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Zhu T, Baker ZG, Trabold M, Kelley-Quon LI, Basin MF, Vazirani R, Chen J, Kokorowski PJ. Sociodemographic differences in opioid use and recovery following ambulatory pediatric urologic procedures. J Child Health Care 2024; 28:291-301. [PMID: 36062326 DOI: 10.1177/13674935221124738] [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] [Indexed: 11/16/2022]
Abstract
Our aim was to examine associations between sociodemographic factors and postoperative opioid use and recovery among pediatric patients undergoing outpatient urologic procedures. We retrospectively evaluated 831 patients undergoing ambulatory urologic procedures from 2013 to 2017 at an urban pediatric hospital. Patients were evaluated for days of opioid use and days until return to baseline behavior. Differences in outcomes by race/ethnicity, primary language, median neighborhood household income, and health insurance type were analyzed using negative binomial regression models. Overall, patients reported a median of 1.0 day (IQR: 2.0) of postoperative opioid use and 3.0 days (IQR: 6.0) of recovery time. After controlling for covariates, patients with non-English speaking parents took opioids for 26.5% (95% CI: 11.4-41.7%) longer and had 27.8% (95% CI: 8.1-51.0%) longer recovery time than patients with English-speaking parents. Hispanic patients took opioids for 27.5% (95% CI: 0.1-54.9%) longer than White patients. Patients with public insurance used opioids for 47.6% (95% CI: 5.0-107.4%) longer than privately insured patients. Non-English speaking, Hispanic, and publicly insured patients had a longer duration of postoperative opioid use than primarily English-speaking, White, and privately insured patients, respectively. Identifying these disparities is important for designing equitable postoperative care pathways.
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Affiliation(s)
- Terry Zhu
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Zoë G Baker
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Melissa Trabold
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael F Basin
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Ragini Vazirani
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Jiayao Chen
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Paul J Kokorowski
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Roberts E, Strang J, Horgan P, Eastwood B. The development and internal validation of a multivariable model predicting 6-month mortality for people with opioid use disorder presenting to community drug services in England: a protocol. Diagn Progn Res 2024; 8:7. [PMID: 38622702 PMCID: PMC11020443 DOI: 10.1186/s41512-024-00170-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/07/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND People with opioid use disorder have substantially higher standardised mortality rates compared to the general population; however, lack of clear individual prognostic information presents challenges to prioritise or target interventions within drug treatment services. Previous prognostic models have been developed to estimate the risk of developing opioid use disorder and opioid-related overdose in people routinely prescribed opioids but, to our knowledge, none have been developed to estimate mortality risk in people accessing drug services with opioid use disorder. Initial presentation to drug services is a pragmatic time to evaluate mortality risk given the contemporaneous routine collection of prognostic indicators and as a decision point for appropriate service prioritisation and targeted intervention delivery. This study aims to develop and internally validate a model to estimate 6-month mortality risk for people with opioid use disorder from prognostic indicators recorded at initial assessment in drug services in England. METHODS An English national dataset containing records from individuals presenting to drug services between 1 April 2013 and 1 April 2023 (n > 800,000) (the National Drug Treatment Monitoring System (NDTMS)) linked to their lifetime hospitalisation and death records (Hospital Episode Statistics-Office of National Statistics (HES-ONS)). Twelve candidate prognostic indicator variables were identified based on literature review of demographic and clinical features associated with increased mortality for people in treatment for opioid use disorder. Variables will be extracted at initial presentation to drug services with mortality measured at 6 months. Two multivariable Cox regression models will be developed one for 6-month all-cause mortality and one for 6-month drug-related mortality using backward elimination with a fractional polynomial approach for continuous variables. Internal validation will be undertaken using bootstrapping methods. Discrimination of both models will be reported using Harrel's c and d-statistics. Calibration curves and slopes will be presented comparing expected and observed event rates. DISCUSSION The models developed and internally validated in this study aim to improve clinical assessment of mortality risk for people with opioid use disorder presenting to drug services in England. External validation in different populations will be required to develop the model into a tool to assist future clinical decision-making.
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Affiliation(s)
- Emmert Roberts
- National Addiction Centre and the Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and the Maudsley NHS Foundation Trust, London, UK.
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK.
| | - John Strang
- National Addiction Centre and the Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and the Maudsley NHS Foundation Trust, London, UK
| | - Patrick Horgan
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Brian Eastwood
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
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Salekešin M, Vorobjov S, Des Jarlais D, Uusküla A. Mortality among people who inject drugs - the interwoven roles of fentanyl and HIV: a community-based cohort study. Eur J Public Health 2024; 34:329-334. [PMID: 38041408 PMCID: PMC10990538 DOI: 10.1093/eurpub/ckad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Excess all-cause mortality is a key indicator for assessing direct and indirect consequences of injection drug use and data are warranted to delineate sub-populations within people who inject drugs at higher risk of death. Our aim was to examine mortality and factors associated with mortality among people who inject drugs in Estonia. METHODS Retrospective cohort study using data from people who inject drugs recruited in the community with linkage to death records. Standardized mortality ratios were used to compare the cohort mortality to the general population and potential predictors of death were examined through survival analysis (Cox regression). The cohort include a total of 1399 people who inject drugs recruited for cross-sectional surveys using respondent driven sampling between 2013 and 2018 in Estonia. A cohort with follow-up through 2019 was formed with linkage to national causes of death registry. RESULTS Among 1399 participants with 4684 person-years of follow-up, 10% were deceased by 2019. The all-cause mortality rate in the cohort was 28.9 per 1000 person-years (95% confidence interval 25.3-35.3). Being HIV positive, injecting mainly opioids (fentanyl), living in the capital region and the main source of income other than work were associated with greater mortality risk. CONCLUSIONS While low-threshold services have been available for a long time for people who inject drugs, there is still a need to widen the availability and integration of services, particularly the integration of HIV and opioid treatment.
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Affiliation(s)
- Maris Salekešin
- Department of Risk Behavior Studies, National Institute for Health Development, Tallinn, Estonia
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Sigrid Vorobjov
- Department of Risk Behavior Studies, National Institute for Health Development, Tallinn, Estonia
| | - Don Des Jarlais
- School of Global Public Health, New York University, New York, USA
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Jawa R, Murray S, Blakemore S, Ventura AS, Hristova T, Wilder A, Shang M, LaBelle C. Xylazine and Adulterants in the Evolving Drug Supply: Urgent Call for Responsive Education Models. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:168-175. [PMID: 38375666 PMCID: PMC11121508 DOI: 10.1177/29767342241231114] [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] [Indexed: 02/21/2024]
Abstract
Novel adulterants and synthetic substances are rapidly infiltrating the US drug supply causing new clinical harms. There is an urgent need for responsive education and training to address these evolving harms and mitigate new risks. Since 2020, xylazine, a veterinary tranquilizer, has become increasingly common in the illicit opioid supply, especially alongside fentanyl. Training and technical assistance (TTA) programs employing an adaptive model can quickly disseminate emerging information and provide the tools to respond effectively. We describe our TTA program's experience developing and delivering virtual instructor-led xylazine training to a diverse group of addiction care professionals. The training objectives included the following: (1) introducing epidemiologic trends, pharmacology, and existing literature related to xylazine; (2) reviewing xylazine-associated harms and management; and (3) discussing harm reduction strategies related to xylazine use. We conducted 14 training sessions between October 2022 and July 2023, which were attended by over 2000 individuals across 49 states. We review our experience developing innovative training content and managing flexible training logistics and highlight our lessons learned, including targeting multidisciplinary professionals, leveraging online synchronous delivery methods, and a need for sustainable funding for TTA programs.
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Affiliation(s)
- Raagini Jawa
- Center for Research on Healthcare, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA
| | - Stephen Murray
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA
| | - Samantha Blakemore
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA
| | - Alicia S. Ventura
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA
| | - Tavita Hristova
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA
| | - Alexa Wilder
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA
| | - Margaret Shang
- Center for Research on Healthcare, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colleen LaBelle
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA
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Weber AN, Arndt S, Miskle B, Bormann NL. Mortality in Treatment-seeking Older Adults Receiving Medications for Opioid Use Disorder. J Addict Med 2024; 18:185-187. [PMID: 38084854 DOI: 10.1097/adm.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVES Older adults (OAs; age 55+ years) are increasingly seeking specialty treatment of opioid use disorder. Previous analyses of the Treatment Episode Data Set-Discharges (TEDS-D) database have reported higher rates of in-treatment mortality for those receiving medications for opioid use disorder (MOUD). We evaluate current trends in mortality for treatment-seeking OAs. METHODS Using the 2020 TEDS-D, logistic regression predicted in-treatment mortality for OAs from planned MOUD, service level, and interaction terms. RESULTS Of the 26,993 OA treatment discharges, 679 people were discharged due to death (2.52%). OAs with MOUD (3.65%, 95% confidence interval [CI], 3.37%-3.95%) were significantly more likely to discharge due to death than those without MOUD (0.82%; 95% CI, 0.66%-1.01%). Most records were for nonintensive outpatient (83.7%; n = 22,588), which had the highest mortality (2.89%; 95% CI, 2.68%-3.11%); intensive services (n = 4405) had a mortality rate of 0.61% (95% CI, 0.42%-0.89%). Among OAs, planned MOUD with nonintensive outpatient services had a mortality rate of 4.17% (95% CI, 3.56%-4.9%). CONCLUSIONS This TEDS-D analysis extends previous literature highlighting a significant interaction between planned MOUD and service intensity on in-treatment mortality for OAs. Additional research is needed to address the causal mechanisms behind these interactions and inform the delivery of safe effective care in the growing OA population.
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Affiliation(s)
- Andrea N Weber
- From the University of Iowa, Iowa City, IA (ANW, SA, BM); and Mayo Clinic, Rochester, MN (NLB)
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Bahji A, Bastien G, Bach P, Choi J, Le Foll B, Lim R, Jutras-Aswad D, Socias ME. The Association Between Self-Reported Anxiety and Retention in Opioid Agonist Therapy: Findings From a Canadian Pragmatic Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:172-182. [PMID: 37697811 PMCID: PMC10874605 DOI: 10.1177/07067437231194385] [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] [Indexed: 09/13/2023]
Abstract
BACKGROUND Prescription-type opioid use disorder (POUD) is often accompanied by comorbid anxiety, yet the impact of anxiety on retention in opioid agonist therapy (OAT) is unclear. Therefore, this study investigated whether baseline anxiety severity affects retention in OAT and whether this effect differs by OAT type (methadone maintenance therapy (MMT) vs. buprenorphine/naloxone (BNX)). METHODS This secondary analysis used data from a pan-Canadian randomized trial comparing flexible take-home dosing BNX and standard supervised MMT for 24 weeks. The study included 268 adults with POUD. Baseline anxiety was assessed using the Beck Anxiety Inventory (BAI), with BAI ≥ 16 indicating moderate-to-severe anxiety. The primary outcomes were retention in assigned and any OAT at week 24. In addition, the impact of anxiety severity on retention was examined, and assigned OAT was considered an effect modifier. RESULTS Of the participants, 176 (65%) reported moderate-to-severe baseline anxiety. In adjusted analyses, there was no significant difference in retention between those with BAI ≥ 16 and those with BAI < 16 assigned (29% vs. 28%; odds ratio (OR) = 2.03, 95% confidence interval (CI) = 0.94-4.40; P = 0.07) or any OAT (35% vs. 34%; OR = 1.57, 95% CI = 0.77-3.21; P = 0.21). In addition, there was no significant effect modification by OAT type for retention in assigned (P = 0.41) or any OAT (P = 0.71). In adjusted analyses, greater retention in treatment was associated with BNX (vs. MMT), male gender identity (vs. female, transgender, or other), enrolment in the Quebec study site (vs. other sites), and absence of a positive urine drug screen for stimulants at baseline. CONCLUSIONS Baseline anxiety severity did not significantly impact retention in OAT for adults with POUD, and there was no significant effect modification by OAT type. However, the overall retention rates were low, highlighting the need to develop new strategies to minimize the risk of attrition from treatment. CLINICAL TRIAL REGISTRATION This study was registered in ClinicalTrials.gov (NCT03033732).
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Affiliation(s)
- Anees Bahji
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - JinCheol Choi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ron Lim
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - M. Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Ye J, Mehta S, Peterson H, Ibrahim A, Saeed G, Linsky S, Kreinin I, Tsang S, Nwanaji-Enwerem U, Raso A, Arora J, Tokoglu F, Yip SW, Alice Hahn C, Lacadie C, Greene AS, Constable RT, Barry DT, Redeker NS, Yaggi H, Scheinost D. Investigating brain dynamics and their association with cognitive control in opioid use disorder using naturalistic and drug cue paradigms. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.25.24303340. [PMID: 38464297 PMCID: PMC10925365 DOI: 10.1101/2024.02.25.24303340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Objectives Opioid use disorder (OUD) impacts millions of people worldwide. The prevalence and debilitating effects of OUD present a pressing need to understand its neural mechanisms to provide more targeted interventions. Prior studies have linked altered functioning in large-scale brain networks with clinical symptoms and outcomes in OUD. However, these investigations often do not consider how brain responses change over time. Time-varying brain network engagement can convey clinically relevant information not captured by static brain measures. Methods We investigated brain dynamic alterations in individuals with OUD by applying a new multivariate computational framework to movie-watching (i.e., naturalistic; N=76) and task-based (N=70) fMRI. We further probed the associations between cognitive control and brain dynamics during a separate drug cue paradigm in individuals with OUD. Results Compared to healthy controls (N=97), individuals with OUD showed decreased variability in the engagement of recurring brain states during movie-watching. We also found that worse cognitive control was linked to decreased variability during the rest period when no opioid-related stimuli were present. Conclusions These findings suggest that individuals with OUD may experience greater difficulty in effectively engaging brain networks in response to evolving internal or external demands. Such inflexibility may contribute to aberrant response inhibition and biased attention toward opioid-related stimuli, two hallmark characteristics of OUD. By incorporating temporal information, the current study introduces novel information about how brain dynamics are altered in individuals with OUD and their behavioral implications.
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Affiliation(s)
- Jean Ye
- Interdepartmental Neuroscience Program, Yale University
| | - Saloni Mehta
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
| | | | - Ahmad Ibrahim
- Department of Internal Medicine, Yale School of Medicine
| | - Gul Saeed
- Department of Internal Medicine, Roger Williams Medical Center
| | | | - Iouri Kreinin
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine
| | | | | | - Anthony Raso
- Frank H. Netter M.D. School of Medicine, Quinnipiac University
| | - Jagriti Arora
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
| | - Fuyuze Tokoglu
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
| | - Sarah W Yip
- Interdepartmental Neuroscience Program, Yale University
- Department of Psychiatry, Yale School of Medicine
- Child Study Center, Yale School of Medicine
| | - C Alice Hahn
- Yale Center for Clinical Investigation, Yale School of Medicine
| | - Cheryl Lacadie
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
| | | | - R Todd Constable
- Interdepartmental Neuroscience Program, Yale University
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
- Department of Biomedical Engineering, Yale School of Engineering and Applied Science
- Department of Neurosurgery, Yale School of Medicine
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine
- Child Study Center, Yale School of Medicine
- Department of Research, APT foundation
| | | | - Henry Yaggi
- Department of Internal Medicine, Yale School of Medicine
- Clinical Epidemiology Research Center, VA CT Healthcare System
| | - Dustin Scheinost
- Interdepartmental Neuroscience Program, Yale University
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
- Child Study Center, Yale School of Medicine
- Department of Biomedical Engineering, Yale School of Engineering and Applied Science
- Department of Statistics & Data Science, Yale School of Medicine
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Ericson ØB, Eide D, Lobmaier P, Clausen T. Mortality risk and causes of death among people who use opioids in a take-home naloxone cohort. Drug Alcohol Depend 2024; 255:111087. [PMID: 38228056 DOI: 10.1016/j.drugalcdep.2024.111087] [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: 11/23/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND People who use opioids (PWUO) have an excess mortality from a range of causes. The cumulative effect of behavioral, social, and health risk factors complicates the interpretation of the effects of suitable interventions. This study explores mortality causes among a cohort of PWUO in the take-home naloxone (THN) program. METHODS This was a prospective cohort study of PWUO who received THN between 2015 and 2023. Participant data was linked with death registry data. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all causes, internal causes, and accidental opioid overdoses (AOOs). In addition to age and gender, risk factors like main route of administration, polydrug use, self-experienced overdoses, and using while alone were fitted in a Cox Regression model to explore factors associated with mortality. RESULTS The 2194 participants had a considerably higher mortality ratio for all causes investigated when compared to the general population (SMR=10.9, 95 % CI = 9.3,12.6). AOOs were the most prevalent cause of death (49 %). Those who reported frequent opioid use while alone had an elevated risk of dying of 2.6 (95 % CI = 1.1,6.4) compared to those who never used while alone. CONCLUSIONS Frequent opioid use while alone was associated with elevated mortality risk, supporting the importance of overdose prevention education with naloxone distribution, and additional efforts to improve environmental and social areas for safer drug-use practices among PWUO. The variety of mortality causes found in this study illustrates the need for multifaceted and targeted interventions for people at risk of overdosing.
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Affiliation(s)
- Øystein Bruun Ericson
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway.
| | - Desiree Eide
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway
| | - Philipp Lobmaier
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway; Diakonhjemmet Hospital, Division of Mental Health and Substance Abuse, P.O. box 23 Vinderen, Oslo 0319, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway
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Böttcher L, Chou T, D’Orsogna MR. Forecasting drug-overdose mortality by age in the United States at the national and county levels. PNAS NEXUS 2024; 3:pgae050. [PMID: 38725534 PMCID: PMC11079616 DOI: 10.1093/pnasnexus/pgae050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 05/12/2024]
Abstract
The drug-overdose crisis in the United States continues to intensify. Fatalities have increased 5-fold since 1999 reaching a record high of 108,000 deaths in 2021. The epidemic has unfolded through distinct waves of different drug types, uniquely impacting various age, gender, race, and ethnic groups in specific geographical areas. One major challenge in designing interventions and efficiently delivering treatment is forecasting age-specific overdose patterns at the local level. To address this need, we develop a forecasting method that assimilates observational data obtained from the CDC WONDER database with an age-structured model of addiction and overdose mortality. We apply our method nationwide and to three select areas: Los Angeles County, Cook County, and the five boroughs of New York City, providing forecasts of drug-overdose mortality and estimates of relevant epidemiological quantities, such as mortality and age-specific addiction rates.
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Affiliation(s)
- Lucas Böttcher
- Department of Computational Science and Philosophy, Frankfurt School of Finance and Management, 60322 Frankfurt am Main, Germany
| | - Tom Chou
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1766, USA
| | - Maria R D’Orsogna
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1766, USA
- Department of Mathematics, California State University at Northridge, Los Angeles, CA 91330-8313, USA
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10
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Patient Assessment. J Oral Maxillofac Surg 2023; 81:E13-E34. [PMID: 37833021 DOI: 10.1016/j.joms.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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11
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Marshall T, Olson K, Youngson E, Abba-Aji A, Li XM, Vohra S, Lewanczuk R. Preexisting mental health disorders and risk of opioid use disorder in young people: A case-control study. Early Interv Psychiatry 2023; 17:963-973. [PMID: 36792950 DOI: 10.1111/eip.13385] [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: 12/09/2021] [Revised: 11/23/2022] [Accepted: 01/01/2023] [Indexed: 02/17/2023]
Abstract
AIM Opioid use disorder (OUD) is a leading cause of preventable mortality amongst young people worldwide. Early identification and intervention of modifiable risk factors may reduce future OUD risk. The aim of this study was to explore whether the onset of OUD is associated with preexisting mental health conditions such as anxiety and depressive disorders in young people. METHODS A retrospective, population-based case-control study was conducted from 31 March 2018 until 01 January 2002. Provincial administrative health data were collected from Alberta, Canada. CASES Individuals 18-25 years on 01 April 2018, with a previous record of OUD. CONTROLS Individuals without OUD were matched to cases, on age/sex/index date. Conditional logistic regression analysis was used to control for additional covariates (e.g., alcohol-related disorders, psychotropic medications, opioid analgesics, and social/material deprivation). RESULTS We identified N = 1848 cases and N = 7392 matched controls. After adjustment, OUD was associated with the following preexisting mental health conditions: Anxiety disorders, aOR = 2.53 (95% CI = 2.16-2.96); depressive disorders, aOR = 2.20 (95% CI = 1.80-2.70); alcohol-related disorders, aOR = 6.08 (95% CI, 4.86-7.61); anxiety and depressive disorders, aOR = 1.94 (95% CI = 1.56-2.40); anxiety and alcohol-related disorders, aOR = 5.22 (95% CI = 4.03-6.77); depressive and alcohol-related disorders, aOR = 6.47 (95% CI = 4.73-8.84); anxiety, depressive and alcohol-related disorders, aOR = 6.09 (95% CI = 4.41-8.42). DISCUSSION Preexisting mental health conditions such as anxiety and depressive disorders are risk factors for future OUD in young people. Preexisting alcohol-related disorders showed the strongest association with future OUD and demonstrated an additive risk when concurrent with anxiety/depression. As not all plausible risk factors could be examined, more research is still needed.
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Affiliation(s)
- Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Erik Youngson
- Health Research Methods and Analytics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Adam Abba-Aji
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Xin-Min Li
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Vohra
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Gong H, Huang Y, Zhu X, Lu W, Cai Z, Zhu N, Huang J, Jin Y, Sun X. Impact of combination of intermittent theta burst stimulation and methadone maintenance treatment in individuals with opioid use disorder: A comparative study. Psychiatry Res 2023; 327:115411. [PMID: 37574603 DOI: 10.1016/j.psychres.2023.115411] [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: 05/24/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
Prior studies indicate that subjects undergoing methadone maintenance therapy (MMT) may experience anxiety, depression and cravings. This study aimed to explore the impact of intermittent theta burst stimulation (iTBS)-MMT combination on craving and emotional symptoms of opioid use disorder. This comparative study included subjects with opioid use disorder at the Methadone Maintenance Clinic of Pudong New Area between September 2019 and March 2020. The subjects were divided into two groups: those who received iTBS-MMT combination treatment (iTBS-MMT) and those who received MMT treatment and sham stimulation treatment (MMT). Outcomes were reduction rate of anxiety, depression and craving. Anxiety was measured by Hamilton Anxiety (HAMA) scale, depression was determined by Hamilton Depression (HAMD) scale and craving was analyzed using visual analog scale. A total of 76 subjects completed the treatment, with 38 subjects in each group. Twenty days after treatment, subjects in the iTBS-MMT group had significant improvement of anxiety (HAMA reduction rate), depression (HAMD reduction rate) and craving (Craving reduction rate) reduction rate compared with MMT group. iTBS-MMT combination treatment may produce better drug craving reduction and emotional improvement than MMT alone.
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Affiliation(s)
- Hengfen Gong
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Mental Disorders, School of Medicine, Tongji University, Shanghai, China.
| | - Ying Huang
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Mental Disorders, School of Medicine, Tongji University, Shanghai, China
| | - Xingjia Zhu
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Wei Lu
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Zhengyi Cai
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Na Zhu
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Juan Huang
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Ying Jin
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Mental Disorders, School of Medicine, Tongji University, Shanghai, China.
| | - Xirong Sun
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Mental Disorders, School of Medicine, Tongji University, Shanghai, China.
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13
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Powell VD, Macleod C, Sussman J, Lin LA, Bohnert ASB, Lagisetty P. Variation in Clinical Characteristics and Longitudinal Outcomes in Individuals with Opioid Use Disorder Diagnosis Codes. J Gen Intern Med 2023; 38:699-706. [PMID: 35819683 PMCID: PMC9971398 DOI: 10.1007/s11606-022-07732-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/28/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patterns of opioid use vary, including prescribed use without aberrancy, limited aberrant use, and potential opioid use disorder (OUD). In clinical practice, similar opioid-related International Classification of Disease (ICD) codes are applied across this spectrum, limiting understanding of how groups vary by sociodemographic factors, comorbidities, and long-term risks. OBJECTIVE (1) Examine how Veterans assigned opioid abuse/dependence ICD codes vary at diagnosis and with respect to long-term risks. (2) Determine whether those with limited aberrant use share more similarities to likely OUD vs those using opioids as prescribed. DESIGN Longitudinal observational cohort study. PARTICIPANTS National sample of Veterans categorized as having (1) likely OUD, (2) limited aberrant opioid use, or (3) prescribed, non-aberrant use based upon enhanced medical chart review. MAIN MEASURES Comparison of sociodemographic and clinical factors at diagnosis and rates of age-adjusted mortality, non-fatal opioid overdose, and hospitalization after diagnosis. An exploratory machine learning analysis investigated how closely those with limited aberrant use resembled those with likely OUD. KEY RESULTS Veterans (n = 483) were categorized as likely OUD (62.1%), limited aberrant use (17.8%), and prescribed, non-aberrant use (20.1%). Age, proportion experiencing homelessness, chronic pain, anxiety disorders, and non-opioid substance use disorders differed by group. All-cause mortality was high (44.2 per 1000 person-years (95% CI 33.9, 56.7)). Hospitalization rates per 1000 person-years were highest in the likely OUD group (831.5 (95% CI 771.0, 895.5)), compared to limited aberrant use (739.8 (95% CI 637.1, 854.4)) and prescribed, non-aberrant use (411.9 (95% CI 342.6, 490.4). The exploratory analysis reclassified 29.1% of those with limited aberrant use as having likely OUD with high confidence. CONCLUSIONS Veterans assigned opioid abuse/dependence ICD codes are heterogeneous and face variable long-term risks. Limited aberrant use confers increased risk compared to no aberrant use, and some may already have OUD. Findings warrant future investigation of this understudied population.
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Affiliation(s)
- Victoria D Powell
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA.
- Geriatrics Research, Education, and Clinical Center, LTC Charles S. Kettles VA Medical Center, Ann Arbor, MI, USA.
| | - Colin Macleod
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy Sussman
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lewei A Lin
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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14
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Ilonze OJ, Vidot DC, Breathett K, Camacho-Rivera M, Raman SV, Kobashigawa JA, Allen LA. Cannabis Use and Heart Transplantation: Disparities and Opportunities to Improve Outcomes. Circ Heart Fail 2022; 15:e009488. [PMID: 36252094 PMCID: PMC9772032 DOI: 10.1161/circheartfailure.122.009488] [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: 01/10/2023]
Abstract
Heart transplantation (HT) remains the optimal therapy for many patients with advanced heart failure. Use of substances of potential abuse has historically been a contraindication to HT. Decriminalization of cannabis, increasing cannabis use, clinician biases, and lack of consensus for evaluating patients with heart failure who use cannabis all have the potential to exacerbate racial and ethnic and regional disparities in HT listing and organ allocation. Here' we review pertinent pre-HT and post-HT considerations related to cannabis use' and relative attitudes between opiates and cannabis are offered for context. We conclude with identifying unmet research needs pertaining to the use of cannabis in HT that can inform a standardized evaluation process.
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Affiliation(s)
- Onyedika J. Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
| | - Denise C. Vidot
- University of Miami School of Nursing and Health Studies, Coral Gables, FL
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
| | | | - Subha V. Raman
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
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15
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Bahji A, Di Nota PM, Groll D, Carleton RN, Anderson GS. Psychological interventions for post-traumatic stress injuries among public safety personnel: a systematic review and meta-analysis. Syst Rev 2022; 11:255. [PMID: 36434683 PMCID: PMC9701019 DOI: 10.1186/s13643-022-02112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Public safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various post-traumatic stress injuries (PTSIs). While there are many evidence-based psychological interventions for PTSI, the effectiveness of each intervention for PSP remains unclear. OBJECTIVES The current study assessed the effectiveness and acceptability of psychological interventions for PTSI among PSPs. METHODS A systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, post-traumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen's d), rate ratios (RR), and their 95% confidence intervals (95% CI) to measure pooled effect sizes across studies; negative d values and RR values less than one indicated a reduction in symptoms compared to baseline or control groups. In addition, heterogeneity was quantified using I2, and publication bias was evaluated using Egger's test. RESULTS The analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioral therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counseling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d = - 1.23; 95% CI - 1.81, - 0.65; 7 studies; I2 = 81%), anxiety (- 0.76; 95% CI - 1.28, - 0.24; 3 studies; I2 = 47%), and depression (d = - 1.10; 95% CI - 1.62, - 0.58; 5 studies; I2 = 64%). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d = - 1.29 [- 2.31, - 0.27]), anxiety (d = - 0.82 [- 1.20, - 0.44]), and depression (d = - 0.46 [- 0.77, - 0.14]). There were no statistically significant differences in dropout rates (RR = 1.00 [0.96, 1.05]), suggesting high acceptability across interventions. CONCLUSIONS There is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies on PSP indicates a need for additional research into treating PTSI among PSP. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42019133534.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Paula M Di Nota
- Office of Applied Research and Graduate Studies, Justice Institute of British Columbia, Vancouver, BC, Canada
| | - Dianne Groll
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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16
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Tlali M, Scheibe A, Ruffieux Y, Cornell M, Wettstein AE, Egger M, Davies MA, Maartens G, Johnson LF, Haas AD. Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: A cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103853. [PMID: 36202041 PMCID: PMC9884995 DOI: 10.1016/j.drugpo.2022.103853] [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] [Received: 05/04/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of opioids is increasing globally, but data from low- and middle-income countries on opioid-related mental and behavioural disorders (hereafter referred to as opioid-related disorders) are scarce. This study examines the incidence of opioid-related disorders, opioid agonist use, and excess mortality among persons with opioid-related disorders in South Africa's private healthcare sector. METHODS We analysed longitudinal data of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having an opioid-related disorder if they received an opioid agonist (buprenorphine or methadone) or an ICD-10 diagnosis for harmful opioid use (F11.1), opioid dependence or withdrawal (F11.2-4), or an unspecified or other opioid-related disorder (F11.0, F11.5-9). We calculated adjusted hazard ratios (aHR) for factors associated with opioid-related disorders, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 diagnosis for opioid dependence or withdrawal, and examined excess mortality among beneficiaries with opioid-related disorders. RESULTS Of 1,251,458 beneficiaries, 1286 (0.1%) had opioid-related disorders. Between 2011 and 2020, the incidence of opioid-related disorders increased by 12% (95% CI 9%-15%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of opioid-related disorders. The cumulative incidence of opioid agonist use among beneficiaries who received an ICD-10 diagnosis for opioid dependence or withdrawal was 18.0% (95% CI 14.0-22.4) 3 years after diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, opioid-related disorders were associated with an increased risk of mortality (aHR 2.28, 95% CI 1.84-2.82). Opioid-related disorders were associated with a 7.8-year shorter life expectancy. CONCLUSIONS The incidence of people diagnosed with or treated for an opioid-related disorder in the private sector is increasing rapidly. People with opioid-related disorders are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of opioid-related disorders is urgently needed to improve the health outcomes of people with opioid-related disorders.
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Affiliation(s)
- Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Andrew Scheibe
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa; TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa; Community Oriented Primary Care Research Unit, Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Yann Ruffieux
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Anja E Wettstein
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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17
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Bahji A, Bach P, Danilewitz M, Crockford D, el-Guebaly N, Devoe DJ, Saitz R. Comparative efficacy and safety of pharmacotherapies for alcohol withdrawal: a systematic review and network meta-analysis. Addiction 2022; 117:2591-2601. [PMID: 35194860 PMCID: PMC9969997 DOI: 10.1111/add.15853] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS There have been few head-to-head clinical trials of pharmacotherapies for alcohol withdrawal (AW). We, therefore, aimed to evaluate the comparative performance of pharmacotherapies for AW. METHODS Six databases were searched for randomized clinical trials through November 2021. Trials were included after a blinded review by two independent reviewers. Outcomes included incident seizures, delirium tremens, AW severity scores, adverse events, dropouts, dropouts from adverse events, length of hospital stay, use of additional medications, total benzodiazepine requirements, and death. Effect sizes were pooled using frequentist random-effects network meta-analysis models to generate summary ORs and Cohen's d standardized mean differences (SMDs). RESULTS Across the 149 trials, there were 10 692 participants (76% male, median 43.5 years old). AW severity spanned mild (n = 32), moderate (n = 51), and severe (n = 66). Fixed-schedule chlormethiazole (OR, 0.16; 95% CI, 0.04-0.65), fixed-schedule diazepam (OR, 0.16; 95% CI, 0.04-0.59), fixed-schedule lorazepam (OR = 0.19; 95% CI, 0.08-0.45), fixed-schedule chlordiazepoxide (OR = 0.21; 95% CI, 0.08-0.53), and divalproex (OR = 0.22; 95% CI, 0.05-0.86) were superior to placebo at reducing incident AW seizures. However, only fixed-schedule diazepam (OR, 0.19; 95% CI, 0.05-0.76) reduced incident delirium tremens. Oxcarbazepine (d = -3.69; 95% CI, -6.21 to -1.17), carbamazepine (d = -2.76; 95% CI, -4.13 to -1.40), fixed-schedule oxazepam (d = -2.55; 95% CI, -4.26 to -0.83), and γ-hydroxybutyrate (d = -1.80; 95% CI, -3.35 to -0.26) improved endpoint Clinical Institute Withdrawal Assessment for Alcohol-Revised scores over placebo. Promazine and carbamazepine were the only agents significantly associated with greater dropouts because of adverse events. The quality of evidence was downgraded because of the substantial risk of bias, heterogeneity, inconsistency, and imprecision. CONCLUSIONS Although some pharmacotherapeutic modalities, particularly benzodiazepines, appear to be safe and efficacious for reducing some measures of alcohol withdrawal, methodological issues and a high risk of bias prevent a consistent estimate of their comparative performance.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- British Columbia Centre for Substance Use, Vancouver, BC, Canada
| | - Paxton Bach
- British Columbia Centre for Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marlon Danilewitz
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David Crockford
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Nady el-Guebaly
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Daniel J. Devoe
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Richard Saitz
- Department of Community Health Sciences, School of Public Health, Boston University School of Public Health, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Clinical Translational Science Institute, Boston University, Boston, MA, USA
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18
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Vallecillo G, Pedro-Botet J, Fernandez S, Román I, Elosua R, Camps A, Torrens M, Marrugat J. High cardiovascular risk in older patients with opioid use disorder: Differences with the general population. Drug Alcohol Rev 2022; 41:1078-1084. [PMID: 35178806 DOI: 10.1111/dar.13449] [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: 01/06/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiovascular disease is a health concern in ageing population with opioid use disorders (OUD). The study aims to analyse the cardiovascular risk factors in individuals with OUD. METHODS An observational study was carried out to compare cardiovascular risk factors of adults >50 years with OUD on methadone therapy from public outpatient drug treatment centres, with that of an age- and gender-matched sample (ratio of 1:5) of subjects from a sample of the Spanish population (REGICOR cohort). High cardiovascular risk (HCVR) at 10 years was defined according to Framingham-REGICOR and SCORE risk functions. RESULTS The individuals studied included 94 people with OUD and 495 from the general population; the mean age was 55.7 ± 4.8 years and 432 (72.7%) were men. Obesity (21.2% vs. 35.2%), hypertension (26.3% vs. 42.1%), total cholesterol (30.3% vs. 65.4%) and LDL-cholesterol ≥130 mg/dL (27.2% vs. 59.3%) were significantly more prevalent in the general population group, while tobacco smoking (96.0% vs. 25.9%), low HDL-cholesterol (46.5% vs. 21.2%), hypertriglyceridaemia (39.4% vs. 18.8%) and atherogenic dyslipidaemia (30.3% vs. 10.5%) were significantly higher in individuals with OUD. Differences in abdominal obesity (62.6% vs. 65.3%) were not significant. HCVR was more prevalent in patients with OUD: 15.2% versus 5.8% (Framingham-REGICOR function) and 21.2% versus 11.3% (SCORE function). DISCUSSION AND CONCLUSIONS Older adults with OUD on methadone therapy have a different prevalence of cardiovascular risk factors and HCVR than the general population. Preventive measures, particularly tobacco smoking cessation and weight control, should be included in the routine care of individuals with OUD.
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Affiliation(s)
- Gabriel Vallecillo
- Drug Addiction Program, Instituto de Neuropsiquiatría y Adicciones, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Juan Pedro-Botet
- Lipid and Cardiovascular Risk Unit, Department of Endocrinology, Hospital del Mar, Barcelona, Spain.,Departmento de Medicina, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Silvia Fernandez
- Registre Gironí del COR (REGICOR) Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Irene Román
- Registre Gironí del COR (REGICOR) Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Cardiovascular Epidemiology and Genetics Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,CIBERCV of Cardiovascular Research, Madrid, Spain
| | - Anna Camps
- Registre Gironí del COR (REGICOR) Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Marta Torrens
- Drug Addiction Program, Instituto de Neuropsiquiatría y Adicciones, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Departmento de Medicina, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Jaume Marrugat
- Registre Gironí del COR (REGICOR) Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,CIBERCV of Cardiovascular Research, Madrid, Spain
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19
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Wilson M, Brumwell A, Stowe MJ, Shelly S, Scheibe A. Personal experience and awareness of opioid overdose occurrence among peers and willingness to administer naloxone in South Africa: findings from a three-city pilot survey of homeless people who use drugs. Harm Reduct J 2022; 19:17. [PMID: 35148779 PMCID: PMC8832761 DOI: 10.1186/s12954-021-00561-w] [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: 03/19/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Drug overdoses occur when the amount of drug or combination of drugs consumed is toxic and negatively affects physiological functioning. Opioid overdoses are responsible for the majority of overdose deaths worldwide. Naloxone is a safe, fast-acting opioid antagonist that can reverse an opioid overdose, and as such, it should be a critical component of community-based responses to opioid overdose. However, the burden of drug overdose deaths remains unquantified in South Africa, and both knowledge about and access to naloxone is generally poor. The objective of this study was to describe the experiences of overdose, knowledge of responses to overdose events, and willingness to call emergency medical services in response to overdose among people who use drugs in Cape Town, Durban, and Pretoria (South Africa). Methods We used convenience sampling to select people who use drugs accessing harm reduction services for this cross-sectional survey from March to July 2019. Participants completed an interviewer-administered survey, assessing selected socio-demographic characteristics, experiences of overdose among respondents and their peers, knowledge about naloxone and comfort in different overdose responses. Data, collected on paper-based tools, were analysed using descriptive statistics and categorised by city. Results Sixty-six participants participated in the study. The median age was 31, and most (77%) of the respondents were male. Forty-one per cent of the respondents were homeless. Heroin was the most commonly used drug (79%), and 82% of participants used drugs daily. Overall, 38% (25/66) reported overdosing in the past year. Most (76%, 50/66) knew at least one person who had ever experienced an overdose, and a total of 106 overdose events in peers were reported. Most participants (64%, 42/66) had not heard of naloxone, but once described to them, 73% (48/66) felt comfortable to carry it. More than two-thirds (68%, 45/66) felt they would phone for medical assistance if they witnessed an overdose. Conclusion Drug overdose was common among participants in these cities. Without interventions, high overdose-related morbidity and mortality is likely to occur in these contexts. Increased awareness of actions to undertake in response to an overdose (calling for medical assistance, using naloxone) and access to naloxone are urgently required in these cities. Additional data are needed to better understand the nature of overdose in South Africa to inform policy and responses.
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Affiliation(s)
- Michael Wilson
- Advance Access and Delivery South Africa, 112 Stamfordhill Road, Greyville, Durban, 4001, South Africa. .,Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | | | - M J Stowe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,South African Network of People Who Use Drugs (SANPUD), Cape Town, South Africa
| | - Shaun Shelly
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Andrew Scheibe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,TB HIV Care, Cape Town, South Africa.,Urban Futures Centre, Faculty of Engineering, Durban University of Technology, Durban, South Africa
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20
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Opioid Use Disorder Comorbidity in Individuals With Schizophrenia-Spectrum Disorders: A Systematic Review and Meta-Analysis. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Marshall T, Hancock M, Kinnard EN, Olson K, Abba-Aji A, Rittenbach K, Stea JN, Tanguay R, Vohra S. Treatment options and shared decision-making in the treatment of opioid use disorder: A scoping review. J Subst Abuse Treat 2021; 135:108646. [PMID: 34810044 DOI: 10.1016/j.jsat.2021.108646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shared decision-making (SDM) is an approach to clinical decision-making that includes patients' values and preferences during health-related decisions. Previous research suggests that SDM may be beneficial in the treatment of substance use disorders; however, the impact of SDM in the treatment of opioid use disorder (OUD) remains unclear. OBJECTIVES To identify relevant peer-reviewed literature related to SDM in the treatment of adults with OUD, and to summarize the main findings according to patient outcomes. METHODS The research team conducted a scoping review. The team searched five electronic health databases from database inception until September 2019 using MeSH and keywords related to SDM. The team included only peer-reviewed studies where adults (≥18 years) with OUD were provided a choice and/or allowed input into their treatment plan. Two independent reviewers screened, extracted, and assessed the quality of included studies. RESULTS Fourteen studies (n = 1748 participants) met inclusion criteria, including seven randomized controlled trials, three non-randomized controlled trials, two observational studies, and one qualitative study. Treatment options included: patient regulated methadone dosing vs. fixed dosing (n = 4 studies), optional vs. mandatory counseling (n = 4 studies), home vs. office buprenorphine inductions (n = 2 studies), and inpatient vs. outpatient treatment (n = 1 study). None of the studies measured SDM with a validated instrument. Seven of 14 studies reported at least one improved patient outcome. CONCLUSIONS The review found few studies that explored whether providing treatment options and/or encouraging participation in decision-making are beneficial for adults with OUD. Preliminary evidence suggests that SDM may be promising for this population. However, the field needs more research on person-centered care and SDM.
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Affiliation(s)
- Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Myles Hancock
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth N Kinnard
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, United States of America
| | - Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Adam Abba-Aji
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Katherine Rittenbach
- Addiction and Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada; Department of Psychology, University of Calgary, Alberta, Canada
| | - Jonathan N Stea
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Robert Tanguay
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Sunita Vohra
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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22
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Meshberg-Cohen S, Ross MacLean R, Schnakenberg Martin AM, Sofuoglu M, Petrakis IL. Treatment outcomes in individuals diagnosed with comorbid opioid use disorder and Posttraumatic stress disorder: A review. Addict Behav 2021; 122:107026. [PMID: 34182307 DOI: 10.1016/j.addbeh.2021.107026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 06/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Opioid use disorder (OUD) is a public health emergency. Evidence suggests that posttraumatic stress disorder (PTSD) is common among individuals with OUD; however, few studies evaluate whether concurrent diagnoses affect treatment outcomes. This review examines the impact of concurrent diagnoses of OUD and PTSD on treatment outcomes. METHODS A search was performed using articles identified through June 30, 2020 in PubMed, PsycINFO, and EMBASE. Included peer-reviewed articles evaluated individuals with OUD and a PTSD diagnosis via standardized assessment and/or medical record diagnoses, and reported relationships between diagnosis and treatment outcomes and/or other psychiatric conditions. RESULTS Out of 412 articles, 17 studies met inclusion criteria for this review (from 13 databases). Articles included had a total of n = 2190 with OUD, with n = 79 non-OUD comparison participants. Studies examining individuals with OUD revealed comorbid PTSD was associated with more severe addiction, higher rates of depression, attempted suicide, and psychosocial problems. CONCLUSIONS Among individuals with OUD, presence of PTSD is associated with multiple mental health problems. The impact of PTSD on drug use is inconclusive. Although only 5 studies examined psychosocial PTSD treatment, all found PTSD-focused treatment to be effective for those with comorbid OUD. Overall, results suggest the need to better identify PTSD among those with OUD, and to develop and evaluate interventions that are brief, integrative, and easy to implement in clinical settings.
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Affiliation(s)
- Sarah Meshberg-Cohen
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA.
| | - R Ross MacLean
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Ashley M Schnakenberg Martin
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Ismene L Petrakis
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
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23
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Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan. Healthcare (Basel) 2021; 9:healthcare9111402. [PMID: 34828449 PMCID: PMC8625753 DOI: 10.3390/healthcare9111402] [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: 09/09/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022] Open
Abstract
(1) Background: The prevalence of opioid use in Taiwan increased by 41% between 2002 and 2014. However, little is known regarding the risk of mortality among long-term opioid analgesics users who do not have cancer. This study investigated this mortality risk with an emphasis on the calendar year and patients’ age and sex. (2) Methods: This retrospective cohort study included 12,990 adult individuals without cancer who were long-term users of opioid analgesics and were randomly selected from the data set of Taiwan’s National Health Insurance program from 2000 to 2012. They were then followed up through 2013. Information on the underlying causes of death was retrieved from the Taiwan Death Registry. Age, sex, and calendar year-standardized mortality ratios (SMRs) of all-cause and cause-specific mortality were calculated with reference to those of the general population. (3) Results: With up to 14 years of follow-up, 558 individuals had all-cause mortality in 48,020 person-years (cumulative mortality: 4.3%, mortality rate: 11.62 per 1000 person-years). Compared with the general population, the all-cause SMR of 4.30 (95% confidence interval (95% CI): 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural (5.04, 95% CI: 3.88–6.45) causes. (4) Conclusions: Long-term opioid analgesics use among individuals without cancer in Taiwan was associated with a significantly increased risk of mortality. The notably increased mortality in younger adults warrants attention. Strategies to reduce long-term opioid analgesics use, especially their overuse or misuse, are in an urgent need.
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24
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Supporting Persons Who Use Drugs During the COVID-19 Pandemic: A Rapid Review of International Guidelines. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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25
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Prevalence and correlates of multiple non-fatal opioid overdoses among people who inject drugs who utilise needle syringe programs in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103245. [PMID: 33840562 DOI: 10.1016/j.drugpo.2021.103245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Non-fatal overdose (NFOD) is a major cause of morbidity among people who inject drugs (PWID) and multiple NFOD is associated with increased risk of fatal overdose. Despite this, few studies have examined the prevalence and correlates of drug-specific multiple NFOD. The current study aimed to determine the prevalence and correlates of recent multiple non-fatal opioid overdose (NFOOD) among PWID who access needle syringe programs (NSPs) in Australia. METHODS The Australian Needle and Syringe Program Survey is conducted annually and was conducted at 46 sites across Australia in 2019. Participation involves completion of a self-administered questionnaire and a capillary dried blood spot for HIV and hepatitis C virus testing. In 2019, respondents who reported a minimum of one NFOOD in the previous 12 months (recent NFOOD) were asked to complete supplementary questions regarding their last NFOOD. Bivariate and multivariate logistic regression were used to determine factors independently associated with multiple recent NFOOD. RESULTS A total of 222 respondents reported recent NFOOD. Respondents were predominantly male (59%), one third (39%) were aged less than 39 years and 73% reported last injecting heroin at their last NFOOD. One in two respondents (48%, n = 107) reported multiple opioid overdoses (median 3, interquartile range 2-5). The odds of reporting multiple NFOOD were higher among respondents who reported injecting in a public location at their last NFOOD (adjusted odds ratio [AOR] 2.10, 95% CI 1.14-3.90, p = 0.018) and benzodiazepine use in the 12 h prior to NFOOD (AOR 2.74, 95% CI 1.50-4.99, p = 0.001). CONCLUSIONS Multiple NFOOD was prevalent among PWID who utilised NSPs who reported recent NFOOD. Public injecting and benzodiazepine use were associated with increased risk of multiple NFOOD, and there is a need for interventions specifically targeting PWID who report these high risk injecting practices.
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Rao R, Yadav D, Bhad R, Rajhans P. Mobile methadone dispensing in Delhi, India: implementation research. Bull World Health Organ 2021; 99:422-428. [PMID: 34108752 PMCID: PMC8164184 DOI: 10.2471/blt.20.251983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the implementation of a mobile dispensing service to improve opioid users’ access to methadone maintenance therapy. Methods In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service. Findings The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9-month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients’ adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites. Conclusion It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic.
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Affiliation(s)
- Ravindra Rao
- National Drug Dependence Treatment Centre, Department of Psychiatry, 4th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepak Yadav
- National Drug Dependence Treatment Centre, Department of Psychiatry, 4th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Roshan Bhad
- National Drug Dependence Treatment Centre, Department of Psychiatry, 4th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pallavi Rajhans
- National Drug Dependence Treatment Centre, Department of Psychiatry, 4th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India
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Hadland SE, Aalsma MC, Akgül S, Alinsky RH, Bruner A, Chadi N, Galagali PM, Kreida EC, Robinson CA, Wilson JD. Medication for Adolescents and Young Adults With Opioid Use Disorder. J Adolesc Health 2021; 68:632-636. [PMID: 33485735 PMCID: PMC7902443 DOI: 10.1016/j.jadohealth.2020.12.129] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Opioid-related morbidity and mortality have risen in many settings globally. It is critical that practitioners who work with adolescents and young adults (AYAs) provide timely, evidence-based treatment for opioid use disorder (OUD). Such treatment should include medications for opioid use disorder (MOUD), including buprenorphine, naltrexone, and methadone. Medication treatment is associated with reduced mortality, fewer relapses to opioid use, and enhanced recovery and retention in addiction care, among other positive health outcomes. Unfortunately, the vast majority of AYAs with OUD do not receive medication. The Society for Adolescent Health and Medicine recommends that AYAs be offered MOUD as a critical component of an integrated treatment approach. Barriers to receipt of medications are widespread; many are common to high-, middle-, and low-income countries alike, whereas others differ. Such barriers should be minimized to ensure equitable access to youth-friendly, affirming, and confidential addiction treatment that includes MOUD. Robust education on OUD and medication treatment should be provided to all practitioners who work with AYAs. Strategies to reduce stigma surrounding medication-and stigma experienced by individuals with substance use disorders more generally-should be widely implemented. A broad research agenda is proposed with the goal of expanding the evidence base for the use and delivery of MOUD for AYAs.
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Affiliation(s)
- Scott E. Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA,Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany Street, Room 2055, Boston, MA, 02119, USA
| | - Matthew C. Aalsma
- Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University, 410 West 10th Street, Suite 1001, Indianapolis, IN, 46202, USA
| | - Sinem Akgül
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Ankara, Turkey, 06100
| | - Rachel H. Alinsky
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Rubenstein Child Health Building, 200 N. Wolfe Street, Room 2085, Baltimore, MD, 21287, USA
| | - Ann Bruner
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD, 21229, USA
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada, H3T 1C5
| | - Preeti M Galagali
- Bangalore Adolescent Care and Counselling Centre, 528, 2nd block Rajainagar, Bangalore 560010, India
| | - Ellen C. Kreida
- Department of Psychiatry, Boston Medical Center, 850 Harrison Avenue, 9th Floor, Boston, MA, 02118, USA
| | - Camille A. Robinson
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Rubenstein Child Health Building, 200 N. Wolfe Street, Room 2085, Baltimore, MD, 21287, USA
| | - J. Deanna Wilson
- University of Pittsburgh School of Medicine, University of Pittsburgh School of Medicine, Divisions of General Internal Medicine and Adolescent and Young Adult Medicine, 3420 Fifth Avenue, Pittsburgh, PA, 15213, USA
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28
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Jeon M, Jagodnik KM, Kropiwnicki E, Stein DJ, Ma'ayan A. Prioritizing Pain-Associated Targets with Machine Learning. Biochemistry 2021; 60:1430-1446. [PMID: 33606503 DOI: 10.1021/acs.biochem.0c00930] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
While hundreds of genes have been associated with pain, much of the molecular mechanisms of pain remain unknown. As a result, current analgesics are limited to few clinically validated targets. Here, we trained a machine learning (ML) ensemble model to predict new targets for 17 categories of pain. The model utilizes features from transcriptomics, proteomics, and gene ontology to prioritize targets for modulating pain. We focused on identifying novel G-protein-coupled receptors (GPCRs), ion channels, and protein kinases because these proteins represent the most successful drug target families. The performance of the model to predict novel pain targets is 0.839 on average based on AUROC, while the predictions for arthritis had the highest accuracy (AUROC = 0.929). The model predicts hundreds of novel targets for pain; for example, GPR132 and GPR109B are highly ranked GPCRs for rheumatoid arthritis. Overall, gene-pain association predictions cluster into three groups that are enriched for cytokine, calcium, and GABA-related cell signaling pathways. These predictions can serve as a foundation for future experimental exploration to advance the development of safer and more effective analgesics.
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Affiliation(s)
- Minji Jeon
- Department of Pharmacological Sciences, Knowledge Management Center for Illuminating the Druggable Genome (KMC-IDG), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1603, New York, New York 10029, United States
| | - Kathleen M Jagodnik
- Department of Pharmacological Sciences, Knowledge Management Center for Illuminating the Druggable Genome (KMC-IDG), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1603, New York, New York 10029, United States
| | - Eryk Kropiwnicki
- Department of Pharmacological Sciences, Knowledge Management Center for Illuminating the Druggable Genome (KMC-IDG), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1603, New York, New York 10029, United States
| | - Daniel J Stein
- Department of Pharmacological Sciences, Knowledge Management Center for Illuminating the Druggable Genome (KMC-IDG), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1603, New York, New York 10029, United States
| | - Avi Ma'ayan
- Department of Pharmacological Sciences, Knowledge Management Center for Illuminating the Druggable Genome (KMC-IDG), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1603, New York, New York 10029, United States
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