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Hedden-Clayton B, Cochran J, Carroll JJ, Kral AH, Victor G, Comartin E, Ray B. "If everyone knew about this, how many lives could we save?": Do drug suppliers have a role in reducing overdose risk? DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100250. [PMID: 39055120 PMCID: PMC11269852 DOI: 10.1016/j.dadr.2024.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/07/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
Introduction An unpredictable illicit drug supply is driving high levels of overdose death in North America. Prior research has demonstrated the importance of involving people who use drugs in harm reduction intervention design and implementation. The inclusion of people who supply drugs in these efforts has been scant. We explore this possibility by interviewing persons targeted by a harm reduction educational program designed specifically for people who supply drugs. Methods In-person interviews with people who use drugs were conducted in 2022 in Indianapolis, Indiana. We conducted a thematic analysis of data from six interviews with people who were either primarily or secondarily trained through this harm reduction training for people who supply drugs. Results Participants described a diverse array of harm reduction strategies, some gained through the targeted education program, which they regularly practiced as they consumed and/or supplied drugs to others. People who supply drugs were regularly identified as key actors capable of widely reducing risk across drug networks. Participants described being motivated by a moral imperative to protect community members, tying the previous loss of friends and loved ones to overdose to their commitments to the safety of others. Conclusion This article contributes to the scholarship on the role of people who supply drugs in implementing harm reduction interventions and reducing overdose risk. Better enabling grassroots harm reduction organizations to provide people who supply drugs with harm reduction training and access to harm reduction resources may help to reduce drug-related harms.
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Affiliation(s)
- Bethany Hedden-Clayton
- Wayne State University, Center for Behavioral Health and Justice, 5447 Woodward Avenue, Detroit, MI 48202, USA
- Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, USA
| | - Jes Cochran
- The Never Alone Project, Indianapolis, IN, USA
| | - Jennifer J. Carroll
- North Carolina State University, Department of Sociology and Anthropology, 10 Current Drive, Suite 334, Raleigh, NC 27606-8017, USA
| | - Alex H. Kral
- RTI International, 2750 Shattuck Avenue, Berkeley, CA, USA
| | - Grant Victor
- Rutgers University, School of Social Work, New Brunswick, NJ, USA
| | - Erin Comartin
- Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, USA
| | - Bradley Ray
- RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709, USA
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Syvertsen J. Looking into the black mirror of the overdose crisis: Assessing the harms of collaborative surveillance technologies in the United States response. Med Anthropol Q 2024. [PMID: 39145768 DOI: 10.1111/maq.12875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/12/2024] [Indexed: 08/16/2024]
Abstract
Drug overdose is a leading cause of death among adults in the United States, prompting calls for more surveillance data and data sharing across public health and law enforcement to address the crisis. This paper integrates Black feminist science and technology studies (STS) into an anthropological analysis of the collision of public health, policing, and technology as embedded in the US National Overdose Response Strategy and its technological innovation, the Overdose Detection Mapping Application Program (ODMAP). The dystopian Netflix series "Black Mirror," which explores the seemingly useful but quietly destructive potential of technology, offers a lens through which to speculate upon and anticipate the harms of collaborative surveillance projects. Ultimately, I ask: are such technological interventions a benevolent approach to a public health crisis or are we looking into a black mirror of racialized surveillance and criminalization of overdose in the United States?
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Affiliation(s)
- Jennifer Syvertsen
- Department of Anthropology, University of California, Riverside, Riverside, California, USA
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Gray AC, Neitzke-Spruill L, Hughes C, O'Connell DJ, Anderson TL. Opioid-stimulant trends in overdose toxicology by race, ethnicity, & gender: An analysis in Delaware, 2013-2019. J Ethn Subst Abuse 2024; 23:471-500. [PMID: 35973048 DOI: 10.1080/15332640.2022.2109790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Recent upticks of stimulant presence in overdose deaths suggest the opioid epidemic is morphing, which raises questions about what drugs are involved and who is impacted. We investigate annual and growth rate trends in combined opioid-stimulant overdose toxicology between 2013 and 2019 for White, Black, and Hispanic male and female decedents in Delaware. During these years, toxicology shifted to illegal drugs for all with fentanyl leading the increase and opioid-cocaine combinations rising substantially. While combined opioid-cocaine toxicology grew among Black and Hispanic Delawareans, White males continue to report the highest rates overall. These findings depart from historical patterns and may challenge existing opioid epidemic policies.
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Affiliation(s)
| | | | | | - Daniel J O'Connell
- Center for Drug and Health Studies, University of Delaware, Newark, Delaware
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4
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Morrissey B, El-Sabawi T, Carroll JJ. Prosecuting overdose: An exploratory study of prosecutorial motivations for drug-induced homicide prosecutions in North Carolina. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 125:104344. [PMID: 38342051 PMCID: PMC11031346 DOI: 10.1016/j.drugpo.2024.104344] [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: 09/27/2023] [Revised: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Prosecutorial use of drug-induced homicide (DIH) laws varies, and their public health impacts are poorly understood. This mixed-methods study explores associations between the number of DIH charges filed in North Carolina's 42 prosecutorial districts and district-level characteristics. Further, it documents the experience and views of North Carolina prosecutors on DIH cases. METHODS We conducted a descriptive, exploratory analysis of DIH enforcement by prosecutorial district in North Carolina to assess associations between overdose deaths, number of prosecutors employed, and rurality of the district. We also sent a survey to all N.C. prosecutors requesting that they detail their experience with and views on DIH prosecutions. RESULTS We found no association between overdose deaths or the number of prosecutors and DIH charges within a district. Survey data suggests that perceived justice for the deceased and perceived imperatives to "do something" about overdose influence prosecutorial use of DIH charges. Prosecutors generally appeared to agree that DIH cases had the potential to reduce substance use and/or drug dealing and/or fentanyl dealing and/or drug overdose in their districts, though how DIH cases would produce those effects was not clarified. Many prosecutors framed people who use drugs as helpless victims and forged categorical distinctions between (1) people who use drugs and sell drugs to support their addiction and (2) people who use drugs and sell drugs and are motivated by profit. Several prosecutors suggested that charging one person with homicide for another person's consensual acts may not appear logical to all jurors. CONCLUSIONS DIH prosecutions do not appear to be predicted by district characteristics commonly believed to shape prosecutorial action. Many prosecutors endorsed claims about the community-level impacts of DIH prosecutions that are unproven and generally contradict the available evidence. More research on the implementation and community-level outcomes of DIH prosecutions is needed.
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Affiliation(s)
- Brandon Morrissey
- North Carolina State University, Department of Sociology and Anthropology, 10 Current Drive, Suite 334, Campus Box 8107, Raleigh, NC 27695-8107, USA.
| | - Taleed El-Sabawi
- Florida International University College of Law, 11200 SW 8th Street, Rafael Diaz Balart Hall, Miami, FL 33199, USA
| | - Jennifer J Carroll
- North Carolina State University, Department of Sociology and Anthropology, 10 Current Drive, Suite 334, Campus Box 8107, Raleigh, NC 27695-8107, USA
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5
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Ostrach B, Hixon V, Bryce A. "When people who use drugs can't differentiate between medical care and cops, it's a problem." Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies. HEALTH & JUSTICE 2024; 12:3. [PMID: 38319474 PMCID: PMC10848405 DOI: 10.1186/s40352-023-00256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Community-based harm reduction programming is widely recognized as an effective strategy for reducing the increased risks for and spread of HIV, HCV, and for reducing the growing rate of overdose deaths among people who use drugs (PWUD). PWUD in the United States (US) are a highly justice-involved population, also at increased risk for law enforcement interaction, arrest, and incarceration. These risks compound and interact in the context of criminalization and law enforcement surveillance. Justice involvement increases risks for overdose and for riskier injecting behavior among PWUD, in turn increasing HCV and HIV risks. In Central and Southern Appalachia specifically, PWUD have identified fear of law enforcement harassment and arrest as a barrier to engaging in harm reduction behavior, and a deterrent to seeking help at the scene of an overdose. Moreover, stigmatizing and punitive treatment in healthcare settings can deter PWUD from seeking care, with life or death consequences. This evaluation research study assessing the successes and impacts of a grant-funded project to increase access to safer drug consumption supplies and overdose prevention education for PWUD, including justice-involved participants of a syringe access program (SAP), in public housing and beyond in a South-Central Appalachian setting used key informant and opportunistic sampling. Mixed-methods data were compiled and collected including secondary program data; primary interview and participant-observation data. RESULTS The evaluation research identified that grant deliverables were largely achieved, despite challenges presented by the COVID-19 pandemic. In addition, SAP participants and staff reported larger themes surrounding grant-funded activities, in which they perceived that widespread local law enforcement harassment of PWUD increased participants' risks for overdose death and infectious disease risks and that punitive local healthcare settings and policies acted as deterrents to care-seeking for many PWUD. CONCLUSIONS Overall, the evaluation research found that participants' experiences with and perceptions of local law enforcement harassment combined with their understandings and experiences of local punitive healthcare settings and policies; together compounding and increasing overdose risks and negative health consequences for local justice-involved PWUD.
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Affiliation(s)
- Bayla Ostrach
- Boston University School of Medicine; Fruit of Labor Action Research & Technical Assistance, LLC, Fairview, NC, USA.
| | - Vanessa Hixon
- Appalachian Medical Solidarity, Asheville, North Carolina, USA
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Dahlem CH, Patil R, Khadr L, Ploutz-Snyder RJ, Boyd CJ, Shuman CJ. Effectiveness of take ACTION online naloxone training for law enforcement officers. HEALTH & JUSTICE 2023; 11:47. [PMID: 37979100 PMCID: PMC10656891 DOI: 10.1186/s40352-023-00250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Training law enforcement officers (LEOs) to administer naloxone is a recommended strategy to reduce overdose deaths in the United States. To achieve this, an evidence-based and scalable naloxone training curriculum that is easy to use and readily scalable is needed. Convenient web-based training is a flexible method for delivering educational interventions particularly for LEOs who have irregular or shifting schedules. This study examined the effectiveness of a comprehensive web-based naloxone training that was created in partnership with LEOs on their knowledge, confidence, and attitudes regarding naloxone. METHODS From May 2019 to September 2020, five law enforcement departments from Michigan participated in web-based naloxone training. A total of 182 LEOs (77% male) were in the final sample based on matching pre-and post-test surveys. LEOs were assessed on knowledge, confidence, and attitudes towards naloxone. Negative binomial and Poisson regression was conducted to assess associations between knowledge, confidence, and attitudes towards naloxone before and after training. RESULTS Significant improvements in overdose knowledge and confidence were revealed across all departments with median (IQR) total composite scores for knowledge increasing from 35 (32, 37) to 40 (39, 42) (p < 0.01) and confidence increasing from 18.5 (15, 20) to 20 (20, 25) (p < 0.01). Median (IQR) attitude scores did not change. CONCLUSION Our web-based naloxone training was effective in improving knowledge and confidence for LEOs but did not significantly improve LEOs attitudes towards naloxone across most departments. The web-based format is readily scalable and quickly disseminated and meets the immediate need for LEO overdose training. Additional intervention is needed to address the negative attitudes of LEOs regarding naloxone.
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Affiliation(s)
- Chin Hwa Dahlem
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA.
| | - Rohan Patil
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
| | - Lara Khadr
- Applied Biostatistics Laboratory, Ann Arbor, USA
| | | | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
| | - Clayton J Shuman
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
- Department of System Populations and Leadership, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
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7
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Kimmel SD, Xuan Z, Yan S, Lambert AM, Formica SW, Green TC, Carroll JJ, Bagley SM, Rosenbloom D, Beletsky L, Walley AY. Characteristics of post-overdose outreach programs and municipal-level opioid overdose in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104164. [PMID: 37713939 DOI: 10.1016/j.drugpo.2023.104164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Post-overdose outreach programs have proliferated in response to opioid overdose. Implementing these programs is associated with reductions in overdose rates, but the role of specific program characteristics in overdose trends has not been evaluated. METHODS Among 58 Massachusetts municipalities with post-overdose outreach programs, we examined associations between five domains of post-overdose outreach program characteristics (outreach contact rate, naloxone distribution, coercive practices, harm reduction activities, and social service provision or referral) and rates of fatal opioid overdoses and opioid-related emergency medical system responses (i.e., ambulance activations) per calendar quarter from 2013 to 2019 using segmented regression analyses with adjustment for municipal covariates and fixed effects. For both outcomes, each domain was modeled: a) individually, b) with other characteristics, and c) with other characteristics and municipal-level fixed effects. RESULTS There were no significant associations (p < 0.05) between outreach contact rate, naloxone distribution, coercive practices, or harm reduction activities with municipal fatal overdose trends. Municipalities with programs providing or referring to more social services experienced 21% fewer fatal overdoses compared to programs providing or referring to more social services (Rate Ratio (RR) 0.79, 95% Confidence Interval (CI) 0.66-0.93, p = 0.01). Compared to municipalities in quarters when programs had no outreach contacts, municipalities with some, but less than the median outreach contacts, experienced 14% lower opioid-related emergency responses (RR 0.86, 95% CI 0.78-0.96, p = 0.01). Associations between naloxone distribution, coercive practices, harm reduction practices, or social services and opioid-related emergency responses were not consistently significant across modeling approaches. CONCLUSION Municipalities with post-overdose outreach programs providing or referring to more social services had lower fatal opioid overdose rates. Municipalities in quarters when programs outreached to overdose survivors had fewer opioid-related emergency responses, but only among programs with below the median number of outreach contacts. Social service linkage should be core to post-overdose programs. Evaluations should assess program characteristics to optimize program design.
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Affiliation(s)
- Simeon D Kimmel
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Building - 4th Floor, Boston, MA 02118, United States
| | - Shapei Yan
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States
| | - Audrey M Lambert
- AHOPE, Department of Recovery Services, Boston Public Health Commission, 774 Albany St, Boston, MA 02118, United States
| | - Scott W Formica
- Social Science Research and Evaluation, Inc, 84 Mill Street, Lincoln, MA 01773, United States
| | - Traci C Green
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 024537, United States; Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; COBRE on Opioids and Overdose at Rhode Island Hospital, 1125 North Main St., Providence, RI 02904, United States
| | - Jennifer J Carroll
- Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; Department of Sociology and Anthropology, North Carolina State University, Raleigh, NC, United States
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 801 Albany St, Boston, MA 02118, United States
| | - David Rosenbloom
- Department of Health, Law, Policy and Management, Boston University School of Public Health, 348W, 715 Albany Street, Boston, MA 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and The Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Division of Global Public Health and Infectious Diseases, University of California, San Diego School of Medicine, 9500 Gillman Drive, La Jolla, CA 92093, United States
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States
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8
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Carroll JJ, Rossi SL, Vetrova MV, Blokhina E, Sereda Y, Lioznov D, Luoma J, Kiriazova T, Lunze K. The impacts of COVID-19 on structural inequities faced by people living with HIV who inject drugs: A qualitative study in St. Petersburg, Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104060. [PMID: 37210965 DOI: 10.1016/j.drugpo.2023.104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND People who inject drugs (PWID) living with HIV may be disproportionately impacted by pandemic restrictions. This study qualitatively explored the impacts of the SARS-CoV-2 pandemic on PWID with HIV in St. Petersburg, Russia. METHODS In March and April 2021, we conducted remote, semi-structured interviews with PWID with HIV, health care providers, and harm reductionists. RESULTS We interviewed 25 PWID with HIV (aged 28-56 years, 46% female) and 11 providers. The pandemic exacerbated economic and psychological challenges experienced by PWID with HIV. Simultaneously, barriers to HIV care access, ART prescription refill and dispensing and police violence, which hindered the health and safety of PWID with HIV, were themselves hindered from normal operations by the pandemic, significantly reducing these burdens. CONCLUSION Pandemic responses should account for the unique vulnerabilities of PWID with HIV to avoid worsening the structural violence they already experience. Wherever the pandemic decreased structural barriers, such as institutional, administrative, and bureaucratic challenges and state violence enacted by police and other elements of the criminal justice system, such changes should be protected.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology and Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC, 27695, USA; Warren Alpert School of Medicine at Brown University, 222 Richmond St, Providence, RI, 02903 USA.
| | - Sarah L Rossi
- Department of Medicine, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Marina V Vetrova
- Pavlov University, 11 Komendantsky pr., office 45N, St. Petersburg, 197227, Russia
| | - Elena Blokhina
- Pavlov University, 11 Komendantsky pr., office 45N, St. Petersburg, 197227, Russia
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, 10 B. Khmelnytskoho St., Apt. 60, Kyiv, 01054, Ukraine; Smorodintsev Research Institute of Influenza, 15/17 Popov St., St. Petersburg, 197376, Russia
| | - Dmitry Lioznov
- Pavlov University, 11 Komendantsky pr., office 45N, St. Petersburg, 197227, Russia
| | - Jason Luoma
- Portland Psychotherapy Clinic, Training, and Research Center, 3700N Williams Ave, Portland, OR, 97227, USA
| | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 10 B. Khmelnytskoho St., Apt. 60, Kyiv, 01054, Ukraine
| | - Karsten Lunze
- Department of Medicine, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA; School of Medicine, Boston University, 72 E Concord St, Boston, MA, 02118, USA
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Pamplin JR, Rouhani S, Davis CS, King C, Townsend TN. Persistent Criminalization and Structural Racism in US Drug Policy: The Case of Overdose Good Samaritan Laws. Am J Public Health 2023; 113:S43-S48. [PMID: 36696623 PMCID: PMC9877371 DOI: 10.2105/ajph.2022.307037] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
The US overdose crisis continues to worsen and is disproportionately harming Black and Hispanic/Latino people. Although the "War on Drugs" continues to shape drug policy-at the disproportionate expense of Black and Hispanic/Latino people-states have taken some steps to reduce War on Drugs-related harms and adopt a public health-centered approach. However, the rhetoric regarding these changes has, in many cases, outstripped reality. Using overdose Good Samaritan Laws (GSLs) as a case study, we argue that public health-oriented policy changes made in some states are undercut by the broader enduring environment of a structurally racist drug criminalization agenda that continues to permeate and constrict most attempts at change. Drawing from our collective experiences in public health research and practice, we describe 3 key barriers to GSL effectiveness: the narrow parameters within which they apply, the fact that they are subject to police discretion, and the passage of competing laws that further criminalize people who use illicit drugs. All reveal a persisting climate of drug criminalization that may reduce policy effectiveness and explain why current reforms may be destined for failure and further disadvantage Black and Hispanic/Latino people who use drugs. (Am J Public Health. 2023;113(S1):S43-S48. https://doi.org/10.2105/AJPH.2022.307037).
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Affiliation(s)
- John R Pamplin
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
| | - Saba Rouhani
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
| | - Corey S Davis
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
| | - Carla King
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
| | - Tarlise N Townsend
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
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10
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Wagner KD, Marks C, Felsher M, Latkin C, Pearson JL, Falade-Nwulia OO. Individual and social network correlates of responding to multiple overdoses among a cohort of people who use drugs. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100107. [PMID: 36688935 PMCID: PMC9854250 DOI: 10.1016/j.dadr.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The purpose of this study was to identify characteristics of people who respond to two or more overdoses (i.e., multiple overdose responders; MOR) compared to those who respond to zero or one, and the association between MOR status and changes in network size. Methods Secondary analysis of data from a randomized trial among 199 PWUD in Baltimore, MD (2016-2019). We used cross-tabulation, 𝜒 2 , and ANOVA models to identify cross-sectional associations between overdose response and demographic, drug use, and network size; and ANCOVA models to examine the relationship between baseline MOR status and change in network size. Results From the cohort of 199, 185 people provided data on overdose response at baseline; 197 provided data at 6-month follow-up. At baseline, 27.6% of participants were classified as MORs (ever). Correlates of MOR status included homelessness; age; injecting drug use; quality of interactions with police (respectful vs. not); and use of powder cocaine, prescription opioids, and heroin. MORs had larger networks and their network size decreased more over time, but the association was not statistically significant. At follow-up, 16% were classified as MORs (past 6 months); correlates of follow-up MOR status were similar to those at baseline. Conclusions Overdose prevention interventions rely on PWUD to respond to overdoses. Identifying factors associated with MOR status could increase intervention efficiency and providing MORs with support could increase sustainability. Our findings suggest that PWUD experiencing homelessness, using cocaine and heroin, and demonstrating increased salience of overdose in their lives would benefit from targeted programs.
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Affiliation(s)
- Karla D. Wagner
- School of Public Health, University of Nevada, Reno; Reno, Nevada, USA,Corresponding Author: 1664 N. Virginia St. MC 0274; Reno, NV 89557, (K.D. Wagner)
| | - Charles Marks
- School of Public Health, University of Nevada, Reno; Reno, Nevada, USA
| | - Marisa Felsher
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine; Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins School of Medicine; Baltimore, MD, USA
| | | | - Oluwaseun O Falade-Nwulia
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine; Baltimore, MD, USA
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11
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"I don't go to funerals anymore": how people who use opioids grieve drug-related death in the US overdose epidemic. Harm Reduct J 2022; 19:110. [PMID: 36183109 PMCID: PMC9526383 DOI: 10.1186/s12954-022-00693-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid-related overdose death is a public health epidemic in much of the USA, yet little is known about how people who use opioids (PWUO) experience overdose deaths in their social networks. We explore these experiences through a qualitative study of opioid-related overdose death bereavement among PWUO. METHODS We recruited 30 adults who inject opioids from a syringe service program in the Midwestern USA and interviewed them using a semi-structured guide that addressed experiences of opioid use, opioid-related overdose, and overdose reversal via the medication naloxone. Interviews were transcribed verbatim and analyzed thematically. FINDINGS Participants described overdose death as ever-present in their social worlds. Most (approximately 75%) reported at least one overdose death in their social network, and many came to consider death an inevitable end of opioid use. Participants described grief shaped by complex social relations and mourning that was interrupted due to involvement with social services and criminal legal systems. They also reported several ways that overdose deaths influenced their drug use, with some increasing their use and others adopting safer drug use practices. Despite the high prevalence of overdose deaths in their social networks, only one participant reported receiving grief support services. DISCUSSION Findings underscore the need for interventions that not only maintain life, such as naloxone distribution, but also improve quality of life by attending to grief related to overdose death bereavement. We discuss policies and practices with the potential to address the unique psychological, social, and structural challenges of grief for this population.
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12
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Doe-Simkins M, El-Sabawi T, Carroll JJ. Whose Concerns? It's Time to Adjust the Lens of Research on Police-Involved Overdose Response. Am J Public Health 2022; 112:1239-1241. [PMID: 35862884 PMCID: PMC9382179 DOI: 10.2105/ajph.2022.306988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Maya Doe-Simkins
- Maya Doe-Simkins is with the Remedy Alliance, Cedar, MI. Taleed El-Sabawi is with the College of Law, Florida International University, Miami. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh, and Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Taleed El-Sabawi
- Maya Doe-Simkins is with the Remedy Alliance, Cedar, MI. Taleed El-Sabawi is with the College of Law, Florida International University, Miami. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh, and Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Jennifer J Carroll
- Maya Doe-Simkins is with the Remedy Alliance, Cedar, MI. Taleed El-Sabawi is with the College of Law, Florida International University, Miami. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh, and Warren Alpert School of Medicine, Brown University, Providence, RI
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13
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White MD, Watts S, Orosco C, Perrone D, Malm A. Leveraging Body-Worn Camera Footage to Better Understand Opioid Overdoses and the Impact of Police-Administered Naloxone. Am J Public Health 2022; 112:1326-1332. [PMID: 35862885 PMCID: PMC9382158 DOI: 10.2105/ajph.2022.306918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate what transpires at opioid overdoses where police administer naloxone and to identify the frequency with which concerns about police-administered naloxone are observed. Methods. We reviewed body-worn camera (BWC) footage of all incidents where a Tempe, Arizona police officer administered naloxone or was present when the Tempe Fire Medical Rescue (TFMR) administered it, from February 3, 2020 to May 7, 2021 (n = 168). We devised a detailed coding instrument and employed univariate and bivariate analysis to examine the frequency of concerns regarding police-administered naloxone. Results. Police arrived on scene before the TFMR in 73.7% of cases. In 88.6% of calls the individual was unconscious when police arrived, but 94.6% survived the overdose. The primary concerns about police-administered naloxone were rarely observed. There were no cases of improper naloxone administration or accidental opioid exposure to an officer. Aggression toward police from an overdose survivor rarely occurred (3.6%), and arrests of survivors (3.6%) and others on scene (1.2%) were infrequent. Conclusions. BWC footage provides a unique window into opioid overdoses. In Tempe, the concerns over police-administered naloxone are overstated. If results are similar elsewhere, those concerns are barriers that must be removed. (Am J Public Health. 2022;112(9):1326-1332. https://doi.org/10.2105/AJPH.2022.306918).
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Affiliation(s)
- Michael D White
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
| | - Seth Watts
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
| | - Carlena Orosco
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
| | - Dina Perrone
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
| | - Aili Malm
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
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14
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Ray B, Hedden BJ, Carroll JJ, Del Pozo B, Wagner K, Kral AH, O'Donnell D, Victor G, Huynh P. Prevalence and correlates of incarceration following emergency medical services response to overdose. Drug Alcohol Depend 2022; 238:109571. [PMID: 35868181 DOI: 10.1016/j.drugalcdep.2022.109571] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND To describe the prevalence of incarceration among survivors of non-fatal overdose addressed through an emergency medical services (EMS) response, and compare incarceration by whether the emergency was for opioid-involved or stimulant-involved overdose. METHODS Administrative records on 192,113 EMS incidents and 70,409 jail booking events occurring between January 1, 2019 and December 31, 2020 in Indianapolis, Indiana were record-linked at the event level. Incarceration taking place within 6-hours of an EMS incident was associated with that incident. Logistic regression was used to calculate adjusted odds ratios (AOR) of incarceration after an overdose. RESULTS Among all EMS incidents, 2.6% were followed by incarceration. For overdose EMS incidents, the prevalence of incarceration was 10.0%. Overdose incidents had higher odds than non-overdose incidents of leading to a charge of felony, booked on a warrant, and transferred to another law enforcement agency upon release. Prevalence of incarceration following a stimulant-involved overdose was 21.3%, compared to 9.3% for opioid-involved overdose survivors. Compared to persons from other EMS incidents, overdose survivors had greater odds of incarceration (AOR=3.48, 95% confidence interval (CI)= 3.22, 3.75, p < .001), with opioid-involved overdoses (AOR=3.03, 95% CI=2.76, 3.33, p < .001) and stimulant-involved overdoses (AOR=6.70, 95% CI=5.26, 8.55, p < .001) leading to higher odds of incarceration. CONCLUSION Incarceration in county jail followed one in ten overdose-involved EMS responses. As illicit drug consumption increasingly involves stimulants, the frequency of incarceration following these events is likely to increase. Policy changes and interventions are needed to reduce incarceration after overdose emergencies.
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Affiliation(s)
- Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Bethany J Hedden
- Center for Behavioral Health and Justice, Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, USA
| | - Jennifer J Carroll
- North Carolina State University, Department of Sociology and Anthropology, 10 Current Drive, Suite 334, Raleigh, NC 27606-8017, USA
| | - Brandon Del Pozo
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Karla Wagner
- University of Nevada, Reno, School of Public Health, 1644 N. Virginia St., Reno, NV 89557, USA
| | | | - Daniel O'Donnell
- Indiana University School of Medicine, Indianapolis Emergency Medical Services, 3930 Georgetown Rd., Indianapolis, IN 46254, USA
| | - Grant Victor
- Rutgers University, School of Social Work, 120 Albany St, New Brunswick, NJ 08901, USA
| | - Phil Huynh
- Center for Behavioral Health and Justice, Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, USA
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15
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Hamilton LK, Wheeler-Martin K, Davis CS, Martins SS, Samples H, Cerdá M. A modified Delphi process to identify experts' perceptions of the most beneficial and harmful laws to reduce opioid-related harm. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103809. [PMID: 35908313 DOI: 10.1016/j.drugpo.2022.103809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND States have enacted multiple types of laws, with a variety of constituent provisions, in response to the opioid epidemic, often simultaneously. This temporal proximity and variation in state-to-state operationalization has resulted in significant challenges for empirical research on their effects. Thus, expert consensus can be helpful to classify laws and their provisions by their degree of helpfulness and impact. METHODS We conducted a four-stage modified policy Delphi process to identify the top 10 most helpful and 5 most harmful provisions from eight opioid-related laws. This iterative consultation with six types of opioid experts included a preliminary focus group (n=12), two consecutive surveys (n=56 and n=40, respectively), and a final focus group feedback session (n=5). RESULTS On a scale of very harmful (0) to very helpful (4), overdose Good Samaritan laws received the highest average helpfulness rating (3.62, 95% CI: 3.48-3.75), followed by naloxone access laws (3.37, 95% CI: 3.22-3.51), and pain management clinic laws (3.08, 95% CI: 2.89-3.26). Drug-induced homicide (DIH) laws were rated the most harmful (0.88, 95% CI: 0.66-1.11). Impact ratings aligned similarly, although Medicaid laws received the second highest overall impact rating (3.71, 95% CI: 3.45, 3.97). The two most helpful provisions were naloxone standing orders (3.94, 95% CI: 3.86-4.02) and Medicaid coverage of medications for opioid use disorder (MOUD) (3.89, 95% CI: 3.82). Mandatory minimum DIH laws were the most harmful provision (0.73, 95% CI 0.53-0.93); followed by requiring prior authorization for Medicaid coverage of MOUD (1.00 95% CI: 0.72-1.27). CONCLUSION Overall, experts rated laws and provisions that facilitated harm reduction efforts and access to MOUD as most helpful. Laws and provisions rated as most harmful criminalized substance use and placed restrictions on access to MOUD. These ratings provide a foundation for evaluating the overall overdose policy environment for each state.
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Affiliation(s)
- Leah K Hamilton
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, United States; New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States.
| | - Katherine Wheeler-Martin
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States
| | - Corey S Davis
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States; Network for Public Health Law, 7101 York Avenue South, #270, Edina, MN 55435, United States
| | - Silvia S Martins
- Columbia University, Mailman School of Public Health, Department of Epidemiology, Epidemiology, 722 West 168th St. New York, NY 10032, United States
| | - Hillary Samples
- Rutgers Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, United States; Rutgers School of Public Health, Department of Health Behavior, 683 Hoes Lane West, Piscataway, NJ 08854, United States
| | - Magdalena Cerdá
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States
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16
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Opinion: Public health and police: Building ethical and equitable opioid responses. Proc Natl Acad Sci U S A 2021; 118:2118235118. [PMID: 34732582 DOI: 10.1073/pnas.2118235118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
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