to somatic factors.
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Abstract
PURPOSE OF REVIEW This review provides an update on recently published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences, and treatment. RECENT FINDINGS Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both preceding and during the COVID-19 pandemic. Fentanyl-related overdose is rising in new geographic areas e.g. the western USA. Stimulant-related overdose is also increasing nationwide driven by methamphetamine and cocaine. Polysubstance use, e.g. the use of a stimulant along with an opioid is driving stimulant-related overdose. Other medical consequences of injection drug use are rising including HIV and hepatitis C infections. Medication approaches to treating opioid use disorder remain the standard of care and there are new promising pharmacological approaches to treating methamphetamine use disorder. SUMMARY A 'fourth wave' of high mortality involving methamphetamine and cocaine use has been gathering force in the USA. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.
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Affiliation(s)
- Daniel Ciccarone
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
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Dennis F. Drug fatalities and treatment fatalism: Complicating the ageing cohort theory. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1175-1190. [PMID: 33955586 PMCID: PMC7611256 DOI: 10.1111/1467-9566.13278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
Deaths related to drug 'misuse' remain at an all-time high in the United Kingdom (UK). Older heroin consumers are particularly at risk, with the highest rates of deaths among people aged 40-49 and the steepest rises in the over-fifty age bracket. Accordingly, a popular theory for the UK's increase in drug-related deaths, made by the government, and propelled in the media, is that there is an ageing cohort of heroin users with age-related health complications predisposing them to an overdose. However, drawing on in-depth interviews with those people deemed to be most at risk, this article works to complicate this theory, with participants citing a shift in (a) experience and responsibility, (b) route of administration, (c) desired effects, (d) acceptance of their drug use and 'user' status and (e) valuing health. Disrupting age as a given risk factor, this article turns attention away from the individual and these 'natural' processes to what participants describe as a singular, punitive, and inflexible treatment system and its intersecting structures. Approaching life and death as a matter of sociomaterial 'mattering', this article rethinks a reductionist, causal link between age and drug-related death with a treatment despondency and fatalism that could prove fatal.
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Affiliation(s)
- Fay Dennis
- Goldsmiths, University of London, London, UK
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Lippold K, Ali B. Racial/ethnic differences in opioid-involved overdose deaths across metropolitan and non-metropolitan areas in the United States, 1999-2017. Drug Alcohol Depend 2020; 212:108059. [PMID: 32447173 DOI: 10.1016/j.drugalcdep.2020.108059] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND From 1999 to 2017, more than 400,000 Americans died from a drug overdose death involving an opioid. Early surveillance studies have observed large variations in opioid-involved overdose deaths among different geographic regions and racial/ethnic groups. The purpose of this study was to characterize trends in racial/ethnic opioid-involved overdose deaths across metropolitan and non-metropolitan areas in the United States from 1999 to 2017. METHODS The analysis used National Vital Statistics System data from 1999 to 2017 that were accessed through the CDC WONDER online database. Drug overdose deaths involving any opioid were identified using the International Classification of Diseases, Tenth Revision, codes and were represented as age-adjusted rates per 100,000 population. Joinpoint regression was used to examine trends in opioid-involved overdose deaths among racial/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic other) by metropolitan and non-metropolitan status (large metropolitan areas, medium-small metropolitan areas, and non-metropolitan areas). RESULTS The annual age-adjusted death rates for drug overdose deaths that involved any opioid significantly increased for all racial/ethnic groups in metropolitan and non-metropolitan areas from 1999 to 2017. The largest average annual increases in rates occurred among non-Hispanic whites in non-metropolitan areas (13.6% increase per year) and medium-small metropolitan areas (12.3% increase per year), followed by non-Hispanic blacks in medium-small metropolitan areas (11.3% increase per year). CONCLUSIONS The variations in opioid-involved overdose deaths among different racial/ethnic groups across geographic regions support the existence of multiple sub-epidemics in the current opioid overdose crisis and provide directions for targeted intervention efforts.
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Affiliation(s)
- Kumiko Lippold
- Milkin Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052, United States.
| | - Bina Ali
- Milkin Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052, United States; Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900 Calverton, MD 20705, United States.
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