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Takemoto E, Bolton A, Goetz CT. Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019-21. Addiction 2024; 119:1400-1409. [PMID: 38808397 DOI: 10.1111/add.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
AIMS The aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity. DESIGN AND SETTING Analysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019-21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year. CASES The analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021. MEASUREMENTS Evidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) was based on the death certificate. FINDINGS In the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40-50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5-0.9; 2020: OR = 0.5, 95% CI = 0.4-0.7; 2021: OR = 0.6, 95% CI = 0.5-0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents. CONCLUSION After controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people.
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Affiliation(s)
- Erin Takemoto
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Ashley Bolton
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Carrie Thomas Goetz
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
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2
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Pappalardo FS, Krieger M, Park C, Beaudoin FL, Wightman RS. Patients presenting to the ED with nonfatal drug overdose: Self-reported history of overdose and naloxone use. Am J Emerg Med 2024; 82:21-25. [PMID: 38759250 PMCID: PMC11254540 DOI: 10.1016/j.ajem.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/04/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In the context of polysubstance use and fentanyl detection in non-opioid drugs supplies (e.g., cocaine, methamphetamine), it is important to re-evaluate and expand our understanding of which populations are at high risk for fatal drug overdoses. The primary objective of this pilot study was to gather data from the ED to characterize the population presenting with drug overdose, including demographics, drug use patterns and comorbidities, to inform upstream overdose prevention efforts. METHODS A consecutive sample of ED patients undergoing treatment for non-fatal overdose were prospectively recruited for study participation at the time of ED visit. Participants reported history of substance use over the past six months, recent and lifetime overdose, and naloxone receipt and administration history. RESULTS A total of 76 eligible participants were enrolled over the course of seven months. Participants reported high rates of opioid (56%), stimulant (56%), and cannabis use (59%). Self-reported polysubstance use, defined as self-reported use of more than one substance, was 83%. Of enrolled participants, 64% reported at least one overdose and 39% reported three or more lifetime overdoses prior to their index overdose ED visit. Participants with no self-reported intentional opioid use (n = 32) in the past six months had fentanyl positive urine drug screen 84% of the time versus 89% in the overall study population (n = 74). Participants who did not report opioid use in the past six months were less likely to possess (34% vs. 55%) or to know how to acquire (50% vs. 74%) naloxone compared to participants with self-reported history of opioid use. CONCLUSION This study demonstrated high rates of fentanyl exposure on toxicology testing at time of overdose across all participants including study participants without self-reported intentional opioid use. Data gathered in the ED at time of overdose can be used to inform upstream naloxone distribution and public health initiatives.
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Affiliation(s)
- Francesco S Pappalardo
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St, Providence, RI 02906, USA.
| | - Maxwell Krieger
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Carolyn Park
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St, Providence, RI 02906, USA; Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
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3
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Zang X, Walley AY, Chatterjee A, Kimmel SD, Morgan JR, Murphy SM, Linas BP, Nolen S, Reilly B, Urquhart C, Schackman BR, Marshall BDL. Changes to opioid overdose deaths and community naloxone access among Black, Hispanic and White people from 2016 to 2021 with the onset of the COVID-19 pandemic: An interrupted time-series analysis in Massachusetts, USA. Addiction 2023; 118:2413-2423. [PMID: 37640687 PMCID: PMC10986189 DOI: 10.1111/add.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIMS The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a surge in opioid overdose deaths in Massachusetts, particularly affecting racial and ethnic minority communities. We aimed to compare the impact of the pandemic on opioid overdose fatalities and naloxone distribution from community-based programs across racial and ethnic groups in Massachusetts. DESIGN Interrupted time-series. SETTING AND CASES Opioid overdose deaths (OODs) among non-Hispanic White, non-Hispanic Black, Hispanic and non-Hispanic other race people in Massachusetts, USA (January 2016 to June 2021). MEASUREMENTS Rate of OODs per 100 000 people, rate of naloxone kits distributed per 100 000 people and ratio of naloxone kits per opioid overdose death as a measure of naloxone availability. We applied five imputation strategies using complete data in different periods to account for missingness of race and ethnicity for naloxone data. FINDINGS Before COVID-19 (January 2016 to February 2020), the rate of OODs declined among non-Hispanic White people [0.2% monthly reduction (95% confidence interval = 0.0-0.4%)], yet was relatively constant among all other population groups. The rate of naloxone kits increased across all groups (0.8-1.2% monthly increase) and the ratio of naloxone kits per OOD death among non-Hispanic White was 1.1% (0.8-1.4%) and among Hispanic people was 1.0% (0.2-1.8%). After the onset of the pandemic (March 2020+), non-Hispanic Black people experienced an immediate increase in the rate of OODs [63.6% (16.4-130%)], whereas rates among other groups remained similar. Trends in naloxone rescue kit distribution did not substantively change among any groups, and the ratio of naloxone kits per OOD death for non-Hispanic Black people did not compensate for the surge in OODs deaths in this group. CONCLUSIONS With the onset of the COVID-19 pandemic, there was a surge in opioid overdose deaths among non-Hispanic Black people in Massachusetts, USA with no compensatory increase in naloxone rescue kit distribution. For non-Hispanic White and Hispanic people, opioid overdose deaths remained stable and naloxone kit distribution continued to increase.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Avik Chatterjee
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Simeon D Kimmel
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brittni Reilly
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
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Qayyum SN, Ansari RS, Ullah I, Siblini D. The FDA approves the second OTC naloxone - a step toward opioid crisis mitigation. Int J Surg 2023; 109:4349-4350. [PMID: 37678319 PMCID: PMC10720828 DOI: 10.1097/js9.0000000000000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Sardar N Qayyum
- Department of Internal Medicine, Bacha Khan Medical College, Mardan, Khyber Pakhtunkhwa
| | | | - Irfan Ullah
- Department of Internal Medicine, Bacha Khan Medical College, Mardan, Khyber Pakhtunkhwa
| | - Dima Siblini
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Li Y, Miller HJ, Hyder A, Jia P. Understanding the spatiotemporal evolution of opioid overdose events using a regionalized sequence alignment analysis. Soc Sci Med 2023; 334:116188. [PMID: 37651825 DOI: 10.1016/j.socscimed.2023.116188] [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: 04/07/2023] [Revised: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Opioid overdose events and deaths have become a serious public health crisis in the United States, and understanding the spatiotemporal evolution of the disease occurrences is crucial for developing effective prevention strategies, informing health systems policy and planning, and guiding local responses. However, current research lacks the capability to observe the dynamics of the opioid crisis at a fine spatial-temporal resolution over a long period, leading to ineffective policies and interventions at the local level. METHODS This paper proposes a novel regionalized sequential alignment analysis using opioid overdose events data to assess the spatiotemporal similarity of opioid overdose evolutionary trajectories within regions that share similar socioeconomic status. The model synthesizes the shape and correlation of space-time trajectories to assist space-time pattern mining in different neighborhoods, identifying trajectories that exhibit similar spatiotemporal characteristics for further analysis. RESULTS By adopting this methodology, we can better understand the spatiotemporal evolution of opioid overdose events and identify regions with similar patterns of evolution. This enables policymakers and health researchers to develop effective interventions and policies to address the opioid crisis at the local level. CONCLUSIONS The proposed methodology provides a new framework for understanding the spatiotemporal evolution of opioid overdose events, enabling policymakers and health researchers to develop effective interventions and policies to address this growing public health crisis.
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Affiliation(s)
- Yuchen Li
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Harvey J Miller
- Department of Geography, The Ohio State University, Columbus, USA; Center for Urban and Regional Analysis, The Ohio State University, Columbus, USA
| | - Ayaz Hyder
- College of Public Health, The Ohio State University, Columbus, USA
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, China; School of Public Health, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China.
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Freiermuth CE, Ancona RM, Brown JL, Punches BE, Ryan SA, Ingram T, Lyons MS. Evaluation of a large-scale health department naloxone distribution program: Per capita naloxone distribution and overdose morality. PLoS One 2023; 18:e0289959. [PMID: 37566565 PMCID: PMC10420337 DOI: 10.1371/journal.pone.0289959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES To report per-capita distribution of take-home naloxone to lay bystanders and evaluate changes in opioid overdose mortality in the county over time. METHODS Hamilton County Public Health in southwestern Ohio led the program from Oct 2017-Dec 2019. Analyses included all cartons distributed within Hamilton County or in surrounding counties to people who reported a home address within Hamilton County. Per capita distribution was estimated using publicly available census data. Opioid overdose mortality was compared between the period before (Oct 2015-Sep 2017) and during (Oct 2017-Sep 2019) the program. RESULTS A total of 10,416 cartons were included for analyses, with a total per capita distribution of 1,275 cartons per 100,000 county residents (average annual rate of 588/100,000). Median monthly opioid overdose mortality in the two years before (28 persons, 95% CI 25-31) and during (26, 95% CI 23-28) the program did not differ significantly. CONCLUSIONS Massive and rapid naloxone distribution to lay bystanders is feasible. Even large-scale take-home naloxone distribution may not substantially reduce opioid overdose mortality rates.
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Affiliation(s)
- Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Rachel M. Ancona
- Department of Emergency Medicine, Washington University, St Louis, Missouri, United States of America
| | - Jennifer L. Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Brittany E. Punches
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Shawn A. Ryan
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Brightview Health LLC, Cincinnati, Ohio, United States of America
| | - Tim Ingram
- Hamilton County Public Health, Cincinnati, Ohio, United States of America
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Michael S. Lyons
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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7
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Bohler RM, Freeman PR, Villani J, Hunt T, Linas BS, Walley AY, Green TC, Lofwall MR, Bridden C, Frazier LA, Fanucchi LC, Talbert JC, Chandler R. The policy landscape for naloxone distribution in four states highly impacted by fatal opioid overdoses. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100126. [PMID: 36643788 PMCID: PMC9838196 DOI: 10.1016/j.dadr.2022.100126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Expanding access to naloxone is one of the most impactful interventions in decreasing opioid-related mortality. However, state distribution rates of naloxone are insufficient to meet community need. The current study sought to better understand this gap by focusing on state policies that may facilitate or impede naloxone distribution in four states highly impacted by fatal opioid overdoses - Kentucky, Massachusetts, New York, and Ohio. Methods We provide a descriptive analysis of the policy landscape impacting naloxone distribution through pharmacy and community channels in the four states participating in the HEALing Communities Study (HCS). Publicly available data and the expertise of the research team were used to describe each state's naloxone access laws (NALs), Medicaid coverage of naloxone, and community overdose education and naloxone distribution infrastructure. Data presented in this study represent the most current policy landscape through September 2022. Results Variation exists between specific components of the NALs of each state, the structure of Medicaid coverage of naloxone, and the community distribution infrastructure networks. Massachusetts and New York have a statewide standing order, but other states use different strategies short of a statewide standing order to expand access to naloxone. Quantity limits specific to naloxone may limit access to Medicaid beneficiaries in some states. Conclusion States participating in the HCS have developed innovative but different mechanisms to ensure naloxone access. Policies were dynamic and moved towards greater access. Research should consider the policy landscape in the implementation and sustainability of interventions as well as the analysis of outcomes.
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Affiliation(s)
- Robert M. Bohler
- Institute for Behavioral Health, Brandeis University, 415 South Street, Waltham, MA 02453, United States,Corresponding author. (R.M. Bohler)
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Tim Hunt
- School of Social Work, Social Intervention Group (SIG), Center for Healing of Opioid and Other Substance Use Disorders (CHOSEN), Columbia University, New York, NY, United States
| | - Beth S. Linas
- RTI International, Research Triangle Park, NC, United States
| | - Alexander Y. Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Traci C. Green
- Institute for Behavioral Health, Brandeis University, 415 South Street, Waltham, MA 02453, United States
| | - Michelle R. Lofwall
- Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Carly Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Lisa A. Frazier
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Laura C. Fanucchi
- Department of Internal Medicine, Division of Infectious Disease, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Jeffery C. Talbert
- Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Redonna Chandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
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8
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Linas BP, Morgan JR, Murphy SM, Walley AY, Schackman BR, Marshall BDL. Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts. Drug Alcohol Depend 2022; 241:109668. [PMID: 36309001 PMCID: PMC9833886 DOI: 10.1016/j.drugalcdep.2022.109668] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. METHODS We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and "other" (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. RESULTS From 2016-2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. CONCLUSION We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA; The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI 02906, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA.
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9
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Zang X, Bessey SE, Krieger MS, Hallowell BD, Koziol JA, Nolen S, Behrends CN, Murphy SM, Walley AY, Linas BP, Schackman BR, Marshall BDL. Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island. JAMA Netw Open 2022; 5:e2241174. [PMID: 36350649 PMCID: PMC9647481 DOI: 10.1001/jamanetworkopen.2022.41174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
IMPORTANCE In 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations. OBJECTIVE To compare various strategies to increase naloxone distribution through community-based programs in Rhode Island to identify one most effective and efficient strategy in preventing opioid overdose deaths (OODs). DESIGN, SETTING, AND PARTICIPANTS In this decision analytical model study conducted from January 2016 to December 2022, a spatial microsimulation model with an integrated decision tree was developed and calibrated to compare the outcomes of alternative strategies for distributing 10 000 additional naloxone kits annually among all individuals at risk for opioid overdose in Rhode Island. INTERVENTIONS Distribution of 10 000 additional naloxone kits annually, focusing on people who inject drugs, people who use illicit opioids and stimulants, individuals at various levels of risk for opioid overdose, or people who misuse prescription opioids vs no additional kits (status quo). Two expanded distribution implementation approaches were considered: one consistent with the current spatial distribution patterns for each distribution program type (supply-based approach) and one consistent with the current spatial distribution of individuals in each of the risk groups, assuming that programs could direct the additional kits to new geographic areas if required (demand-based approach). MAIN OUTCOMES AND MEASURES Witnessed OODs, cost per OOD averted (efficiency), geospatial health inequality measured by the Theil index, and between-group variance for OOD rates. RESULTS A total of 63 131 simulated individuals were estimated to be at risk for opioid overdose in Rhode Island based on current population data. With the supply-based approach, prioritizing additional naloxone kits to people who use illicit drugs averted more witnessed OODs by an estimated mean of 18.9% (95% simulation interval [SI], 13.1%-30.7%) annually. Expanded naloxone distribution using the demand-based approach and focusing on people who inject drugs had the best outcomes across all scenarios, averting an estimated mean of 25.3% (95% SI, 13.1%-37.6%) of witnessed OODs annually, at the lowest mean incremental cost of $27 312 per OOD averted. Other strategies were associated with fewer OODs averted at higher costs but showed similar patterns of improved outcomes and lower unit costs if kits could be reallocated to areas with greater need. The demand-based approach reduced geospatial inequality in OOD rates in all scenarios compared with the supply-based approach and status quo. CONCLUSIONS AND RELEVANCE In this decision analytical model study, variations in the effectiveness, efficiency, and health inequality of the different naloxone distribution expansion strategies and approaches were identified. Future efforts should be prioritized for people at highest risk for overdose (those who inject drugs or use illicit drugs) and redirected toward areas with the greatest need. These findings may inform future naloxone distribution priority settings.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Sam E. Bessey
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Maxwell S. Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | | | | | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Czarina N. Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Alexander Y. Walley
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Brandon D. L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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10
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Morgan JR, Freibott CE, Jalali A, Jeng PJ, Walley AY, Chatterjee A, Green TC, Nolan ML, Linas BP, Marshall BD, Murphy SM. The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100083. [PMID: 36337350 PMCID: PMC9631422 DOI: 10.1016/j.dadr.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Naloxone distributed to people at risk for opioid overdose has been associated with reduced overdose death rates; however, associations of retail pharmacy-distributed naloxone with overdose mortality have not been evaluated. Methods Our analytic cohort uses retail pharmacy claims data; three health departments' community distribution data; federal opioid overdose data; and American Community Survey data. Data were analyzed by 3-digit ZIP Code and calendar quarter-year (2016Q1-2018Q4), and weighted by population. We regressed opioid-related overdose mortality on retail-pharmacy and community naloxone distribution, and community-level demographics using a linear model, hypothesizing that areas with high overdose rates would have higher current levels of naloxone distribution but that increasing naloxone distribution from one quarter to the next would be associated with lower overdose. Results From Q1-2016 to Q4-2018, the unadjusted naloxone distribution rate increased from 97 to 257 kits per 100,000 persons, while the unadjusted opioid overdose mortality rate fell from 8.1 to 7.2 per 100,000 persons. The concurrent level of naloxone distribution (both pharmacy and community) was positively and significantly associated with fatal opioid overdose rates. We did not detect associations between change in naloxone distribution rates and overdose mortality. Conclusion Naloxone distribution volumes were correlated with fatal opioid overdose, suggesting medication was getting to communities where it was needed most. Amid high rates of overdose driven by fentanyl in the drug supply, our findings suggest additional prevention, treatment, and harm reduction interventions are required-and dramatically higher naloxone volumes needed-to reverse the opioid overdose crisis in the US.
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Affiliation(s)
- Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America
- Corresponding author.
| | - Christina E. Freibott
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Philip J. Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
| | - Avik Chatterjee
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
| | - Traci C. Green
- Brandeis University Heller School for Social Policy and Management, Rhode Island Hospital, RI, United States of America
- Brown University School of Public Health, Department of Epidemiology, RI, United States of America
- COBRE on Opioids and Overdose, Rhode Island Hospital, RI, United States of America
| | - Michelle L. Nolan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Benjamin P. Linas
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, RI, United States of America
- COBRE on Opioids and Overdose, Rhode Island Hospital, RI, United States of America
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
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11
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Morgan JR, LaRochelle MR. Commentary on Karnik et al.: Harmonization now-the need for consistent, validated measures to identify opioid use disorder in observational data. Addiction 2022; 117:2448-2449. [PMID: 35762525 DOI: 10.1111/add.15977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Marc R LaRochelle
- Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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12
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Stringfellow EJ, Lim TY, Humphreys K, DiGennaro C, Stafford C, Beaulieu E, Homer J, Wakeland W, Bearnot B, McHugh RK, Kelly J, Glos L, Eggers SL, Kazemi R, Jalali MS. Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis. SCIENCE ADVANCES 2022; 8:eabm8147. [PMID: 35749492 PMCID: PMC9232111 DOI: 10.1126/sciadv.abm8147] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Opioid overdose deaths remain a major public health crisis. We used a system dynamics simulation model of the U.S. opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. These strategies spanned opioid misuse and OUD prevention, buprenorphine capacity, recovery support, and overdose harm reduction. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. Increasing buprenorphine providers' capacity to treat more people decreased fatal overdose, but only in the short term. Our analysis provides insight into the kinds of multifaceted approaches needed to save lives.
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Affiliation(s)
| | - Tse Yang Lim
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA, USA
| | | | | | | | - Jack Homer
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
- Homer Consulting, Barrytown, NY, USA
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, OR, USA
| | - Benjamin Bearnot
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - John Kelly
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lukas Glos
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sara L. Eggers
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Reza Kazemi
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Mohammad S. Jalali
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
- Corresponding author.
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13
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Kumar A, Linas BP, Morgan JR, Murphy SM, Walley AY, Yan S, Schackman BR, Marshall BDL. Community-based naloxone coverage equity for the prevention of opioid overdose fatalities in racial/ethnic minority communities in Massachusetts and Rhode Island. Addiction 2022; 117:1372-1381. [PMID: 34825427 PMCID: PMC8983544 DOI: 10.1111/add.15759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Opioid-related overdose death rates continue to rise in the United States, especially in racial/ethnic minority communities. Our objective was to determine if US municipalities with high percentages of non-white residents have equitable access to the overdose antidote naloxone distributed by community-based organizations. METHODS We used community-based naloxone data from the Massachusetts Department of Public Health and the Rhode Island non-pharmacy naloxone distribution program for 2016-18. We obtained publicly available opioid-related overdose death data from Massachusetts and the Office of the State Medical Examiners in Rhode Island. We defined the naloxone coverage ratio as the number of community-based naloxone kits received by a resident in a municipality divided by the number of opioid-related overdose deaths among residents, updated annually. We used a Poisson regression with generalized estimating equations to analyze the relationship between the municipal racial/ethnic composition and naloxone coverage ratio. To account for the potential non-linear relationship between naloxone coverage ratio and race/ethnicity we created B-splines for the percentage of non-white residents; and for a secondary analysis examining the percentage of African American/black and Hispanic residents. The models were adjusted for the percentage of residents in poverty, urbanicity, state and population size. RESULTS Between 2016 and 2018, the annual naloxone coverage ratios range was 0-135. There was no difference in naloxone coverage ratios among municipalities with varying percentages of non-white residents in our multivariable analysis. In the secondary analysis, municipalities with higher percentages of African American/black residents had higher naloxone coverage ratios, independent of other factors. Naloxone coverage did not differ by percentage of Hispanic residents. CONCLUSIONS There appear to be no municipal-level racial/ethnic inequities in naloxone distribution in Rhode Island and Massachusetts, USA.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, Providence, RI, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Aranshi Kumar
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Shapei Yan
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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14
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Jawa R, Murray S, Tori M, Bratberg J, Walley A. Federal Policymakers Should Urgently and Greatly Expand Naloxone Access. Am J Public Health 2022; 112:558-561. [PMID: 35319955 PMCID: PMC8961838 DOI: 10.2105/ajph.2021.306699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Raagini Jawa
- Raagini Jawa is with the Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine and the Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, MA. Stephen Murray is with the Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and a trainee at Boston University School of Public Health. Marco Tori is with the Division of General Internal Medicine, Boston University School of Medicine. Jeffrey Bratberg is with the College of Pharmacy, University of Rhode Island, Kingston. Alexander Walley is with the Grayken Center for Addiction and with Clinical Addiction Research and Education Unit, Boston University School of Medicine
| | - Stephen Murray
- Raagini Jawa is with the Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine and the Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, MA. Stephen Murray is with the Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and a trainee at Boston University School of Public Health. Marco Tori is with the Division of General Internal Medicine, Boston University School of Medicine. Jeffrey Bratberg is with the College of Pharmacy, University of Rhode Island, Kingston. Alexander Walley is with the Grayken Center for Addiction and with Clinical Addiction Research and Education Unit, Boston University School of Medicine
| | - Marco Tori
- Raagini Jawa is with the Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine and the Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, MA. Stephen Murray is with the Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and a trainee at Boston University School of Public Health. Marco Tori is with the Division of General Internal Medicine, Boston University School of Medicine. Jeffrey Bratberg is with the College of Pharmacy, University of Rhode Island, Kingston. Alexander Walley is with the Grayken Center for Addiction and with Clinical Addiction Research and Education Unit, Boston University School of Medicine
| | - Jeffrey Bratberg
- Raagini Jawa is with the Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine and the Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, MA. Stephen Murray is with the Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and a trainee at Boston University School of Public Health. Marco Tori is with the Division of General Internal Medicine, Boston University School of Medicine. Jeffrey Bratberg is with the College of Pharmacy, University of Rhode Island, Kingston. Alexander Walley is with the Grayken Center for Addiction and with Clinical Addiction Research and Education Unit, Boston University School of Medicine
| | - Alexander Walley
- Raagini Jawa is with the Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine and the Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, MA. Stephen Murray is with the Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and a trainee at Boston University School of Public Health. Marco Tori is with the Division of General Internal Medicine, Boston University School of Medicine. Jeffrey Bratberg is with the College of Pharmacy, University of Rhode Island, Kingston. Alexander Walley is with the Grayken Center for Addiction and with Clinical Addiction Research and Education Unit, Boston University School of Medicine
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