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Lin C, Cousins SJ, Zhu Y, Clingan SE, Mooney LJ, Kan E, Wu F, Hser YI. A scoping review of social determinants of health's impact on substance use disorders over the life course. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 166:209484. [PMID: 39153733 PMCID: PMC11418584 DOI: 10.1016/j.josat.2024.209484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/14/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Substance use is a public crisis in the U.S. Substance use can be understood as a series of events in the life course, from initiation to mortality. Social Determinants of Health (SDoH) have increasingly been recognized as essential contributors to individuals' health. This scoping review aims to examine available evidence of SDoH impact on the life course of substance use disorder (SUD). METHODS This study identified peer-reviewed articles that reported longitudinal studies with SDoH factors as independent variables and substance use and disorders as dependent variables from PubMed, Embase, and Web of Science. The reported associations between SDoH and substance use stages over the life course were narratively and graphically summarized. RESULTS Among the 50 studies identified, ten revealed parental monitoring/support and early childhood education as protective factors, while negative peer influences and neighborhood instability were risk factors of substance use initiation. Nineteen articles reported factors associated with escalation in substance use, including unemployment, neighborhood vulnerability, negative peer influence, violence/trauma, and criminal justice system (CJS) involvement. Ten articles suggested that employment, social support, urban living, and low-barrier medication treatment facilitated treatment participation, while stigma and CJS involvement had negative impact on treatment trajectory. Social support and employment could foster progress in recovery and CJS involvement and unstable housing deterred recovery. Four studies suggested that unemployment, unstable housing, CJS involvement, and lack of social support were associated with overdose and mortality. CONCLUSIONS This review underscores the influence of social networks and early life experiences on the life course of SUD. Future SDoH research should investigate overdose and mortality and the impact of broader upstream SDoH on SUD. Interventions addressing these social factors are needed to mitigate their detrimental effects on the trajectories of SUD over the life course.
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Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90024, United States of America
| | - Sarah J Cousins
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90024, United States of America
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90024, United States of America
| | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90024, United States of America
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90024, United States of America; VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States of America
| | - Emily Kan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90024, United States of America
| | - Fei Wu
- Los Angeles County Chief Executive Office, Los Angeles, CA 90012, United States of America
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90024, United States of America.
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McGlothen-Bell K, Cartagena D, Malin KJ, Vittner D, McGrath JM, Koerner RL, Vance AJ, Crawford AD. Reimagining Supportive Approaches at the Intersection of Mandatory Reporting Policies for the Mother-Infant Dyad Affected by Substance Use. Adv Neonatal Care 2024; 24:424-434. [PMID: 39133542 DOI: 10.1097/anc.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND As rates of substance use during pregnancy persist, the health and optimal development of infants with prenatal substance exposure remain a key priority. Nurses are tasked with identifying and reporting suspected cases of child maltreatment, including abuse and neglect, which is often assumed to be synonymous with substance use during pregnancy. While policies aimed at protecting infants from child abuse and neglect are well intentioned, literature regarding the short- and long-term social and legal implications of mandatory reporting policies is emerging. PURPOSE In this article, we explore the intersections between the condition of substance use in pregnancy and policies related to mandatory reporting. METHODS We provide an overview of historical and current trends in mandatory reporting policies for nurses related to substance use in pregnancy and related ethical and social implications for mother-infant dyads. RESULTS Nurses often function at the intersection of healthcare and social services, underscoring the important role they play in advocating for ethical and equitable care for both members of the mother-infant dyad affected by substance use. IMPLICATIONS FOR PRACTICE AND RESEARCH We offer recommendations for practice including the integration of respectful care and family-centered support for the mother-infant dyad affected by substance use. Cross-sectoral collaborations, inclusive of the family, are important to the advancement of evidence-based and equity-focused research, advocacy, and policy initiatives to support familial preservation and reduce mother-infant separation.
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Affiliation(s)
- Kelly McGlothen-Bell
- School of Nursing, UT Health San Antonio, San Antonio, Texas (Drs McGlothen-Bell, McGrath, and Crawford); School of Nursing, Old Dominion University, Norfolk, Virginia (Dr Cartagena); College of Nursing, Marquette University, Milwaukee, Wisconsin (Dr Malin); Egan School of Nursing and Health Studies, Fairfield University, Fairfield, Connecticut (Dr Vittner); Neonatal Intensive Care Unit, Connecticut Children's, Hartford, Connecticut (Dr Vittner); College of Nursing, University of South Florida, Tampa, Florida (Dr Koerner); and Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan (Dr Vance)
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Byles H, Sedaghat N, Rider N, Rioux W, Loverock A, Seo B, Dhanoa A, Orr T, Dunnewold N, Tjosvold L, Ghosh SM. Barriers to calling emergency services amongst people who use substances in the event of overdose: A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 132:104559. [PMID: 39197374 DOI: 10.1016/j.drugpo.2024.104559] [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: 03/02/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND North America is grappling with an ongoing drug overdose crisis. While harm reduction measures like take-home naloxone kits, and supervised consumption sites, have helped reduce mortality, other strategies to address this public health emergency are required. Good Samaritan Laws (GSLs) offer legal protection for individuals who report overdoses, yet people who use substances (PWUS) may still hesitate to seek help due to concerns about existing legislation. This scoping review explores barriers preventing PWUS from calling emergency services for overdoses, along with potential solutions and facilitators to address this challenge. METHODS PRISMA-ScR was used as a guide to conduct this study. Health sciences librarians searched Medline, Embase, PsychINFO, CINAHL, and SCOPUS to identify relevant articles. Six reviewers contributed to screening and extracting the articles through Covidence. Two reviewers performed thematic analysis using NVivo software to identify key barriers and facilitators. RESULTS An initial search found 6275 articles for title and abstract screening, resulting in 48 studies meeting the inclusion criteria. The primary barrier to calling 911 pertained to concerns about police arrivng with other first responders, especially regarding their presence and involvement at the scene of overdose. This was followed by legal repercussions, including fear of arrest, incarceration, and fear of eviction, amongst others. Some studies noted the lack of knowledge or trust in GSLs as a deterrent to seeking medical assistance. Additional barriers included concerns about privacy and confidentiality, preference to manage an overdose alone/receive help from another peer, confidence in naloxone effectiveness, limited access to cell phones, peer pressure to not call for help, and identifying as Black, Indigenous, or a Person of Colour (BIPOC). Facilitators include increased GSL awareness among PWUS and law enforcement, expanded legal safeguards for 911 callers, reduced police intervention in overdose cases, and enhanced naloxone availability at key access points. CONCLUSION Despite the good intentions of GSLs, PWUS continue to experience significant barriers to calling emergency services in the event of an overdose. Understanding these barriers and key facilitators is necessary to inform future drug policy and advocacy efforts.
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Affiliation(s)
- Hannah Byles
- Department of Pediatrics, University of Calgary, Canada
| | | | - Nathan Rider
- Department of Public Health, University of Calgary, Canada
| | - William Rioux
- Department of Medicine, University of Alberta, Canada
| | | | - Boogyung Seo
- Department of Medicine, University of Calgary, Canada
| | - Avnit Dhanoa
- Department of Medicine, University of Alberta, Canada
| | | | | | | | - S Monty Ghosh
- Department of Medicine, University of Alberta, Canada; University of Calgary, Canada.
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Rouhani S, Winiker AK, Zhang L, Sherman SG, Bandara S. "What I should be doing is harm reduction, if I'm doing my job right": Engagement with harm reduction principles among prosecutors enacting drug policy reform in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 131:104541. [PMID: 39067354 DOI: 10.1016/j.drugpo.2024.104541] [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: 02/21/2024] [Revised: 06/26/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Prosecutorial discretion to pursue or decline criminal charges is a powerful mechanism determining criminal justice outcomes among people who use drugs (PWUD). In the US, prosecutors are increasingly employing this tool to prevent arrest, incarceration, and subsequent health and social harms among PWUD. Many cite harm reduction as a basis for these reforms; however, the extent of prosecutors' knowledge and understanding of harm reduction principles, and how they are operationalized in the policy process, remains unclear. METHODS We assess references to and application of harm reduction in the policy design and implementation process of prosecutorial drug policy reform in 14 US jurisdictions. In-depth-interviews (N = 16) were conducted with elected prosecutors and their policy staff from November 2021-April 2022. Through initial structured analysis, policymakers' understanding and utilization of the term 'harm reduction' emerged as a salient theme which we conducted secondary thematic analysis to further explore. RESULTS While all participants identified as progressive, there was wide variation in their ideologies, policy provisions, and engagement with harm reduction principles. Eleven participants explicitly referred to 'reducing harms of drug use' or 'harm reduction' as guiding their policy approach; the remainder did not invoke 'harm reduction' by name but highlighted relevant concepts like racial equity and 'public health approaches' as core policy tenets. While some prosecutors demonstrated familiarity with traditional harm reduction principles (meeting PWUD where they are, reducing harms to them), others focused on harm to the wider community (the 'public,' businesses, etc). Invocation of harm reduction was not always consistent with specific policy provisions: prosecutors implemented policies ranging from unconditional non-prosecution of drug possession to diversion, some of which were odds with core harm reduction principles of dignity and justice (i.e., involving coercive treatment incentives/requirements). CONCLUSIONS As prosecutors shift their approach to redress the harms caused by drug criminalization, clarity is needed on what a harm reduction approach to using discretionary powers entails. Targeting reform-minded prosecutors with messaging on the principles, evidence base, and best practices of harm reduction is merited.
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Affiliation(s)
- Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Leanne Zhang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
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Bathish R, Madden A, Duff C, Ritter A. Guiding principles for breaking down drug-related stigma in academic writing. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 131:104515. [PMID: 39208549 DOI: 10.1016/j.drugpo.2024.104515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Ramez Bathish
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Annie Madden
- Harm Reduction Australia, Sydney, Australia; International Network of People Who Use Drugs, London, United Kingdom
| | - Cameron Duff
- Centre for Organisations and Social Change, RMIT University, Melbourne, Australia
| | - Alison Ritter
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
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Hackett C. "I Was Treated Differently": Reproductive Health Care Experiences Among Women With Recent Experiences of Incarceration, Homelessness, And/Or Substance Use in a Medically Underserved Area in the Southwestern US. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241277352. [PMID: 39168483 DOI: 10.1177/2752535x241277352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Background: Women with upstream social determinants of health, particularly those with recent experiences of incarceration, homelessness, and/or substance use, encounter a series of barriers in accessing health care services and consequently face poor sexual and reproductive health outcomes. Driven by a community concern for increasing rates of syphilis and congenital syphilis among women who are structurally disadvantaged, this study focuses on their experiences with reproductive healthcare access across healthcare settings.Research Design and Study Sample: This community-based pláticas (conversational) research project gathered 12 in-depth interviews and testimonios (testimonies) with women who reported a criminalized upstream barrier (incarceration, homelessness, and/or substance use) in a small city in the southwestern U.S. - most of whom identified as Latina/Hispanic.Analysis and Results: Using a grounded analysis and drawing upon Chicana feminist methodologies, this study identifies four major themes: (1) homelessness and economic vulnerabilities, (2) incarceration and health care, (3) drug use, provider stigma, and motherhood, and (4) desired changes to the healthcare experience.Conclusion: Results highlight the need for economic and transportation supports, community-based preventive services as alternatives to incarcerated healthcare, along with more compassionate and structurally competent provider-patient dialogue.
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Affiliation(s)
- Colleen Hackett
- Criminology and Criminal Justice, Northern Arizona University, Flagstaff, AZ, USA
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Long B, Zhou J, Tan F, Bellur S. Deciphering Factors Contributing to Cost-Effective Medicine Using Machine Learning. Bioengineering (Basel) 2024; 11:818. [PMID: 39199777 PMCID: PMC11351455 DOI: 10.3390/bioengineering11080818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024] Open
Abstract
This study uses machine learning to identify critical factors influencing the cost-effectiveness of over-the-counter (OTC) medications. By developing a novel cost-effectiveness rating (CER) based on user ratings and prices, we analyzed data from Amazon. The findings indicate that Flexible Spending Account (FSA)/Health Savings Account (HSA) eligibility, symptom treatment range, safety warnings, special effects, active ingredients, and packaging size significantly impact cost-effectiveness across cold, allergy, digestion, and pain relief medications. Medications eligible for FSA or HSA funds, treating a broader range of symptoms, and having smaller packaging are perceived as more cost-effective. Cold medicines with safety warnings were cost-effective due to their lower average price and effective ingredients like phenylephrine and acetaminophen. Allergy medications with kid-friendly features showed higher cost-effectiveness, and ingredients like calcium, famotidine, and magnesium boosted the cost-effectiveness of digestion medicines. These insights help consumers make informed purchasing decisions and assist manufacturers and retailers in enhancing product competitiveness. Overall, this research supports better decision-making in the pharmaceutical industry by highlighting factors that drive cost-effective medication purchases.
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Affiliation(s)
- Bowen Long
- Department of Analytics, Harrisburg University of Science and Technology, Harrisburg, PA 17101, USA
| | | | - Fangya Tan
- Department of Analytics, Harrisburg University of Science and Technology, Harrisburg, PA 17101, USA
| | - Srikar Bellur
- Department of Analytics, Harrisburg University of Science and Technology, Harrisburg, PA 17101, USA
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Takemoto E, Bolton A, Goetz CT. Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019-21. Addiction 2024; 119:1400-1409. [PMID: 38808397 DOI: 10.1111/add.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
AIMS The aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity. DESIGN AND SETTING Analysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019-21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year. CASES The analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021. MEASUREMENTS Evidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) was based on the death certificate. FINDINGS In the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40-50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5-0.9; 2020: OR = 0.5, 95% CI = 0.4-0.7; 2021: OR = 0.6, 95% CI = 0.5-0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents. CONCLUSION After controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people.
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Affiliation(s)
- Erin Takemoto
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Ashley Bolton
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Carrie Thomas Goetz
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
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Rouhani S, Luo L, Byregowda H, Weaver N, Park JN. Epidemiology of drug arrests in the United States: Evidence from the national survey on drug use and health, 2015-2019. Prev Med 2024; 185:108058. [PMID: 38969022 DOI: 10.1016/j.ypmed.2024.108058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Following changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S. METHODS Serial cross-sectional data from the National Survey on Drug Use and Health (2015-2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression. RESULTS Past-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals [aOR 1.92, 95% CI 1.30, 2.84]. CONCLUSION Despite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.
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Affiliation(s)
- Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA; Center for Anti-racism, Social Justice and Public Health, New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Lingzi Luo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Himani Byregowda
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Nicholas Weaver
- Department of Psychology, University of Texas at Austin College of Liberal Arts, 108 E Dean Keeton St, Austin, TX 78712, USA
| | - Ju Nyeong Park
- Division of General Internal Medicine, Brown University Alpert Medical School, 222 Richmond Street, Providence, RI 02903, USA
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Zemlak JL, Barry A, Mattson N. Perceptions of Women in Opioid Recovery Regarding Policies and Laws on Sexual and Reproductive Health. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00250-8. [PMID: 39038604 DOI: 10.1016/j.jogn.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE To explore perceptions of policies and laws on sexual and reproductive health among women in recovery from opioid use disorder (OUD). DESIGN Qualitative descriptive. SETTING Telephone interviews conducted in a midsized urban area in the midwestern region of the United States. PARTICIPANTS Twenty-two women ages 18 to 49 years who self-identified as being in recovery from OUD. METHODS We conducted individual, semistructured telephone interviews and analyzed the data using reflexive thematic analysis. RESULTS We identified three themes: Barriers to OUD Treatment and Recovery, Pregnancy as a Gateway to Treatment and Recovery, and The Dobbs Effect. Participants described OUD treatment barriers such as inadequate recovery resources for women and the criminalization of drug use. Many participants described pregnancy as a gateway to recovery because of improved access to treatment services and enhanced motivation for engaging in recovery. Participants described unintended pregnancy as a threat to recovery that made them seek woman-controlled contraceptive methods they could use without negotiating with a partner (e.g., intrauterine devices) after the Supreme Court overturned constitutionally protected access to abortion. CONCLUSION Opioid use disorder is a public and mental health crisis in the United States that affects reproductive-age women. Participants in our study closely connected recovery from OUD with sexual and reproductive health policy and laws. There is a need for regulation to support the unique needs of women in OUD treatment. The recent Supreme Court decision that overturned constitutionally protected abortion creates challenges for women in recovery from OUD. Nurses are ideally positioned to advocate for recovery and sexual and reproductive health policies and laws that improve the physical and mental health of women in recovery.
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Curran JA, Lane J, McCulloch H, Keeping-Burke L, Johnson C, Wong H, Cassidy C, McIsaac JL, Lamptey DL, Clegg J, Forbes N, Breneol S, Sheriko J, Best S, Burgess S, Sinclair D, Elliot Rose A, Standing MA, Somerville M, King S, Doucet S, Flieger H, Lamb M, Parsons Leigh J, Stewart D. Uncovering the wider impact of COVID-19 measures on the lives of children with complex care needs and their families: A mixed-methods study protocol. PLoS One 2024; 19:e0305543. [PMID: 38976707 PMCID: PMC11230525 DOI: 10.1371/journal.pone.0305543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 05/31/2024] [Indexed: 07/10/2024] Open
Abstract
Existing barriers to care were exacerbated by the development and implementation of necessary public health restrictions during the COVID-19 pandemic. Children with complex care needs and their families represent a small portion of the paediatric population, and yet they require disproportionately high access to services. Little is known about the impact of COVID-19 public health measures on this population. This study will generate evidence to uncover the wider impact of COVID-19 measures on the lives of children with complex care needs and their families in relation to policy and service changes. This multi-site sequential mixed methods study will take place across the Canadian Maritime provinces and use an integrated knowledge translation approach. There are two phases to this study: 1) map COVID-19 public health restrictions and service changes impacting children with complex care needs by conducting an environmental scan of public health restrictions and service changes between March 2020 and March 2022 and interviewing key informants involved in the development or implementation of restrictions and service changes, and 2) explore how children with complex care needs and their families experienced public health restrictions and service changes to understand how their health and well-being were impacted.
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Affiliation(s)
- Janet A Curran
- IWK Health Centre, Halifax, NS, Canada
- Department of Health, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Lane
- IWK Health Centre, Halifax, NS, Canada
- Department of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Lisa Keeping-Burke
- Department of Nursing & Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | | | - Helen Wong
- Department of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Jessie-Lee McIsaac
- Department of Child and Youth Study, Mount Saint Vincent University, Halifax, NS, Canada
| | - De-Lawrence Lamptey
- Department of Child and Youth Study, Mount Saint Vincent University, Halifax, NS, Canada
| | | | - Neil Forbes
- Department of Nursing & Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Sydney Breneol
- Department of Health, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | - Mary-Ann Standing
- Centre for Health and Community Research, University of Prince Edward Island, Charlottetown, PEI, Canada
| | | | | | - Shelley Doucet
- Department of Nursing & Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | | | - Margie Lamb
- Nova Scotia Health Authority, Halifax, NS, Canada
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Yang S, Feldman CH. Interpreting and Addressing Racialized Inequities in Rheumatic Disease Care and Outcomes. Arthritis Care Res (Hoboken) 2024; 76:908-913. [PMID: 38751111 PMCID: PMC11209766 DOI: 10.1002/acr.25375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Affiliation(s)
- Sherry Yang
- Harvard Medical School, Harvard University, Boston, MA
- Harvard Kennedy School of Government, Harvard University, Cambridge MA
| | - Candace H. Feldman
- Harvard Medical School, Harvard University, Boston, MA
- Brigham and Women’s Hospital, Boston, MA
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Rouhani S, Zhang L, Winiker AK, Sherman SG, Bandara S. Emerging models of de facto drug policy reforms in the United States. Drug Alcohol Depend 2024; 260:111341. [PMID: 38815292 DOI: 10.1016/j.drugalcdep.2024.111341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion-or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD). METHODS We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach. RESULTS Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability. CONCLUSIONS Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.
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Affiliation(s)
- Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health, United States; Center for Anti-racism, Social Justice and Public Health, New York University School of Global Public Health, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Leanne Zhang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
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14
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Fleming T, Boyd J, Gagnon M, Kerr T, McNeil R. Using drugs alone in single room occupancy housing: Understanding environmental drivers of overdose risk. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104444. [PMID: 38754243 PMCID: PMC11420829 DOI: 10.1016/j.drugpo.2024.104444] [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: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Across North America most overdose deaths occur in housing, largely due to individuals using drugs alone. In cities, fatalities are disproportionately concentrated in low-income housing, including single room occupancy (SRO) housing. While research has highlighted how SROs operate as risk environments for various poor outcomes, there has been little attention to specific drug use practices (i.e., using alone) associated with overdose vulnerability in these spaces. This study explores how environmental contexts of SROs shape overdose risks, with specific attention to practices of using drugs alone. METHODS In-depth semi-structured interviews were conducted with 30 people who use drugs (PWUD) living in Vancouver SROs. Interviews covered topics such as social-structural environments of housing, drug use practices, and housing-based harm reduction. Thematic analysis drew on the intersectional risk environment framework. RESULTS Narratives positioned SROs as extensions of public space, with similar expectations of risks and behaviours as in public spaces. For some participants, using alone in their room was characterized as a practice in claiming privacy within the context of a public existence. Participants highlighted how certain features of SRO's social-structural environments were routinely leveraged against them (e.g., security cameras, staff surveillance), suggesting using alone as a tactic to minimize risks of hyper-surveillance and punitive policies. Further, participants discussed using alone as "safer," describing how this practice mitigated place-based risks of social-structural harms (e.g., violence, criminalization) in ways that eclipsed overdose risk. CONCLUSION Using drugs alone may be understood as a spatial negotiation of vulnerability to diverse harms produced by environmental contexts of SROs. Interventions accounting for broader contextual factors (e.g., improvements housing quality/quantity, providing a safer supply of drugs) that render using alone as instrumental to survival, and that reduce the implicit threat of punishment from intensive surveillance and control practices are critical to reduce vulnerability to overdose and other harms.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA.
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15
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Frederique K, Ferguson A, Dodd Z. Why Patients Leave: The Role of Stigma and Discrimination in Decisions to Refuse Post-Overdose Treatment. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:1-5. [PMID: 38635422 DOI: 10.1080/15265161.2024.2333219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
| | | | - Zoё Dodd
- a Drug Policy Alliance
- b National Survivors Union
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16
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Hammock JA, López-Castro T, Fox AD. Prior incarceration, restrictive housing, and posttraumatic stress disorder symptoms in a community sample of persons who use drugs. HEALTH & JUSTICE 2024; 12:20. [PMID: 38668954 PMCID: PMC11046833 DOI: 10.1186/s40352-024-00276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Criminalization of drugs in the United States (US) has extensive consequences for people who use drugs (PWUD). Incarceration and substance use overlap with 65% of the US prison population meeting substance use disorder (SUD) criteria. Exposure to the criminal-legal system negatively impacts the health of PWUD. PTSD is commonly comorbid with SUDs, and exposure to restrictive housing (RH) during incarceration may worsen mental health. Because PWUD are disproportionately incarcerated, experiences occurring during incarceration, such as RH, may contribute to the development or exacerbation of PTSD and SUDs. This study of PWUD investigated prior criminal-legal system exposure and its association with PTSD symptoms in community-dwelling PWUD. METHODS This cross-sectional study recruited PWUD from syringe service programs (SSP). Inclusion criteria were: age 18+, current or past opioid use disorder, and SSP enrollment. Data collected included: sociodemographics; incarceration, substance use, SUD treatment history, and PTSD assessments (Life Events Checklist for DSM-5 and the PTSD Checklist for DSM-5). Bivariate testing and multivariate logistic regression analyses, with probable PTSD as the dependent variable and a three-level variable for criminal legal history as the independent variable, were conducted to determine whether incarceration and RH were associated with probable PTSD. RESULTS Of 139 participants, 78% had an incarceration history with 57% of these having a history of RH. 57% of participants screened positive for probable PTSD, and physical assault was the most common traumatic exposure. Any history of incarceration was not associated with probable PTSD diagnosis; however, in multivariate testing, adjusting for age, sex, and substance use, a history of RH (adjusted odds ratio [aOR]: 3.76, 95% CI 1.27-11.11) was significantly associated with probable PTSD. CONCLUSIONS RH and PTSD were both exceptionally common in a sample of SSP participants. RH can be detrimental to physical and mental health. Clinicians and policy makers may not consider incarceration as a traumatic experience for PWUD; however, our data suggest that among highly marginalized PWUD, prior exposure to incarceration and RH may add an additional burden to their daily struggles, namely PTSD.
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Affiliation(s)
- James A Hammock
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Teresa López-Castro
- The City College of New York, City University of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - Aaron D Fox
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
- Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA.
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17
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De Genna NM, Jacobsen E, Ganguli M. Marijuana use among community-dwelling older adults: A population-based study. Int J Geriatr Psychiatry 2024; 39:e6086. [PMID: 38613138 PMCID: PMC11112682 DOI: 10.1002/gps.6086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES There is a paucity of population-level data on marijuana use and mental health and functioning in older adults. METHODS We analyzed cross-sectional data (n = 910) from a well-characterized cohort, the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. MYHAT is an age-stratified random sample of the population age 65 years and older from a small-town in the USA. Half the sample was female and half were over 75 (Mean age = 77). Most participants were non-Hispanic White. Marijuana use was assessed by self-report and symptoms of mood disorders were screened using the modified Centers for Epidemiological Studies-Depression Scale and the Generalized Anxiety Disorder screener. Cognition was assessed by the Mini-Mental State Examination and a neuropsychological test battery; functioning using the OARS Activities of Daily Living and Instrumental Activities of Daily Living; and overall assessment using the Clinical Dementia Rating (CDR®). RESULTS One in five MYHAT participants had a history of marijuana use and 5% reported recent use, primarily for pain (41%) and recreation/relaxation (37%). Recent use was associated with cigarette and alcohol use, symptoms of depression or anxiety, and impairments in attention. CONCLUSIONS Twenty-percent of community-dwelling older adults living in a US state where recreational marijuana use is illegal had a history of marijuana use. Recent marijuana use was less common but, consistent with prior research, associated with other substance use and poorer mental health.
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Affiliation(s)
- Natacha M. De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Mary Ganguli
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Departments of Psychiatry and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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18
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Eschliman EL, Patel EU, Murray SM, German D, Kirk GD, Mehta SH, Kaufman MR, Genberg BL. Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use. Subst Use Misuse 2024; 59:1210-1220. [PMID: 38519443 PMCID: PMC11194036 DOI: 10.1080/10826084.2024.2330906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. METHODS This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. RESULTS 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15-1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04-1.59) and among some subgroups. CONCLUSIONS Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.
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Affiliation(s)
- Evan L. Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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19
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Castillo-Toledo C, Fraile-Martínez O, Donat-Vargas C, Lara-Abelenda FJ, Ortega MA, Garcia-Montero C, Mora F, Alvarez-Mon M, Quintero J, Alvarez-Mon MA. Insights from the Twittersphere: a cross-sectional study of public perceptions, usage patterns, and geographical differences of tweets discussing cocaine. Front Psychiatry 2024; 15:1282026. [PMID: 38566955 PMCID: PMC10986306 DOI: 10.3389/fpsyt.2024.1282026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Cocaine abuse represents a major public health concern. The social perception of cocaine has been changing over the decades, a phenomenon closely tied to its patterns of use and abuse. Twitter is a valuable tool to understand the status of drug use and abuse globally. However, no specific studies discussing cocaine have been conducted on this platform. Methods 111,508 English and Spanish tweets containing "cocaine" from 2018 to 2022 were analyzed. 550 were manually studied, and the largest subset underwent automated classification. Then, tweets related to cocaine were analyzed to examine their content, types of Twitter users, usage patterns, health effects, and personal experiences. Geolocation data was also considered to understand regional differences. Results A total of 71,844 classifiable tweets were obtained. Among these, 15.95% of users discussed the harm of cocaine consumption to health. Media outlets had the highest number of tweets (35.11%) and the most frequent theme was social/political denunciation (67.88%). Regarding the experience related to consumption, there are more tweets with a negative sentiment. The 9.03% of tweets explicitly mention frequent use of the drug. The continent with the highest number of tweets was America (55.44% of the total). Discussion The findings underscore the significance of cocaine as a current social and political issue, with a predominant focus on political and social denunciation in the majority of tweets. Notably, the study reveals a concentration of tweets from the United States and South American countries, reflecting the high prevalence of cocaine-related disorders and overdose cases in these regions. Alarmingly, the study highlights the trivialization of cocaine consumption on Twitter, accompanied by a misleading promotion of its health benefits, emphasizing the urgent need for targeted interventions and antidrug content on social media platforms. Finally, the unexpected advocacy for cocaine by healthcare professionals raises concerns about potential drug abuse within this demographic, warranting further investigation.
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Affiliation(s)
- Consuelo Castillo-Toledo
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Spain
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Carolina Donat-Vargas
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- IMDEA-Food Institute, Universidad Autónoma de Madrid, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - F. J. Lara-Abelenda
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Spain
- Departamento Teoria de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Escuela Tecnica Superior de Ingenieria de Telecomunicación, Universidad Rey Juan Carlos, Fuenlabrada, Spain
| | - Miguel Angel Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Cielo Garcia-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Fernando Mora
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), Alcalá de Henares, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
| | - Miguel Angel Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
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20
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Yoon S, Ploss A, Hutzel M, Webb R, Hatfield A, Lee JY, Munshi A, Radney A, McClellan J. Parenting attitudes and behaviors among parents involved with the child welfare system and affected by substance use disorders. CHILD ABUSE & NEGLECT 2024; 149:106657. [PMID: 38262180 DOI: 10.1016/j.chiabu.2024.106657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Co-occurring parental substance use and child maltreatment is a serious concern in the U.S child welfare system. OBJECTIVE The aim of the study was to examine parenting attitudes and practices among parents who participated in Ohio START (Sobriety, Treatment, And Reducing Trauma), a statewide initiative that provides support to families affected by co-occurring parental substance use and child maltreatment. PARTICIPANTS AND SETTING Study 1 involved quantitative data collected from 73 enrolled parents through pre-test and post-test telephone surveys. Study 2 (parent interviews) involved qualitative data collected through in-depth interviews with 34 enrolled parents. METHODS The paired-sample t-test and the McNemar test were conducted in Study 1 and thematic analysis was conducted in Study 2. RESULTS Quantitative analysis indicated significant improvements in parental expectations of children (t = -3.42, p = .001, Cohen's d = -0.40), parent-child family roles (t = -5.74, p < .001, Cohen's d = -0.67), and children's power and independence (t = -3.42, p = .001, Cohen's d = -0.40). Qualitative analysis revealed six themes related to changes in parenting after participation in Ohio START: (1) Being present for children, (2) Engaging in activities with children, (3) Enjoyment in providing care to children, (4) Maintaining employment for financial stability, (5) Better emotion regulation and stress management, and (6) a sense of pride. CONCLUSIONS Our findings demonstrate positive changes in parenting attitudes and practices among parents who participated in Ohio START and provide further support for the potential merits of this model and its continued expansion throughout Ohio.
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Affiliation(s)
- Susan Yoon
- College of Social Work, The Ohio State University, Columbus, OH, USA; Department of Social Welfare, College of Social Sciences, Ewha Womans University, Seoul, South Korea.
| | - Alexa Ploss
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Margaret Hutzel
- Voinovich School of Leadership and Public Service, Ohio University, Athens, OH, USA
| | - Robin Webb
- Voinovich School of Leadership and Public Service, Ohio University, Athens, OH, USA
| | - Ally Hatfield
- Voinovich School of Leadership and Public Service, Ohio University, Athens, OH, USA
| | - Joyce Y Lee
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Additti Munshi
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Angelise Radney
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Jen McClellan
- Public Children Services Association of Ohio (PCSAO), Columbus, OH, USA
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21
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Stowe MJ, Gatonye R, Maharjan I, Kehinde S, Arya S, Valderrábano JH, Mcbride A, Scheibein F, Igonya EK, Fast D. The war on drugs is a war on us: young people who use drugs and the fight for harm reduction in the Global South. Harm Reduct J 2024; 21:43. [PMID: 38368391 PMCID: PMC10874574 DOI: 10.1186/s12954-023-00914-7] [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: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 02/19/2024] Open
Abstract
In the Global South, young people who use drugs (YPWUD) are exposed to multiple interconnected social and health harms, with many low- and middle-income countries enforcing racist, prohibitionist-based drug policies that generate physical and structural violence. While harm reduction coverage for YPWUD is suboptimal globally, in low- and middle-income countries youth-focused harm reduction programs are particularly lacking. Those that do exist are often powerfully shaped by global health funding regimes that restrict progressive approaches and reach. In this commentary we highlight the efforts of young people, activists, allies, and organisations across some Global South settings to enact programs such as those focused on peer-to-peer information sharing and advocacy, overdose monitoring and response, and drug checking. We draw on our experiential knowledge and expertise to identify and discuss key challenges, opportunities, and recommendations for youth harm reduction movements, programs and practices in low- to middle-income countries and beyond, focusing on the need for youth-driven interventions. We conclude this commentary with several calls to action to advance harm reduction for YPWUD within and across Global South settings.
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Affiliation(s)
- M-J Stowe
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
- South African Network of People Who Use Drugs (SANPUD), Cape Town, South Africa.
- Community Orientated Substance Use Program, University of Pretoria, Pretoria, South Africa.
| | - Rita Gatonye
- Women in Response to HIV/AIDS and Drug Addiction, Umuahia, Nigeria
| | | | - Seyi Kehinde
- Youth RISE Nigeria, Federal Capital Territory, Nigeria
| | - Sidarth Arya
- State Drug Dependence Treatment Centre, Institute of Mental Health, Pt B.D.S University of Health Sciences, Rohtak, India
| | | | - Angela Mcbride
- South African Network of People Who Use Drugs (SANPUD), Cape Town, South Africa
| | - Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | | | - Danya Fast
- University of British Columbia and British Columbia Centre On Substance Use, Vancouver, Canada
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Kenefick HW, Wing A. BeHERE's effective virtual training to build capacity to support people who use drugs in non-substance use disorder settings. Harm Reduct J 2024; 21:38. [PMID: 38351012 PMCID: PMC10863279 DOI: 10.1186/s12954-024-00948-5] [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: 12/14/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Human service settings not specifically focused on supporting people who use drugs (PWUD), especially those with a substance use disorder (SUD), such as probation and parole services, homeless shelters, and work re-entry and job training programs, offer a unique opportunity to assist this population and prevent overdose deaths. During the COVID-19 pandemic (pandemic), building capacity in such settings for overdose prevention, harm reduction, and to address barriers to treatment, recovery, and support services required that training vendors use a virtual format. Post-pandemic, virtual training remains a cost-effective and convenient alternative to in-person training. The Behavioral Health and Racial Equity (BeHERE) Training Initiative of Health Resources in Action, which offers eight training modules on prevention, recovery, and harm reduction, delivered 224 online trainings between April 2020 and June 2022. METHODS A mixed methods evaluation based upon the Kirkpatrick Training Evaluation Model was employed, which utilized post-training (n = 1272) and follow-up surveys (n = 62), and key informant interviews (n = 35). RESULTS The findings showed BeHERE's trainings were relevant, engaging, and satisfying to trainees; increased their knowledge, skills, and confidence; and influenced workplace performance. Some participants also indicated that the training influenced the effectiveness of their work with clients and other staff. CONCLUSIONS The evaluation identified aspects of training that make a virtual format effective at improving the capacity of non-SUD settings to address substance use and support PWUD. Findings offer insights for those interested in delivery of virtual training, as well as training to influence the practice of human service providers across different settings to support PWUD.
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Affiliation(s)
| | - Alexis Wing
- Health Resources in Action, 2 Boylston Street, Suite 400, Boston, MA, 02116, USA
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23
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Bailey A, Taylor BG, Pollack HA, Schneider JA, Evans EA. Gender identity, stimulant drug use, and criminal justice history on internalized stigma among a nationally representative sample of adults who misuse opioids. Soc Psychiatry Psychiatr Epidemiol 2024; 59:305-313. [PMID: 37322292 PMCID: PMC10721725 DOI: 10.1007/s00127-023-02500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The rise of fatal stimulant use among adults who use opioids is a public health problem. Internalized stigma is a barrier to substance use treatment, which is greater for women and populations with criminal justice involvement. METHODS Using a nationally representative sample of adults in the United States from a probability-based survey on household opinions in 2021, we examined characteristics of women (n = 289) and men (n = 416) who misuse opioids. In gender-stratified multivariable linear regression, we investigated factors associated with internalized stigma, and tested for the interaction of stimulant use and criminal justice involvement. RESULTS Compared to men, women reported greater mental health symptom severity (3.2 vs. 2.7 on a 1 to 6 scale, p < 0.001). Internalized stigma was similar between women (2.3 ± 1.1) and men (2.2 ± 0.1). Among women and not men, however, stimulant use was positively associated with internalized stigma (0.36, 95% CI [0.07, 0.65]; p = 0.02). Interaction between stimulant use and criminal justice involvement was negatively associated with internalized stigma among women (- 0.60, 95% CI [- 1.16, -0.04]; p = 0.04); among men, the interaction was not significant. Predictive margins illustrate among women, stimulant use eliminated the gap in internalized stigma such that women with no criminal justice involvement had a similar level of internalized stigma as women with criminal justice involvement. CONCLUSION Internalized stigma between women and men who misuse opioids differed based on stimulant use and criminal justice involvement. Future research should assess whether internalized stigma influences treatment utilization among women with criminal justice involvement.
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Affiliation(s)
- Amelia Bailey
- Department of Behavioral and Social Sciences, School of Public Health, School of Public Health, Brown University, Box G-S121-3, Providence, RI, 02912, USA.
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant St., Arnold House, Amherst, MA, 01003, USA.
| | - Bruce G Taylor
- Public Health Department, NORC at the University of Chicago, Chicago, IL, USA
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, IL, USA
| | | | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant St., Arnold House, Amherst, MA, 01003, USA
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Padilla T, Reyes A. Hitting closer to home: State policies' impacts on health by race and legal status. Soc Sci Med 2024; 343:116562. [PMID: 38242032 PMCID: PMC11104556 DOI: 10.1016/j.socscimed.2024.116562] [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: 05/08/2023] [Revised: 12/24/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
While the proliferation of inclusionary and exclusionary state policies has led to an increasingly heterogeneous patchwork of state climates, state policy and the climates they create have become increasingly important for health outcomes. We leverage the heterogeneity across state policy climates to test the relationship between state-level policies and health inequality across the US. We include 24 state policies related to public health and safety, immigration enforcement, integration, and healthcare to capture the state climate. Using the Survey of Income and Program Participation (SIPP), a nationally representative study of households in the U.S., we estimate multilevel regression models to assess the relationship between state policy climate and healthcare utilization. We further examine differential effects of the policy climate across various vulnerable groups, by examining differences by citizenship status and race. We find that more exclusionary policies may be detrimental to healthcare utilization for all residents regardless of race and legal status- but ultimately racial minorities and noncitizens see the greatest benefits from inclusive policy climates.
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Affiliation(s)
- Tatiana Padilla
- Cornell University, 116 Reservoir Ave, Martha Van Rensselaer Hall, Ithaca, NY, 14853, United States.
| | - Adriana Reyes
- Cornell University, 116 Reservoir Ave, Martha Van Rensselaer Hall, Ithaca, NY, 14853, United States
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25
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Roberts K, Smith E, Sousa C, Young JE, Corley AG, Szczotka D, Sepanski A, Hartoch A. Centering persons who use drugs: addressing social determinants of health among patients hospitalized with substance use disorders. SOCIAL WORK IN HEALTH CARE 2024; 63:19-34. [PMID: 37929597 DOI: 10.1080/00981389.2023.2278777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
Social workers have emerged as leaders within Addiction Consult Services (ACS) due to their ability to provide a wide range of services, from crisis work and brief therapeutic interventions to connecting patients to community resources. Many hospitals have implemented ACS to address the overdose crisis and the sharp rise in drug use-related infections, including skin and soft tissue infections, osteomyelitis, and endocarditis; a result of unaddressed systemic social determinants of health (SDOH). Yet, despite social workers being at the forefront of inpatient substance use work, little guidance exists regarding social work's role in leading person-centered addiction care and addressing SDOH in the hospital setting. The authors of this paper are licensed clinical social workers who have worked across five different health systems, engaging persons who use drugs (PWUD) in the context of an ACS. This paper examines five practice interventions of social work practice within hospitals that represent key points for innovation. Drawing on social work's unique commitments to social justice, strengths, and person-in-environment, these interventions operate within eco-social approaches to help us grapple more effectively with ways that health - and disease - are socially and economically produced by multiple interacting factors. We provide a clinical roadmap of interventions for social workers in hospital settings with PWUD to demonstrate how social work leadership within inpatient care models can help us better address the impacts of various intersecting SDOH on the care of PWUD.
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Affiliation(s)
- Kate Roberts
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
| | - Emily Smith
- Michigan Opioid Collaboratived, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Cindy Sousa
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
| | - J Elaina Young
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anna Grace Corley
- Addiction Medicine, Prisma Health Internal Medicine, Greenville, South Carolina, USA
| | - Darin Szczotka
- Michigan Opioid Collaboratived, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Abby Sepanski
- Addiction Medicine, Prisma Health Internal Medicine, Greenville, South Carolina, USA
| | - Ashley Hartoch
- Psychiatry, Stanford Health Care, Palo Alto, California, USA
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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27
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Giorgi S, Habib DRS, Bellew D, Sherman G, Curtis B. A linguistic analysis of dehumanization toward substance use across three decades of news articles. Front Public Health 2023; 11:1275975. [PMID: 38074754 PMCID: PMC10701530 DOI: 10.3389/fpubh.2023.1275975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Substances and the people who use them have been dehumanized for decades. As a result, lawmakers and healthcare providers have implemented policies that subjected millions to criminalization, incarceration, and inadequate resources to support health and wellbeing. While there have been recent shifts in public opinion on issues such as legalization, in the case of marijuana in the U.S., or addiction as a disease, dehumanization and stigma are still leading barriers for individuals seeking treatment. Integral to the narrative of "substance users" as thoughtless zombies or violent criminals is their portrayal in popular media, such as films and news. Methods This study attempts to quantify the dehumanization of people who use substances (PWUS) across time using a large corpus of over 3 million news articles. We apply a computational linguistic framework for measuring dehumanization across three decades of New York Times articles. Results We show that (1) levels of dehumanization remain high and (2) while marijuana has become less dehumanized over time, attitudes toward other substances such as heroin and cocaine remain stable. Discussion This work highlights the importance of a holistic view of substance use that places all substances within the context of addiction as a disease, prioritizes the humanization of PWUS, and centers around harm reduction.
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Affiliation(s)
- Salvatore Giorgi
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Roy Sadek Habib
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Douglas Bellew
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Garrick Sherman
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Brenda Curtis
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
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28
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Whiteside B, Dunn M. Voices represented and voices silenced: Represented voices in the media coverage of the implementation of a supervised injecting facility. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104213. [PMID: 37776603 DOI: 10.1016/j.drugpo.2023.104213] [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: 12/02/2022] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Victoria's first medically supervised injecting room (MSIR) has remained controversial despite mounting evidence in support of the facility. The opposition to a policy idea is subject to a myriad of factors including the media. Favouring the opinions of various actors, the media are a fundamental element of the narrative formation process. In this article, we examine the voices represented and voice silenced in print news media and the possible effects of such reporting. METHODS A quantitative content and qualitative thematic analysis of Victorian print media (n=645) focusing on the implementation and continued operation of North Richmond Community Health's medically supervised injecting room was conducted. RESULTS The representations of the MSIR were debated by three predominant actors - politicians, public, and residents. Politicians largely relied on the 'saving lives' rhetoric when supporting the facility. In addition, competing representations of 'public amenity' were presented by both advocates and proponents of the MSIR. We found the voices of people who inject drugs were inadequately represented within the data. Instead, overdose statistics were featured as were discursive descriptions of people who inject drugs such as 'addicts', 'junkies', and 'druggies'. CONCLUSION Despite people who inject drugs being the population the MSIR is designed to benefit, their experiences and voices were lacking, highlighting social power structures, denying the silenced power, and obstructing social change. Overdose rates were consistently presented as numbers, negating personal experiences and lacking meaningful debate. Further, negative discourse referring to people who inject drugs may have implications regarding internalised and externalised stigma and drug policy.
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Affiliation(s)
- Bianca Whiteside
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Australia.
| | - Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Australia
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29
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Febres-Cordero S, Shasanmi-Ellis RO, Sherman ADF. Labeled as "drug-seeking": nurses use harm reduction philosophy to reflect on mending mutual distrust between healthcare workers and people who use drugs. Front Public Health 2023; 11:1277562. [PMID: 37908688 PMCID: PMC10614634 DOI: 10.3389/fpubh.2023.1277562] [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: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Over 50 years of approaching drug use from the "War on Drugs" has led to ignoring the systemic structural and social determinants of health, enforced drug use stigma, and damaging stereotypes of people who use drugs or are labeled as "drug-seeking," and sorely failed to support those needing assistance. On philosophy of harm reduction and power People who use drugs are often disenfranchised and pathologized by being labeled as "a drug addict," which then serves as a rationalization for mistreatment by healthcare providers. This is in opposition to a harm-reduction approach. Harm reduction philosophy is an epistemic valuation necessary for drug use stigma and our moral obligation to reduce harm from interlocking systems of power that perpetuate harm. On drug-seeking mistrust and human rights We have encountered many clients who use drugs that report harmful interactions with healthcare providers. Harm reduction is an issue of health equity, social justice, and fundamental human rights. This paper presents three vignettes, the author's experiences of being labeled as-and advocating for family members labeled as "drug-seeking." Discussion To better serve as healthcare providers, workers must be equipped to work with people who use drugs and reinforce the social justice commitment against medical stigma, neglect, racism, and inadequate pain coverage and withdrawal treatment. Nurses and our epistemic lens can meet the challenge of complex intersectional issues affecting our use of power to develop more just and equitable health systems and advance our rebuilding of a trusting relationship with the people we serve.
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30
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Matson TE, Williams EC, Lapham GT, Oliver M, Hallgren KA, Bradley KA. Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample. Drug Alcohol Depend 2023; 251:110946. [PMID: 37688980 PMCID: PMC10655701 DOI: 10.1016/j.drugalcdep.2023.110946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Brief cannabis screening followed by standardized assessment of symptoms may support diagnosis and treatment of cannabis use disorder (CUD). This study tested whether the probability of a medical provider diagnosing and treating CUD increased with the number of substance use disorder (SUD) symptoms documented in patients' EHRs. METHODS This observational study used EHR and claims data from an integrated healthcare system. Adult patients were included who reported daily cannabis use and completed the Substance Use Symptom Checklist, a scaled measure of DSM-5 SUD symptoms (0-11), during routine care 3/1/2015-3/1/2021. Logistic regression estimated associations between SUD symptom counts and: 1) CUD diagnosis; 2) CUD treatment initiation; and 3) CUD treatment engagement, defined based on Healthcare Effectiveness Data and Information Set (HEDIS) ICD-codes and timelines. We tested moderation across age, gender, race, and ethnicity. RESULTS Patients (N=13,947) were predominantly middle-age, male, White, and non-Hispanic. Among patients reporting daily cannabis use without other drug use (N=12,568), the probability of CUD diagnosis, treatment initiation, and engagement increased with each 1-unit increase in Symptom Checklist score (p's<0.001). However, probabilities of diagnosis, treatment, and engagement were low, even among those reporting ≥2 symptoms consistent with SUD: 14.0% diagnosed (95% CI: 11.7-21.6), 16.6% initiated treatment among diagnosed (11.7-21.6), and 24.3% engaged in treatment among initiated (15.8-32.7). Only gender moderated associations between Symptom Checklist and diagnosis (p=0.047) and treatment initiation (p=0.012). Findings were similar for patients reporting daily cannabis use with other drug use (N=1379). CONCLUSION Despite documented symptoms, CUD was underdiagnosed and undertreated in medical settings.
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Affiliation(s)
- Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98101, USA.
| | - Emily C Williams
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98101, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Kevin A Hallgren
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
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31
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Davis CS, Joshi S, Rivera BD, Cerdá M. Changes in arrests following decriminalization of low-level drug possession in Oregon and Washington. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104155. [PMID: 37567089 DOI: 10.1016/j.drugpo.2023.104155] [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: 03/24/2023] [Revised: 07/08/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Despite evidence that the U.S. "War on Drugs" is associated with increases in drug-related harm and other negative outcomes, all U.S. states have long criminalized most drug possession. In early 2021, both Oregon and Washington became exceptions to this rule when they fully (Oregon) or partially (Washington) decriminalized possession of small amounts of all drugs. METHODS We obtained arrest data for 2019 to 2021 for intervention states (Oregon and Washington) and control states (Colorado, Idaho, Montana, and Nevada). We calculated monthly rates for arrests overall and for violent crimes, drug possession, equipment possession, non-drug crimes, and a set of low-level crimes termed displaced arrests. Using an interrupted time series analysis, we examined changes in monthly arrest rates after the implementation of policy change in Oregon and Washington compared to control states. RESULTS In Oregon, there were 3 fewer drug possession arrests per 100,000 in the month after the policy change; the rate decreased throughout the post-implementation period. In Washington, there were almost 5 fewer drug possession arrests per 100,000 in the month following policy change, and the rate remained stable thereafter. Both declines were significantly greater than in comparison states. There were also statistically significant reductions in arrests for possession of drug equipment in Washington and a significant increase in displaced arrests in Oregon. There were no significant changes in overall arrests, non-drug arrests or arrests for violent crime in either state, relative to controls. CONCLUSION This analysis demonstrates that it is possible for state drug decriminalization policies to dramatically reduce arrests for drug possession without increasing arrests for violent crimes, potentially reducing harm to people who use drugs and their communities. Additional research is needed to determine whether these legal reforms were associated with changes in overdose rates and other drug-related harms.
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Affiliation(s)
- Corey S Davis
- Department of Population Health, Grossman School of Medicine, New York University Langone, 180 Madison Ave, 4th Floor New York, NY 10016, United States; Network for Public Health Law, 7101 York Avenue South, #270 Edina, MN 55435, United States.
| | - Spruha Joshi
- Department of Population Health, Grossman School of Medicine, New York University Langone, 180 Madison Ave, 4th Floor New York, NY 10016, United States
| | - Bianca D Rivera
- Department of Population Health, Grossman School of Medicine, New York University Langone, 180 Madison Ave, 4th Floor New York, NY 10016, United States
| | - Magdalena Cerdá
- Department of Population Health, Grossman School of Medicine, New York University Langone, 180 Madison Ave, 4th Floor New York, NY 10016, United States
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32
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Burton KL, Ritchwood TD, Metzger IW. Structural Racism and Racial Trauma Among African Americans at Elevated Risk for HIV Infection. Am J Public Health 2023; 113:S102-S106. [PMID: 37339423 PMCID: PMC10282852 DOI: 10.2105/ajph.2023.307223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Kelsey L Burton
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
| | - Tiarney D Ritchwood
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
| | - Isha W Metzger
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
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33
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Joshi S, Doonan SM, Pamplin JR. A tale of two cities: Racialized arrests following decriminalization and recreational legalization of cannabis. Drug Alcohol Depend 2023; 249:109911. [PMID: 37301067 DOI: 10.1016/j.drugalcdep.2023.109911] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In the U.S., "War on Drugs" policies have led to large and unequal increases in arrests among particularly of Black/African American men. The change in the legal status of cannabis may reduce the racial disparity in arrests. We examined the impact of changing legal status on arrest disparities. METHODS We obtained publicly available deidentified cannabis arrest data from the District of Columbia (D.C.) Metropolitan Police Department (2012-2019) and Los Angeles (L.A.) Police Department (2010-2019). We examined the differences in average monthly cannabis arrest rates for each city and each outcome (possession, possession with intent to distribute, distribution, and public consumption) across racial groups. RESULTS For both D.C. and L.A. following changes in the legal status of cannabis, we saw a decrease of the absolute disparity in possession-related arrests. There was also a reduction in D.C. for the relative disparity, but there was an increase in the relative disparity in L.A. In both cities, there was an emergence of public consumption-arrests. In D.C., there was an absolute increase of 4.0 (SD=2.5) more arrests per-month for Black people than white people and a relative increase of 9.1 (SD=1.5). In L.A., absolute disparity of 0.6(SD=1.3) and a relative disparity of 6.7 (SD=2.0). CONCLUSIONS There was a reduction in the absolute arrest disparity for cannabis-related possession arrests following decriminalization and legalization in both D.C and L.A. However, we saw the emergence of arrests for public consumption. This emergence of possession arrests towards public consumptions arrests, underscores the need to examine arrests beyond possession.
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Affiliation(s)
- Spruha Joshi
- Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, 4th Floor, New York, NY10016, United States.
| | - Samantha M Doonan
- Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, 4th Floor, New York, NY10016, United States
| | - John R Pamplin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY10032, United States
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Goddard-Eckrich D, Gilbert L, Richer A, Chang M, Hunt T, Henderson A, Marotta P, Wu E, Johnson K, Moses H, Liu Y, El-Bassel N. Moderation Analysis of a couple-based HIV/STI Intervention Among Heterosexual Couples in the Criminal Legal System Experiencing Intimate Partner Violence: Results from a Randomized Controlled Trial. AIDS Behav 2023; 27:1653-1665. [PMID: 36322218 PMCID: PMC9629199 DOI: 10.1007/s10461-022-03897-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Since the COVID-19 pandemic, intimate partner violence (IPV) rates have increased in the United States. Although accumulating research has documented the effectiveness of couple-based interventions in reducing HIV/STIs, it remains unclear whether they are effective and safe for couples experiencing IPV. We used moderation analysis from a randomized clinical trial to evaluate whether a couples-based HIV/STI intervention may have differential effectiveness in reducing HIV/STI risks among couples where one or both partners reported experiencing IPV compared to couples without such IPV among a sample of 230 men at risk for HIV/STIs who reported using drugs and were mandated to community supervision settings in New York City and their main female sexual partners. The findings of this study suggest that the effectiveness of this evidence-based couple HIV intervention in reducing condomless sex and other HIV/STI risks did not differ between couples with IPV compared to couples without IPV. Intimate partners who use drugs and are involved in the criminal legal system are disproportionately impacted by both HIV/STIs and IPV, underscoring the importance of couple-level interventions that may be scaled up to address the dyadic HIV risks and IPV together in community supervision settings.
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Affiliation(s)
- Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA.
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Ariel Richer
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Mingway Chang
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Ambuir Henderson
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Phillip Marotta
- Brown School, Washington University, 1 Brookings Dr, 63130, St Louis, MO, 63130, USA
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Karen Johnson
- University of Alabama, School of Social Work, Little Hall, 670 Judy Bonner Drive, Tuscaloosa, AL, 35401, USA
| | - Hermione Moses
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Yifan Liu
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
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Richter L, Oster R, Vuolo L. Government Investment in the Marijuana Industry's Commercial Interests Harms Vulnerable Groups. Am J Public Health 2023; 113:484-486. [PMID: 36926959 PMCID: PMC10088960 DOI: 10.2105/ajph.2023.307257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Linda Richter
- All authors are with the Partnership to End Addiction, New York, NY
| | - Robyn Oster
- All authors are with the Partnership to End Addiction, New York, NY
| | - Lindsey Vuolo
- All authors are with the Partnership to End Addiction, New York, NY
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Lowder EM, Zhou W, Peppard L, Bates R, Carr T. Supply-side predictors of fatal drug overdose in the Washington/Baltimore HIDTA region: 2016-2020. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103902. [PMID: 36343432 DOI: 10.1016/j.drugpo.2022.103902] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rising rates of fentanyl- and polydrug-involved drug overdose deaths have prompted inquiry into the role of drug supply in fatal overdose outcomes in the United States. To date, however, there have been few empirical investigations of drug enforcement strategies on fatal overdose rates, despite knowledge that both drug use and supply are often geographically distributed. To address this limitation, we examined measures of drug enforcement as predictors of next-year fatal overdose rates in the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA). METHODS We conducted mixed-effects models to examine the role of drug seizures and disruption in drug trafficking organizations (DTOs) and money laundering organizations (MLOs) on fatal overdose rates over a 5-year period (2016-2020) across 45 local jurisdictions in the W/B HIDTA region. Outcomes included any, opioid-involved, and fentanyl-involved fatal overdose. RESULTS Adjusting for covariates, both the total number of drug seizures and amount of cocaine seized (in dosage units per capita) positively predicted next-year opioid- and fentanyl-involved fatal overdose rates. Disruption to DTO and MLO operations did not significantly predict next-year fatal overdose rates for any outcome. CONCLUSION Supply-side enforcement activities alone may have limited impact on reducing fatal overdose rates, but may serve as important markers to identify communities at high risk of fatal overdose and facilitate targeted intervention. Our findings underscore the importance of comprehensive law enforcement approaches that extend beyond drug enforcement to integrate prevention, linkage to treatment, and harm reduction strategies as needed to address the overdose epidemic.
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Affiliation(s)
- Evan M Lowder
- Department of Criminology, Law and Society, George Mason University, 4400 University Dr, Enterprise Hall 308, Fairfax, VA 22030, USA.
| | - Weiyu Zhou
- Department of Statistics, School of Computing, George Mason University, 4511 Patriot Cir, Fairfax, VA 22030, USA
| | - Lora Peppard
- Center for Drug Policy and Prevention, University of Baltimore, 1800 Alexander Bell Drive, Suite 300, Reston, VA 20191, USA
| | - Rebecca Bates
- Center for Drug Policy and Prevention, University of Baltimore, 1800 Alexander Bell Drive, Suite 300, Reston, VA 20191, USA
| | - Thomas Carr
- Center for Drug Policy and Prevention, University of Baltimore, 1800 Alexander Bell Drive, Suite 300, Reston, VA 20191, USA
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