1
|
Smart R, Powell D, Pacula RL, Peet E, Abouk R, Davis CS. Investigating the complexity of naloxone distribution: Which policies matter for pharmacies and potential recipients. JOURNAL OF HEALTH ECONOMICS 2024; 97:102917. [PMID: 39043099 DOI: 10.1016/j.jhealeco.2024.102917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 04/13/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024]
Abstract
Despite efforts to expand naloxone access, opioid-related overdoses remain a significant contributor to mortality. We study state efforts to expand naloxone distribution through pharmacies by reducing the non-monetary costs to prescribers, dispensers, and/or potential recipients of naloxone. We find that laws that only address liability costs have small and insignificant effects on the volume of naloxone dispensed through pharmacies. In contrast, we estimate large effects of laws removing the need for patients to obtain prescriptions from traditional prescribers (e.g., primary care physicians): laws authorizing non-patient-specific prescription distribution and laws granting pharmacists prescriptive authority. We test whether areas designated as primary care shortage areas-where it would be costlier to obtain a prescription-were disproportionately impacted. Shortage areas experienced sharper growth in pharmacy naloxone dispensing in states adopting prescriptive authority policies. These gains were primarily due to those facing low out-of-pocket costs, suggesting that price barriers also must be addressed to increase naloxone purchases.
Collapse
Affiliation(s)
| | | | | | | | - Rahi Abouk
- William Paterson University, United States
| | | |
Collapse
|
2
|
Dowd WN. The effect of untargeted naloxone distribution on opioid overdose outcomes. HEALTH ECONOMICS 2023; 32:2801-2818. [PMID: 37670413 DOI: 10.1002/hec.4755] [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: 12/06/2022] [Revised: 06/06/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
Opioid overdose has claimed the lives of over 340,000 Americans in the last decade. Over that same period, policymakers have taken steps to increase the availability of naloxone-an opioid antagonist used to rescue overdose victims-to people in the community. Previous studies, most of which have examined the effects of state laws designed to facilitate access to naloxone, have reached mixed conclusions about the effects of naloxone access on fatal and non-fatal overdoses. This paper exploits a unique policy experiment provided by two naloxone giveaways intended to increase naloxone possession among the general public in Pennsylvania to estimate the causal impact of naloxone distribution on fatal overdoses and opioid-related emergency department (ED) visits. Using a difference-in-differences design, I find evidence that opioid overdose deaths fell immediately following the first giveaway but increased following the second giveaway and discuss these apparently contradictory findings in the context of the changing composition of the opioid supply. I also find some evidence of a decline in opioid overdose-related ED visits following the giveaways. This study is the first to examine the effects of untargeted naloxone distribution and has implications for other novel, naloxone distribution efforts currently underway.
Collapse
Affiliation(s)
- William N Dowd
- Public Health Division, RTI International, Research Triangle Park, North Carolina, USA
- Division of Health Research, Lancaster University, Lancaster, UK
| |
Collapse
|
3
|
Rengifo S, Wu A, Ioffreda P, Ilyas AM. Differences in Opioid-Related Deaths in the Appalachian Region in 2018-2021 by State and Rural-Urban County Classification. Cureus 2023; 15:e40480. [PMID: 37461797 PMCID: PMC10349683 DOI: 10.7759/cureus.40480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction The rapid increase in opioid-related deaths since the early 2000s is a major US public health concern. This crisis has transitioned from pharmaceuticals to illicit synthetic opioids and street mixtures. This epidemic has significantly impacted the Appalachian region. This study investigated opioid-related death rates among the Appalachian states, focusing on death rates among urban, suburban, and rural counties. Methods Opioid-related death data from 2018-2021 for the 13 states that make up the Appalachian region were collected using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Opioid analgesic overdose deaths were defined using ICD-10 codes X40-X44, X60-X64, and Y10-Y14, where an opioid analgesic was also coded (T40.2-T40.4). US census data was used to calculate opioid-related death rates by population. Counties were classified as urban, suburban, and rural using the 2013 Rural-Urban Continuum Codes from the US Department of Agriculture. The data were descriptively broken down and reported as either percentages or means. Results Of the opioid-related deaths between 2018 and 2021, 498 counties were identified in the 13 Appalachian states as having reported at least 10 opioid-related deaths per year. Among these counties, 337 (67.7%) were classified as urban/metropolitan, 138 (27.7%) as suburban, and 23 (4.62%) as rural. Overall, mean opioid-related deaths by populations per 1000 among all counties were 0.24 in 2018, 0.24 in 2019, 0.33 in 2020, and 0.38 in 2021. For urban/metropolitan counties, opioid-related deaths per 1000 gradually increased from 0.23 in 2018 to 0.35 in 2021. For suburban counties, the mean opioid-related deaths per 1000 increased from 0.25 in 2018 to 0.43 in 2021. For rural counties, the mean opioid-related deaths per 1000 increased from 0.43 in 2018 to 0.62 in 2021. Conclusion Opioid-related deaths, on average and by population, have risen steadily in the Appalachian region from 2018-2021 across all geographic areas (urban/metropolitan, suburban, rural). Rural counties consistently showed the highest opioid-related deaths per population compared to urban/metropolitan and suburban areas. Addressing social determinants of health such as income level, education level, healthcare access, and community-based interventions is crucial in combating this issue. Community and health system interventions must be implemented to combat the disproportionately high rate of opioid prescribing in the Appalachian region.
Collapse
Affiliation(s)
- Santiago Rengifo
- Foundation for Opioid Research & Education, Rothman Orthopaedic Institute, Philadelphia, USA
- Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, USA
- Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Alice Wu
- Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Patrick Ioffreda
- Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Asif M Ilyas
- Foundation for Opioid Research and Education, Rothman Orthopaedic Institute, Philadelphia, USA
- Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, USA
- Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson, Philadelphia, USA
- Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| |
Collapse
|
4
|
Tay Wee Teck J, Oteo A, Baldacchino A. Rapid opioid overdose response system technologies. Curr Opin Psychiatry 2023:00001504-990000000-00063. [PMID: 37185583 DOI: 10.1097/yco.0000000000000870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW Opioid overdose events are a time sensitive medical emergency, which is often reversible with naloxone administration if detected in time. Many countries are facing rising opioid overdose deaths and have been implementing rapid opioid overdose response Systems (ROORS). We describe how technology is increasingly being used in ROORS design, implementation and delivery. RECENT FINDINGS Technology can contribute in significant ways to ROORS design, implementation, and delivery. Artificial intelligence-based modelling and simulations alongside wastewater-based epidemiology can be used to inform policy decisions around naloxone access laws and effective naloxone distribution strategies. Data linkage and machine learning projects can support service delivery organizations to mobilize and distribute community resources in support of ROORS. Digital phenotyping is an advancement in data linkage and machine learning projects, potentially leading to precision overdose responses. At the coalface, opioid overdose detection devices through fixed location or wearable sensors, improved connectivity, smartphone applications and drone-based emergency naloxone delivery all have a role in improving outcomes from opioid overdose. Data driven technologies also have an important role in empowering community responses to opioid overdose. SUMMARY This review highlights the importance of technology applied to every aspect of ROORS. Key areas of development include the need to protect marginalized groups from algorithmic bias, a better understanding of individual overdose trajectories and new reversal agents and improved drug delivery methods.
Collapse
Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
- Forward Leeds and Humankind Charity, Durham, UK
| | - Alberto Oteo
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
| | - Alexander Baldacchino
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
| |
Collapse
|
5
|
Tabatabai M, Cooper RL, Wilus DM, Edgerton RD, Ramesh A, MacMaster SA, Patel PN, Singh KP. The Effect of Naloxone Access Laws on Fatal Synthetic Opioid Overdose Fatality Rates. J Prim Care Community Health 2023; 14:21501319221147246. [PMID: 36625264 PMCID: PMC9834937 DOI: 10.1177/21501319221147246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Increases in fatal synthetic opioid overdoses over the past 8 years have left states scrambling for effective means to curtail these deaths. Many states have implemented policies and increased service capacity to address this rise. To better understand the effectiveness of policy level interventions we estimated the impact of the presence of naloxone access laws (NALs) on synthetic opioid fatalities at the state level. METHODS A multivariable longitudinal linear mixed model with a random intercept was used to determine the relationship between the presence of NALs and synthetic opioid overdose death rates, while controlling for, Good Samaritan laws, opioid prescription rate, and capacity for medication for opioid use disorder (MOUD), utilizing a quadratic time trajectory. Data for the study was collected from the National Vital Statistics System using multiple cause-of-death mortality files linked to drug overdose deaths. RESULTS The presence of an NAL had a significant (univariate P-value = .013; multivariable p-value = .010) negative relationship to fentanyl overdose death rates. Other significant controlling variables were quadratic time (univariate and multivariable P-value < .001), MOUD (univariate P-value < .001; multivariable P-value = .009), and Good Samaritan Law (univariate P-value = .033; multivariable P-value = .018). CONCLUSION Naloxone standing orders are strongly related to fatal synthetic opioid overdose reduction. The effect of NALs, MOUD treatment capacity, and Good Samaritan laws all significantly influenced the synthetic opioid overdose death rate. The use of naloxone should be a central part of any state strategy to reduce overdose death rate.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Karan P. Singh
- University of Texas at Tyler School of
Medicine, Tyler, TX, USA
| |
Collapse
|
6
|
Townsend TN, Hamilton LK, Rivera-Aguirre A, Davis CS, Pamplin JR, Kline D, Rudolph KE, Cerdá M. Use of an Inverted Synthetic Control Method to Estimate Effects of Recent Drug Overdose Good Samaritan Laws, Overall and by Black/White Race/Ethnicity. Am J Epidemiol 2022; 191:1783-1791. [PMID: 35872589 PMCID: PMC9989361 DOI: 10.1093/aje/kwac122] [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: 11/18/2020] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 01/29/2023] Open
Abstract
Overdose Good Samaritan laws (GSLs) aim to reduce mortality by providing limited legal protections when a bystander to a possible drug overdose summons help. Most research into the impact of these laws is dated or potentially confounded by coenacted naloxone access laws. Lack of awareness and trust in GSL protections, as well as fear of police involvement and legal repercussions, remain key deterrents to help-seeking. These barriers may be unequally distributed by race/ethnicity due to racist policing and drug policies, potentially producing racial/ethnic disparities in the effectiveness of GSLs for reducing overdose mortality. We used 2015-2019 vital statistics data to estimate the effect of recent GSLs on overdose mortality, overall (8 states) and by Black/White race/ethnicity (4 states). Given GSLs' near ubiquity, few unexposed states were available for comparison. Therefore, we generated an "inverted" synthetic control method (SCM) to compare overdose mortality in new-GSL states with that in states that had GSLs throughout the analytical period. The estimated relationships between GSLs and overdose mortality, both overall and stratified by Black/White race/ethnicity, were consistent with chance. An absence of effect could result from insufficient protection provided by the laws, insufficient awareness of them, and/or reticence to summon help not addressable by legal protections. The inverted SCM may be useful for evaluating other widespread policies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Magdalena Cerdá
- Correspondence to Dr. Magdalena Cerdá, Department of Population Health, Center for Opioid Epidemiology and Policy, 180 Madison Avenue, New York, NY 10016 (e-mail: )
| |
Collapse
|
7
|
Rudolph KE, Gimbrone C, Matthay EC, Díaz I, Davis CS, Keyes K, Cerdá M. When Effects Cannot be Estimated: Redefining Estimands to Understand the Effects of Naloxone Access Laws. Epidemiology 2022; 33:689-698. [PMID: 35944151 PMCID: PMC9373236 DOI: 10.1097/ede.0000000000001502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Violations of the positivity assumption (also called the common support condition) challenge health policy research and can result in significant bias, large variance, and invalid inference. We define positivity in the single- and multiple-timepoint (i.e., longitudinal) health policy evaluation setting, and discuss real-world threats to positivity. We show empirical evidence of the practical positivity violations that can result when attempting to estimate the effects of health policies (in this case, Naloxone Access Laws). In such scenarios, an alternative is to estimate the effect of a shift in law enactment (e.g., the effect if enactment had been delayed by some number of years). Such an effect corresponds to what is called a modified treatment policy, and dramatically weakens the required positivity assumption, thereby offering a means to estimate policy effects even in scenarios with serious positivity problems. We apply the approach to define and estimate the longitudinal effects of Naloxone Access Laws on opioid overdose rates.
Collapse
Affiliation(s)
- Kara E. Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Catherine Gimbrone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ellicott C. Matthay
- Center for Health and Community, School of Medicine, University of California, San Francisco
| | - Iván Díaz
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | | | - Katherine Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, School of Medicine, New York University, New York, New York
| |
Collapse
|
8
|
Grant S, Smart R. Expert views on state-level naloxone access laws: a qualitative analysis of an online modified-Delphi process. Harm Reduct J 2022; 19:64. [PMID: 35676719 PMCID: PMC9175531 DOI: 10.1186/s12954-022-00645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Expanding availability to naloxone is a core harm reduction strategy in efforts to address the opioid epidemic. In the US, state-level legislation is a prominent mechanism to expand naloxone availability through various venues, such as community pharmacies. This qualitative study aimed to identify and summarize the views of experts on state-level naloxone access laws. Methods We conducted a three-round modified-Delphi process using the online ExpertLens platform. Participants included 46 key stakeholders representing various groups (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with expertise naloxone access laws. Participants commented on the effectiveness and implementability of 15 state-level naloxone access laws (NALs). We thematically analyzed participant comments to summarize views on NALs overall and specific types of NAL. Results Participants commented that the effectiveness of NALs in reducing opioid-related mortality depends on their ability to make sustained, significant impacts on population-level naloxone availability. Participants generally believed that increased naloxone availability does not have appreciable negative impacts on the prevalence of opioid misuse, opioid use disorder (OUD), and non-fatal opioid overdoses. Implementation barriers include stigma among the general public, affordability of naloxone, and reliance on an inequitable healthcare system. Conclusions Experts believe NALs that significantly increase naloxone access are associated with less overdose mortality without risking substantial unintended public health outcomes. To maximize impacts, high-value NALs should explicitly counter existing healthcare system inequities, address stigmatization of opioid use and naloxone, maintain reasonable prices for purchasing naloxone, and target settings beyond community pharmacies to distribute naloxone.
Collapse
Affiliation(s)
- Sean Grant
- Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN, 46202, USA.
| | - Rosanna Smart
- Economics, Sociology, and Statistics Department, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| |
Collapse
|
9
|
Hill LG, Loera LJ, Evoy KE, Renfro ML, Torrez SB, Zagorski CM, Perez JC, Jones SM, Reveles KR. Availability of buprenorphine/naloxone films and naloxone nasal spray in community pharmacies in Texas, USA. Addiction 2021; 116:1505-1511. [PMID: 33140519 DOI: 10.1111/add.15314] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Patients with opioid use disorder (OUD) must be able to obtain prescribed buprenorphine/naloxone films (BUP/NX) and naloxone nasal spray (NNS) from a pharmacy promptly to reduce risk for a recurrence of use and subsequent morbidity and mortality. Telephone audits have identified concerning gaps in availability of NNS within US pharmacies, but the availability of BUP/NX has not been rigorously evaluated. This study estimated the availability of BUP/NX and NNS in the US state of Texas and compared availability by pharmacy type and metropolitan status. DESIGN A cross-sectional telephone audit with a secret shopper approach conducted from 18 May 2020 to 7 June 2020. Setting and Participants A random sample of 800 of 5078 (16%) community pharmacies licensed with the Texas State Board of Pharmacy. MEASUREMENTS Primary outcomes included availability of a 1-week supply of generic BUP/NX 8/2 mg films and a single unit of NNS 4 mg, overall and by pharmacy type. Secondary outcomes included willingness and estimated time-frame to order BUP/NX if unavailable. FINDINGS Data from 704 pharmacies (471 chain, 233 independent) were included for analyses. Of these, 34.1% of pharmacies (45.0% of chains versus 12.0% of independents, P < 0.0001) were willing and able to dispense a 1-week supply of generic BUP/NX and a single unit of NNS. BUP/NX alone was available in 42.2% of pharmacies (52.4% of chains versus 21.5% of independents, P < 0.0001). NNS alone was available in 60.1% of pharmacies (77.9% of chains versus 24.0% of independents, P < 0.0001). Of the 397 pharmacies with generic BUP/NX unavailable, 62.2% of pharmacies (73.9% of chains versus 48.0% of independents, P < 0.0001) indicated willingness to order. CONCLUSIONS Most pharmacies in Texas do not appear to be willing and able to dispense prescribed buprenorphine/naloxone films and naloxone nasal spray to patients with opioid use disorder in a timely manner. Deficiencies in availability are markedly more pronounced in independent pharmacies compared with chain pharmacies.
Collapse
Affiliation(s)
- Lucas G Hill
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Lindsey J Loera
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kirk E Evoy
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Mandy L Renfro
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Sorina B Torrez
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Claire M Zagorski
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Joshua C Perez
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Shaun M Jones
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, Austin, TX, USA
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
10
|
Evaluation of Policy Effectiveness by Mathematical Modeling for the Opioid Crisis with Spatial Study and Trend Analysis. Healthcare (Basel) 2021; 9:healthcare9050585. [PMID: 34069018 PMCID: PMC8155830 DOI: 10.3390/healthcare9050585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
The current opioid epidemic in the US presents a great problem which calls for policy supervision and regulation. In this work, the opioid cases of five states were used for trend analysis and modeling for the estimation of potential policy effects. An evaluation model was established to analyze the severity of the opioid abuse based on the entropy weight method (EWM) and rank sum ratio (RSR). Four indexes were defined to estimate the spatial distribution of development and spread of the opioid crisis. Thirteen counties with the most severe opioid abuse in five states were determined using the EWM-RSR model and those indexes. Additionally, a forecast of the development of opioid abuse was given based on an autoregressive (AR) model. The RSR values of the thirteen counties would increase to the range between 0.951 and 1.226. Furthermore, the least absolute shrinkage and selection operator (LASSO) method was adopted. The previous indexes were modified, incorporating the comprehensive socioeconomic effects. The optimal penalty term was found to facilitate the stability and reliability of the model. By using the comprehensive model, it was found that three factors—VC112, VC114, VC115—related to disabled people have a great influence on the development of opioid abuse. The simulated policies were performed in the model to decrease the values of the indicators by 10%–50%. The corresponding RSR values can decline to the range between 0.564 and 0.606. Adopting policies that benefit the disabled population should inhibit the trend of opioid abuse.
Collapse
|
11
|
Bagley SM, Gai MJ, Earlywine JJ, Schoenberger SF, Hadland SE, Barocas JA. Incidence and Characteristics of Nonfatal Opioid Overdose Among Youths Aged 11 to 24 Years by Sex. JAMA Netw Open 2020; 3:e2030201. [PMID: 33331919 PMCID: PMC7747019 DOI: 10.1001/jamanetworkopen.2020.30201] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Opioid-related overdose has substantially increased among adolescents and young adults in recent years. How overdose differs by age and sex among youths and the factors associated with overdose by sex remain poorly described. OBJECTIVE To compare the sociodemographic and clinical characteristics of female and male youths who have experienced a nonfatal opioid overdose (NFOD) and compare the incidence of NFOD by sex. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data on US individuals aged 11 to 24 years with a diagnosis of NFOD from the IBM MarketScan Commercial Database from January 1, 2006, through December 31, 2017. EXPOSURE Sex. MAIN OUTCOMES AND MEASURES The primary outcome was NFOD stratified by sex; covariates included sociodemographic and clinical characteristics. RESULTS Among 20 312 youths aged 11 to 24 years who had a history of NFOD and met study eligibility criteria, the median age was 20 years (interquartile range, 18-22 years; mean [SD] age, 20.0 [2.9] years) and 56.7% were male. Compared with male youths, female youths had a higher baseline prevalence of mood or anxiety disorder (65.5% vs 51.9%, P < .001), trauma and stress-related disorders (16.4% vs 10.1%, P < .001), and history of suicide attempt or self-harm (14.6% vs 9.9%, P < .001). Male youths had a higher prevalence of opioid use disorder (44.7% vs 29.2%, P < .001), cannabis use disorder (18.3% vs 11.3%, P < .001), and alcohol use disorder (20.3% vs 14.4%, P < .001). The incidence rate ratio of NFODs in females vs males was greater than 1 for ages 11 to 16 years and was less than or equal to 1 after age 17 years. CONCLUSIONS AND RELEVANCE This cohort study found differences between female and male youths in sociodemographic and clinical characteristics and incidence of NFOD. Although female and male youths who experience overdose appear to have different risk factors, many of these risk factors may be amenable to early detection through screening and intervention.
Collapse
Affiliation(s)
- Sarah M. Bagley
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
- Grayken Center for Addiction, Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Mam Jarra Gai
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Joel J. Earlywine
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Samantha F. Schoenberger
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Scott E. Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
- Grayken Center for Addiction, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Joshua A. Barocas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| |
Collapse
|