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Simha S, Ahmed Y, Brummett CM, Waljee JF, Englesbe MJ, Bicket MC. Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review. Reg Anesth Pain Med 2024; 49:361-362. [PMID: 36427903 DOI: 10.1136/rapm-2022-104169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Siddartha Simha
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Yusuf Ahmed
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
- Surgery, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Michael J Englesbe
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
- Surgery, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Mark C Bicket
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
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Abasilim C, Friedman LS, Karch L, Holloway-Beth A. Trends in non-fatal and fatal opioid overdoses during the first two years of the coronavirus disease-2019 pandemic. Ann Epidemiol 2024; 90:35-41. [PMID: 38501569 DOI: 10.1016/j.annepidem.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/19/2023] [Accepted: 10/26/2023] [Indexed: 03/20/2024]
Abstract
PURPOSE This study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems. METHODS We examined opioid-involved overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases. RESULTS The overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (β = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (β = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses. CONCLUSIONS We underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.
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Affiliation(s)
- Chibuzor Abasilim
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Lee S Friedman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Lydia Karch
- Epidemiology Unit, Cook County Department of Public Health, Bridgeview, IL
| | - Alfreda Holloway-Beth
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL; Epidemiology Unit, Cook County Department of Public Health, Bridgeview, IL
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Simha S, Ahmed Y, Brummett CM, Waljee JF, Englesbe MJ, Bicket MC. Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review. Reg Anesth Pain Med 2023; 48:37-43. [DOI: 10.1136/rapm-2022-103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023]
Abstract
ImportanceThe COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future response efforts.ObjectiveTo summarize changes from the COVID-19 pandemic on outcomes regarding opioid use and misuse in the USA and Canada.Evidence reviewWe searched MEDLINE via PubMed, EMBASE, and CENTRAL for peer-reviewed articles published between March 2020 and December 2021 that examined outcomes relevant to patients with opioid use, misuse, and opioid use disorder by comparing the period before vs after COVID-19 onset in the USA and Canada. Two reviewers independently screened studies, extracted data, assessed methodological quality and bias via Newcastle-Ottawa Scale, and synthesized results.FindingsAmong 20 included studies, 13 (65%) analyzed service utilization, 6 (30%) analyzed urine drug testing results, and 2 (10%) analyzed naloxone dispensation. Opioid-related emergency medicine utilization increased in most studies (85%, 11/13) for both service calls (17% to 61%) and emergency department visits (42% to 122%). Urine drug testing positivity results increased in all studies (100%, 6/6) for fentanyl (34% to 138%), most (80%, 4/5) studies for heroin (-12% to 62%), and most (75%, 3/4) studies for oxycodone (0% to 44%). Naloxone dispensation was unchanged and decreased in one study each.InterpretationSignificant increases in surrogate measures of the opioid crisis coincided with the onset of COVID-19. These findings serve as a call to action to redouble prevention, treatment, and harm reduction efforts for the opioid crisis as the pandemic evolves.PROSPERO registration numberCRD42021236464.
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Foltin RW, Zale S, Sykes KA, Nagaraj N, Scranton RE, Comer SD. A novel long-acting formulation of oral buprenorphine/naloxone produces prolonged decreases in fentanyl self-administration by rhesus monkeys. Drug Alcohol Depend 2022; 239:109599. [PMID: 35963210 DOI: 10.1016/j.drugalcdep.2022.109599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to the poor oral bioavailability of buprenorphine, an oral formulation has not been thought possible. Lyndra Therapeutics is developing a once-weekly long-acting oral product containing buprenorphine. We evaluated the efficacy of this formulation in reducing intravenous (i.v.) fentanyl self-administration by three male and three female rhesus monkeys. METHODS Buprenorphine HCl and naloxone HCl were co-formulated using an 11:1 ratio of buprenorphine:naloxone in a controlled-release gastric residence formulation administered in an oral capsule (LYN-013). Naloxone was included to determine the feasibility of combining naloxone with buprenorphine in the formulation as an abuse deterrent. Complete fentanyl dose-response functions were determined during each session. The efficacy of single doses of 56/5, 112/10 and 168/15 mg buprenorphine/naloxone in reducing fentanyl self-administration was examined over 13 days. RESULTS LYN-013 significantly decreased the rate of responding for fentanyl for 3 days and significantly reduced total intake of fentanyl for 8 days. Time to maximal buprenorphine levels (Tmax) ranged between 56 and 68 h for all 3 doses. The maximal buprenorphine level (Cmax) following 168 mg was 2.3 ng/ml which was significantly greater that those observed for 56 mg (1.22 ng/ml) and 112 mg (1.35 ng/ml). Finally, the area-under-curves (AUCtau) were buprenorphine dose-dependently increased from 88 to 127-265 h*ng/ml. There were no signs of non-specific changes in behavior. CONCLUSIONS A once-weekly oral buprenorphine/naloxone formulation produced sustained suppression of fentanyl self-administration in monkeys suggesting that oral delivery of buprenorphine with this formulation could provide a new opportunity to treat opioid use disorders (OUD).
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Affiliation(s)
- Richard W Foltin
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Stephen Zale
- Lyndra Therapeutics, Inc., 65 Grove St, Watertown, MA 02472, USA
| | - Kristine A Sykes
- Lyndra Therapeutics, Inc., 65 Grove St, Watertown, MA 02472, USA
| | - Nayana Nagaraj
- Lyndra Therapeutics, Inc., 65 Grove St, Watertown, MA 02472, USA
| | | | - Sandra D Comer
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
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Smart R, Haffajee RL, Davis CS. Legal review of state emergency medical services policies and protocols for naloxone administration. Drug Alcohol Depend 2022; 238:109589. [PMID: 35932751 PMCID: PMC10395068 DOI: 10.1016/j.drugalcdep.2022.109589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Given the continued rise in opioid-related overdoses, many states have expanded access to the opioid antagonist naloxone. We sought to provide comprehensive data on one such strategy: the authority of providers at different emergency medical services (EMS) licensure levels to administer naloxone. METHODS We conducted a systematic legal review of state laws and protocols governing the authority of different EMS licensure levels to administer naloxone. We used Westlaw, state government websites and scope of practice protocols. We coded relevant policies regarding which, if any, administration routes and dosages of naloxone are permitted for each licensure level: emergency medical responder (EMR), emergency medical technician (EMT), advanced emergency medical technician (AEMT), and paramedic. RESULTS As of July 2020, all states with relevant laws or protocols authorize paramedics, AEMTs, and EMTs to administer naloxone. Thirty-nine states with an EMR licensure level and statewide protocol authorize naloxone administration by EMRs, up from only two in 2013. Permissible routes of administration have increased across all EMS provider levels, providing advanced life support providers (i.e., paramedics and AEMTs) with expanded discretion; however, authorization for intravenous and intramuscular administration remains relatively uncommon for basic life support (BLS) providers. When specified, maximum doses authorized ranged widely, from 2.0 to 12.0 milligrams. CONCLUSIONS Naloxone administration authority is now widely granted to EMS providers. Most states allow all licensed EMS provider levels to administer naloxone, a substantial increase for EMRs and EMTs since 2013. Paramedics and AEMTs have the greatest authority to select the dosage and route of administration.
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Affiliation(s)
| | - Rebecca L Haffajee
- Principal Deputy Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC, United States.
| | - Corey S Davis
- Network for Public Health Law, Los Angeles, CA, United States.
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Ornato JP, Dunbar EG, Harbour W, Ludin T, Peberdy MA. Importance of Analyzing Intervals to Emergency Medical Service Treatments. PREHOSP EMERG CARE 2022; 27:927-933. [PMID: 35894873 DOI: 10.1080/10903127.2022.2107124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Although most US emergency medical services (EMS) systems collect time-to-treatment data in their electronic prehospital patient care reports (PCRs), analysis of these data seldom appears in publications. We believe EMS agencies should routinely analyze the initial time-to-treatment data for various potentially life-threatening conditions. This not only assures that protocol-required treatments have been provided but can discover avoidable delays and drive protocol/treatment priority change. Our study purpose was to analyze the interval from 9-1-1 call receipt until the first administration of naloxone to adult opioid overdose victims to demonstrate the quality assurance importance of analyzing time-to-treatment data. METHODS Retrospective analysis of intervals from 9-1-1 call receipt to initial naloxone treatment in adult opioid overdose victims. We excluded victims <18 years of age and cases where a bystander, police, or a health care worker gave naloxone before EMS arrival. We compared data collected before and during the COVID-19 pandemic to determine its effect on the analysis. RESULTS The mean patient age of 582 opioid overdose victims was 40.7 years [95% CI 39.6, 41.8] with 405 males (69.6%). EMS units' scene arrival was 6.7 minutes from the 9-1-1 call receipt. It took 1.8 minutes to reach the victim, and 8.6 additional minutes to administer the first naloxone regardless of administration route (70.4% intravenous, 26.1% intranasal, 2.7% intraosseous, 0.7% intramuscular). EMS personnel administered the first naloxone 17.1 minutes after the 9-1-1 call receipt, with 50.3% of the delay occurring after patient contact. There was no statistically significant difference in the times-to-treatment before vs. during the pandemic. CONCLUSION The prepandemic interval from 9-1-1 call receipt until initial EMS administration of naloxone was substantial and did not change significantly during COVID-19. Our findings exemplify why EMS agencies should analyze initial time-to-treatment data, especially for life-threatening conditions, beyond assuring that protocol-required treatments have been provided. Based on our analysis, fire department crews now carry intranasal naloxone, and intranasal naloxone is given to "impaired" opioid overdose victims the first-arriving fire department or EMS personnel. We continue to collect data on intervals-to-treatment prospectively and monitor our critical process/treatment intervals using the plan-do-study-act model to improve our process/carry out change, and publish our results in a future publication.
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Affiliation(s)
- Joseph P Ornato
- Department of Emergency Medicine, Virginia Commonwealth University Health, Richmond, Virginia
- Richmond Ambulance Authority, Richmond, Virginia
- Internal Medicine (Cardiology), Richmond, Virginia
| | - Emily G Dunbar
- Richmond Ambulance Authority, Richmond, Virginia
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Tom Ludin
- Richmond Ambulance Authority, Richmond, Virginia
| | - Mary Ann Peberdy
- Department of Emergency Medicine, Virginia Commonwealth University Health, Richmond, Virginia
- Internal Medicine (Cardiology), Richmond, Virginia
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Abstract
This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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8
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Choi NG, Choi BY, DiNitto DM, Marti CN, Baker SD. Heroin and fentanyl overdose deaths among cases age 50+ in the National Poison Data System, 2015-2020. Clin Toxicol (Phila) 2022; 60:639-646. [PMID: 34985395 PMCID: PMC9881359 DOI: 10.1080/15563650.2021.2016798] [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: 10/28/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 01/31/2023]
Abstract
CONTEXT Illicit opioid use and heroin treatment admissions among individuals age 50+ have increased. Little research has, however, examined correlates of illicit opioid overdose deaths in this age group before or during the COVID-19 pandemic or the healthcare services used in these cases. METHODS The sample included illicit opioid (heroin, fentanyl, or other synthetic, nonpharmaceutical opioids) poisoning cases age 50+ (N = 5576) in the National Poison Data System (NPDS), 2015-2020. Using descriptive statistics and logistic regression models, we report changes in overdose death rates during the study period and associations of death with healthcare service use, naloxone administration, and clinical and demographic characteristics. RESULTS The 6-year average overdose death rate from illicit opioids among those age 50+ was 2.9%, increasing from 1.4% in 2015 to 4.0% in 2019 and 3.6% in 2020. Logistic regression results showed that exposure year was not a significant factor in the odds of overdose death; however, odds were significantly higher among cases that were not managed at any healthcare facility (HCF) (adjusted odds ratio [AOR] = 4.60, 95% confidence interval [CI] = 3.19-6.63) and lower among those who received naloxone therapy (AOR = 0.64, 95% CI = 0.45-0.92). The odds of death were also higher among cases involving exposure at own or another's home and co-use of prescription opioids, alcohol, and other illicit drugs. CONCLUSIONS Although the NPDS did not show increases in illicit opioid overdose death rates among cases age 50+ in 2020 compared to 2019, overdose deaths were greater among cases that were not managed at HCF and did not receive naloxone therapy. Many appear to have died before they received any intervention to prevent death. Improved access to healthcare services and social support and access to naloxone therapy for older adults with opioid use problems are needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine & Bayhealth Medical Center, Dover, DE, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Choi NG, Choi BY, DiNitto DM, Marti CN, Baker SD. Naloxone therapy for prescription and illicit opioid poisoning cases aged 50 + in the national poison data system, 2015-2020. Clin Toxicol (Phila) 2022; 60:499-506. [PMID: 34554013 PMCID: PMC9904880 DOI: 10.1080/15563650.2021.1981362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
CONTEXT Older adults are less likely than younger adults to receive naloxone therapy. Given high rates of prescription opioid use/misuse and increasing illicit opioid use among older adults, factors associated with naloxone administration for older opioid poisoning cases need examination. METHODS We analyzed the 83,135 opioid-involved cases aged 50+ from the 2015-2020 National Poison Data System. Single-variable logistic regression was used to examine associations of naloxone administration with demographic factors, exposure site/reason, medical outcomes, management site/level of care, clinical effects, and other interventions. Multivariable logistic regression models were fit to examine associations of naloxone administration with different types of opioids. RESULTS Over the six years, the proportion of prescription opioid cases that received naloxone therapy increased steadily from 21.9% to 28.4%. The proportion of illicit opioid cases that received naloxone therapy was 51.9% in 2015 and 59.8% in 2020 with a high of 64.4% in 2019. In 2020, the death rate for illicit opioid cases without naloxone therapy was 31.4% compared to 2.3% for those with the therapy. Cases managed at healthcare facilities (HCF) had higher odds of receiving naloxone therapy. Among prescription opioid cases, naloxone therapy rates among older and female cases and those managed at non-HCF settings were especially low even for major medical outcomes. Cases involving oxycodone, morphine, methadone, prescription fentanyl, hydromorphone, oxymorphone, and other/unknown opioids had higher odds of naloxone administration. DISCUSSION Rates of naloxone therapy for older prescription opioid poisoning cases need improvement. While rates were higher among illicit opioid cases, the drop in 2020 and the sharp increase in deaths among illicit opioid cases without naloxone therapy confirm the importance of access to this life-saving intervention. CONCLUSIONS Increased naloxone co-prescribing and other means of facilitating access to naloxone are needed to prevent opioid poisoning deaths among older adults who use prescription opioids.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine & Bayhealth Medical Center, Dover, DE, USA
| | - Diana M. DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - C. Nathan Marti
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Irvine MA, Oller D, Boggis J, Bishop B, Coombs D, Wheeler E, Doe-Simkins M, Walley AY, Marshall BDL, Bratberg J, Green TC. Estimating naloxone need in the USA across fentanyl, heroin, and prescription opioid epidemics: a modelling study. Lancet Public Health 2022; 7:e210-e218. [PMID: 35151372 PMCID: PMC10937095 DOI: 10.1016/s2468-2667(21)00304-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The US overdose crisis is driven by fentanyl, heroin, and prescription opioids. One evidence-based policy response has been to broaden naloxone distribution, but how much naloxone a community would need to reduce the incidence of fatal overdose is unclear. We aimed to estimate state-level US naloxone need in 2017 across three main naloxone access points (community-based programmes, provider prescription, and pharmacy-initiated distribution) and by dominant opioid epidemic type (fentanyl, heroin, and prescription opioid). METHODS In this modelling study, we developed, parameterised, and applied a mechanistic model of risk of opioid overdose and used it to estimate the expected reduction in opioid overdose mortality after deployment of a given number of two-dose naloxone kits. We performed a literature review and used a modified-Delphi panel to inform parameter definitions. We refined an established model of the population at risk of overdose by incorporating changes in the toxicity of the illicit drug supply and in the naloxone access point, then calibrated the model to 2017 using data obtained from proprietary data sources, state health departments, and national surveys for 12 US states that were representative of each epidemic type. We used counterfactual modelling to project the effect of increased naloxone distribution on the estimated number of opioid overdose deaths averted with naloxone and the number of naloxone kits needed to be available for at least 80% of witnessed opioid overdoses, by US state and access point. FINDINGS Need for naloxone differed by epidemic type, with fentanyl epidemics having the consistently highest probability of naloxone use during witnessed overdose events (range 58-76% across the three modelled states in this category) and prescription opioid-dominated epidemics having the lowest (range 0-20%). Overall, in 2017, community-based and pharmacy-initiated naloxone access points had higher probability of naloxone use in witnessed overdose and higher numbers of deaths averted per 100 000 people in state-specific results with these two access points than with provider-prescribed access only. To achieve a target of naloxone use in 80% of witnessed overdoses, need varied from no additional kits (estimated as sufficient) to 1270 kits needed per 100 000 population across the 12 modelled states annually. In 2017, only Arizona had sufficient kits to meet this target. INTERPRETATION Opioid epidemic type and how naloxone is accessed have large effects on the number of naloxone kits that need to be distributed, the probability of naloxone use, and the number of deaths due to overdose averted. The extent of naloxone distribution, especially through community-based programmes and pharmacy-initiated access points, warrants substantial expansion in nearly every US state. FUNDING National Institute of Health, National Institute on Drug Abuse.
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Affiliation(s)
- Michael A Irvine
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Jesse Boggis
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Brian Bishop
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Daniel Coombs
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Traci C Green
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; Brown University School of Public Health, Providence, RI, USA.
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Khare A, Sidana A, Mohemmed A, Allicock DM, Waterstone A, Zimmer MA, Il'yasova D. Acceleration of opioid-related EMS runs in the spring of 2020: The National Emergency Medical Services Information System data for 2018-2020. Drug Alcohol Depend 2022; 232:109271. [PMID: 35051696 DOI: 10.1016/j.drugalcdep.2022.109271] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND State- and county-level reports suggest that the COVID-19 pandemic exacerbated the opioid crisis. We examined US national trends of nonfatal opioid overdose in 2020 in comparison to pre-COVID years 2018-2019. METHODS We used National Emergency Medical Services Information System (NEMSIS) data to conduct a temporal analysis from 2018 to 2020. Opioid-related EMS run was defined using five scenarios of naloxone administration. To determine annual patterns and slope inflection points, we used the Prophet model of the time series analysis. Linear slopes and their 95% confidence intervals (CIs) were calculated for pre-stay-at-home (pre-SaH) and SaH periods in 2020 and compared to the slopes during the same time in 2018-2019. Three cut-points for SaH start were considered: March 19, 24, and 29. RESULTS We identified 91,065, 144,802, and 242,904 opioid-related EMS runs in 2018-2020, respectively. In 2020, opioid-related runs increased in January-June, with a pronounced acceleration in March, which coincides with the stay-at-home (SaH) orders. In both 2018 and 2019, opioid-related runs increased in January-August without the spring acceleration. In 2020, weekly increases (95% CI) during SaH for all examined cut-points were significantly greater than in pre-SaH: 18.09 (16.03-20.16) vs. 6.44 (3.42-9.47) for March 19, 17.77 (15.57-19.98) vs. 4.85 (2.07-7.64) for March 24, 18.03 (15.68-20.39) vs. 4.97(2.4-7.54) for March 29. No significant difference was found between these periods in 2018-2019. CONCLUSIONS The acceleration of opioid-related EMS runs during the SaH period of 2020 suggests that EMS data may serve as an early warning system for local health jurisdictions to deploy harm reduction/prevention resources.
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Affiliation(s)
- Akshat Khare
- Maverick Quantum, Inc., Level 9, Unit-2A Octave, Knowledge City, Hitech City, Hyderabad, Telangana 500081, India
| | - Arsh Sidana
- Maverick Quantum, Inc., Level 9, Unit-2A Octave, Knowledge City, Hitech City, Hyderabad, Telangana 500081, India
| | - Ammar Mohemmed
- MTX Group Inc., 17 Eaglewood Gdns S, Beaumont Hills, NSW 2155, Australia
| | | | - Anna Waterstone
- Department of Emergency Medicine, Stanford University, 900 Welch Road - Suite 350, Palo Alto, CA 94304, USA
| | - Matthew Aaron Zimmer
- MTX Group Inc., 1450 Western Ave. STE 304, Albany, NY 12203, USA; Maverick Quantum, Inc., 6303 Cowboys Way STE 400, Frisco, TX 75034, USA
| | - Dora Il'yasova
- MTX Group Inc., 1450 Western Ave. STE 304, Albany, NY 12203, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC Box 2914, Durham, NC 27710, USA.
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12
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Emergency department utilization for substance use disorders and mental health conditions during COVID-19. PLoS One 2022; 17:e0262136. [PMID: 35025921 PMCID: PMC8757912 DOI: 10.1371/journal.pone.0262136] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.
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Root ED, Slavova S, LaRochelle M, Feaster DJ, Villani J, Defiore-Hyrmer J, El-Bassel N, Ergas R, Gelberg K, Jackson R, Manchester K, Parikh M, Rock P, Walsh SL. The impact of the national stay-at-home order on emergency department visits for suspected opioid overdose during the first wave of the COVID-19 pandemic. Drug Alcohol Depend 2021; 228:108977. [PMID: 34598100 PMCID: PMC8397502 DOI: 10.1016/j.drugalcdep.2021.108977] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although national syndromic surveillance data reported declines in emergency department (ED) visits after the declaration of the national stay-at-home order for COVID-19, little is known whether these declines were observed for suspected opioid overdose. METHODS This interrupted time series study used syndromic surveillance data from four states participating in the HEALing Communities Study: Kentucky, Massachusetts, New York, and Ohio. All ED encounters for suspected opioid overdose (n = 48,301) occurring during the first 31 weeks of 2020 were included. We examined the impact of the national public health emergency for COVID-19 (declared on March 14, 2020) on trends in ED encounters for suspected opioid overdose. RESULTS Three of four states (Massachusetts, New York and Ohio) experienced a statistically significant immediate decline in the rate of ED encounters for suspected opioid overdose (per 100,000) after the nationwide public health emergency declaration (MA: -0.99; 95 % CI: -1.75, -0.24; NY: -0.10; 95 % CI, -0.20, 0.0; OH: -0.33, 95 % CI: -0.58, -0.07). After this date, Ohio and Kentucky experienced a sustained rate of increase for a 13-week period. New York experienced a decrease in the rate of ED encounters for a 10-week period, after which the rate began to increase. In Massachusetts after a significant immediate decline in the rate of ED encounters, there was no significant difference in the rate of change for a 6-week period, followed by an immediate increase in the ED rate to higher than pre-COVID levels. CONCLUSIONS The heterogeneity in the trends in ED encounters between the four sites show that the national stay-at-home order had a differential impact on opioid overdose ED presentation in each state.
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Affiliation(s)
- Elisabeth D Root
- Department of Geography and Division of Epidemiology, The Ohio State University, Columbus, OH, United States.
| | - Svetla Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States
| | - Marc LaRochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jennifer Villani
- National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Jolene Defiore-Hyrmer
- Bureau of Health Improvement and Wellness, Ohio Department of Health, Columbus, OH, United States
| | - Nabila El-Bassel
- School of Social Work, Columbia University, New York, NY, United States
| | - Rosa Ergas
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, Jamaica Plain, MA, United States
| | - Kitty Gelberg
- New York State Department of Health, Office of Drug User Health, Albany, NY, United States
| | - Rebecca Jackson
- Departments of Physical Medicine and Rehabilitation, Internal Medicine/ Endocrinology, and Diabetes and Metabolism, Ohio State University, Columbus, OH, United States
| | - Kara Manchester
- Ohio Violence and Injury Prevention Program, Ohio Department of Health, Columbus, OH, United States
| | - Megha Parikh
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, Jamaica Plain, MA, United States
| | - Peter Rock
- Center for Clinical and Translational Science, University of Kentucky, Lexington, KY, United States
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
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Lindqvist K, Wallmofeldt C, Holmén E, Hammarberg A, Kåberg M. Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic. Harm Reduct J 2021; 18:52. [PMID: 33971892 PMCID: PMC8107802 DOI: 10.1186/s12954-021-00499-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Background and aims People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden’s initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic.
Methods NEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020. Results During the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0–7.2). Conclusions The Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.
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Affiliation(s)
- K Lindqvist
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - C Wallmofeldt
- Norra Stockholms Psykiatri (Psychiatry of Northern Stockholm), S:t Görans Hospital, Stockholm, Sweden
| | - E Holmén
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - M Kåberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden. .,Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Sprututbytet, S:t Görans sjukhus, Akutvägen 29, 112 81, Stockholm, Sweden.
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