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Eide D, Gjersing L, Danielsen AW, Skulberg AK, Dale O, Braarud AC, Heyerdahl F, Tylleskar I. Heightened mortality risk after a non-fatal opioid overdose: Risk factors for mortality in the week following emergency treatment. Addiction 2024; 119:2131-2138. [PMID: 39183709 DOI: 10.1111/add.16632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/08/2024] [Indexed: 08/27/2024]
Abstract
AIMS To measure all-cause mortality risk after an ambulance-attended non-fatal opioid overdose and associations with number of days following attendance, and individual and clinical characteristics. DESIGN A prospective observational study. SETTING Oslo, Norway. PARTICIPANTS Patients treated with naloxone for opioid overdose by Oslo Emergency Services between 1 June 2014 and 31 December 2018. MEASUREMENTS Medical records were linked to the national Cause of Death Registry (1 June 2014-31 December 2019). Crude mortality rates (CMR) and incidence risk ratios (IRR) with 95% confidence intervals (CI) were estimated for the time periods (0-7 days, 8-31 days, 32-91 days, 92-183 days, >183 days) using multivariate Poisson regression analysis. IRR were estimated for sex, age, Glasgow Coma Scale (GCS), respiration rate, place of attendance and non-transportation following treatment. Robust variance estimates applied due to multiple risk periods. Standardized Mortality Rates (SMR) were estimated. FINDINGS Overall, 890 patients treated for 1764 overdoses contributed to a total time at risk of 3142 person-years (PY). Median number of attendances was 1 (range 1-27). The majority were male (75.5%) and the mean age was 37.7 years. In total, 112 (12.6%) died; 5.2% within 183 days and 2.2% between 184 and 365 days. Acute poisoning was the most common single cause of death (52.7%). The CMR was 3.6 (95% CI = 3.0-4.2) per 100-PY. The women had a SMR of 32 (95% CI = 15.8-57.9) and the men 24.9 (95% CI = 17.7-34.2). The CMR (22.2, 95% CI = 10.6-46.8) was particularly high in the first 7 days, and significantly higher than in the following periods. However, this finding was only valid for those with severe overdose symptoms (GCS score = 3/15 and/or respiratory rate ≤6/min). Except for increasing age, no other indicators were associated with the mortality risk. CONCLUSION Patients treated by Oslo Emergency Services between June 2014 and December 2018 for a non-fatal opioid overdose with severe overdose symptoms at attendance had an overall high mortality risk compared with the general population, but particularly during the first 7 days after attendance.
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Affiliation(s)
- Desiree Eide
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Linn Gjersing
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Division for Master and Postgraduate Programmes, Lovisenberg Diaconal University College, Oslo, Norway
| | | | - Arne Kristian Skulberg
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ola Dale
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Fridtjof Heyerdahl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Ida Tylleskar
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Sauda TH, Yockey RA, Marin SB, Hoopsick RA. Sex Differences in Methamphetamine Mortality in the United States: Heroin and Fentanyl Coinvolvement, 1999-2021. Am J Prev Med 2024:S0749-3797(24)00363-5. [PMID: 39490694 DOI: 10.1016/j.amepre.2024.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 10/07/2024] [Accepted: 10/17/2024] [Indexed: 11/05/2024]
Abstract
INTRODUCTION Prepandemic data suggests that methamphetamine-related mortality and opioid coinvolvement have been increasing in the U.S. However, there was a staggering number of U.S. drug overdose deaths in 2020 and 2021, particularly among males. An updated examination of sex-specific trends in methamphetamine-related mortality, the extent to which these deaths may be driven by the heroin and fentanyl coinvolvement, and whether this coinvolvement might explain the disproportionate number of male methamphetamine deaths is warranted. METHODS The authors leveraged final and provisional data from the CDC WONDER multiple causes of death database to examine deaths involving methamphetamine (i.e., psychostimulants with abuse potential, ICD-10 code T43.6) and methamphetamine-related deaths that coinvolved heroin and/or synthetic opioids excluding methadone (ICD-10 code T40.4; e.g., fentanyl) among U.S. residents aged 15-74 years. The authors plotted age-adjusted methamphetamine mortality rates by sex and year and quantified the proportion of deaths with heroin/synthetic opioid coinvolvement. Finally, they used Joinpoint regression models to quantify sex-specific trends in methamphetamine mortality and the proportion of deaths with heroin and/or synthetic opioid coinvolvement. RESULTS From 1999 to 2021, the methamphetamine-related mortality rate increased 58.8-fold among males (0.33 per 100,000 to 19.74 per 100,000) and 65.3-fold among females (0.12 per 100,000 to 7.96 per 100,000), with the greatest increases occurring between 2019 and 2021. The proportion of these deaths that coinvolved heroin and/or synthetic opioids increased among both males (13.1% to 61.5%) and females (7.7% to 63.1%) from 1999 to 2021. CONCLUSIONS Increasing methamphetamine-related mortality among males and females has been accompanied by a dramatic increase in the proportion of heroin and/or synthetic opioid coinvolvement among both sexes. Robust harm reduction efforts are needed to mitigate these increases, particularly for people who couse stimulants and opioids.
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Affiliation(s)
- Tonazzina H Sauda
- Department of Health and Kinesiology, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - R Andrew Yockey
- Department of Public Health, School of Applied Sciences, University of Mississippi, Oxford, Mississippi
| | - Sofia B Marin
- Department of Health and Kinesiology, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Rachel A Hoopsick
- Department of Health and Kinesiology, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois.
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O'Shaughnessy BR, Mayock P, Kakar A. The recovery experiences of homeless service users with substance use disorder: A systematic review and qualitative meta-synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104528. [PMID: 39053034 DOI: 10.1016/j.drugpo.2024.104528] [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: 04/25/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The relationship between homelessness and substance use disorder (SUD) is layered and complex. Adults pursuing recovery while dealing with homelessness and SUD face many challenges. Little research has inspected qualitative first-person accounts of recovery in the context of homelessness and SUD, and few studies have employed conceptualisations of recovery beyond abstinence. In this systematic review study, we examine the qualitative literature on the recovery experiences of adult homeless service users with SUD. METHODS 2,042 records were identified via database and secondary searching strategy. After title and abstract and full text screening, 15 eligible studies remained. Critical Appraisal Skills Programme quality appraisal criteria was used to assess potential bias in the studies. Meta-ethnography was employed to synthesise extracted data. RESULTS Four themes were generated from the extracted data: Two sides of the Service Coin; Navigating Relationships; Recovery Practices and Personal Attributes; and Housing as Foundational for Recovery. CONCLUSION Unconditional housing, a broad array of supports, opportunities to contribute to society, and family reunification supports all facilitate the development of recovery for adults with SUD experiencing homelessness. Implications for policy are discussed.
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Affiliation(s)
- Branagh R O'Shaughnessy
- School of Social Work and Social Policy, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, College Green, Dublin 2, Ireland
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Santo T, Gisev N, Campbell G, Colledge-Frisby S, Wilson J, Tran LT, Lynch M, Martino-Burke D, Taylor S, Degenhardt L. Prevalence of comorbid substance use disorders among people with opioid use disorder: A systematic review & meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104434. [PMID: 38677160 DOI: 10.1016/j.drugpo.2024.104434] [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: 01/17/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Comorbid substance use disorders (SUDs) among people with opioid use disorder (OUD) contribute to poor clinical outcomes, including overdose and mortality. We present the first systematic review and meta-analysis to estimate the prevalence of specific non-opioid SUDs among people with OUD. METHODS We searched Embase, PsycINFO, and MEDLINE from 1990 to 2022 for studies that used Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria to assess the prevalence of non-opioid SUDs among individuals with OUD. We used random-effects meta-analyses with 95% Confidence Intervals (CIs) to pool current and lifetime prevalence estimates separately. Meta-regressions and stratified meta-analyses were used to examine differences in prevalence estimates by sample characteristics and methodological factors. RESULTS Of the 36,971 publications identified, we included data from 194 studies and 77,212 participants with OUD. The prevalence of any comorbid SUD among people with OUD was 59.5% (95%CI 49.1-69.5%) for current non-opioid SUDs, with 72.0% (95%CI 52.5-87.9%) experiencing a comorbid SUD in their lifetime. Of the studies that examined current comorbid SUDs, cocaine use disorder (30.5%, 95%CI 23.0-38.7%) was most common, followed by alcohol (27.1%, 95%CI 24.4- 30.0%), cannabis (22.7%, 95%CI 19.0-26.6%), sedative (16.1%, 95%CI 13.1-19.3%), and methamphetamine (11.4%, 95%CI 6.8-17.1%) use disorders. Substantial heterogeneity (I2>90%) across estimates was observed. Substantial heterogeneity (I2>90%) was observed across estimates, with significant variations in prevalence identified across geographic locations, recruitment settings, and other study-level factors. CONCLUSION Findings from this study emphasize the importance of comorbid SUD treatment access for people with OUD. Our estimates can inform the provision of treatment and harm reduction strategies for people with OUD and specific subpopulations.
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Affiliation(s)
- Thomas Santo
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia.
| | - Natasa Gisev
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia; School of Psychology, University of Queensland, St. Lucia, Queensland, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia; National Drug Research Institute, Curtin University, Melbourne, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Jack Wilson
- Matilda Centre, The University of the Sydney, Sydney, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Michelle Lynch
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Daniel Martino-Burke
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Sophia Taylor
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
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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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Amundsen EJ, Melsom AKM, Eriksen BO, Løchen ML. No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions. NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:111-130. [PMID: 38356787 PMCID: PMC10863554 DOI: 10.1177/14550725231195413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010-2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010-2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed.
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Affiliation(s)
- Ellen J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne-Karine M Melsom
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Centre for Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn O Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway; Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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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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Karamouzian M, Cui Z, Hayashi K, DeBeck K, Reddon H, Buxton JA, Kerr T. Longitudinal polysubstance use patterns and non-fatal overdose: A repeated measures latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104301. [PMID: 38182524 PMCID: PMC11222307 DOI: 10.1016/j.drugpo.2023.104301] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 11/06/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Polysubstance use (PSU) is common among people who use opioids (PWUO) and has been associated with drug-related harms. We aimed to identify latent longitudinal PSU classes among a cohort of PWUO and characterize non-fatal overdose risks among different sub-classes over time. METHODS We used longitudinal data (2005-2018) from three ongoing prospective cohorts of people who use drugs in Vancouver, Canada. The primary outcome of interest was self-reported non-fatal overdose during the past six months. The primary exposure of interest was longitudinal PSU patterns among PWUO, obtained from repeated measures latent class analysis (RMLCA) of weekly substance use-related outcome indicators. Multivariable generalized estimating equations models were built to assess the association between latent PSU class membership and non-fatal overdose, adjusting for potential sociodemographic, behavioural, and structural confounders. RESULTS 2627 PWUO were included in the analysis, and 1094 (41.6 %) had experienced at least one non-fatal overdose during the study period. RMLCA revealed five distinct latent longitudinal PSU classes, including low/infrequent use (Class 1; 30 %), primarily opioid and methamphetamine use (Class 2; 22 %), primarily cannabis use (Class 3; 15 %), primarily opioid and crack use (Class 4; 29 %), and frequent PSU (Class 5; 4 %). In comparison with Class 1 (low), membership in all latent PSU classes except Class 3 (cannabis) was associated with increased odds of non-fatal overdose: Class 2 (opioids + meth) vs. Class 1 (Adjusted odds ratios [aOR] = 2.20, 95 % confidence intervals [CI]: 1.51-3.22), Class 4 (opioids + crack) vs. Class 1 (aOR = 1.06, 95 % CI: 0.85-1.33), and Class 5 (frequent) vs. Class 1 (aOR = 2.39, 95 % CI: 1.92-2.97). CONCLUSION Our findings highlighted the heterogeneous characteristics of PWUO in terms of patterns of PSU and non-fatal overdose risk. The diverse nature of PWUO and the potential additive or multiplicative impact of using several substances on overdoses should be reflected across the substance use treatment continuum and care provision.
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Affiliation(s)
- Mohammad Karamouzian
- Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON M5B 1T8, Canada; British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, Burnaby, BC V6B 5K3, Canada
| | - Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
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Yilin D, Bellerose M, Borbely C, Rowell-Cunsolo TL. Assessing the relationship between drug use initiation age and racial characteristics. J Ethn Subst Abuse 2023:1-15. [PMID: 37882363 DOI: 10.1080/15332640.2023.2271871] [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: 10/27/2023]
Abstract
Initiating drug use in adolescence is associated with greater risk of drug misuse and dependence in adulthood and co-occurring mental health disorders. Initiating drug use in adulthood has been linked to higher-risk drug use networks and primary use of "harder drugs". The aim of our research is to examine racial/ethnic differences in age at drug use initiation and its relationship with adult outcomes. Based on data from the 2019 National Survey on Drug Use and Health (NSDUH), we used survey-weighted Poisson regression models with robust variance to identify associations between racial characteristics, age at drug use initiation, and three adult outcomes - past year polydrug use, substance use, and mental illness - adjusting for individual-level characteristics. Among 25,986 respondents who ever used drugs and reported their drug use initiation age, Asian-Americans reported the oldest drug use initiation age (19.5) on average, while Native Americans reported the youngest initiation age (16.6). While there were no significant differences in type of drug used during onset by race or ethnicity, generally, individuals start to use inhalants at the earliest age (17.4), while the misuse of sedatives is initiated at the oldest age (46.4). Initiation during late adolescence was associated with greater likelihood of a substance use disorder diagnosis, mental health diagnoses, and polydrug use in adulthood. Drug use prevention interventions should be tailored and accessible during adolescence to delay onset. Interventions that are culturally sensitive, screen for vulnerability to drug use, and offer age-appropriate services should be prioritized.
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Affiliation(s)
- Diandian Yilin
- School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Meghan Bellerose
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Carson Borbely
- School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Stiltner B, Pietrzak RH, Tylee DS, Nunez YZ, Adhikari K, Kranzler HR, Gelernter J, Polimanti R. Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder. iScience 2023; 26:107336. [PMID: 37554454 PMCID: PMC10405253 DOI: 10.1016/j.isci.2023.107336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
To characterize polysubstance addiction (PSA) patterns of cocaine use disorder (CoUD), we performed a latent class analysis (LCA) in 7,989 participants with a lifetime DSM-5 diagnosis of CoUD. This analysis identified three PSA subgroups among CoUD participants (i.e., low, 17%; intermediate, 38%; high, 45%). While these subgroups varied by age, sex, and racial-ethnic distribution (p < 0.001), there was no difference with respect to education or income (p > 0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR = 21.96 vs. 6.39, difference-p = 8.08✕10-6), agoraphobia (OR = 4.58 vs. 2.05, difference-p = 7.04✕10-4), mixed bipolar episode (OR = 10.36 vs. 2.61, difference-p = 7.04✕10-4), posttraumatic stress disorder (OR = 11.54 vs. 5.86, difference-p = 2.67✕10-4), antidepressant medication use (OR = 13.49 vs. 8.02, difference-p = 1.42✕10-4), and sexually transmitted diseases (OR = 5.92 vs. 3.38, difference-p = 1.81✕10-5) than the low-PSA CoUD subgroup. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.
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Affiliation(s)
- Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Daniel S. Tylee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Yaira Z. Nunez
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Keyrun Adhikari
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Henry R. Kranzler
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Mental Illness Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
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11
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Ellis JD, Rabinowitz JA, Ware OD, Wells J, Dunn KE, Huhn AS. Patterns of polysubstance use and clinical comorbidity among persons seeking substance use treatment: An observational study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208932. [PMID: 36880895 PMCID: PMC10035066 DOI: 10.1016/j.josat.2022.208932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/08/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Polysubstance use is common among individuals seeking treatment for substance use disorders (SUD). However, we know less about patterns and correlates of polysubstance use among treatment-seeking populations. The current study aimed to identify latent patterns of polysubstance use and associated risk factors in persons entering SUD treatment. METHODS Patients (N = 28,526) being admitted for substance use treatment reported on their use of thirteen substances (e.g., alcohol, cannabis, cocaine, amphetamines, methamphetamines, other stimulants, heroin, other opioids, benzodiazepines, inhalants, synthetics, hallucinogens, and club drugs) in the month before treatment and prior to the month before treatment. Latent class analysis (LCA) determined the relationship between class membership and gender, age, employment status, unstable housing, self-harm, overdose, past treatment, depression, generalized anxiety disorder, and/or post-traumatic stress disorder (PTSD). RESULTS Identified classes included: 1) Alcohol primary, 2) Moderate probability of past-month alcohol, cannabis, and/or opioid use; 3) Alcohol primary, Lifetime cannabis and cocaine use; 4) Opioid primary, Lifetime use of alcohol, cannabis, hallucinogens, club drugs, amphetamines, and cocaine; 5) Moderate probability of past-month alcohol, cannabis, and/or opioid use, Lifetime use of various substances; 6) Alcohol and cannabis primary, Lifetime use of various substances; and 7) High past-month polysubstance use. Individuals who engaged in past-month polysubstance use attended to face elevated risk of screening positive for recent unstable housing, unemployment, depression, anxiety, PTSD, self-harm, and overdose. CONCLUSIONS Current polysubstance use is associated with significant clinical complexity. Tailored treatments that reduce harms resulting from polysubstance use and related psychiatric comorbidity may improve treatment outcomes in this population.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Orrin D Ware
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, United States of America
| | - Jonathan Wells
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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12
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Stiltner B, Pietrzak RH, Tylee DS, Nunez YZ, Adhikari K, Kranzler HR, Gelernter J, Polimanti R. Polysubstance addiction and psychiatric, somatic comorbidities among 7,989 individuals with cocaine use disorder: a latent class analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.08.23285653. [PMID: 36798273 PMCID: PMC9934788 DOI: 10.1101/2023.02.08.23285653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Aims We performed a latent class analysis (LCA) in a sample ascertained for addiction phenotypes to investigate cocaine use disorder (CoUD) subgroups related to polysubstance addiction (PSA) patterns and characterized their differences with respect to psychiatric and somatic comorbidities. Design Cross-sectional study. Setting United States. Participants Adult participants aged 18-76, 39% female, 47% African American, 36% European American with a lifetime DSM-5 diagnosis of CoUD (N=7,989) enrolled in the Yale-Penn cohort. The control group included 2,952 Yale-Penn participants who did not meet for alcohol, cannabis, cocaine, opioid, or tobacco use disorders. Measurements Psychiatric disorders and related traits were assessed via the Semi-structured Assessment for Drug Dependence and Alcoholism. These features included substance use disorders (SUD), family history of substance use, sociodemographic information, traumatic events, suicidal behaviors, psychopathology, and medical history. LCA was conducted using diagnoses and diagnostic criteria of alcohol, cannabis, opioid, and tobacco use disorders. Findings Our LCA identified three subgroups of PSA (i.e., low, 17%; intermediate, 38%; high, 45%) among 7,989 CoUD participants. While these subgroups varied by age, sex, and racial-ethnic distribution (p<0.001), there was no difference on education or income (p>0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR=21.96 vs. 6.39, difference-p=8.08×10 -6 ), agoraphobia (OR=4.58 vs. 2.05, difference-p=7.04×10 -4 ), mixed bipolar episode (OR=10.36 vs. 2.61, difference-p=7.04×10 -4 ), posttraumatic stress disorder (OR=11.54 vs. 5.86, difference-p=2.67×10 -4 ), antidepressant medication use (OR=13.49 vs. 8.02, difference-p=1.42×10 -4 ), and sexually transmitted diseases (OR=5.92 vs. 3.38, difference-p=1.81×10 -5 ) than the low-PSA CoUD subgroup. Conclusions We found different patterns of PSA in association with psychiatric and somatic comorbidities among CoUD cases within the Yale-Penn cohort. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.
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Belfrage A, Mjølhus Njå AL, Lunde S, Årstad J. Traumatic experiences and PTSD symptoms in substance use disorder: A comparison of recovered versus current users. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:61-75. [PMID: 36793481 PMCID: PMC9893129 DOI: 10.1177/14550725221122222] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: The aim of this study was to investigate the prevalence of traumatic experiences and symptoms of posttraumatic stress disorder (PTSD) in treatment-seeking individuals with ongoing substance use disorder (SUD) compared to individuals who have recovered from SUD. Methods: Patients with SUD recruited from the STAYER study (N = 114) underwent an examination of alcohol and drug use, childhood trauma, negative life events and PTSD symptomatology. In this study, only participants with 12-month concurrent polysubstance use was included. Using historical data from the STAYER study, alcohol and drug trajectories were dichotomised as (1) current SUD (current SUD) or (2) recovered from substance use disorder (recovered SUD). Crosstabs and chi-tests were used to measure differences between groups. Results: Childhood maltreatment, traumatic experiences later in life and symptoms of concurrent PTSD were highly prevalent in the study population. We found no significant difference between the current and recovered SUD groups. Recovered women reported a lower prevalence of physical neglect (p = 0.031), but a higher prevalence of multiple lifetime traumas (p = 0.019) compared to women with current SUD. Both women with current SUD and recovered women reported a significantly higher prevalence of sexual aggression than men (p < 0.001 and p < 0.001, respectively). In addition, men who have recovered from SUD reported a lower prevalence of PTSD symptoms over cut-off 38 (p = 0.017), of re-experiencing (p = 0.036) and of avoidance (p = 0.015), compared to recovered women. Conclusion: Reported trauma did not differ between persons with current SUD and those who had recovered from SUD. Gender differences discovered in this study indicate the importance of developing individualised and gender-specific treatment models for comorbid PTSD/SUD.
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Affiliation(s)
- Anna Belfrage
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Anne Lill Mjølhus Njå
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Siri Lunde
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Janne Årstad
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
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Mehr JB, Bennett ER, Price JL, de Souza NL, Buckman JF, Wilde EA, Tate DF, Marshall AD, Dams-O'Connor K, Esopenko C. Intimate partner violence, substance use, and health comorbidities among women: A narrative review. Front Psychol 2023; 13:1028375. [PMID: 36778165 PMCID: PMC9912846 DOI: 10.3389/fpsyg.2022.1028375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
Exposure to intimate partner violence (IPV), including physical, sexual, and psychological violence, aggression, and/or stalking, impacts overall health and can have lasting mental and physical health consequences. Substance misuse is common among individuals exposed to IPV, and IPV-exposed women (IPV-EW) are at-risk for transitioning from substance misuse to substance use disorder (SUD) and demonstrate greater SUD symptom severity; this too can have lasting mental and physical health consequences. Moreover, brain injury is highly prevalent in IPV-EW and is also associated with risk of substance misuse and SUD. Substance misuse, mental health diagnoses, and brain injury, which are highly comorbid, can increase risk of revictimization. Determining the interaction between these factors on the health outcomes and quality of life of IPV-EW remains a critical need. This narrative review uses a multidisciplinary perspective to foster further discussion and research in this area by examining how substance use patterns can cloud identification of and treatment for brain injury and IPV. We draw on past research and the knowledge of our multidisciplinary team of researchers to provide recommendations to facilitate access to resources and treatment strategies and highlight intervention strategies capable of addressing the varied and complex needs of IPV-EW.
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Affiliation(s)
- Jacqueline B. Mehr
- School of Environmental and Biological Sciences, Rutgers University – New Brunswick, New Brunswick, NJ, United States
| | - Esther R. Bennett
- School of Social Work, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Julianne L. Price
- Department of Kinesiology and Health, Rutgers University - New Brunswick, New Brunswick, NJ, United States
- Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Nicola L. de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer F. Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, New Brunswick, NJ, United States
- Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Elisabeth A. Wilde
- Department of Neurology, School of Medicine, The University of Utah, Salt Lake City, UT, United States
- George E. Wahlen, VA Salt Lake City Healthcare System, Research Care Line, Salt Lake City, UT, United States
| | - David F. Tate
- Department of Neurology, School of Medicine, The University of Utah, Salt Lake City, UT, United States
- George E. Wahlen, VA Salt Lake City Healthcare System, Research Care Line, Salt Lake City, UT, United States
| | - Amy D. Marshall
- Department of Psychology, College of the Liberal Arts, The Pennsylvania State University, State College, PA, United States
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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15
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Hanoa K, Bilgrei OR, Buvik K. The Importance of Perceived Safety, Stigma and Pleasure for Solitary Injecting. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231151377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Many people who inject drugs (PWID) inject when they are alone which increases the risk for drug-related mortality, and the majority of overdose-related deaths occur among solitary users in residential environments. Drawing on qualitative data from interviews with 80 PWID in Norway, this study explores the complex practices of solitary injecting. The analysis illustrates that the risk environments in which they participated involved high levels of distress, fear and stigma that made them prefer solitary injecting. This involved a perceived notion of safety from an unpredictable social environment. Stigma was described as causing additional harms and they therefore wanted to hide their drug-using practices. Finally, injecting drug use involved contextual pleasures that were maximised by injecting alone. The study illustrates how the risk environment the PWID inhabited caused additional harms, by which solitary injections was rationalized, despite its increased mortality risks. Future harm-reduction initiatives should reflect this important aspect.
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Affiliation(s)
- Kristin Hanoa
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Agency for Social and Welfare Services, Oslo Municipality, Norway
| | - Ola Røed Bilgrei
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristin Buvik
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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16
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Black JC, Rockhill KM, Dart RC, Iwanicki J. Clustering patterns in polysubstance mortality in the United States in 2017: a multiple correspondence analysis of death certificate data. Ann Epidemiol 2023; 77:119-126. [PMID: 35378292 DOI: 10.1016/j.annepidem.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/25/2022] [Accepted: 03/24/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE The main goal of this analysis was to identify mortality patterns apparent when many drug classes are analyzed together. METHODS The Drug Involved Mortality database is a registry of drug terms mentioned on death certificates of all drug-related deaths in the United States. Means of total number of drugs involved and percentages of specific drug combinations were calculated. Dimensionality reduction using multiple correspondence analysis and hierarchical clustering identified clusters of drugs listed on death certificates. RESULTS An average of 2.4 specific drugs were listed on death certificates in 2017. For 9 of the top 10 drugs involved, over 80% of deaths involved at least one other drug. As expected, opioid drugs and psychostimulants clustered together, but other psychoactive substances (non-opioid analgesics, sedatives, antidepressants, antipsychotics) clustered together into multi-class groups. Other drugs (e.g., acetaminophen, oxymorphone) were frequently involved in polysubstance death, but did not cluster with any other specific drug. Deaths involving illicit drugs listed fewer drugs than deaths involving prescription drugs. CONCLUSIONS While individual drug substances might contribute to many deaths (e.g., fentanyl), polysubstance mortality is more common than single substance mortality. Multidimensional analyses integrating all drugs involved are useful to identify uncommon patterns of overdose and changing trends.
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Affiliation(s)
- Joshua C Black
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO.
| | - Karilynn M Rockhill
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Richard C Dart
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Janetta Iwanicki
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
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17
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Bonfiglio NS, Portoghese I, Renati R, Mascia ML, Penna MP. Polysubstance Use Patterns among Outpatients Undergoing Substance Use Disorder Treatment: A Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16759. [PMID: 36554643 PMCID: PMC9779802 DOI: 10.3390/ijerph192416759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Substance Use Disorders (SUDs) pose significant challenges to both individuals and society at large. The primary focus of existing research with clinical SUD populations has been on individual substances, but research is required to better understand the profiles of individuals who use different substances simultaneously. The purpose of the current study was, therefore, to identify patterns of use among subjects (n = 1025) who reported using multiple substances by adopting a Latent Class Analysis (LCA) methodology. The Addiction Severity Index (ASI-lite) was included as a measure of substance misuse, we performed LCA to identify patterns of substance use through the administration of the ASI-Lite. Responses were collected from the following substances: alcohol, cannabis/cannabinoids, opioids and heroin, and cocaine. Results identified two latent classes: (1) alcohol use dominant, and (2) poly-abuser use dominants. Class 1 represented 60.0% of the sample and refers to individuals with the dominant use of alcohol, of those a higher proportion (47%) reported low-frequency use (1 to 7 days per month) and 26% reported a frequency of use of 24 to 30 days per month. Furthermore, 18% used alcohol in combination with cocaine. Class 2 represents 40.0% of the sample. This class is characterized by low-frequency and high-frequency users of several substances. The results obtained highlight the importance of deepening the study of the concomitant use of substances in individuals with SUDs to better understand the health risk of the combined use of two or more substances.
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Affiliation(s)
- Natale Salvatore Bonfiglio
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
- Noah SRL, 27100 Pavia, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Roberta Renati
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
- Noah SRL, 27100 Pavia, Italy
| | - Maria Lidia Mascia
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
| | - Maria Pietronilla Penna
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
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18
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Mefodeva V, Carlyle M, Walter Z, Chan G, Hides L. Polysubstance use in young people accessing residential and day-treatment services for substance use: substance use profiles, psychiatric comorbidity and treatment completion. Addiction 2022; 117:3110-3120. [PMID: 35851706 PMCID: PMC9804256 DOI: 10.1111/add.16008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/27/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS People with substance use disorders (SUDs) frequently present to treatment with polysubstance use and mental health comorbidities. Different combinations of substance use and mental health problems require different treatment approaches. Our study aimed to: (i) identify the shared substance use classes among young people at treatment admission, (ii) determine which mental health symptoms, quality of life (QoL) and service types were associated with the identified substance use classes, and (iii) prospectively determine which substance use classes and service types were more likely to complete treatment. DESIGN Cross-sectional and prospective study using service and outcome data. SETTING Substance use treatment services in Queensland and New South Wales, Australia. PARTICIPANTS De-identified service and outcome measure data were extracted from the files of 744 clients aged 18-35 years (48% male) admitted into seven residential and four day-treatment programmes. MEASUREMENTS Substance use and severity among tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, opioids, sedatives and inhalants. Other variables included: depression, anxiety, post-traumatic stress and psychotic symptoms, as well as QoL. FINDINGS Latent class analysis identified three polysubstance use classes: wide-ranging polysubstance users (WRPU; 22.45%), primary amphetamine users (56.45%) and alcohol and cannabis users (21.10%). The WRPU class had higher odds of psychotic symptoms than the alcohol and cannabis use class [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.11-1.11]; and double the odds of residential programme enrolment than those in the amphetamine use class (OR = 2.35; 95% CI = 1.50-3.68). No other class differences on mental health or QoL variables were found. Clients enrolled in day-programmes had higher odds of completing treatment. CONCLUSIONS There appear to be high levels of polysubstance use among young people entering substance use treatment in Australia. Wide-ranging polysubstance users were more likely to report psychotic symptoms and be enrolled into a residential programme than primary amphetamine users and alcohol and cannabis users.
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Affiliation(s)
- Valeriya Mefodeva
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Molly Carlyle
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Zoe Walter
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Gary Chan
- National Centre for Youth Substance Use Research (NCYSUR)University of QueenslandBrisbaneQueenslandAustralia
| | - Leanne Hides
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia,National Centre for Youth Substance Use Research (NCYSUR)University of QueenslandBrisbaneQueenslandAustralia
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19
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Ericson ØB, Eide D, Lobmaier P, Clausen T. Risks and overdose responses: Participant characteristics from the first seven years of a national take-home naloxone program. Drug Alcohol Depend 2022; 240:109645. [PMID: 36191532 DOI: 10.1016/j.drugalcdep.2022.109645] [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: 06/30/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND In 2014, the Norwegian government funded a large-scale take-home naloxone (THN) program to address high overdose mortality rates. The aims of this study are to describe characteristics among persons trained to receive THN, describe actions taken following THN use at an overdose event and to explore factors associated with naloxone use. METHODS This was a prospective cohort study of individuals who received THN from 2014 to 2021. Descriptive characteristics were collected at initial training. When returning for refill, participants reported on their previous naloxone use. In a multivariable logistic regression model exploring associations with naloxone use: gender, age, opioid use history, concomitant drug use, injecting, history of experienced or witnessed overdose were included. RESULTS In total, 3527 individuals were included in this study. There were 958 individuals who returned for refills 2303 times. Most participants were male (63.6%), with a history of opioid use (77.5%). Those who reported naloxone use were more likely to have a history of opioid use (aOR= 4.1; 95% CI=2.77,6.1), were younger (aOR=0.98; 95% CI=0.97,0.99) and had witnessed overdoses (aOR=3.3; 95% CI=1.98,5.34). Among current opioid users, the odds were higher for injectors (aOR=1.57; 95% CI=1.18,2.1). Naloxone use was reported 1282 times. Additional actions such as waking the person and calling the ambulance were frequently reported. Survival was reported in almost all cases (94%). CONCLUSION People who use drugs are a suitable target group for THN-programs, as they seem to be willing and capable to reverse overdoses effectively. Given their personal risk factors for overdosing, recipients will likely also benefit from overdose prevention education.
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Affiliation(s)
- Øystein Bruun Ericson
- The Norwegian Centre for Addiction Research, Building 45, Ullevål Hospital, Kirkeveien 166, 0450 Oslo, Norway.
| | - Desiree Eide
- The Norwegian Centre for Addiction Research, Building 45, Ullevål Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Philipp Lobmaier
- The Norwegian Centre for Addiction Research, Building 45, Ullevål Hospital, Kirkeveien 166, 0450 Oslo, Norway; Diakonhjemmet Hospital, Division of Mental Health and Substance Abuse, PB 23 Vinderen, 0319 Oslo, Norway
| | - Thomas Clausen
- The Norwegian Centre for Addiction Research, Building 45, Ullevål Hospital, Kirkeveien 166, 0450 Oslo, Norway
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20
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Ingebrigtsen E, Persett PS, Brekke M, Heyerdahl F, Hovda KE, Vallersnes OM. Poisoning with central stimulant drugs: an observational study from Oslo, Norway. Int J Emerg Med 2022; 15:54. [PMID: 36175843 PMCID: PMC9520889 DOI: 10.1186/s12245-022-00457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of central stimulant drugs causes significant morbidity. We describe poisonings with central stimulant drugs and compare the different central stimulants concerning combinations with other drugs, treatment, and clinical course. METHODS: Patients presenting from 1 October 2013 to 31 March 2016 with poisoning related to the recreational use of central stimulant drugs were retrospectively included at a primary care emergency outpatient clinic and at a hospital emergency department in Oslo, Norway. Diagnosis of toxic agents was mainly based on the clinical assessment of the doctor treating the patient. Amphetamine and methamphetamine were co-categorized as amphetamine. RESULTS Among the 1131 cases of acute poisoning with central stimulant drugs at the outpatient clinic, amphetamine was involved in 808 (71.4%), cocaine in 252 (22.3%) methylenedioxymethamphetamine (MDMA) in 104 (9.2%), and methylphenidate in 13 (1.1%). Among the 211 cases at the hospital, amphetamine was involved in 167 (79.1%), cocaine in 60 (28.4%), and MDMA in 38 (18.0%). Amphetamine was frequently combined with opioids (40.1% at the outpatient clinic and 41.9% at the hospital) and benzodiazepines (28.3% and 45.5%), while MDMA often was combined with ethanol (64.4% and 71.1%), as was cocaine (62.7% and 61.7%). Sedation was given in 5.2% and 38.4% of cases, naloxone in 9.4% and 37.0%, and flumazenil in 0.1% and 28.0%. In total, 16.5% of the cases at the outpatient clinic were transferred to a hospital for medical review and 8.5% to a psychiatric hospital. Among the hospital patients, 92.9% were admitted to intensive care. CONCLUSION Amphetamine was the most common central stimulant drug involved in acute poisoning in Oslo, often combined with opioids and benzodiazepines.
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Affiliation(s)
- Erlend Ingebrigtsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Surgery, Orkdal Hospital, St Olav's Hospital, Orkdal, Norway
| | | | - Mette Brekke
- General Practice Research Unit, University of Oslo, Oslo, Norway
| | - Fridtjof Heyerdahl
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Erik Hovda
- Department of Acute Medicine, The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway.
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway.
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21
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Hawn SE, Zhao X, Sullivan DR, Logue M, Fein-Schaffer D, Milberg W, McGlinchey R, Miller MW, Wolf EJ. For whom the bell tolls: psychopathological and neurobiological correlates of a DNA methylation index of time-to-death. Transl Psychiatry 2022; 12:406. [PMID: 36153327 PMCID: PMC9509393 DOI: 10.1038/s41398-022-02164-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Psychopathology is a risk factor for accelerated biological aging and early mortality. We examined associations between broad underlying dimensions of psychopathology (reflecting internalizing and externalizing psychiatric symptoms), PTSD, and age-adjusted GrimAge ("GrimAge residuals"), a DNA methylation biomarker of mortality risk relative to age. We also examined neurobiological correlates of GrimAge residuals, including neurocognitive functioning, blood-based biomarkers (of inflammation, neuropathology, metabolic disease), and cortical thickness. Data from two independent trauma-exposed military cohorts (n = 647 [62.9% male, Mage = 52], n = 434 [90% male, Mage = 32]) were evaluated using linear regression models to test associations between GrimAge residuals, psychopathology, and health correlates. Externalizing psychopathology significantly predicted GrimAge residuals in both cohorts (ps < 0.028). PTSD predicted GrimAge residuals in the younger (p = 0.001) but not the older cohort. GrimAge residuals were associated with several neurobiological variables available in the younger cohort, including cognitive disinhibition (padj = 0.021), poorer memory recall (padj = 0.023), cardiometabolic pathology (padj < 0.001), oxidative stress (padj = 0.003), astrocyte damage (padj = 0.021), inflammation (C-reactive protein: padj < 0.001; IL-6: padj < 0.001), and immune functioning (padj < 0.001). A subset of inflammatory and neuropathology analytes were available in the older cohort and showed associations with GrimAge residuals (IL-6: padj < 0.001; TNF-α: padj < 0.001). GrimAge residuals were also associated with reduced cortical thickness in right lateral orbitofrontal cortex (padj = 0.018) and left fusiform gyrus (padj = 0.030), which are related to emotion regulation and facial recognition, respectively. Psychopathology may be a common risk factor for elevated mortality risk. GrimAge could help identify those at risk for adverse health outcomes and allow for early disease identification and treatment.
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Affiliation(s)
- Sage E Hawn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
- Department of Psychology, Old Dominion University, Mills Godwin Bldg (134A), Norfolk, VA, USA
| | - Xiang Zhao
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Danielle R Sullivan
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Mark Logue
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
- Boston University School of Medicine, Department of Medicine, Biomedical Genetics, Boston, MA, USA
- Boston University School of Public Health, Department of Biostatistics, Boston, MA, USA
| | - Dana Fein-Schaffer
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
| | - William Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Erika J Wolf
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA.
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA.
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22
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Eide D, Lobmaier P, Clausen T. Who is using take-home naloxone? An examination of supersavers. Harm Reduct J 2022; 19:65. [PMID: 35717240 PMCID: PMC9206241 DOI: 10.1186/s12954-022-00647-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 06/08/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND As the opioid overdose crisis persists and take-home naloxone (THN) programmes expand, it is important that the intervention is targeted towards those most likely to use it. We examined THN program participants to 1) describe those that return for refills, specifically those that reported multiple use (supersavers), and 2) to examine what rescuer characteristics were associated with higher rates of THN use. METHODS This study included a cohort of consenting THN recipients from June 2014-June 2021 who completed initial and refill questionnaires from a widespread program in Norway. Age, gender, number of witnessed and experienced overdoses were assessed for associations with higher reported rates of THN use. 'Supersavers' reported 3 or more THN uses. RESULTS A total of 1054 participants returned for a THN refill during the study period. Of these, 558 reported their last THN to have been used on an overdose. Supersavers (those that reported 3 or more THN uses) were younger, primarily reported current opioid use, and had witnessed higher rates of overdoses at the time of initial training when compared to non-supersavers (those that reported 0-2 THN uses). CONCLUSIONS THN programs should continue to emphasize and prioritize THN for people actively using drugs, particularly those who have witnessed overdoses previously.
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Affiliation(s)
- Desiree Eide
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
| | - Philipp Lobmaier
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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Karamouzian M, Pilarinos A, Hayashi K, Buxton JA, Kerr T. Latent patterns of polysubstance use among people who use opioids: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103584. [DOI: 10.1016/j.drugpo.2022.103584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 02/07/2023]
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24
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Olivari CF, Gaete J, Rodriguez N, Pizarro E, Del Villar P, Calvo E, Castillo-Carniglia A. Polydrug Use and Co-occurring Substance Use Disorders in a Respondent Driven Sampling of Cocaine Base Paste Users in Santiago, Chile. J Psychoactive Drugs 2021; 54:348-357. [PMID: 34724873 DOI: 10.1080/02791072.2021.1976886] [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: 10/19/2022]
Abstract
We characterized substance use patterns and co-occurring substance use disorders among active cocaine base paste (CBP) users in Santiago, Chile using data from respondent-driven sampling (RDS) in three areas of Metropolitan Santiago. Recruitment began with nine seeds, reaching 398 active CBP users (18% women; mean age 37.7 years), defined as persons consuming CBP at least twice per week in the last three months. Population proportions and uncertainty were estimated accounting for individuals' social network and homophily. The median CBP age of initiation was 21 years, and the median number of years using CBP was 7 for women and 15 for men. The median days of use in the past month was 25 days, with a median of 56 doses per week. The proportion of monthly income spent on CBP was 65%. The prevalence of substance use disorders (SUDs) were: 98% for CBP, 67% for alcohol, 60% for marijuana, and 41% for cocaine hydrochloride. Heavy polydrug use patterns and co-occurring SUDs are frequent among active CBP users in the metropolitan area of Santiago. Traditional surveillance strategies may have underestimated polysubstance use and co-occurring SUDs in active CBP users. RDS proved to be a feasible methodology that could be effectively used for substance use surveillance among hard-to-reach populations.
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Affiliation(s)
- Carla F Olivari
- Society and Health Research Center, Universidad Mayor, Santiago, Chile
| | - Jorge Gaete
- Faculty of Education, Universidad de los Andes, Santiago, Chile.,Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, MI, USA
| | - Nicolás Rodriguez
- Research Department, National Service for Prevention and Rehabilitation of Drug and Alcohol Consumption (SENDA), Santiago, Chile
| | - Esteban Pizarro
- Research Department, National Service for Prevention and Rehabilitation of Drug and Alcohol Consumption (SENDA), Santiago, Chile
| | - Paloma Del Villar
- Centro de estudios Justicia y Sociedad, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Esteban Calvo
- Society and Health Research Center, Universidad Mayor, Santiago, Chile.,School of Public Health, Universidad Mayor, Santiago, Chile.,Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.,Laboratory on Aging and Social Epidemiology, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Alvaro Castillo-Carniglia
- Society and Health Research Center, Universidad Mayor, Santiago, Chile.,School of Public Health, Universidad Mayor, Santiago, Chile.,Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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25
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Lähteenvuo M, Batalla A, Luykx JJ, Mittendorfer‐Rutz E, Tanskanen A, Tiihonen J, Taipale H. Morbidity and mortality in schizophrenia with comorbid substance use disorders. Acta Psychiatr Scand 2021; 144:42-49. [PMID: 33650123 PMCID: PMC8359349 DOI: 10.1111/acps.13291] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/03/2021] [Accepted: 02/23/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Schizophrenia is highly comorbid with substance use disorders (SUD) but large epidemiological cohorts exploring the prevalence and prognostic significance of SUD are lacking. Here, we investigated the prevalence of SUD in patients with schizophrenia in Finland and Sweden, and the effect of these co-occurring disorders on risks of psychiatric hospitalization and mortality. METHODS 45,476 individuals with schizophrenia from two independent national cohort studies, aged <46 years at cohort entry, were followed during 22 (1996-2017, Finland) and 11 years (2006-2016, Sweden). We first assessed SUD prevalence (excluding smoking). Then, we performed Cox regression on risk of psychiatric hospitalization and all-cause and cause-specific mortality in SUD compared with those without SUD. RESULTS The prevalence of SUD ranged from 26% (Finland) to 31% (Sweden). Multiple drug use (n = 4164, 48%, Finland; n = 3268, 67%, Sweden) and alcohol use disorders (n = 3846, 45%, Finland; n = 1002, 21%, Sweden) were the most prevalent SUD, followed by cannabis. Any SUD comorbidity, and particularly multiple drug use and alcohol use, were associated with 50% to 100% increase in hospitalization (aHR any SUD: 1.53, 95% CI = 1.46-1.61, Finland; 1.83, 1.72-1.96, Sweden) and mortality (aHR all-cause mortality: 1.65, 95% CI = 1.50-1.81, Finland; 2.17, 1.74-2.70, Sweden) compared to individuals without SUD. Elevated mortality risks were observed especially for suicides and other external causes. All results were similar across countries. CONCLUSION Co-occurring SUD, and particularly alcohol and multiple drug use, are associated with high rates of hospitalization and mortality in schizophrenia. Preventive interventions should prioritize detection and tailored treatments for these comorbidities, which often remain underdiagnosed and untreated.
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Affiliation(s)
- Markku Lähteenvuo
- Department of Forensic PsychiatryUniversity of Eastern FinlandNiuvanniemi HospitalKuopioFinland
| | - Albert Batalla
- Department of PsychiatryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Jurjen J. Luykx
- Department of PsychiatryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of Translational NeuroscienceUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Outpatient Second Opinion ClinicGGNet Mental HealthWarnsveldThe Netherlands
| | | | - Antti Tanskanen
- Department of Forensic PsychiatryUniversity of Eastern FinlandNiuvanniemi HospitalKuopioFinland,Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Jari Tiihonen
- Department of Forensic PsychiatryUniversity of Eastern FinlandNiuvanniemi HospitalKuopioFinland,Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Center for Psychiatry ResearchStockholmSweden
| | - Heidi Taipale
- Department of Forensic PsychiatryUniversity of Eastern FinlandNiuvanniemi HospitalKuopioFinland,Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,School of PharmacyUniversity of Eastern FinlandKuopioFinland
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26
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Han BH, Doran KM, Krawczyk N. National trends in substance use treatment admissions for opioid use disorder among adults experiencing homelessness. J Subst Abuse Treat 2021; 132:108504. [PMID: 34102461 DOI: 10.1016/j.jsat.2021.108504] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/05/2021] [Accepted: 05/21/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE People experiencing homelessness (PEH) have high rates of substance use, and homelessness may be an important driver of health disparities in the opioid overdose epidemic. However, few studies focus on homelessness among the opioid use disorder (OUD) treatment population. We examine national-level trends in substance use treatment admissions among PEH with OUD. METHODS This study used data from first-time treatment admissions in the United States from the Treatment Episode Data Set: Admissions (TEDS-A) to examine characteristics and trends of adults experiencing homelessness who entered state-licensed substance use treatment programs for OUD from 2013 to 2017. We used chi-squared analyses to examine changes in characteristics of this population over time and logistic regression to assess characteristics associated with receipt of medications for opioid use disorder (MOUD) among PEH. RESULTS Among all adults with OUD entering specialty treatment from 2013 to 2017, 12.5% reported experiencing homelessness. Compared to individuals not experiencing homelessness, PEH were more likely to be male, inject opioids, use cocaine or methamphetamine, and enter into residential detoxification treatment. PEH were less likely to enter outpatient treatment or receive MOUD. From 2013 to 2017, significant increases occurred in the proportion of PEH who had co-occurring psychiatric problems and used methamphetamines. Over time, treatment type shifted significantly from residential detoxification to outpatient treatment. Receipt of MOUD increased among PEH over time (13.7% to 25.2%), but lagged behind increases among individuals not experiencing homelessness. Among PEH, being older was associated with receiving MOUD, while concurrent methamphetamine use [adjusted odds ratio (AOR) 0.63; 95% CI 0.58, 0.69] and living in the southern United States (AOR 0.27; 95% CI 0.25, 0.30) were associated with not receiving MOUD. DISCUSSION The proportion of PEH with OUD who receive medications as part of treatment increased over time, but three quarters of PEH entering treatment still do not receive this highest standard in evidence-based care. The sharp increase observed in concomitant methamphetamine use in this population is concerning and has implications for treatment.
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Affiliation(s)
- Benjamin H Han
- Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego School of Medicine, 9500 Gilman Dr, San Diego, CA 92161, United States of America.
| | - Kelly M Doran
- Department of Emergency Medicine, NYU School of Medicine, 550 First Avenue, New York, NY 10016, United States of America; Department of Population Health, NYU School of Medicine, 550 First Avenue, New York, NY 10016, United States of America
| | - Noa Krawczyk
- Department of Population Health, NYU School of Medicine, 550 First Avenue, New York, NY 10016, United States of America
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27
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Gjersing L, Bretteville-Jensen AL. Characteristics and risk of incarceration among "hard-to-reach" people who use drugs: A five-year prospective cohort study combining self-reports and registry data. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103288. [PMID: 34004380 DOI: 10.1016/j.drugpo.2021.103288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Incarcerations are associated with an increased risk of morbidity and mortality among people who use drugs (PWUD). In a sample of 884 PWUD, we examine and estimate the risk of incarcerations (i.e., number, duration, and most serious offense). METHODS In this prospective cohort study, PWUD were recruited from street- and low-threshold services in seven Norwegian cities in 2013 (Sept-Nov), and followed through the Correctional Service Registry until 20.12.2018. The risk of incarceration during follow-up was examined with multivariable logistic (no incarceration vs. at least one) and multinomial regression models ("no incarcerations", vs. "1″, "≥2″), while accounting for gender, age, homelessness/shelter use, opioid substitution treatment, illegal income sources, injecting behaviours, previous incarcerations, and recruitment city. RESULTS During follow-up, there were in total 662 incarceration episodes, and 44.7% of the participants were incarcerated at least once. Overall, 37.5% of those incarcerated had at least one episode due to a drug offense. The average incarceration duration was 65.2 days with 3.5% of the episodes lasting ≥one year. Gender (male), homelessness/shelter use, illegal income sources, injecting stimulants, and previous incarcerations increased the odds of incarceration, while older age decreased the odds. Gender (male), younger age, self-reported theft or theft and dealing, injecting stimulants or heroin and stimulants and previous incarcerations increased the risk of multiple incarcerations. CONCLUSION In a five-year prospective study of PWUD, incarcerations were common, and short-term sentences and recidivism were the norm. This is of concern as incarcerations add to an already elevated morbidity and mortality risk in this population.
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Affiliation(s)
- Linn Gjersing
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway.
| | - Anne Line Bretteville-Jensen
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway
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28
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Association between discharges against medical advice and readmission in patients treated for drug injection-related skin and soft tissue infections. J Subst Abuse Treat 2021; 126:108465. [PMID: 34116815 DOI: 10.1016/j.jsat.2021.108465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/08/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prevalence of injection drug use (IDU)-related skin and soft tissue infections (SSTI) in Philadelphia has been steadily increasing since 2013. Patients seeking treatment for these infections are more likely to be discharged against medical advice (AMA), increasing the likelihood that they will end antibiotic treatment prematurely and require additional medical interventions. METHODS The research team performed a nested case-control study using the Pennsylvania Health Care Cost Containment Council database for Philadelphia residents hospitalized for SSTI and substance use-related diagnoses between 2013 and 2018. The primary outcome was readmission in the same or following quarter. The study examined the impact of discharge AMA on readmission along with clinical characteristics including diagnoses for anxiety, bipolar disorder, depression, schizophrenia, diabetes, and polydrug use. RESULTS There were 8265 hospitalizations for IDU-related SSTI and 316 (6%) were readmitted to the hospital at least once in the same or following quarter. In total, 23.4% of cases and 13% of controls left AMA. In the final multivariable regression model, AMA discharge (AOR 2.04, 95% CI 1.46-2.86), anxiety (AOR 1.44, 95% CI 1.01-2.05), diabetes (AOR 2.02, 95% CI 1.46-2.81), and polydrug use (AOR 2.11, 95% CI 1.52-2.92) were associated with higher odds of readmission. CONCLUSIONS Our study demonstrates that readmissions for IDU-related SSTI are associated with recent discharge AMA. As IDU-related SSTI and polydrug use continue to rise, premature antibiotic treatment completion will impact more people, leading to worse health outcomes and additional strain on the health care system.
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29
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Ford JA, Schepis TS, McCabe SE. Poly-prescription drug misuse across the life course: Prevalence and correlates across different adult age cohorts in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 88:103017. [PMID: 33227640 PMCID: PMC8005409 DOI: 10.1016/j.drugpo.2020.103017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Most research on prescription drug misuse (PDM) focuses on the misuse of specific classes of psychoactive prescription drugs among adolescents or young adults. The current research addressed important gaps in the literature by assessing poly-prescription drug misuse (poly-PDM), the misuse of more than one class of psychoactive prescription drug, across different adult age cohorts. METHODS We used the 2015-2018 National Survey on Drug Use and Health to examine the prevalence of past-year poly-PDM and specific combinations of PDM. Multinomial logistic regression was used to identify demographic, health-related factors, and substance use behaviors that were significantly associated with poly-PDM. RESULTS The prevalence of poly-PDM decreases with age and is common among individuals who engage in PDM. Slightly more than one in four respondents in age cohorts 18-25 (31.66%, 95% CI = 30.35, 33.00) and 26-34 (29.92%, 95% CI = 25.82, 30.12) who engage in PDM, misused more than one class of prescription drug. Additionally, poly-PDM was identified as a high-risk type of PDM as roughly 60% of adults younger than 65 who endorse poly-PDM reported having a substance use disorder (SUD). While certain characteristics (i.e., race/ethnicity, marital status, depression, suicidal ideation, illegal drug use, and SUD) were consistently associated with poly-PDM across age cohorts, other characteristics (i.e., sexual identity, income, and justice involvement) varied across age cohorts. Finally, a comparison of poly-PDM to single PDM showed, in all age cohorts, that having an SUD was associated with an increased likelihood of poly-PDM, while Black adults were less likely than whites to report poly-PDM. CONCLUSIONS By identifying prevalence and correlates of poly-PDM across adult age cohorts, the current research has significant implications. Understanding stability and heterogeneity in the characteristics associated with poly-PDM should inform interventions, identify at-risk groups, and shape public health approaches to dealing with high-risk substance use behavior.
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Affiliation(s)
- Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, FL United States.
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, TX United States
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, United States; Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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30
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Martínez-Loredo V, Macipe V, Errasti Pérez JM, Al-Halabí S. Clinical symptoms and personality traits predict subpopulations of treatment-seeking substance users. J Subst Abuse Treat 2021; 125:108314. [PMID: 34016301 DOI: 10.1016/j.jsat.2021.108314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/09/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The heterogeneity of treatment-seeking substance users represents a challenge, as most studies include participants having problems with specific substances or merge polysubstance users into the same category without considering differences between profiles. Considering the inconsistent literature on predictors of treatment outcomes, this study aimed to identify subpopulations of individuals with substance use disorders (SUDs) and analyze the association among class membership, previous relapses, and treatment retention. METHODS The study recruited a total of 159 participants (mean age = 40.60, SD = 8.70; 85.5% males) from two treatment facilities (outpatient daycare and inpatient residential centers). The baseline assessment gathered lifetime and current substance use, and personality and psychopathology measures. The study performed a latent class analysis to identify subpopulations of substance users and explored predictors of class membership using a multinomial regression analysis. RESULTS The study found six different classes of substance users based on their diagnosis and pattern of substance use: class 1 (6.92% of participants): individuals with cannabis as primary substance, alcohol/cocaine as secondary substance and additional use of stimulants or other drugs; class 2 (30.82%): cocaine as primary substance, alcohol as secondary and additional cannabis use; class 3 (20.13%): alcohol as primary substance, cocaine as secondary and additional cannabis use; class 4 (17.61%): cocaine as primary substance, cannabis as secondary and additional alcohol/other drugs use; class 5 (16.35%): alcohol as primary and cannabis as secondary substance; class 6 (8.18%): heroin as primary substance, cocaine as secondary and additional alcohol use. Several traits and clinical symptoms predicted distinct class memberships. Participants pertaining to class 6 presented the highest number of relapses (M = 2.54, SD = 1.56). CONCLUSIONS These results have several clinical implications. Belonging to class 6 was associated with a greater number of previous relapses. Also, specific psychopathological symptoms and personality traits may impact SUD treatment response, which may help clinicians to guide initial assessment and treatment allocation.
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Affiliation(s)
- V Martínez-Loredo
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain; Department of Psychology and Sociology, University of Zaragoza, Teruel, Aragón, Spain.
| | - V Macipe
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain
| | - J M Errasti Pérez
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain
| | - S Al-Halabí
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain
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31
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Pijl E, Oosterbroek T, Motz T, Mason E, Hamilton K. Peer-assisted injection as a harm reduction measure in a supervised consumption service: a qualitative study of client experiences. Harm Reduct J 2021; 18:5. [PMID: 33407575 PMCID: PMC7788836 DOI: 10.1186/s12954-020-00455-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Peer assistance is an emerging area of study in injection drug use. When Canada’s first supervised consumption site (SCS) opened in 2003 in Vancouver, Canada, clients were prohibited from injecting their peers; only recently has this practise been introduced as a harm reduction measure at these sites. In 2018, Health Canada granted federal exemption to allow peer-assisted injection at certain SCS sites, under the Controlled Drugs and Substances Act. Literature pertaining to peer-assisted injection addresses several topics: interpersonal relationships between the injection provider and recipient; the role of pragmatism; trust and expertise; and gender relations. Methods In this qualitative study, participants (n = 16) were recruited to be interviewed about their experiences in a peer-assisted injection program (PAIP) at one SCS regulated by Health Canada. Interview data were transcribed and thematically analyzed. Quantitative administrative data were used to provide context and to describe the study population, comprised of people in the PAIP (n = 248). Results PAIP clients made up 17.4% of all SCS clients. PAIP clients were more likely to be female and Indigenous. Injection providers expressed being moved by compassion to help others inject. While their desire to assist was pragmatic, they felt a significant burden of responsibility for the outcomes. Other prominent factors related to the injection provider-recipient relationship were social connection, trust, safety, social capital, and reciprocity. Participants also made suggestions for improving the PAIP which included adding more inhalation rooms so that if someone was unable to inject they could smoke in a safe place instead. Additionally, being required by law to divide drugs outside of the SCS, prior to preparing and using in the site, created unsafe conditions for clients. Conclusions Regular use of the SCS, and access to its resources, enabled participants to lower their risk through smoking and to practice lower-risk injections. At the federal level, there is considerable room to advocate for allowing clients to divide drugs safely within the SCS, and to increase capacity for safer alternatives such as inhalation.
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Affiliation(s)
- Em Pijl
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada.
| | - Tracy Oosterbroek
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada
| | | | | | - Keltie Hamilton
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada
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Gjersing L, Helle MK. Injecting Alone is More Common among Men, Frequent Injectors and Polysubstance Users in a Sample of People Who Inject Drugs. Subst Use Misuse 2021; 56:2214-2220. [PMID: 34565289 DOI: 10.1080/10826084.2021.1981388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Injecting alone increases the risk of a fatal overdose. We examined the extent of such behavior in a sample of people who inject drugs (PWID) and the typical characteristics of those injecting alone at least once during the past four weeks. A cross-sectional study. PWID recruited from the street and from low-threshold services in seven Norwegian cities in September 2017 (n = 359). Associations between characteristics and injecting alone were examined using logistic regression analysis. The independent variables were gender (female/male), age, having received overdose-prevention education (no/yes), and, in the past four weeks; homelessness/shelter use (no/yes), in opioid substitution treatment (no/yes), injecting ≥ four days a week (no/yes), and substances injected (opioids only/opioids and other/other only/central stimulants (CS) only/CS and other/CS and opioids/CS, opioids and other). The adjusted odds ratios (aOR) and 95% Confidence Intervals (CI) were reported. Of the 359 PWID, 84.4% reported having injected alone. Males were more likely than females to inject alone (aOR = 1.88 95% CI 1.00-3.54). Furthermore, those injecting frequently (aOR = 1.99 95% CI 1.02-3.86) and those injecting multiple substances (CS, opioids and other) (aOR = 2.94 95% CI 1.01-8.58) were more likely to inject alone compared to those injecting less frequently and opioids only. Although not statistically significant, the effect sizes in the logistic regression models suggest that polysubstance use may be driven by CS use. Injecting alone was common in our sample of PWID, and male gender, frequent injecting and polysubstance injecting were associated with this behavior.
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Affiliation(s)
- Linn Gjersing
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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Kotera Y, Rhodes C. Commentary: Suggesting Shinrin-yoku (forest bathing) for treating addiction. Addict Behav 2020; 111:106556. [PMID: 32745943 DOI: 10.1016/j.addbeh.2020.106556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 12/28/2022]
Abstract
Shinrin-yoku ('') (i.e., forest bathing), a Japanese wellbeing practice, aims to harmonise a person with a forest by bathing in the forest mindfully using our five senses (Miyazaki, 2018). Practitioners can choose whatever they like to focus on in the forest: different colours of leaves, the sounds of streams, or the warmth of sunshine beaming between leaves. Since the birth of this practice in 1982, shinrin-yoku has been widely used in the Japanese clinical fields (Hansen, Jones, & Tocchini, 2017). Recently, this healing practice has received attention from healthcare practitioners and researchers worldwide (Wen, Yan, Pan, Gu, & Liu, 2019). In this commentary, we will discuss limitations of the current shinrin-yoku research, and how future research can be conducted to appraise the effects of shinrin-yoku on addiction.
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Welle-Strand GK, Skurtveit S, Clausen T, Sundal C, Gjersing L. COVID-19 survey among people who use drugs in three cities in Norway. Drug Alcohol Depend 2020; 217:108302. [PMID: 32961453 PMCID: PMC7500397 DOI: 10.1016/j.drugalcdep.2020.108302] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known regarding what people who use drugs (PWUD) know about COVID-19 related issues and changes in the drug market due to COVID-19. We therefore conducted a survey to explore these issues. METHODS In a cross-sectional study, we interviewed 226 PWUD from three Norwegian cities in May/June 2020. Participants completed an interview-administrated questionnaire. Three separate multiple binary logistic regression models were estimated with the outcomes (no/yes): 1. Familiarity with COVID-19 symptoms, 2. Awareness of COVID-19 services tailored towards PWUD and, 3. Willingness to take a COVID-19 test. RESULTS The mean age was 44.1 years and 73 % were males. Fifty-four percent were injectors, and heroin/other opioids (35.8 %) and cocaine/amphetamine (25.2 %) were the most common main drugs used. Overall, 54.9 % were in opioid maintenance treatment (OMT). The majority (65.9 %) stated they knew the COVID-19 symptoms. Almost all the participants (91.2 %) reported they would take a COVID-19 test if experiencing relevant symptoms. The majority (63.7 %) were not aware of COVID-19 services available to PWUD. OMT patients were more likely to be familiar with COVID-19 symptoms (aOR = 3.4, 95 % CI 1.7; 6.8), and to be aware of COVID-19 services (aOR = 2.7, 95 % CI 1.1; 6.3). Overall, 35.4 % reported reduced drug availability, mainly for tranquilizers, while 61.5 % reported increased drug prices, mainly for cannabis. CONCLUSION Drug treatment may play an important role in COVID-19 prevention, as those in OMT were more likely to be aware of symptoms and of availability of services.
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Affiliation(s)
- Gabrielle K Welle-Strand
- Norwegian Centre for Addiction Research (Seraf), University of Oslo, Norway; Vestli Isolation Unit, Agency for Social and Welfare Services, Municipality of Oslo, Norway.
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research (Seraf), University of Oslo, Norway; Norwegian Institute of Public Health, Norway.
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (Seraf), University of Oslo, Norway.
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Valente PK, Bazzi AR, Childs E, Salhaney P, Earlywine J, Olson J, Biancarelli DL, Marshall BDL, Biello KB. Patterns, contexts, and motivations for polysubstance use among people who inject drugs in non-urban settings in the U.S. Northeast. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102934. [PMID: 32911318 PMCID: PMC7770041 DOI: 10.1016/j.drugpo.2020.102934] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/12/2020] [Accepted: 08/20/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Polysubstance use (i.e., using ≥2 psychoactive substances concomitantly) is associated with increased morbidity and mortality and complicates drug treatment needs among people who inject drugs (PWID). We explored patterns, contexts, motivations, and perceived consequences of polysubstance use among PWID in small cities and towns in the U.S. Northeast. METHODS Between October 2018 and March 2019, we conducted semi-structured interviews with 45 PWID living outside of the capital cities of Rhode Island and Massachusetts recruited online and through community-based organizations. Written transcripts were coded inductively and deductively using a team-based approach and analyzed thematically. RESULTS All participants reported recent polysubstance use, with most using five or more classes of substances in the past three months. Polysubstance use often followed long personal drug use histories (i.e., years or decades of occasional drug use). Reasons for polysubstance use included obtaining synergistic psychoactive effects as a result of mixing drugs (i.e., using drugs to potentiate effects of other drugs) and managing undesirable effects of particular drugs (e.g., offsetting the depressant effects of opioids with stimulants or vice-versa). Polysubstance use to self-medicate poorly managed physical and mental health conditions (e.g., chronic pain, anxiety, and depression) was also reported. Inadequately managed cravings and withdrawal symptoms prompted concomitant use of heroin and medications for opioid use disorder, including among individuals reporting cocaine or crack as their primary "issue" drugs. Polysubstance use was perceived to increase overdose risks and to be a barrier to accessing healthcare and drug treatment services. CONCLUSION Healthcare services and clinicians should acknowledge, assess, and account for polysubstance use among patients and promote harm reduction approaches for individuals who may be using multiple drugs. Comprehensive healthcare that meets the social, physical, mental health, and drug treatment needs of PWID may decrease the perceived need for polysubstance use to self-medicate poorly managed health conditions and symptoms.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Ellen Childs
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Peter Salhaney
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Joel Earlywine
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Jennifer Olson
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Dea L Biancarelli
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
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Broman CL, Wright MK, Choi SH, Wang Y. Heavy drug use in young adulthood. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1760369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Clifford L. Broman
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Mellissa K. Wright
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Seung Hee Choi
- School of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
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Hochheimer M, Sacco P, Ware OD. Latent classes of lifetime drug use disorder in national epidemiological survey on alcohol and related conditions - III. Addict Behav 2020; 106:106379. [PMID: 32199206 DOI: 10.1016/j.addbeh.2020.106379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/06/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
AIMS/BACKGROUND People diagnosed with multiple drug use disorders are high-risk subpopulations, but changes in diagnostic classification and drug use prevalence mean patterning of drug use disorders has changed in the past decade. We analyzed comorbidity patterns of lifetime drug use disorder in a general population sample. DESIGN Using latent class analysis, we derived lifetime drug use disorder classes based on dichotomous indicators of sedative, cannabis, opioid, cocaine, stimulant, hallucinogen, inhalant/solvent, club drug, heroin, and other drug use disorders in the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309). Multinomial models assessed associations between sociodemographic and clinical correlates and latent class status. RESULTS Four latent classes of lifetime substance use disorder were identified: A very low risk class, a class with high opioid, sedative and heroin comorbidity, a class based on cocaine and stimulant comorbidity, and class with high likelihood of multiple lifetime drug use disorders. All higher risk classes were associated with higher risk of lifetime personality disorder and mood disorder. Conduct disorder was also associated with higher risk, but level of risk varied by class. Opioid and sedative class was associated with higher odds of lifetime eating disorder diagnosis. CONCLUSIONS Comorbidity of drug use disorders is associated with a range of lifetime mental health disorder diagnoses. Unlike previous research, we did not identify a cannabis use class, possibly due to changes in diagnostic criteria and cannabis prevalence rates.
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Abstract
Opioid use disorder (OUD) is a chronic relapsing disorder that, whilst initially driven by activation of brain reward neurocircuits, increasingly engages anti-reward neurocircuits that drive adverse emotional states and relapse. However, successful recovery is possible with appropriate treatment, although with a persisting propensity to relapse. The individual and public health burdens of OUD are immense; 26.8 million people were estimated to be living with OUD globally in 2016, with >100,000 opioid overdose deaths annually, including >47,000 in the USA in 2017. Well-conducted trials have demonstrated that long-term opioid agonist therapy with methadone and buprenorphine have great efficacy for OUD treatment and can save lives. New forms of the opioid receptor antagonist naltrexone are also being studied. Some frequently used approaches have less scientifically robust evidence but are nevertheless considered important, including community preventive strategies, harm reduction interventions to reduce adverse sequelae from ongoing use and mutual aid groups. Other commonly used approaches, such as detoxification alone, lack scientific evidence. Delivery of effective prevention and treatment responses is often complicated by coexisting comorbidities and inadequate support, as well as by conflicting public and political opinions. Science has a crucial role to play in informing public attitudes and developing fuller evidence to understand OUD and its associated harms, as well as in obtaining the evidence today that will improve the prevention and treatment interventions of tomorrow.
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Gjerde H, Bretteville-Jensen AL, Furuhaugen H, Bache-Andreassen L, Bergh MSS, Vindenes V. Determination of drug residues in used syringe needles. Drug Test Anal 2020; 12:410-416. [PMID: 31899604 DOI: 10.1002/dta.2759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/02/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Hallvard Gjerde
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | | - Håvard Furuhaugen
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Lihn Bache-Andreassen
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Marianne Skov-Skov Bergh
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Vigdis Vindenes
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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Golladay M, Donner K, Nechuta S. Using statewide death certificate data to understand trends and characteristics of polydrug overdose deaths in Tennessee, 2013–2017. Ann Epidemiol 2020; 41:43-48.e1. [DOI: 10.1016/j.annepidem.2019.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 01/30/2023]
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Karjalainen K, Haukka J, Kuussaari K, Hautala S, Hakkarainen P. Mortality and causes of death among people suspected of driving under the influence and testing positive for multiple substances. Scand J Public Health 2019; 48:809-816. [PMID: 31856686 DOI: 10.1177/1403494819894166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Understanding the mortality of drug users using multiple substances is helpful in preventing the harmful effects of polydrug use. We examined overall and cause-specific mortality and differences in mortality based on social background among people suspected of driving under the influence and testing positive for multiple substances (DUIMS) compared with the general Finnish population. Methods: Register data from 785 DUIMS during 2003-2006 were studied, with a reference population (n = 25,381) drawn from the general Finnish population. The effect of DUIMS on all-cause and cause-specific mortality was estimated using a Poisson regression model. Results: DUIMS had an increased risk of death compared with the general population (MRR 5.3, 95% CI 4.2-6.6). The most common causes of death in DUIMS were poisonings (37.9%) and suicides (13.6%), whereas in the reference population these were cardiovascular diseases (30.8%) and cancer (26.6%). The cause-specific risk of death among DUIMS was higher in all observed causes of death, except for cancer. The effect of DUIMS on mortality was modified by age, employment status and marital status; DUIMS was associated with an elevated risk of death especially in younger age groups and in singles. Conclusions: DUIMS indicates higher mortality, and DUIMS' profiles in causes of death differ from the general population. Elevated risk for, for instance, suicidal, accidental and violent death among those using multiple substances highlights the need to also pay attention to causes of death other than poisoning/overdose.
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Affiliation(s)
- Karoliina Karjalainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, University of Helsinki, Finland
| | - Kristiina Kuussaari
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
| | - Sanna Hautala
- Faculty of Social Sciences, University of Lapland, Finland
| | - Pekka Hakkarainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
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Hassan AN, Le Foll B. Polydrug use disorders in individuals with opioid use disorder. Drug Alcohol Depend 2019; 198:28-33. [PMID: 30877954 DOI: 10.1016/j.drugalcdep.2019.01.031] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/07/2018] [Accepted: 01/15/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Understanding the association of polydrug use disorders (PUD) with psychosocial and clinical factors is essential for the treatment of individuals with opioid use disorder (OUD). The aim of this study is to examine whether there is an association between childhood maltreatment, mood disorders, anxiety disorders, personality disorders, or posttraumatic stress disorder (PTSD) and PUD in individuals with OUD. METHODS We used data from 356 individuals with OUD in the past 12 months from a nationally representative database in the United States. PUD patients were classified into two groups: a group with additional one substance disorder (OUD + 1) and that with two or more additional substance disorders (OUD + 2). We conducted multivariate logistic regression to predict the PUD status, after adjustment for confounders including childhood maltreatment. RESULTS Among all individuals, 57.3% were polydrug users (n = 204) and 42.7% were not (n = 152). There was a high prevalence of childhood maltreatment in both groups, ranging from 16.1% to 59.5%, but the difference was not statistically significant. After adjustment for confounders, we found an association between past-year PTSD and OUD + 2 (odds ratio: 3.98; 95% confidence interval: 1.15-13.72; p = 0.03) but not with OUD + 1. CONCLUSION PTSD is highly prevalent in individuals with OUD using multiple substances and could influence PUD. We recommend screening for PTSD in cases of PUD. Future studies should evaluate the effect of PTSD treatment on PUD.
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Affiliation(s)
- Ahmed N Hassan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Departments of Family and Community Medicine, Pharmacology and Toxicology, and Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Van Baelen L, Antoine J, De Ridder K, Plettinckx E, Gremeaux L. All-cause mortality rate of people in treatment for substance use disorders in Belgium: A register-based cohort study. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1604841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Luk Van Baelen
- Department of Public Health and Surveillance, Sciensano, Brussels, Belgium
| | - Jerome Antoine
- Department of Public Health and Surveillance, Sciensano, Brussels, Belgium
| | - Karin De Ridder
- Department of Public Health and Surveillance, Sciensano, Brussels, Belgium
| | - Els Plettinckx
- Department of Public Health and Surveillance, Sciensano, Brussels, Belgium
| | - Lies Gremeaux
- Department of Public Health and Surveillance, Sciensano, Brussels, Belgium
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Cepeda JA, Astemborski J, Kirk GD, Celentano DD, Thomas DL, Mehta SH. Rising role of prescription drugs as a portal to injection drug use and associated mortality in Baltimore, Maryland. PLoS One 2019; 14:e0213357. [PMID: 30830944 PMCID: PMC6398863 DOI: 10.1371/journal.pone.0213357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/20/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Prescription drug abuse is a major public health problem in rural and suburban areas of the United States, however its emergence in large urban settings with endemic injection drug use remains understudied. We examined temporal trends in injection drug use initiation and mortality among people who inject drugs (PWID) in Baltimore, Maryland. METHODS Data were derived from the baseline assessment of PWID enrolled in a community-based cohort study with longitudinal follow-up for mortality assessment. PWID were recruited from 2005-2008 (N = 1,008) and 2015-2018 (N = 737). We compared characteristics by birth cohort (before/after 1980) and type of drug initiated (prescription opioids, prescription non-opioids, non-injection illicit drugs, or injection drugs). We calculated standardized mortality ratios (SMR) using the US general population as the reference. RESULTS PWID born after 1980 were more likely to initiate drug use with prescription opioids and non-opioids and had higher levels of polysubstance prior to injection initiation, compared to individuals born before 1980. Overall mortality was high: 2.59 per 100 person-years (95% CI: 2.27-2.95 per 100 person-years). Compared to the US population, the highest SMRs were observed among participants between 40-44 years of age, with especially high mortality among women in this age group (SMR:29.89, 95% CI: 15.24-44.54). CONCLUSIONS Mirroring national trends, the profile of PWID in Baltimore has changed with increased prescription drug abuse and high levels of polysubstance use among younger PWID. Interventions need to reach those using prescription drugs early after initiation of use in order to reduce transition to injecting. Urgent attention is warranted to address premature mortality, particularly among middle-aged and female PWID.
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Affiliation(s)
- Javier A. Cepeda
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David D. Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David L. Thomas
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Chen T, Zhong N, Du J, Li Z, Zhao Y, Sun H, Chen Z, Jiang H, Zhao M. Polydrug use patterns and their impact on relapse among heroin-dependent patients in Shanghai, China. Addiction 2019; 114:259-267. [PMID: 30276902 DOI: 10.1111/add.14451] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/15/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
AIMS To describe the polysubstance use patterns of heroin-dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes. DESIGN In this secondary analysis, the baseline data of 503 heroin-dependent patients were linked with their 5-year follow-up data from official records. SETTING Four compulsory rehabilitation centres in Shanghai, China. PARTICIPANTS A total of 564 heroin-dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow-up records were included in this analysis. MEASUREMENTS The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5-year follow-up were analysed with the Cox regression model. FINDINGS Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine-type stimulant polydrug users (ASPU; 9.7%). During the 5-year follow-up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81 months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06-2.51] and ASPU (HR = 2.10, 1.24-3.56) classes were positively associated with the risk of heroin relapse. CONCLUSION Polydrug use patterns differ among heroin-dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes.
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Affiliation(s)
- Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhibin Li
- Jiading Mental Health Center, Shanghai, China
| | - Yan Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiming Sun
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhikang Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Madah‐Amiri D, Gjersing L, Clausen T. Naloxone distribution and possession following a large-scale naloxone programme. Addiction 2019; 114:92-100. [PMID: 30129078 PMCID: PMC6585734 DOI: 10.1111/add.14425] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/09/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
AIMS To examine uptake following a large-scale naloxone programme by estimating distribution rates since programme initiation and the proportion among a sample of high-risk individuals who had attended naloxone training, currently possessed or had used naloxone. We also estimated the likelihood of naloxone possession and use as a function of programme duration, individual descriptive and substance use indicators. DESIGN (1) Distribution data (June 2014-August 2017) and date of implementation for each city and (2) a cross-sectional study among a sample of illicit substance users interviewed September 2017. SETTING Seven Norwegian cities. PARTICIPANTS A total of 497 recruited users of illegal opioids and/or central stimulants. MEASUREMENTS Primary outcomes: naloxone possession and use. Random-intercepts logistic regression models (covariates: male, age, homelessness/shelter use, overdose, incarceration, opioid maintenance treatment, income sources, substance use indicators, programme duration). FINDINGS Overall, 4631 naloxone nasal sprays were distributed in the two pilot cities, with a cumulative rate of 495 per 100 000 population. In the same two cities, among high-risk individuals, 44% and 62% reported current naloxone possession. The possession rates of naloxone corresponded well to the duration of each participating city's distribution programme. Overall, in the six distributing cities, 58% reported naloxone training, 43% current possession and 15% naloxone use. The significant indicators for possession were programme duration [adjusted odds ratios (aOR) = 1.44, 95% confidence interval (CI = 0.82-2.37], female gender (aOR = 1.97, 95% CI = 1.20-3.24) and drug-dealing (aOR = 2.36, 95% CI = 1.42-3.93). The significant indicators for naloxone use were programme duration (aOR = 1.49 95%, CI = 1.15-1.92), homelessness/shelter use (aOR = 2.06, 95% CI = 1.02-4.17), opioid maintenance treatment (OMT) (aOR = 2.07, 95% CI = 1.13-3.78), drug-dealing (aOR = 2.40, 95% CI = 1.27-4.54) and heroin injecting (aOR = 2.13, 95% CI = 1.04-4.38). CONCLUSIONS A large-scale naloxone programme in seven Norwegian cities with a cumulative distribution rate of 495 per 100 000 population indicated good saturation in a sample of high-risk individuals, with programme duration in each city as an important indicator for naloxone possession and use.
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Affiliation(s)
| | | | - Thomas Clausen
- Norwegian Centre for Addiction ResearchUniversity of OsloOsloNorway
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Karjalainen K. Comment on Karriker-Jaffe et al. NORDIC STUDIES ON ALCOHOL AND DRUGS 2018; 35:443-445. [PMID: 32934544 PMCID: PMC7434109 DOI: 10.1177/1455072518807052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022] Open
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