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Huber TP. Rethinking leadership approaches for community-wide opioid crisis intervention: harnessing positive inquiry to unearth front-line insight. BMJ LEADER 2024; 8:234-239. [PMID: 37979969 DOI: 10.1136/leader-2023-000862] [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: 06/26/2023] [Accepted: 10/26/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND/AIM The opioid crisis presents a complex and widespread health challenge for communities, necessitating a deeper exploration beyond simple solutions. To address this crisis, it is crucial to identify and disseminate best practices. In this study, we focused on positive deviance narratives from Columbus, Ohio, a community deeply affected by the opioid crisis. METHODS Employing an appreciative inquiry framework, we conducted purposive sampling to interview 47 frontline professionals and individuals grappling with opioid use disorder (OUD). RESULTS Our research revealed several key insights, highlighting successful themes through positive narratives. First, perceiving OUD as a chronic disease emerged as a critical perspective, acknowledging the long-term nature of the condition and the need for sustained care. Second, re-humanising and de-stigmatising opioid users played a vital role in facilitating their recovery and reintegration into society. Embracing inclusive care delivery was another important aspect, ensuring that individuals from diverse backgrounds receive equitable access to effective treatment. Moreover, re-energising professionals to combat burnout proved essential, emphasising the importance of supporting and motivating healthcare providers in their efforts. Finally, fostering cross-institutional relationship building and collaboration emerged as a significant factor, as it encouraged a coordinated approach to addressing the crisis. Designing adaptive organisational structures also played a crucial role, enabling healthcare institutions to respond effectively to evolving challenges. CONCLUSIONS Using a positive deviance approach to a challenging public health crisis like OUD can help us discover new and innovative care management approaches for community wide interventions.
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Stevens A, Keemink JR, Shirley-Beavan S, Khadjesari Z, Artenie A, Vickerman P, Southwell M, Shorter GW. Overdose prevention centres as spaces of safety, trust and inclusion: A causal pathway based on a realist review. Drug Alcohol Rev 2024; 43:1573-1591. [PMID: 39104059 DOI: 10.1111/dar.13908] [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: 02/10/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/07/2024]
Abstract
ISSUES Overdose prevention centres (OPC) are non-residential spaces where people can use illicit drugs (that they have obtained elsewhere) in the presence of staff who can intervene to prevent and manage any overdoses that occur. Many reviews of OPCs exist but they do not explain how OPCs work. APPROACH We carried out a realist review, using the RAMESES reporting standards. We systematically searched for and then thematically analysed 391 documents that provide information on the contexts, mechanisms and outcomes of OPCs. KEY FINDINGS Our retroductive analysis identified a causal pathway that highlights the feeling of safety - and the immediate outcome of not dying - as conditions of possibility for the people who use OPCs to build trust and experience social inclusion. The combination of safety, trust and social inclusion that is triggered by OPCs can - depending on the contexts in which they operate - generate other positive outcomes, which may include less risky drug use practices, reductions in blood borne viruses and injection-related infections and wounds, and access to housing. These outcomes are contingent on relevant contexts, including political and legal environments, which differ for women and people from racialised minorities. CONCLUSIONS OPCs can enable people who live with structural violence and vulnerability to develop feelings of safety and trust that help them stay alive and to build longer term trajectories of social inclusion, with potential to improve other aspects of their health and living conditions.
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Affiliation(s)
- Alex Stevens
- Social Policy, Sociology and Social Research, University of Kent, Medway, UK
| | - Jolie R Keemink
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Sam Shirley-Beavan
- Social Policy, Sociology and Social Research, University of Kent, Medway, UK
| | | | | | | | | | - Gillian W Shorter
- Drug and Alcohol Research Network, Queen's University Belfast, Belfast, UK
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3
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Todd-Kvam J, Clausen T. Practitioner perspectives on working with older patients in opioid agonist treatment (OAT) in Norway: opportunities and challenges. Addict Sci Clin Pract 2024; 19:44. [PMID: 38783382 PMCID: PMC11118995 DOI: 10.1186/s13722-024-00473-7] [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: 08/01/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Norway has a growing proportion of ageing opioid agonist treatment (OAT) patients, with 42% of the 8300 Norwegian OAT patients aged over 50 in 2022. This study aims to explore practitioners' views and experiences from treatment of ageing OAT patients. METHODS Data were collected as a series of semi-structured interviews with treatment staff (roles interviewed: doctor, psychologist, social worker, nurse, and learning disability nurse). Participants were recruited from three OAT outpatient clinics, one with an urban catchment area and two with a mix of urban and rural. The interviews incorporated questions on patients' somatic and mental health, strengths and weaknesses of the service for this group, and patients' quality of life. RESULTS Older patients were perceived to be more often stable in terms of substance use and housing situation, but also experiencing some key challenges in terms of cognitive impairment, loneliness and isolation, and comorbidities. Both the practitioner-patient relationship and healthcare interactions outside OAT had the potential to impact treatment quality positively or negatively depending on how they were managed. CONCLUSIONS Treating older patients in a way that respects and enhances their dignity is important. We argue that this requires better services for those whose functioning is impacted by cognitive impairment/dementia, an age-informed treatment model for this patient group, along with urgent work to improve municipal-level services given practitioners describe them as unacceptable in certain areas.
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Affiliation(s)
- John Todd-Kvam
- Norwegian Centre for Addiction Research, University of Oslo, Blindern, Postboks 1039, 0315, Oslo, Norway.
- Sørlandet Sykehus HF, Lundsiden, Postboks 416, 4604, Kristiansand, Norway.
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, University of Oslo, Blindern, Postboks 1039, 0315, Oslo, Norway
- Sørlandet Sykehus HF, Lundsiden, Postboks 416, 4604, Kristiansand, Norway
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4
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Bakker A, Smith A, Liebrenz M. Comment on Domzaridou et al.: Recognising the complexities of co-prescriptions and lifestyle factors in opioid agonist treatment. Addiction 2024; 119:965-966. [PMID: 38221224 DOI: 10.1111/add.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Affiliation(s)
| | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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Amundsen EJ, Melsom AKM, Eriksen BO, Løchen ML. No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions. NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:111-130. [PMID: 38356787 PMCID: PMC10863554 DOI: 10.1177/14550725231195413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010-2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010-2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed.
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Affiliation(s)
- Ellen J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne-Karine M Melsom
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Centre for Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn O Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway; Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Stam NC, Cogger S, Schumann JL, Weeks A, Roxburgh A, Dietze PM, Clark N. The onset and severity of acute opioid toxicity in heroin overdose cases: a retrospective cohort study at a supervised injecting facility in Melbourne, Australia. Clin Toxicol (Phila) 2022; 60:1227-1234. [PMID: 36200988 DOI: 10.1080/15563650.2022.2126371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To differentiate the severity of acute opioid toxicity and describe both the clinical and physiological features associated with heroin overdose in a cohort of witnessed overdose cases. METHODS Witnessed heroin overdose cases over a 12-month period (30 June 2018 - 30 June 2019) at the Medically Supervised Injecting Room (MSIR) in Melbourne, Australia were examined. The severity of acute opioid toxicity was classified according to the level of clinical intervention required to manage the overdose cases where an escalating level of care was provided. Heroin overdose cases were classified into one of three graded severity categories and a fourth complicated heroin overdose category. RESULTS A total of 1218 heroin overdose cases were identified from 60,693 supervised injecting visits over the study period. On the spectrum of toxicity, 78% (n = 955) of overdose cases were classified as Grade 1 severity, 7% (n = 83) as Grade 2 severity, and 13% (n = 161) as Grade 3 acute opioid toxicity severity cases, as well as 2% (n = 19) classified as complicated heroin overdose cases. The median onset time for heroin overdose cases was 17 min (IQR 11-28 min) from the time the individual was ready to prepare and inject heroin until clinical intervention was initiated. CONCLUSION We demonstrated that heroin overdose is a dynamic illness and cases differ in the severity of acute opioid toxicity. The risk of airway occlusion including positional asphyxia was an early and consistent feature across all levels of toxicity, while exaggerated respiratory depression together with exaggerated depression of consciousness was increasingly observed with greater levels of toxicity. We also demonstrated the importance of early intervention in overdose cases, where in a large cohort of heroin overdose cases there were no fatal outcomes, a very low hospitalisation rate and most cases were able to be managed to clinical resolution on-site.
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Affiliation(s)
- Nathan C Stam
- Medically Supervised Injecting Room, North Richmond Community Health, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Shelley Cogger
- Medically Supervised Injecting Room, North Richmond Community Health, Melbourne, Australia
| | - Jennifer L Schumann
- Drug Intelligence Unit, Victorian Institute of Forensic Medicine, Melbourne, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Anthony Weeks
- Medically Supervised Injecting Room, North Richmond Community Health, Melbourne, Australia
| | - Amanda Roxburgh
- Monash Addiction Research Centre, Monash University, Melbourne, Australia.,Health Risks Program, Burnet Institute, Melbourne, Australia.,National Drug and Alcohol Research Centre, University on New South Wales, Sydney, Australia.,Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Paul M Dietze
- Monash Addiction Research Centre, Monash University, Melbourne, Australia.,Health Risks Program, Burnet Institute, Melbourne, Australia.,National Drug Research Institute and enAble Institute, Curtin University, Melbourne, Australia
| | - Nicolas Clark
- Medically Supervised Injecting Room, North Richmond Community Health, Melbourne, Australia.,Department of Addiction Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Pharmacology, University of Adelaide, Adelaide, Australia
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Armoon B, Griffiths MD, Bayani A, Mohammadi R, Ahounbar E. Prevalence and associates of non-fatal overdose among people who inject drugs in Saveh, Iran. Addict Sci Clin Pract 2022; 17:42. [PMID: 35927753 PMCID: PMC9351099 DOI: 10.1186/s13722-022-00325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background As a public health issue, non-fatal overdose (NFOD) is highly prevalent among people who inject drugs (PWID). This can lead to an elevated risk of future overdose, causing various harms including possible death. It is essential to improve knowledge concerning this problem and its associated risk factors to inform overdose prevention and assistance programs. The primary aim of the present study was to determine the prevalence of NFOD and associated risk factors among PWID in Saveh, Iran. Methods In the present cross-sectional study, 272 PWID living in Saveh, Iran were interviewed face-to-face using a structured survey. Data concerning socio-demographics, substance use, risky behaviors, and services utilization data were collected. The outcome variable (i.e., NFOD) was assessed by answering “Yes” to the question: “In the past three months, have you ever overdosed (at least once) by accident?” Results The prevalence of NFOD among PWID in the past three months was 54%. The characteristics and behaviors that were associated with an increased risk of experiencing NFOD in the past three months were being of older age (AOR = 5.2, p < 0.05), drug use initiation under the age of 22 years (AOR = 7.8, p < 0.05), being an alcohol user (AOR = 3.0, p < 0.05), and being a simultaneous multiple drug user (AOR = 5.8, p < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing a non-fatal overdose in the past three months. Findings also indicated that those who (i) attended a needle and syringe program (AOR: 0.3, p < 0.05), (ii) were visited by a general practitioner (AOR: 0.03, p < 0.05), and (iii) received a psychosocial intervention (AOR: 0.1, p < 0.05) were 0.3, 0.03 and 0.1 times less likely to report non-fatal overdosing than other participants, respectively. Conclusions The results indicate that intervention and prevention initiatives seeking to reduce NFOD among PWID should not only be focused on the primary drug used but also the use of alcohol and polysubstance use. Specific and tailored psychological interventions combined with pharmacotherapy may be highly beneficial for PWID who experience more severe types of substance use, including alcohol use disorders and/or polysubstance abuse.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran. .,School of Nursing and Midwifery, Saveh University of Medical Sciences, Shahid Beheshti Blvd, Shahid Fahmideh Blvd, 4th floor, Saveh, Markazi Province, Iran.
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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8
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Lewer D, Brothers TD, Van Hest N, Hickman M, Holland A, Padmanathan P, Zaninotto P. Causes of death among people who used illicit opioids in England, 2001-18: a matched cohort study. Lancet Public Health 2022; 7:e126-e135. [PMID: 34906332 PMCID: PMC8810398 DOI: 10.1016/s2468-2667(21)00254-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND In many countries, the average age of people who use illicit opioids, such as heroin, is increasing. This has been suggested to be a reason for increasing numbers of opioid-related deaths seen in surveillance data. We aimed to describe causes of death among people who use illicit opioids in England, how causes of death have changed over time, and how they change with age. METHODS In this matched cohort study, we studied patients in the Clinical Practice Research Datalink with recorded illicit opioid use (defined as aged 18-64 years, with prescriptions or clinical observations that indicate use of illicit opioids) in England between Jan 1, 2001, and Oct 30, 2018. We also included a comparison group, matched (1:3) for age, sex, and general practice with no records of illicit opioid use before cohort entry. Dates and causes of death were obtained from the UK Office for National Statistics. The cohort exit date was the earliest of date of death or Oct 30, 2018. We described rates of death and calculated cause-specific standardised mortality ratios. We used Poisson regression to estimate associations between age, calendar year, and cause-specific death. FINDINGS We collected data for 106 789 participants with a history of illicit opioid use, with a median follow-up of 8·7 years (IQR 4·3-13·5), and 320 367 matched controls with a median follow-up of 9·5 years (5·0-14·4). 13 209 (12·4%) of 106 789 participants in the exposed cohort had died, with a standardised mortality ratio of 7·72 (95% CI 7·47-7·97). The most common causes of death were drug poisoning (4375 [33·1%] of 13 209), liver disease (1272 [9·6%]), chronic obstructive pulmonary disease (COPD; 681 [5·2%]), and suicide (645 [4·9%]). Participants with a history of illicit opioid use had higher mortality rates than the comparison group for all causes of death analysed, with highest standardised mortality ratios being seen for viral hepatitis (103·5 [95% CI 61·7-242·6]), HIV (16·7 [9·5-34·9]), and COPD (14·8 [12·6-17·6]). In the exposed cohort, at age 20 years, the rate of fatal drug poisonings was 271 (95% CI 230-313) per 100 000 person-years, accounting for 59·9% of deaths at this age, whereas the mortality rate due to non-communicable diseases was 31 (16-45) per 100 000 person-years, accounting for 6·8% of deaths at this age. Deaths due to non-communicable diseases increased more rapidly with age (1155 [95% CI 880-1431] deaths per 100 000 person-years at age 50 years; accounting for 52·0% of deaths at this age) than did deaths due to drug poisoning (507 (95% CI 452-562) per 100 000 person-years at age 50 years; accounting for 22·8% of deaths at this age). Mirroring national surveillance data, the rate of fatal drug poisonings in the exposed cohort increased from 345 (95% CI 299-391) deaths per 100 000 person-years in 2010-12 to 534 (468-600) per 100 000 person-years in 2016-18; an increase of 55%, a trend that was not explained by ageing of participants. INTERPRETATION People who use illicit opioids have excess risk of death across all major causes of death we analysed. Our findings suggest that population ageing is unlikely to explain the increasing number of fatal drug poisonings seen in surveillance data, but is associated with many more deaths due to non-communicable diseases. FUNDING National Institute for Health Research.
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Affiliation(s)
- Dan Lewer
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Thomas D Brothers
- Department of Epidemiology and Public Health, University College London, London, UK; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Naomi Van Hest
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Holland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, London, UK
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Armoon B, Higgs P, Mohammadi R. Mental health status, health service utilization, drug use behaviors associated with non-fatal overdose among people who use illicit drugs: A meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2019331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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10
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Armoon B, Mohammadi R, Fattah Moghaddam L, Gonabadi-Nezhad L. Type of drug use and risky determinants associated with fatal overdose among people who use drugs: a meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2019329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Leila Gonabadi-Nezhad
- Department of Psychiatry, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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11
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Lee J, Salloum RG, Lindstrom K, Kathryn McHugh R. Benzodiazepine misuse and cigarette smoking status in US adults: Results from the National Survey on Drug Use and Health, 2015-2018. Addict Behav 2021; 123:107058. [PMID: 34315094 DOI: 10.1016/j.addbeh.2021.107058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/25/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Benzodiazepines are the third most commonly misused drugs in the U.S. POPULATION There is a growing public health concern related to recent increases in benzodiazepine-related overdose deaths, emergency department visits, and treatment admissions. Although benzodiazepine misuse often occurs along with other drug use, little is known about the association between benzodiazepine and cigarette smoking. METHODS We used a pooled dataset from the National Survey on Drug Use and Health (NSDUH) for 2015-2018 (N = 171,766). We estimated a multivariable logistic regression model of past-year benzodiazepine misuse as a function of past-year tobacco use (cigarette smoking, other tobacco use), controlling for survey years, sociodemographics, past-year substance use, and psychiatric comorbidities. RESULTS Among the analytic sample (N = 171,766), 2.1% (weighted; unweighted n = 4,942) reported they misused benzodiazepines in the past 12 months. In the multivariable logistic regression model, correlates of past-year benzodiazepine misuse were past-year cigarette smoking (aOR = 1.85, 95% CI = 1.67, 2.06) and other tobacco use (e.g., cigars and smokeless tobacco) (aOR = 1.17, 95% CI = 1.03, 1.34), female (aOR = 1.14, 95% CI = 1.04, 1.26), uninsured (aOR = 1.26, 95% CI = 1.12, 1.42), past-year use of alcohol (aOR = 1.48, 95% CI = 1.21, 1.80), cannabis (aOR = 2.76, 95% CI = 2.46, 3.10), and other drugs (aOR = 7.92, 95% CI = 7.08, 8.86), as well as, past-year distress (aOR = 1.84, 95% CI = 1.61, 2.10), and depressive symptoms (aOR = 1.32, 95% CI = 1.16, 1.51). CONCLUSION Nicotine is independently associated with benzodiazepine misuse, even after controlling for other drug use and psychiatric variables. Future studies examining potential mechanisms linking nicotine and benzodiazepine use are necessary.
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Affiliation(s)
- Juhan Lee
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, United States; Department of Psychiatry, Yale School of Medicine, United States.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States
| | - Katie Lindstrom
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, United States
| | - R Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, MA, United States; Harvard Medical School, Boston, MA, United States
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12
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Armoon B, Bayani A, Griffiths MD, Bayat AH, Mohammadi R, Fattah Moghaddam L, Ahounbar E. Prevalence and high-risk behaviors associated with non-fatal overdose among people who use illicit opioids: A systematic review and meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1978112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bahram Armoon
- Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, Qc, Canada
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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13
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Peacock A, Tran LT, Larney S, Stockings E, Santo T, Jones H, Santomauro D, Degenhardt L. All-cause and cause-specific mortality among people with regular or problematic cocaine use: a systematic review and meta-analysis. Addiction 2021; 116:725-742. [PMID: 32857457 PMCID: PMC7914269 DOI: 10.1111/add.15239] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/02/2020] [Accepted: 08/24/2020] [Indexed: 12/29/2022]
Abstract
AIMS To estimate pooled all-cause and cause-specific mortality risk for people with regular or problematic cocaine use. METHODS Systematic review and meta-analysis of prospective or retrospective cohort studies or clinical trials (n ≥30) of people with regular or problematic cocaine use with data on all-cause or cause-specific mortality. Of 2808 papers, 28 were eligible and reported on 21 cohorts, with a total 170 019 individuals. Cohorts identified based on acute care for drug poisoning or other severe health presentation were excluded. Title/abstract screening was conducted by one reviewer; a second reviewer independently checked 10% of excluded studies. Two reviewers conducted full-text screening. Data were extracted by one reviewer and checked by a second. A customized review-specific study reporting quality/risk of bias tool was used. Data on crude mortality rates (CMR) and standardized mortality ratios were extracted for both all-cause and cause-specific mortality. Standardized mortality ratios were imputed where not provided by the author using extracted data and information from the Global Burden of Disease Study 2017. Data were pooled using a random-effects model. RESULTS The pooled all-cause crude mortality rate was 1.24 per 100 person-years [95% confidence interval (CI) = 0.86, 1.78; n = 16 cohorts], but with considerable heterogeneity (I2 = 98.8%). The pooled all-cause standardized mortality ratio (SMR) was 6.13 (95% CI = 4.15, 9.05; n = 16 cohorts). Suicide (SMR = 6.26, 95% CI = 2.84, 13.80), accidental injury (SMR = 6.36, 95% CI = 4.18, 9.68), homicide (SMR = 9.38, 95% CI 3.45-25.48) and AIDS-related mortality (SMR = 23.12, 95% CI = 11.30, 47.31) were all elevated compared with age and sex peers in the general population. CONCLUSIONS There are elevated rates of mortality among people with regular or problematic cocaine use for traumatic deaths and deaths attributable to infectious disease.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia,School of Psychology, University of Tasmania, Hobart, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Hayley Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Damian Santomauro
- Queensland Centre for Mental Health Research and School of Public Health, University of Queensland, Brisbane, Australia,Institute for Health metrics and Evaluation, University of Washington, Washington, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
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Gjersing L, Helle MK. Injecting Alone is More Common among Men, Frequent Injectors and Polysubstance Users in a Sample of People Who Inject Drugs. Subst Use Misuse 2021; 56:2214-2220. [PMID: 34565289 DOI: 10.1080/10826084.2021.1981388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Injecting alone increases the risk of a fatal overdose. We examined the extent of such behavior in a sample of people who inject drugs (PWID) and the typical characteristics of those injecting alone at least once during the past four weeks. A cross-sectional study. PWID recruited from the street and from low-threshold services in seven Norwegian cities in September 2017 (n = 359). Associations between characteristics and injecting alone were examined using logistic regression analysis. The independent variables were gender (female/male), age, having received overdose-prevention education (no/yes), and, in the past four weeks; homelessness/shelter use (no/yes), in opioid substitution treatment (no/yes), injecting ≥ four days a week (no/yes), and substances injected (opioids only/opioids and other/other only/central stimulants (CS) only/CS and other/CS and opioids/CS, opioids and other). The adjusted odds ratios (aOR) and 95% Confidence Intervals (CI) were reported. Of the 359 PWID, 84.4% reported having injected alone. Males were more likely than females to inject alone (aOR = 1.88 95% CI 1.00-3.54). Furthermore, those injecting frequently (aOR = 1.99 95% CI 1.02-3.86) and those injecting multiple substances (CS, opioids and other) (aOR = 2.94 95% CI 1.01-8.58) were more likely to inject alone compared to those injecting less frequently and opioids only. Although not statistically significant, the effect sizes in the logistic regression models suggest that polysubstance use may be driven by CS use. Injecting alone was common in our sample of PWID, and male gender, frequent injecting and polysubstance injecting were associated with this behavior.
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Affiliation(s)
- Linn Gjersing
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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15
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Bryson WC, Morasco BJ, Cotton BP, Thielke SM. Cannabis Use and Nonfatal Opioid Overdose among Patients Enrolled in Methadone Maintenance Treatment. Subst Use Misuse 2021; 56:697-703. [PMID: 33749499 DOI: 10.1080/10826084.2021.1892137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Some ecological studies found lower rates of opioid overdose in states with liberalized cannabis legislation, but results are mixed, and the association has not been analyzed in individuals. We quantified the association between cannabis use and nonfatal opioid overdose among individuals enrolled in methadone maintenance treatment (MMT) for opioid use disorder (OUD). METHODS We recruited a convenience sample of individuals enrolled in four MMT clinics in Washington State and southern New England who completed a one-time survey.Descriptive statistics and multivariate logistic regression compared the prevalence and risk of nonfatal opioid overdose in the past 12 months between participants reporting frequent (at least weekly) or infrequent (once or none) cannabis use in the past month. RESULTS Of 446 participants, 35% (n = 156) reported frequent cannabis use and 7% (n = 32) reported nonfatal opioid overdose in the past year. The prevalence of nonfatal opioid overdose was 3% among reporters of frequent cannabis use, and 9% among reporters of infrequent/no use (p = 0.02). After imputing missing data and controlling for demographic and clinical factors, the likelihood of self-reported nonfatal opioid overdose in the past year was 71% lower among reporters of frequent cannabis use in the past month (adjusted RR = 0.29, 95% CI 0.10-0.80, p = 0.02). CONCLUSIONS Among individuals enrolled in MMT, frequent cannabis use in the past month was associated with fewer self-reported nonfatal opioid overdoses in the past year. Methodological limitations caution against causal interpretation of this relationship. Additional studies are needed to understand the prospective impact of co-occurring cannabis on opioid-related outcomes.
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Affiliation(s)
- William C Bryson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Benjamin J Morasco
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Brandi P Cotton
- College of Nursing, University of Rhode Island, Providence, RI, USA
| | - Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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16
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Frequent Alcohol Intoxication and High Alcohol Tolerance During Adolescence as Predictors of Mortality: A Birth Cohort Study. J Adolesc Health 2020; 67:692-699. [PMID: 32873498 DOI: 10.1016/j.jadohealth.2020.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Long-term prospective studies evaluating the health burden that is consequent to adolescent drinking are needed. The aim of this study was to examine the predictive associations between self-reported alcohol tolerance and frequent intoxication at age 15-16 years and the risk of death by age 33 years. METHODS A sample (n = 6,615; 49.3% males) of the Northern Finland Birth Cohort Study 1986 was studied. Self-reported alcohol tolerance (drinks needed to feel intoxicated) and frequency of alcohol intoxication at age 15-16 years were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Categories were formed for both predictive variables from self-reported tolerance and frequency of intoxication in mid-adolescence. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30 years. RESULTS By the age of 33 years, of all 6,615 participants, 53 (.8%) were deceased. The HR for death by age 33 years was 3.08 (95% CI 1.17-8.07) among adolescents with high alcohol tolerance compared with adolescents without alcohol use or intoxication. The frequency of alcohol intoxication was also associated with mortality; HR 2.05 (95% CI 1.01-4.16) for those who had been intoxicated one to two times and HR 3.02 (95% CI 1.21-7.54) for those who had been intoxicated three or more times in the past 30 days compared with adolescents without intoxication. CONCLUSIONS High self-reported alcohol tolerance and frequent alcohol intoxication during mid-adolescence significantly predicted death by age 33 years. These behaviors carry long-term repercussions with respect to premature loss of life. Substantial efforts should be made to diminish this mortality risk.
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Noroozi M, Higgs P, Bayani A, Armoon B, Astaneh AN, Moghaddam LF, Askari M. Non -fatal overdose among people who inject drugs in Tehran, Iran. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:80. [PMID: 33054806 PMCID: PMC7559998 DOI: 10.1186/s13011-020-00323-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND With increasing frequencies of non-fatal overdose in people who inject drugs (PWID), it is essential to improve our knowledge about associated risk factors for overdose to inform overdose prevention and assistance programs. The aim of present study was to determine the prevalence of non-fatal overdose and the associated risk factors among PWID in Tehran, Iran. METHODS Snowball sampling was used to collect data from 465 participants in Tehran using a cross-sectional survey. Consenting participants who reported drug injecting in the past month and were able to speak and comprehend Farsi enough to respond to survey questions were interviewed. The endpoint of interest was non-fatal overdose in the previous 6 months, or answering "Yes" to the question: "In the last six months, have you ever overdosed by accident? (at least once)". We used STATA v. 14 for this analysis. Statistical significance was defined as p < 0.05 for all analyses. RESULTS Of 465 PWIDs who participated in this study, all were male, and about half had less than a high school education. The prevalence of self-reported non-fatal overdose in the past 6 months was 38% (CI95%: 34, 43%). Our findings indicate that characteristics and behaviors that were associated with an increased risk of experiencing an overdose in the past 6 months were drug use initiation under 22 years (AOR =2.2, P < 0.05), using methamphetamine (AOR =2.8, P < 0.05), and using multiple drugs at the same time (AOR =2.1, P < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing an overdose in the past 6 months. The odds of experiencing a non-fatal overdose among PWIDs who regularly attended NSP were 0.6 times less than for those who did not attend regularly (OR = 0.6,95% CI: 0.2-0.9). CONCLUSION Methamphetamine and alcohol use were the most significant association for non-fatal overdose among PWIDs. Our results indicate that intervention and prevention initiatives seeking to reduce overdoses among PWIDs should not only be focused on the primary drug used but also the use of alcohol and poly-drug use.
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Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Ali Nazeri Astaneh
- Department of Psychiatry, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Baseline Factors Associated with Mortality in Patients Who Engaged in Buprenorphine Treatment for Opioid Use Disorder: a Cohort Study. J Gen Intern Med 2020; 35:2375-2382. [PMID: 32206993 PMCID: PMC7403281 DOI: 10.1007/s11606-020-05779-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Opioid agonist therapy (OAT) has been shown to reduce mortality in patients with opioid use disorder (OUD), yet mortality in individuals receiving OAT remains higher than in an age- and gender-matched population. OBJECTIVE To identify baseline risk factors in patients who engaged in buprenorphine treatment that are associated with this elevated risk of death. DESIGN We performed a retrospective cohort study from January 1, 2007, to December 31, 2018, using a centralized clinical data registry within a multi-hospital health system in Boston, MA, USA. PARTICIPANTS All adult patients who had ≥ 2 consecutive encounters with sublingual buprenorphine on the active medication list from January 1, 2007, to December 31, 2018. MAIN MEASURES We abstracted several sociodemographic, clinical, and healthcare use characteristics from the clinical data registry. The primary outcome was all-cause mortality and the secondary outcome was opioid overdose-related mortality. We performed multivariable cox regression to identify baseline characteristics independently associated with these outcomes. KEY RESULTS Of 5948 patients in the cohort, the majority were white (80.7%) and male (59.7%), with a mean age of 38.2 years. The all-cause mortality rate was 24.0 deaths per 1000 person-years. Baseline characteristics independently associated with an increased hazard of all-cause mortality included homelessness (adjusted hazard ratio [aHR] = 1.39; 95% confidence interval [CI] = 1.09, 1.78), an opioid on the active medication list (aHR = 1.28; 95% CI = 1.08, 1.52), and entry into the cohort during an inpatient hospitalization (aHR = 1.43; 95% CI = 1.18, 1.73). Homelessness was also associated with an increased hazard of opioid overdose-related mortality (aHR = 1.77; 95% CI = 1.25, 2.50). CONCLUSIONS We identified several novel and potentially modifiable predictors of mortality among patients engaging in buprenorphine treatment who remain at an increased risk of death compared with the general population. Understanding these risk factors can assist healthcare providers in risk stratification and inform the design of targeted interventions to improve outcomes in a high-risk patient population.
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19
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Dong H, Hayashi K, Milloy MJ, DeBeck K, Singer J, Wong H, Wood E, Kerr T. Changes in substance use in relation to opioid agonist therapy among people who use drugs in a Canadian setting. Drug Alcohol Depend 2020; 212:108005. [PMID: 32370932 PMCID: PMC7462099 DOI: 10.1016/j.drugalcdep.2020.108005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although previous studies have shown that opioid agonist therapy (OAT) is linked to reductions in illicit opioid use, less is known about how OAT impacts the use of other psychoactive substances. We aimed to examine the changes in use of different substances by comparing patterns before and after initiating OAT. METHODS Data for this study was derived from three ongoing prospective cohorts involving people who use drugs in Vancouver, Canada from 1996 to 2018. We assessed use patterns for heroin, illicit prescription opioid, cocaine, crack cocaine, crystal methamphetamine, cannabis, daily alcohol use, and benzodiazepines. Segmented regression was conducted to compare the trends of substance use between pre-treatment and post-treatment periods. RESULTS The study included 1107 participants. After OAT engagement, we observed an immediate decline in the proportion as well as a decreasing trend for heroin (Adjusted Odds Ratio (AOR): 0.80, 95% confidence interval (CI): 0.77, 0.83), illicit prescription opioid (AOR: 0.87, 95% CI: 0.83, 0.90), and benzodiazepines (AOR: 0.73, 95 % CI: 0.67, 0.80). There was no significant difference comparing the pre-treatment and post-treatment trends for cocaine, crack cocaine, crystal methamphetamine, and cannabis. However, higher growth slope was noted during the post-treatment period for daily alcohol use (P = 0.016). CONCLUSIONS We observed significant reduction in illicit opioids use following OAT initiation, but not for stimulant and cannabis. The increasing problematic use of alcohol may pose challenges to the safety and effectiveness of OAT. Development of comprehensive and tailored treatment strategies is needed for poly-substance users accessing OAT.
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Affiliation(s)
- Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia V5Z 1Y6, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia V5Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada.
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20
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Ünübol H, Sayar GH. Substance use and its risk factors in Turkey: a nationally representative sample study. J Ethn Subst Abuse 2020; 21:476-498. [DOI: 10.1080/15332640.2020.1781731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Pitkänen T, Kaskela T, Levola J. Mortality of treatment-seeking men and women with alcohol, opioid or other substance use disorders - A register-based follow-up study. Addict Behav 2020; 105:106330. [PMID: 32088539 DOI: 10.1016/j.addbeh.2020.106330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/13/2020] [Accepted: 01/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol (AUD), opioid (OUD) and other substance use disorders (SUD) are associated with an increased risk of premature death. The aim of this register-based follow-up study was to compare the risk of death between individuals who had sought treatment for AUDs, OUDs and other SUDs in Finland. DESIGN, SETTING, PARTICIPANTS Data included 10,888 individuals who had sought help from three clinics at some point between 1990 and 2009. Treatment data were linked to national register data concerning education, hospitalizations and death by the year 2018. MEASUREMENTS Individuals were categorized into four groups: only alcohol (AUD-only), all OUDs (OUD-all), other or multiple SUDs (SUD-other) and outpatients without substance-related diagnoses or hospitalizations (SU-NAS); in mortality analyses, those who had started in opioid substitution treatment (OST) were analyzed separately. COX regression analyses were used to calculate the risk of death by the year 2018 or up to 15 years after seeking treatment. RESULTS Among the 10,888 treatment-seeking individuals the cumulative mortality rates during 1-, 5- and 15-year follow-up were 2.5% (n = 271), 10.9% (n = 1191) and 28.4% (n = 3096), respectively. The mean age at death varied according to substance of use (55.0 years for AUD-only, 35.8 OUD-all, 45.8 SUD-other and 55.6 SU-NAS). The patients who had started in OST had a lower risk of death compared to the other groups, as did the SU-NAS group that likely included individuals with a less severe course of AUDs/SUDs. There were no differences between the AUD-only, OUD-other and SUD-other groups for the risk of death during the 15-year follow-up period when gender and year of birth were included as covariates. CONCLUSIONS The mortality rates were very high; however, most of the deaths occurred several years after seeking treatment. The lower mortality amongst the patients who had initiated OST solidifies previous knowledge on the benefits of OST and efforts should be made to improve access to treatment. These results show that treatment plays a role in lowering the risk of death among individuals with AUDs/SUDs.
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Affiliation(s)
- Tuuli Pitkänen
- A-Clinic Foundation, Ratamestarinkatu 7, FI-00520 Helsinki, Finland.
| | - Teemu Kaskela
- A-Clinic Foundation, Ratamestarinkatu 7, FI-00520 Helsinki, Finland.
| | - Jonna Levola
- A-Clinic Foundation, Ratamestarinkatu 7, FI-00520 Helsinki, Finland; Psychiatry, University of Helsinki and Helsinki University Hospital, HUS Psychiatry, Hyvinkää Area, Sibeliuksenkatu 4C, FI-04400 Järvenpää, Finland.
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22
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Mortality Among People With Opioid Use Disorder: A Systematic Review and Meta-analysis. J Addict Med 2020; 14:e118-e132. [DOI: 10.1097/adm.0000000000000606] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Andersson L, Håkansson A, Krantz P, Johnson B. Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances. Harm Reduct J 2020; 17:5. [PMID: 31918732 PMCID: PMC6953255 DOI: 10.1186/s12954-019-0354-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/27/2019] [Indexed: 12/23/2022] Open
Abstract
Background Opioid-related deaths have increased in Western countries over recent decades. Despite numerous studies investigating opioid-related mortality, only a few have focused on the lives of the deceased individuals prior to their deaths, specifically regarding contact with care-providing authorities such as health, social and correctional services. Furthermore, a change has been noted in the last two decades as to which opioids cause most deaths, from heroin to prescription opioids. However, studies comparing fatalities caused by different substances are rare. The aim of this study was to investigate contact with care-providing authorities during the year prior to death among individuals who died as a result of opioid intoxication and to analyse differences relating to which opioids caused their deaths. Methods The study is based on retrospective register data and includes 180 individuals with a history of illicit drug use, who died from opioid intoxication in Skåne, Sweden, between 1 January 2012 to 31 December 2013 and 1 July 2014 to 30 June 2016. Intoxications caused by heroin, methadone, buprenorphine and fentanyl were included. Data were collected from the National Board of Forensic Medicine, regional health care services, municipal social services and the Prison and Probation Service. Statistical testing was performed using Pearson’s chi-square test, Fisher’s exact test and the Mann-Whitney U test to analyse group differences. Results A total of 89% of the deceased individuals had been in contact with one or more of the care-providing authorities during the year prior to death; 75% had been in contact with health care, 69% with the social services, 28% with the Prison and Probation Service, and 23% had been enrolled in opioid substitution treatment at some point during their final year of life. Few differences appeared between the substance groups with regard to which opioid contributed to the death. In addition to opioids, sedatives were present in more than 80% of the cases. Individuals whose deaths were buprenorphine-related had been in contact with the social services to a significantly lesser extent during the year prior to death. Conclusions The studied population is characterised by extensive contact with care-providing authorities, thus providing numerous opportunities for authorities to reach this group with preventive and other interventions. Few differences emerged between groups with regard to which opioid had contributed to the death.
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Affiliation(s)
- Lisa Andersson
- Department of Social Work, Faculty of Health and Society, Malmö University, Malmö, Sweden.
| | - Anders Håkansson
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.,Malmö Addiction Centre, Region Skåne, Malmö, Sweden
| | - Peter Krantz
- Faculty of Medicine, Department of Clinical Sciences Lund, Forensic Medicine, Lund University, Lund, Sweden
| | - Björn Johnson
- Department of Social Work, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Karjalainen K, Haukka J, Kuussaari K, Hautala S, Hakkarainen P. Mortality and causes of death among people suspected of driving under the influence and testing positive for multiple substances. Scand J Public Health 2019; 48:809-816. [PMID: 31856686 DOI: 10.1177/1403494819894166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Understanding the mortality of drug users using multiple substances is helpful in preventing the harmful effects of polydrug use. We examined overall and cause-specific mortality and differences in mortality based on social background among people suspected of driving under the influence and testing positive for multiple substances (DUIMS) compared with the general Finnish population. Methods: Register data from 785 DUIMS during 2003-2006 were studied, with a reference population (n = 25,381) drawn from the general Finnish population. The effect of DUIMS on all-cause and cause-specific mortality was estimated using a Poisson regression model. Results: DUIMS had an increased risk of death compared with the general population (MRR 5.3, 95% CI 4.2-6.6). The most common causes of death in DUIMS were poisonings (37.9%) and suicides (13.6%), whereas in the reference population these were cardiovascular diseases (30.8%) and cancer (26.6%). The cause-specific risk of death among DUIMS was higher in all observed causes of death, except for cancer. The effect of DUIMS on mortality was modified by age, employment status and marital status; DUIMS was associated with an elevated risk of death especially in younger age groups and in singles. Conclusions: DUIMS indicates higher mortality, and DUIMS' profiles in causes of death differ from the general population. Elevated risk for, for instance, suicidal, accidental and violent death among those using multiple substances highlights the need to also pay attention to causes of death other than poisoning/overdose.
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Affiliation(s)
- Karoliina Karjalainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, University of Helsinki, Finland
| | - Kristiina Kuussaari
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
| | - Sanna Hautala
- Faculty of Social Sciences, University of Lapland, Finland
| | - Pekka Hakkarainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
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Drug-related mortality after discharge from treatment: A record-linkage study of substance abuse clients in Texas, 2006-2012. Drug Alcohol Depend 2019; 204:107473. [PMID: 31520924 DOI: 10.1016/j.drugalcdep.2019.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/23/2019] [Accepted: 05/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients have higher mortality immediately after substance abuse treatment discharge, but there are few data on post-discharge mortality differences across treatment modalities. METHODS A retrospective cohort study examined individuals discharged from substance abuse treatment during 2006-2012 and probabilistically matched treatment records to death records. Logistic regression examined associations between drug-related death (DRD) and demographics; route, frequency, and classes of drugs abused; and treatment. Primary outcome was DRD during post-discharge days 0-28; secondary outcomes examined DRD during days 29-90 and 91-365. RESULTS We examined 178,749 patients discharged from 254,814 treatment episodes. There were 97 DRD during days 0-28 (4.1/1000 person-years), 115 DRD during days 29-90 (2.6/1000 person-years; IRR 0.6 [95% CI 0.5-0.8]), and 293 DRD during days 91-365 (1.9/1000 person-years; IRR 0.5 [0.4-0.6]). Higher 28-day DRD was associated with abuse of opioids (aOR 2.5 [1.4-4.4]), depressants (aOR 2.0 [1.2-3.4]), or alcohol (aOR 1.7 [1.1-2.6]); and opioid injection (aOR 2.2 [1.3-3.7]). Lower DRD was associated with treatment completion (aOR 0.6 [0.4-0.9]), female sex (aOR 0.6 [0.4-0.8]), and employment (aOR 0.5 [0.3-0.9]). Among all patients, DRD rates were higher following residential (IRR 2.6, [1.6-4.2]) and detoxification (IRR 2.9, [1.7-4.9]) treatment compared to outpatient. Patients with prior opioid abuse had higher 28-day DRD after outpatient (6.7/1000 person-years; IRR 4.1 [1.8-9.1]), residential (13.6/1000 person-years; IRR 4.2 [2.2-8.2]), and detoxification (8.8/1000 person-years; IRR 3.2 [1.2, 8.5]) compared to those without. CONCLUSIONS Drug-related mortality is highest during days 0-28 after discharge, especially following residential and detoxification treatment. Opioid abuse is strongly associated with early post-discharge mortality.
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Pv A, Jun Wen T, Karuvetil MZ, Cheong A, Cheok C, Kandasami G. Unnatural Death among Treatment Seeking Substance Users in Singapore: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2743. [PMID: 31370374 PMCID: PMC6695629 DOI: 10.3390/ijerph16152743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
Abstract
Substance use carries a higher risk of unnatural death. A retrospective analysis of 42 treatment seekers between 2011-2015 was conducted through medical record review to understand the profile and circumstances leading to premature deaths. Ninety percent of the subjects were males. The mean age at death was 44.9 (SD ± 13.1). Opioids (52.4%), benzodiazepines (45.2%) and alcohol (35.7%) were the main substances used by the group. Suicide was the most common cause of death (n = 27, 64.3%) followed by accidents (n = 15; 35.7%). Among the suicide cases, alcohol was the main substance used (33.3%) followed by opioids (25.9%). A total of 58.5% (n = 24) deaths occurred within a year of their last visit while 41.5% (n = 17) were dead more than a year after their last visit. Of the total cases (n = 41), 63% had a history of mental illness with depressive disorder (53.8%) being the most common. History of suicide attempts were reported in 34.1% (n = 14) of cases and 50% of the subjects (n = 21) had a history of suicidal ideation. Drug related offences were reported in 57.1% of the subjects, of which 60% (n = 18) committed suicide. The findings support the need for appropriate treatment resources to reduce the untimely deaths among substance users.
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Affiliation(s)
- Asharani Pv
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Tan Jun Wen
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Mohamed Zakir Karuvetil
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Alvin Cheong
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Christopher Cheok
- Forensic Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Gomathinayagam Kandasami
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
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Kearley BW, Cosgrove JA, Wimberly AS, Gottfredson DC. The impact of drug court participation on mortality: 15-year outcomes from a randomized controlled trial. J Subst Abuse Treat 2019; 105:12-18. [PMID: 31443886 DOI: 10.1016/j.jsat.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/14/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
Abstract
AIM To test the effects of drug court participation on long-term mortality risk. METHODS During 1997-98, 235 individuals charged with a non-violent offense were randomly assigned to Baltimore City Drug Treatment Court (BCDTC) or traditional adjudication. Heroin was the predominant substance of choice among the sample. Participant mortality was observed for 15 years following randomization. RESULTS Over 20% of participants died during the study, at an average age of 46.6 years, and 64.4% of deaths were substance-use related. Survival analyses estimated that neither mortality from any cause nor from substance use-related causes significantly differed between BCDTC and traditional adjudication. CONCLUSIONS Frequent and premature death among the sample indicates that this is a high-risk population in need of effective substance use treatment. Roughly half of drug treatment courts are now estimated to offer medication assisted treatment (MAT), which is currently the most effective treatment for opioid use disorders. In this study of BCDTC implemented over 15 years ago, only 7% of participants received MAT, which may explain the lack of program impact on mortality. Historical barriers to providing MAT in drug court settings include access, concerns about diversion, negative attitudes, blanket prohibitions, and stigma. Drug treatment courts should implement best practice standards for substance use treatment and overdose prevention, including increased access to MAT and naloxone, and training to reduce stigmatizing language and practice.
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Affiliation(s)
- Brook W Kearley
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA.
| | - John A Cosgrove
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA.
| | - Alexandra S Wimberly
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA.
| | - Denise C Gottfredson
- University of Maryland, Department of Criminology and Criminal Justice, 2220 Samuel J. LeFrak Hall, 7251 Preinkert Drive, College Park, MD 20742, USA.
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Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019; 200:95-114. [PMID: 31121495 PMCID: PMC6639084 DOI: 10.1016/j.drugalcdep.2019.02.033] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. METHODS PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. RESULTS The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. CONCLUSIONS Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
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Affiliation(s)
- Victoria R. Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA,Corresponding author: Victoria R. Votaw, Clinical Psychology Ph.D. Student Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, Albuquerque, NM 87131,
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Maya M. Rieselbach
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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Fridell M, Bäckström M, Hesse M, Krantz P, Perrin S, Nyhlén A. Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders: a 42-year follow-up. BMC Psychiatry 2019; 19:150. [PMID: 31092225 PMCID: PMC6518448 DOI: 10.1186/s12888-019-2098-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We need to better understand how the use of different substances and psychiatric comorbidity influence premature death generally and cause-specific death by overdose, intoxication and somatic disorders in people with substance use disorders. METHOD A cohort of 1405 patients consecutively admitted to a Swedish detoxification unit for substance use disorders in 1970-1995 was followed-up for 42 years. Substances were identified by toxicological analyses. Mortality figures were obtained from a national registry. Causes of death were diagnosed by forensic autopsy in 594 patients deceased by 2012. Predictions were calculated by competing risks analysis. RESULTS Forty-two per cent of the cohort died during follow-up; more men than women (46.3% vs 30.4%). The standardised mortality ratio (SMR) was calculated as the ratio of observed deaths in males and females in specific age groups in the cohort versus expected deaths in corresponding groups in the general population. SMR was 5.68 for men (CI 95%; 5.04-6.11) and 4.98 (CI 95%; 4.08-5.88) for women. The crude mortality rate (number of deaths divided by number of person observation years) was 2.28% for men and 1.87% for women. Opiates predicted increased risk of premature death while amphetamine and cannabis predicted lower risk. Comorbid psychiatric disorders were identified in 378 cases and personality disorders in 763 cases. Primary psychoses or mood/depression and anxiety disorders predicted a higher risk of premature mortality. Death by overdose was predicted by male gender, younger age at admission to substance treatment, opiate use, and comorbid depression and anxiety syndromes. Cannabis and amphetamine use predicted a lower risk of overdose. Death by intoxication was predicted by male gender, use of sedatives/hypnotics or alcohol/mixed substances, primary psychoses and depression/anxiety syndromes. Premature death by somatic disorder was predicted by male gender and alcohol/mixed abuse. CONCLUSION Psychiatric comorbid disorders were important risk factors for premature drug-related death. Early identification of these factors may be life-saving in the treatment of patients with substance use disorders.
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Affiliation(s)
- Mats Fridell
- Department of Psychology, Lund University, SE-22100, Lund, Sweden.
| | - Martin Bäckström
- 0000 0001 0930 2361grid.4514.4Department of Psychology, Lund University, SE-22100 Lund, Sweden
| | - Morten Hesse
- 0000 0001 1956 2722grid.7048.bCentre for Alcohol and Drug Research, University of Aarhus, Bartholins Allé, 8000 Århus C, Denmark
| | - Peter Krantz
- 0000 0004 0623 9987grid.411843.bDepartment of Forensic Medicine, Lund University Hospital, SE-22185 Lund, Sweden
| | - Sean Perrin
- 0000 0001 0930 2361grid.4514.4Department of Psychology, Lund University, SE-22100 Lund, Sweden
| | - Anna Nyhlén
- 0000 0004 0623 9987grid.411843.bDepartment of Psychiatry, Malmo University Hospital, SE-20502, Malmo, Sweden
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Herring AA, Perrone J, Nelson LS. Managing Opioid Withdrawal in the Emergency Department With Buprenorphine. Ann Emerg Med 2019; 73:481-487. [DOI: 10.1016/j.annemergmed.2018.11.032] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 11/28/2022]
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Hjemsæter AJ, Bramness JG, Drake R, Skeie I, Monsbakken B, Benth JŠ, Landheim AS. Mortality, cause of death and risk factors in patients with alcohol use disorder alone or poly-substance use disorders: a 19-year prospective cohort study. BMC Psychiatry 2019; 19:101. [PMID: 30922325 PMCID: PMC6437965 DOI: 10.1186/s12888-019-2077-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study investigated cause of death, mortality rates and explored if baseline characteristics were associated with risk of death in patients with alcohol use disorder alone or poly-substance use disorders. METHODS This was a prospective, longitudinal study of patients followed for 19 years after entering specialized treatment for substance use disorders. At baseline 291 patients (mean age 38.3 years, standard deviation 11.4 years, 72% male) with high psychiatric co-morbidity were recruited; 130 (45%) had lifetime alcohol use disorder alone, while 161 (55%) had poly-substance use disorders. Time and causes of death were gathered from the Norwegian Cause of Death Registry. Lifetime psychiatric symptom disorders and substance use disorders at baseline were measured with The Composite International Diagnostic Interview and personality disorders at baseline were measured with The Millon Clinical Multiaxial Inventory II. RESULTS Patients with alcohol use disorder alone more often died from somatic diseases (58% versus 28%, p = 0.004) and more seldom from overdoses (9% versus 33%, p = 0.002) compared with patients with poly-substance use disorders. The crude mortality rate per 100 person year was 2.2 (95% confidence interval: 1.8-2.7), and the standardized mortality rate was 3.8 (95% confidence interval: 3.2-4.6) in the entire cohort during 19 years after entering treatment. Having lifetime affective disorder at baseline was associated with lower risk of death (Hazard Ratio 0.58, 95% confidence interval: 0.37-0.91). Older age was associated to increased risk of death among men (p < 0.001) and non-significantly among patients with poly-substance use (p = 0.057). The difference in association between age and risk of death was significantly different between men and women (p = 0.011) and patients with alcohol use disorder alone and poly-substance use disorders (p = 0.041). CONCLUSIONS Patients with alcohol use disorder alone died more often from somatic disease than patients with poly-substance use disorders, and all subgroups of patients had an increased risk of death compared with the general population. Men with long-lasting substance use disorders are a priority group to approach with directed preventive measures for somatic health before they reach 50 years of age.
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Affiliation(s)
- Arne Jan Hjemsæter
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway.
- SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | | | - Ivar Skeie
- SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Innlandet Hospital Trust, Gjøvik, Norway
| | - Bent Monsbakken
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
- SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Oslo, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
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Stam NC, Gerostamoulos D, Pilgrim JL, Smith K, Moran L, Parsons S, Drummer OH. An analysis of issues in the classification and reporting of heroin-related deaths. Addiction 2019; 114:504-512. [PMID: 30397976 DOI: 10.1111/add.14486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/02/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the extent of variability in the reporting of heroin-related deaths in Victoria, Australia. Additionally, to identify opportunities to improve the accuracy and consistency of heroin-related death reporting by examining variability in the attribution, death certification, classification and coding of heroin-related death cases. METHODS Heroin-related deaths in Victoria, Australia during a 2-year period (2012-13) were identified using the National Coronial Information System (NCIS) and used as the 'gold standard' measure in this study. Heroin-related death data from the Australian Institute of Health and Welfare (AIHW) and Australian Bureau of Statistics (ABS) were then compared. Differences in the number of deaths reported as well as the classification and coding assigned to the identified heroin-related death cases were investigated by cross-referencing these data sets and examining the assigned ICD-10 codes. RESULTS A total of 243 heroin-related deaths were identified through the NCIS compared with 165 heroin-related deaths reported by the AIHW and assigned the heroin-specific ICD-10 code of T40.1. Forty per cent of all the missed heroin-related death cases resulted from either the attribution of the death to morphine toxicity or with non-specific drug toxicity certification; 30% occurred where the cases had been attributed to heroin but there were irregularities in death certification. Additional missed heroin-related death cases occurred as a result of late initial registration of these deaths to the Registry of Births, Deaths and Marriages, and where these cases were then not assessed by the ABS for classification and coding purposes. CONCLUSIONS In Victoria, Australia, in 2012 and 2013, the overall number of heroin-related deaths was under-reported by 32% compared with the number of deaths currently identified by the Australian Bureau of Statistics and reported by the Australian Institute of Health and Welfare.
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Affiliation(s)
- Nathan C Stam
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lauren Moran
- Mortality Data Centre, Health and Vital Statistics Section, Australian Bureau of Statistics, Brisbane, Australia
| | - Sarah Parsons
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Melbourne, Australia
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Korotayev A, Khaltourina D, Meshcherina K, Zamiatnina E. Distilled Spirits Overconsumption as the Most Important Factor of Excessive Adult Male Mortality in Europe. Alcohol Alcohol 2019; 53:742-752. [PMID: 30113627 DOI: 10.1093/alcalc/agy054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/03/2018] [Indexed: 02/04/2023] Open
Abstract
Aims To explain comprehensively variations in adult male mortality rate in Europe, and in particular, high mortality in some East European countries with particular focus on specific patterns of alcohol consumption. Short summary Per capita distilled spirits consumption is found to be the strongest determinant of the adult male mortality rate in Europe as soon as the unrecorded alcohol consumption is taken into account. It turns out to be much stronger than the other tested significant determinants such as per capita health expenditures, smoking prevalence, consumption of hard drugs and per capita consumption of vegetables and fruit. Methods Ordinary least squares (OLS) multiple regression with adult male mortality rate as a dependent variable, and various indicators of alcohol and drug consumption as well as logarithm of gross domestic product (GDP) per capita, logarithm of total per capita health expenditures, latitude (climatic factors), per capita fruit and vegetable consumption, smoking prevalence as independent factors. Results Per capita distilled spirits consumption turns out to be the strongest determinant of the adult male mortality rate in Europe as soon as the unrecorded alcohol consumption is taken into account. It turns out to be much stronger than the other tested significant determinants of the adult male mortality rate such as per capita health expenditures, smoking prevalence, consumption of hard drugs and per capita consumption of vegetables and fruit. Still, higher per capita wine consumption has turned out to be a marginally significant determinant of the higher adult male mortality rate in some tests. Latitude, beer and soft drug consumption have turned out insignificant in this study. Conclusions Spirits consumption is a major risk factor of adult male mortality, with significantly greater impact compared to beer and wine. Therefore, reduction in distilled spirits consumption in hard liquor drinking areas should be a major target in health policy.
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Affiliation(s)
- Andrey Korotayev
- Laboratory of Monitoring of Social Destabilization Risks, National Research University Higher School of Economics, 20 Myasnitskaya, Moscow, Russia.,Department of Risk Factor Prevention, Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, 11 Dobrolyubova, Moscow, Russia
| | - Daria Khaltourina
- Department of Risk Factor Prevention, Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, 11 Dobrolyubova, Moscow, Russia
| | - Kira Meshcherina
- Laboratory of Monitoring of Social Destabilization Risks, National Research University Higher School of Economics, 20 Myasnitskaya, Moscow, Russia
| | - Elena Zamiatnina
- Department of Risk Factor Prevention, Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, 11 Dobrolyubova, Moscow, Russia
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Madah‐Amiri D, Gjersing L, Clausen T. Naloxone distribution and possession following a large-scale naloxone programme. Addiction 2019; 114:92-100. [PMID: 30129078 PMCID: PMC6585734 DOI: 10.1111/add.14425] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/09/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
AIMS To examine uptake following a large-scale naloxone programme by estimating distribution rates since programme initiation and the proportion among a sample of high-risk individuals who had attended naloxone training, currently possessed or had used naloxone. We also estimated the likelihood of naloxone possession and use as a function of programme duration, individual descriptive and substance use indicators. DESIGN (1) Distribution data (June 2014-August 2017) and date of implementation for each city and (2) a cross-sectional study among a sample of illicit substance users interviewed September 2017. SETTING Seven Norwegian cities. PARTICIPANTS A total of 497 recruited users of illegal opioids and/or central stimulants. MEASUREMENTS Primary outcomes: naloxone possession and use. Random-intercepts logistic regression models (covariates: male, age, homelessness/shelter use, overdose, incarceration, opioid maintenance treatment, income sources, substance use indicators, programme duration). FINDINGS Overall, 4631 naloxone nasal sprays were distributed in the two pilot cities, with a cumulative rate of 495 per 100 000 population. In the same two cities, among high-risk individuals, 44% and 62% reported current naloxone possession. The possession rates of naloxone corresponded well to the duration of each participating city's distribution programme. Overall, in the six distributing cities, 58% reported naloxone training, 43% current possession and 15% naloxone use. The significant indicators for possession were programme duration [adjusted odds ratios (aOR) = 1.44, 95% confidence interval (CI = 0.82-2.37], female gender (aOR = 1.97, 95% CI = 1.20-3.24) and drug-dealing (aOR = 2.36, 95% CI = 1.42-3.93). The significant indicators for naloxone use were programme duration (aOR = 1.49 95%, CI = 1.15-1.92), homelessness/shelter use (aOR = 2.06, 95% CI = 1.02-4.17), opioid maintenance treatment (OMT) (aOR = 2.07, 95% CI = 1.13-3.78), drug-dealing (aOR = 2.40, 95% CI = 1.27-4.54) and heroin injecting (aOR = 2.13, 95% CI = 1.04-4.38). CONCLUSIONS A large-scale naloxone programme in seven Norwegian cities with a cumulative distribution rate of 495 per 100 000 population indicated good saturation in a sample of high-risk individuals, with programme duration in each city as an important indicator for naloxone possession and use.
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Affiliation(s)
| | | | - Thomas Clausen
- Norwegian Centre for Addiction ResearchUniversity of OsloOsloNorway
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Stam NC, Gerostamoulos D, Smith K, Pilgrim JL, Drummer OH. Challenges with take-home naloxone in reducing heroin mortality: a review of fatal heroin overdose cases in Victoria, Australia. Clin Toxicol (Phila) 2018; 57:325-330. [PMID: 30451007 DOI: 10.1080/15563650.2018.1529319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM Take-home naloxone (THN) programs have been implemented in order to reduce the number of heroin-overdose deaths. Because of recent legislative changes in Australia, there is a provision for a greater distribution of naloxone in the community, however, the potential impact of these changes for reduced heroin mortality remains unclear. The aim of this study was to examine the characteristics of the entire cohort of fatal heroin overdose cases and assess whether there was an opportunity for bystander intervention had naloxone been available at the location and time of each of the fatal overdose events to potentially avert the fatal outcome in these cases. METHODS The circumstances related to the fatal overdose event for the cohort of heroin-overdose deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated. Coronial data were investigated for all cases and data linkage was performed to additionally investigate the Emergency Medical Services information about the circumstances of the fatal heroin overdose event for each of the decedents. RESULTS AND DISCUSSION There were 235 fatal heroin overdose cases identified over the study period. Data revealed that the majority of fatal heroin overdose cases occurred at a private residence (n = 186, 79%) and where the decedent was also alone at the time of the fatal overdose event (n = 192, 83%). There were only 38 cases (17%) where the decedent was with someone else or there was a witness to the overdose event, and in half of these cases the witness was significantly impaired, incapacitated or asleep at the time of the fatal heroin overdose. There were 19 fatal heroin overdose cases (8%) identified where there was the potential for appropriate and timely intervention by a bystander or witness. CONCLUSION This study demonstrated that THN introduction alone could have led to a very modest reduction in the number of fatal heroin overdose cases over the study period. A lack of supervision or a witness to provide meaningful and timely intervention was evident in most of the fatal heroin overdose cases.
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Affiliation(s)
- Nathan C Stam
- a Department of Forensic Medicine , Monash University , Melbourne , Australia.,b Department of Community Emergency Health and Paramedic Practice , Monash University , Melbourne , Australia
| | | | - Karen Smith
- b Department of Community Emergency Health and Paramedic Practice , Monash University , Melbourne , Australia.,d Centre for Research and Evaluation , Ambulance Victoria , Melbourne , Australia.,e Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia
| | - Jennifer L Pilgrim
- a Department of Forensic Medicine , Monash University , Melbourne , Australia
| | - Olaf H Drummer
- a Department of Forensic Medicine , Monash University , Melbourne , Australia
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Stam NC, Gerostamoulos D, Gerstner-Stevens J, Scott N, Smith K, Drummer OH, Pilgrim JL. Determining the effective dose of street-level heroin: A new way to consider fluctuations in heroin purity, mass and potential contribution to overdose. Forensic Sci Int 2018; 290:219-226. [DOI: 10.1016/j.forsciint.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/04/2023]
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Stam NC, Pilgrim JL, Drummer OH, Smith K, Gerostamoulos D. Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment. Clin Toxicol (Phila) 2018; 56:1135-1142. [DOI: 10.1080/15563650.2018.1478093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nathan C. Stam
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | | | - Olaf H. Drummer
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Victorian Institute of Forensic Medicine, Melbourne, Australia
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Yule AM, Lyons RM, Wilens TE. Opioid Use Disorders in Adolescents-Updates in Assessment and Management. CURRENT PEDIATRICS REPORTS 2018; 6:99-106. [PMID: 30895165 PMCID: PMC6422350 DOI: 10.1007/s40124-018-0161-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW To review information specific to adolescents regarding trends in opioid use, risk factors for opioid misuse, medical co-morbidity, and treatment updates. RECENT FINDINGS Although opioid misuse in adolescents is uncommon, it is associated with morbidity and mortality such as hepatitis C and overdose. Adolescents commonly start with prescription opioid misuse before transitioning to heroin use. The existing literature supports the use of buprenorphine/naloxone for the treatment of adolescent opioid use disorders. Safe medication storage and disposal is important to decrease adolescent prescription opioid misuse. SUMMARY Opioid misuse occurs in adolescents and pediatric providers need to remain up to date.
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Affiliation(s)
- Amy M. Yule
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Rachael M. Lyons
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - Timothy E. Wilens
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
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Westover AN, Nakonezny PA, Halm EA, Adinoff B. Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration. Addiction 2018; 113:857-867. [PMID: 29215762 DOI: 10.1111/add.14122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/23/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Non-medical use of prescribed stimulant medications is a growing concern. This study's aims were to ascertain the demographics of stimulant medication users compared with non-users, examine temporal trends of stimulant medication use and estimate risk factors for development of amphetamine use disorder (AUD) and mortality among new users of stimulant medications. DESIGN Cox proportional hazards regression in a retrospective cohort adjusted by baseline covariates. SETTING United States, national administrative database of the Veterans Affairs (VA) health-care system. PARTICIPANTS Adult incident users of stimulant medications (n = 78 829) from fiscal years (FY) 2001 to 2012. MEASUREMENTS Primary outcomes were time-to-event: (1) occurrence of AUD diagnosis and (2) death. Baseline covariates included demographic information, Food and Drug Administration (FDA)-approved indications for stimulant use, substance use disorders (SUD) and depression. FINDINGS Stimulant users compared with non-users were younger, more likely to be non-Hispanic white and female. Incident stimulant medication users increased threefold from FY2001-FY2012 and eightfold among adults aged 18-44 years. Nearly one in 10 incident users in FY2012 had a comorbid baseline SUD. Off-label use was common-nearly three of every five incident users in FY2012. Comorbid SUDs among incident stimulant medication users were risk factors for occurrence of AUD during follow-up, with adjusted hazard ratio (AHR) estimates ranging from 1.54 to 2.83 (Ps < 0.05). Increased mortality risk was observed with occurrence of AUD during follow-up [AHR = 1.55, 95% confidence interval (CI) = 1.13-2.14, P = 0.007], while on-label prescribing was protective against death (AHR = 0.686, 95% CI = 0.63-0.75, P < 0.0001). CONCLUSIONS In a US national cohort of adult incident stimulant medication users in the Veterans Affairs health-care system, measured from fiscal years 2001 to 2012, comorbid substance use disorders were common and were risk factors for development of an amphetamine use disorder (AUD). Increased mortality risk among incident users of stimulant medications was observed among both those who developed an AUD later and those whose use was defined as off-label.
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Affiliation(s)
- Arthur N Westover
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Paul A Nakonezny
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA.,Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bryon Adinoff
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Health Care System, Dallas VAMC, TX, USA
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Gjersing L, Bretteville-Jensen AL. Patterns of substance use and mortality risk in a cohort of 'hard-to-reach' polysubstance users. Addiction 2018; 113:729-739. [PMID: 28987019 DOI: 10.1111/add.14053] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/23/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022]
Abstract
AIMS To examine the mortality risk in a cohort of 'hard-to-reach' polysubstance users and its putative associations with substance use. Specifically, we estimated all-cause mortality risk as a function of individual substance use indicators, and then as a function of their complex, 'real-life' patterns as identified through latent class analysis (LCA). DESIGN Prospective cohort study among street- and low-threshold service-recruited polysubstance users included between September and November 2013 and followed through the National Cause of Death Registry until 31 October 2015. SETTING Seven Norwegian cities. PARTICIPANTS A total of 884 users of illegal opioids and/or stimulants. Of these, 357 were in opioid substitution treatment (OST) at the time of inclusion. Forty-four participants died during follow-up. MEASUREMENTS Primary outcome: all-cause mortality risk. Unadjusted and adjusted Cox proportional hazard (PH) regression models (covariates: male, age, homelessness/shelter use, overdose experience, OST status, years of injecting, individual substance use indicators, city, use patterns). LCA models estimated separately for those in and those not in OST due to measurement invariance. FINDINGS The crude mortality rate was 2.52 per 100 person-years. Standardized mortality ratio was 26.11 [95% confidence interval (CI) = 10.06-54.87] for women and 10.71 (95% CI = 6.39-16.81) for men. No single drug use indicator, such as 'heroin injection' or 'number of drugs used', was associated with the mortality risk. However, meaningful use patterns were identified; three OST and non-OST patterns each. The non-OST patterns 'polysubstance injectors' [hazard ratio (HR) = 3.45, 95% CI = 0.98-12.14] and 'low frequent injectors' (HR = 3.17, CI = 1.05-9.56) were associated significantly with the mortality risk even when adjusted for other known risk factors. CONCLUSIONS In a Norwegian prospective cohort study, 'hard-to-reach' polysubstance users had a more than 10 times higher mortality risk than the general population. Mortality risk was not a function of any single drug use indicator, but two distinct combinations of substances, frequencies and routes of administration were associated with the mortality risk.
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Affiliation(s)
- Linn Gjersing
- Department of Drug Policy, Norwegian Institute of Public Health, Oslo, Norway
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Walton G, Dong H, Milloy MJ, DeBeck K, Kerr T, Wood E, Hayashi K. Increasing availability of benzodiazepines among people who inject drugs in a Canadian setting. Subst Abus 2018; 39:69-76. [PMID: 28727956 DOI: 10.1080/08897077.2017.1356798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Benzodiazepine misuse is associated with mortality and is common among people who inject drugs (PWID). This study aimed to examine the temporal trends in the availability of benzodiazepines among PWID in a Canadian setting, and to identify factors associated with more immediate access to benzodiazepines. METHODS Data were derived from 3 prospective cohorts of PWID in Vancouver, Canada, between June 2012 and May 2015. The primary outcome was the perceived availability of benzodiazepines, measured in 3 levels: not available, delayed availability (available in ≥10 minutes), and immediate availability (available in <10 minutes). The authors used multivariable generalized estimating equations to identify factors associated with availability of benzodiazepines. RESULTS In total, 1641 individuals were included in these analyses. In multivariable analyses, factors associated with immediate benzodiazepine availability included incarceration (adjusted odds ratio [AOR]: 1.42, 95% confidence interval [CI]: 1.06, 1.89) and participation in methadone maintenance therapy (MMT) (AOR: 1.35, 95% CI: 1.14, 1.60). Factors associated with delayed benzodiazepine availability included incarceration (AOR: 1.45, 95% CI: 1.02, 2.07) and participation in MMT (AOR: 1.77, 95% CI: 1.48, 2.12). Benzodiazepine availability increased throughout the study period for both immediate (AOR: 1.14, 95% CI: 1.10, 1.18 per 6-month follow-up period) and delayed (AOR: 1.17, 95% CI: 1.12, 1.22 per 6-month follow-up period) availability. CONCLUSIONS Among our sample of PWID, benzodiazepine availability is increasing and was associated with health and criminal justice system characteristics. Our findings indicate a need to examine prescribing practices and educate both PWID and health care providers about the risks associated with benzodiazepine use.
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Affiliation(s)
- Geoffrey Walton
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Huiru Dong
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - M J Milloy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Kora DeBeck
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,c School of Public Policy , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Thomas Kerr
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Evan Wood
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Kanna Hayashi
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,d Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
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Yule AM, Carrellas NW, Fitzgerald M, McKowen JW, Nargiso JE, Bergman BG, Kelly JF, Wilens TE. Risk Factors for Overdose in Treatment-Seeking Youth With Substance Use Disorders. J Clin Psychiatry 2018; 79:17m11678. [PMID: 29701935 PMCID: PMC6043357 DOI: 10.4088/jcp.17m11678] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/09/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Overdoses (ODs) are among the leading causes of death in youth with substance use disorders (SUDs). Our aim was to identify the prevalence of OD and characteristics associated with a history of OD in youth presenting for SUD outpatient care. METHODS A systematic retrospective medical record review was conducted of consecutive psychiatric and SUD evaluations for patients aged 16 to 26 years with DSM-IV-TR criteria SUD at entry into an outpatient SUD treatment program for youth between January 2012 and June 2013. Unintentional OD was defined as substance use without intention of self-harm that was associated with a significant impairment in level of consciousness. Intentional OD was defined as ingestion of a substance that was reported as a suicide attempt. T tests, Pearson χ² tests, and Fisher exact tests were performed to evaluate characteristics associated with a history of OD. RESULTS We examined the medical records of 200 patients (157 males and 43 females) with a mean ± SD age of 20.2 ± 2.8 years. At intake, 58 patients (29%) had a history of OD, and 62% of those patients had a history of unintentional OD only (n = 36). Youth with ≥ 2 SUDs were 3 times more likely to have a history of OD compared to youth with 1 SUD (all P < .05). Compared to those without a history of OD, those with an OD were more likely to be female and have lifetime histories of alcohol, cocaine, amphetamine, anxiety, depressive, and/or eating disorders (all P < .05). CONCLUSIONS High rates of OD exist in treatment-seeking youth with SUD. OD was associated with more SUDs and psychiatric comorbidity.
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Affiliation(s)
- Amy M. Yule
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114,Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Nicholas W. Carrellas
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - Maura Fitzgerald
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - James W. McKowen
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Jessica E. Nargiso
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Brandon G. Bergman
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - John F. Kelly
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Timothy E. Wilens
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114,Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
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Petterson AG, Madah-Amiri D. Overdose prevention training with naloxone distribution in a prison in Oslo, Norway: a preliminary study. Harm Reduct J 2017; 14:74. [PMID: 29162122 PMCID: PMC5696738 DOI: 10.1186/s12954-017-0200-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/14/2017] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Prison inmates face a ten times increased risk of experiencing a fatal drug overdose during their first 2 weeks upon release than their non-incarcerated counterparts. Naloxone, the antidote to an opioid overdose, has been shown to be feasible and effective when administered by bystanders. Given the particular risk that newly released inmates face, it is vital to assess their knowledge about opioid overdoses, as well as the impact of brief overdose prevention training conducted inside prisons. METHODS Prison inmates nearing release (within 6 months) in Oslo, Norway, voluntarily underwent a brief naloxone training. Using a questionnaire, inmates were assessed immediately prior to and following a naloxone training. Descriptive statistics were performed for main outcome variables, and the Wilcoxon signed-rank test was used to compare the participants' two questionnaire scores from pre-and post-training. RESULTS Participating inmates (n = 31) were found to have a high baseline knowledge of risk factors, symptoms, and care regarding opioid overdoses. Nonetheless, a brief naloxone training session prior to release significantly improved knowledge scores in all areas assessed (p < 0.001). The training appears to be most beneficial in improving knowledge regarding the naloxone, including its use, effect, administration, and aftercare procedures. CONCLUSIONS Given the high risk of overdosing that prison inmates face upon release, the need for prevention programs is critical. Naloxone training in the prison setting may be an effective means of improving opioid overdose response knowledge for this particularly vulnerable group. Naloxone training provided in the prison setting may improve the ability of inmates to recognize and manage opioid overdoses after their release; however, further studies on a larger scale are needed.
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Affiliation(s)
- Aase Grønlien Petterson
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. Box 1039 Blindern, 0315 Oslo, Norway
| | - Desiree Madah-Amiri
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. Box 1039 Blindern, 0315 Oslo, Norway
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Wiessing L, Ferri M, Darke S, Simon R, Griffiths P. Large variation in measures used to assess outcomes of opioid dependence treatment: A systematic review of longitudinal observational studies. Drug Alcohol Rev 2017; 37 Suppl 1:S323-S338. [PMID: 28971544 DOI: 10.1111/dar.12608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 12/19/2022]
Abstract
ISSUES Treatment outcomes for drug users are critical for informing policy and therapeutic practice. The coherence of outcomes, changes and drug use measures from observational studies on opioid use treatment were reviewed. APPROACH Systematic review of the literature for longitudinal observational studies, from 1980 through November 2015, in all languages, with data on treated opioid users, using Pubmed, the Cochrane Library and additional strategies (e.g. Pubmed function 'related citations' and checking reference lists of eligible studies). KEY FINDINGS Twenty-seven studies were included (11 countries, 85 publications, recruitment 1962-2009). Baseline n was >65 686 and median follow-up 34.5 months (21 studies) or 51.4 person-months (10 studies). Eight outcome domains were identified: 'drug use' (21/27 studies), 'crime' (13), 'health' (13), 'treatment-related' outcomes (16), 'social functioning' (13), 'harms' (8), 'mortality' (13) and 'economic estimates' (2 studies). All studies using drug use outcomes included a binary (abstinence) category in at least one measure. Studies typically reported outcomes on less than half (on average 3.7 or 46%) of the eight outcome domains, while the average was 5.1 (64%) in seven studies initiated since 2000. IMPLICATIONS AND CONCLUSION Wide variation exists in outcome measures found in longitudinal observational studies of treatment of opioid users. This reduces replicability of studies and suggests a lack of common expectations on treatment success. Future studies should consider using all or most of eight outcome domains identified (excluding economic analyses if unfeasible), non-binary measures and amount/value of drugs used and consensus meetings with joint ownership of scientific, treatment and patient communities.
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Roland Simon
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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Horton M, McDonald R, Green TC, Nielsen S, Strang J, Degenhardt L, Larney S. A mapping review of take-home naloxone for people released from correctional settings. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:7-16. [DOI: 10.1016/j.drugpo.2017.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/21/2017] [Accepted: 05/02/2017] [Indexed: 01/19/2023]
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Walton GRT, Hayashi K, Bach P, Dong H, Kerr T, Ahamad K, Milloy MJ, Montaner J, Wood E. The Impact of Benzodiazepine Use on Mortality Among Polysubstance Users in Vancouver, Canada. Public Health Rep 2017; 131:491-9. [PMID: 27252569 DOI: 10.1177/003335491613100315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Illicit drug use is a well-established risk factor for increased morbidity and mortality. However, little is known about the impact of benzodiazepine use on mortality among populations of polysubstance users. This study aimed to identify the effect of benzodiazepine use on mortality among a prospective cohort of people in Canada who inject drugs (PWID). METHODS A cohort of PWID in Vancouver, Canada, was prospectively followed from May 1996 through November 2013. Data on participants were linked to the provincial vital statistics registry to ascertain mortality rates and causes of death. Multivariable extended Cox regression with time-dependent variables was used to investigate the relationship between benzodiazepine use and time to all-cause mortality. RESULTS During the study period, 2,802 participants were followed for a median of 67 months (interquartile range: 25-107). In total, 527 (18.8%) participants died, for an incidence density of mortality of 2.9 (95% confidence interval [CI] 2.7, 3.2) deaths per 100 person-years. After adjusting for HIV infection and other potential confounders, benzodiazepine use was independently associated with increased all-cause mortality (adjusted hazard ratio = 1.86, 95% CI 1.38, 2.51) and had a higher risk for mortality than all other traditional substances of abuse among this population. Results were consistent when non-overdose mortality was considered. CONCLUSION In this setting, benzodiazepine use was more strongly associated with mortality than any other substance of abuse. Greater recognition of the safety concerns related to benzodiazepines and strategies to prevent diversion to illicit use are needed.
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Affiliation(s)
- Geoffrey R T Walton
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada; University of British Columbia, Department of Medicine, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada; University of British Columbia, Department of Medicine, Vancouver, BC, Canada
| | - Paxton Bach
- University of British Columbia, Department of Medicine, Vancouver, BC, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Keith Ahamad
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - M J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada; University of British Columbia, Department of Medicine, Vancouver, BC, Canada
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Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, Ferri M, Pastor-Barriuso R. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ 2017; 357:j1550. [PMID: 28446428 PMCID: PMC5421454 DOI: 10.1136/bmj.j1550] [Citation(s) in RCA: 1019] [Impact Index Per Article: 145.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective To compare the risk for all cause and overdose mortality in people with opioid dependence during and after substitution treatment with methadone or buprenorphine and to characterise trends in risk of mortality after initiation and cessation of treatment.Design Systematic review and meta-analysis.Data sources Medline, Embase, PsycINFO, and LILACS to September 2016.Study selection Prospective or retrospective cohort studies in people with opioid dependence that reported deaths from all causes or overdose during follow-up periods in and out of opioid substitution treatment with methadone or buprenorphine.Data extraction and synthesis Two independent reviewers performed data extraction and assessed study quality. Mortality rates in and out of treatment were jointly combined across methadone or buprenorphine cohorts by using multivariate random effects meta-analysis.Results There were 19 eligible cohorts, following 122 885 people treated with methadone over 1.3-13.9 years and 15 831 people treated with buprenorphine over 1.1-4.5 years. Pooled all cause mortality rates were 11.3 and 36.1 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 3.20, 95% confidence interval 2.65 to 3.86) and reduced to 4.3 and 9.5 in and out of buprenorphine treatment (2.20, 1.34 to 3.61). In pooled trend analysis, all cause mortality dropped sharply over the first four weeks of methadone treatment and decreased gradually two weeks after leaving treatment. All cause mortality remained stable during induction and remaining time on buprenorphine treatment. Overdose mortality evolved similarly, with pooled overdose mortality rates of 2.6 and 12.7 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 4.80, 2.90 to 7.96) and 1.4 and 4.6 in and out of buprenorphine treatment.Conclusions Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.
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Affiliation(s)
- Luis Sordo
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain
| | - Maria J Bravo
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - B Iciar Indave
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sidney, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Lucas Wiessing
- Sector Best Practices, Knowledge Exchange and Economic Issues, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Marica Ferri
- Sector Best Practices, Knowledge Exchange and Economic Issues, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Kougiali ZG, Fasulo A, Needs A, Van Laar D. Planting the seeds of change: Directionality in the narrative construction of recovery from addiction. Psychol Health 2017; 32:639-664. [PMID: 28276737 DOI: 10.1080/08870446.2017.1293053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The dominant theoretical perspective that guides treatment evaluations in addiction assumes linearity in the relationship between treatment and outcomes, viewing behaviour change as a 'before and after event'. In this study we aim to examine how the direction of the trajectory of the process from addiction to recovery is constructed in personal narratives of active and recovering users. DESIGN 21 life stories from individuals at different stages of recovery and active use were collected and analysed following the principles of narrative analysis. RESULTS Personal trajectories were constructed in discontinuous, non-linear and long lasting patterns of repeated, and interchangeable, episodes of relapse and abstinence. Relapse appeared to be described as an integral part of a learning process through which knowledge leading to recovery was gradually obtained. CONCLUSION The findings show that long-term recovery is represented as being preceded by periods of discontinuity before change is stabilised. Such periods are presented to be lasting longer than most short-term pre-post intervention designs can capture and suggest the need to rethink how change is defined and measured.
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Affiliation(s)
- Zetta G Kougiali
- a School of Psychology , University of East London, Stratford Campus , London , UK
| | - Alessandra Fasulo
- b Department of Psychology , University of Portsmouth , Portsmouth , UK
| | - Adrian Needs
- b Department of Psychology , University of Portsmouth , Portsmouth , UK
| | - Darren Van Laar
- b Department of Psychology , University of Portsmouth , Portsmouth , UK
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Neale J, Bradford J, Strang J. Development of a proto-typology of opiate overdose onset. Addiction 2017; 112:168-175. [PMID: 27542337 DOI: 10.1111/add.13589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/15/2016] [Accepted: 08/15/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The time available to act is a crucial factor affecting the probable success of interventions to manage opiate overdose. We analyse opiate users' accounts of non-fatal overdose incidents to (i) construct a proto-typology of non-fatal opiate overdose onset and (ii) assess the implications for overdose management and prevention of fatalities. METHODS Re-analysis of a subset of data from a large qualitative study of non-fatal opiate overdose conducted from 1997 to 1999. Data were generated from semi-structured interviews undertaken with opiate users who had experienced a non-fatal overdose in the previous 24 hours. Forty-four participants (30 men; 14 women; aged 16-47 years) provided sufficient information for in-depth analysis. Data relating to 'memory of the moment of overdose', 'time to loss of consciousness' and 'subjective description of the overdose experience' were scrutinised using iterative categorization. FINDINGS Four types of overdose onset were identified: type A 'amnesic' (n = 8), characterized by no memory, rapid loss of consciousness and no description of the overdose experience; type B 'conscious' (n = 17), characterized by some memory, sustained consciousness and a description of the overdose in terms of feeling unwell and symptomatic; type C 'instant' (n = 14), characterized by some memory, immediate loss of consciousness and no description of the overdose experience; and type D 'enjoyable' (n = 5), characterized by some memory, rapid loss of consciousness and a description of the overdose experience as pleasant or positive. CONCLUSIONS The identification of different types of overdose onset highlights the complexity of overdose events, the need for a range of interventions and the challenges faced in managing incidents and preventing fatalities. Opiate overdose victims who retain consciousness for a sustained period and recognize the negative signs and symptoms of overdosing could summon help or self-administer naloxone, thus indicating that opiate overdose training should incorporate self-management strategies.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, King's College London, London, UK
| | - Julia Bradford
- National Addiction Centre, King's College London, London, UK
| | - John Strang
- National Addiction Centre, King's College London, London, UK
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Fairbairn NS, Walley AY, Cheng DM, Quinn E, Bridden C, Chaisson C, Blokhina E, Lioznov D, Krupitsky E, Raj A, Samet JH. Mortality in HIV-Infected Alcohol and Drug Users in St. Petersburg, Russia. PLoS One 2016; 11:e0166539. [PMID: 27898683 PMCID: PMC5127495 DOI: 10.1371/journal.pone.0166539] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/31/2016] [Indexed: 11/18/2022] Open
Abstract
In Russia, up to half of premature deaths are attributed to hazardous drinking. The respective roles of alcohol and drug use in premature death among people with HIV in Russia have not been described. Criminalization and stigmatization of substance use in Russia may also contribute to mortality. We explored whether alcohol, drug use and risk environment factors are associated with short-term mortality in HIV-infected Russians who use substances. Secondary analyses were conducted using prospective data collected at baseline, 6 and 12-months from HIV-infected people who use substances recruited between 2007-2010 from addiction and HIV care settings in a single urban setting of St. Petersburg, Russia. We used Cox proportional hazards models to explore associations between 30-day alcohol hazardous drinking, injection drug use, polysubstance use and environmental risk exposures (i.e. past incarceration, police involvement, selling sex, and HIV stigma) with mortality. Among 700 participants, 59% were male and the mean age was 30 years. There were 40 deaths after a median follow-up of 12 months (crude mortality rate 5.9 per 100 person-years). In adjusted analyses, 30-day NIAAA hazardous drinking was significantly associated with mortality compared to no drinking [adjusted Hazard Ratio (aHR) 2.60, 95% Confidence Interval (CI): 1.24-5.44] but moderate drinking was not (aHR 0.95, 95% CI: 0.35-2.59). No other factors were significantly associated with mortality. The high rates of short-term mortality and the strong association with hazardous drinking suggest a need to integrate evidence-based alcohol interventions into treatment strategies for HIV-infected Russians.
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Affiliation(s)
- Nadia S. Fairbairn
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Y. Walley
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | - Debbie M. Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Emily Quinn
- Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Carly Bridden
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Christine Chaisson
- Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Elena Blokhina
- First Pavlov State Medical University, St. Petersburg, Russian Federation
| | - Dmitry Lioznov
- First Pavlov State Medical University, St. Petersburg, Russian Federation
- North-West Regional AIDS Center, St. Petersburg, Russian Federation
| | - Evgeny Krupitsky
- First Pavlov State Medical University, St. Petersburg, Russian Federation
- Bekhterev Research Psychoneurological Institute, St. Petersburg, Russian Federation
| | - Anita Raj
- Division of Global Public Health, University of California San Diego School of Medicine, La Jolla, California, United States of America
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, United States of America
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