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Skinner A, Nolen S, Cerdá M, Rich JD, Marshall BDL. A simple heuristic for allocating opioid settlement funding to reduce overdose mortality in the United States. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-7. [PMID: 38940829 DOI: 10.1080/00952990.2024.2364338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/01/2024] [Indexed: 06/29/2024]
Abstract
As resolution for opioid-related claims and litigation against pharmaceutical manufacturers and other stakeholders, state and local governments are newly eligible for millions of dollars of settlement funding to address the overdose crisis in the United States. To inform effective use of opioid settlement funds, we propose a simple framework that highlights the principal determinants of overdose mortality: the number of people at risk of overdose each year, the average annual number of overdoses per person at risk, and the average probability of death per overdose event. We assert that the annual number of overdose deaths is a function of these three determinants, all of which can be modified through public health intervention. Our proposed heuristic depicts how each of these drivers of drug-related mortality - and the corresponding interventions designed to address each term - operate both in isolation and in conjunction. We intend for this framework to be used by policymakers as a tool for identifying and evaluating public health interventions and funding priorities that will most effectively address the structural forces shaping the overdose crisis and reduce overdose deaths.
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Affiliation(s)
- Alexandra Skinner
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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2
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Tas B, Walker H, Lawn W, Matcham F, Traykova EV, Evans RAS, Strang J. What impacts the acceptability of wearable devices that detect opioid overdose in people who use opioids? A qualitative study. Drug Alcohol Rev 2024; 43:213-225. [PMID: 37596977 DOI: 10.1111/dar.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Drug-related deaths involving an opioid are at all-time highs across the United Kingdom. Current overdose antidotes (naloxone) require events to be witnessed and recognised for reversal. Wearable technologies have potential for remote overdose detection or response but their acceptability among people who use opioids (PWUO) is not well understood. This study explored facilitators and barriers to wearable technology acceptability to PWUO. METHODS Twenty-four participants (79% male, average age 46 years) with current (n = 15) and past (n = 9) illicit heroin use and 54% (n = 13) who were engaged in opioid substitution therapy participated in semi-structured interviews (n = 7) and three focus groups (n = 17) in London and Nottingham from March to June 2022. Participants evaluated real devices, discussing characteristics, engagement factors, target populations, implementation strategies and preferences. Conversations were recorded, transcribed and thematically analysed. RESULTS Three themes emerged: device-, person- and environment-specific factors impacting acceptability. Facilitators included inconspicuousness under the device theme and targeting subpopulations of PWUO at the individual theme. Barriers included affordability of devices and limited technology access within the environment theme. Trust in device accuracy for high and overdose differentiation was a crucial facilitator, while trust between technology and PWUO was a significant environmental barrier. DISCUSSION AND CONCLUSIONS Determinants of acceptability can be categorised into device, person and environmental factors. PWUO, on the whole, require devices that are inconspicuous, comfortable, accessible, easy to use, controlled by trustworthy organisations and highly accurate. Device developers must consider how the type of end-user and their environment moderate acceptability of the device.
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Affiliation(s)
- Basak Tas
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hollie Walker
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Will Lawn
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Faith Matcham
- School of Psychology, University of Sussex, Falmer, UK
| | - Elena V Traykova
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rebecca A S Evans
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
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3
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Welwean RA, Krieg O, Casey G, Thompson E, Fleetham D, Deering T, Rosen JG, Park JN. Evaluating the Impact of Brave Technology Co-op's Novel Drug Overdose Detection and Response Devices in North America: a Retrospective Study. J Urban Health 2023; 100:1043-1047. [PMID: 37670172 PMCID: PMC10618129 DOI: 10.1007/s11524-023-00779-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 09/07/2023]
Abstract
Assess the preliminary impact of Brave Technology Co-op's overdose detection devices that have been implemented in housing, medical, social service facilities, and several private settings in North America. Administrative data was collected by Brave on their Buttons and Sensors during several proof-of-concept projects and full installations in Canada and United States (US) between December 2018 and July 2022. Data analyzed provided insights on the number of overdoses detected and reversed (averted overdose deaths) using Brave Sensors and Buttons, along with other programmatic and session-specific indicators. Implementation of 486 Brave Buttons and 148 Brave Sensors in Canada has detected and prevented 108 overdose deaths (100 using Buttons and 8 using Sensors) whereas implementation of 170 Buttons in the US has averted 2 overdose deaths to date, with the potential to save many more lives. Brave's devices hold promise for increasing rates of overdose detection and preventing overdose deaths.
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Affiliation(s)
- Ralph Amuanyu Welwean
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - Oona Krieg
- Brave Technology Coop, Vancouver, British Columbia, Canada
| | - Gordon Casey
- Brave Technology Coop, Vancouver, British Columbia, Canada
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI, USA
| | - Dana Fleetham
- Brave Technology Coop, Vancouver, British Columbia, Canada
| | | | - Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI, USA
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
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4
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Tas B, Lawn W, Traykova EV, Evans RAS, Murvai B, Walker H, Strang J. A scoping review of mHealth technologies for opioid overdose prevention, detection and response. Drug Alcohol Rev 2023; 42:748-764. [PMID: 36933892 DOI: 10.1111/dar.13645] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/20/2023]
Abstract
ISSUES Opioid overdose kills over 100,000 people each year globally. Mobile health (mHealth) technologies and devices, including wearables, with the capacity to prevent, detect or respond to opioid overdose exist in early form, or could be re-purposed or designed. These technologies may particularly help those who use alone. For technologies to be successful, they must be effective and acceptable to the at-risk population. The aim of this scoping review is to identify published studies on mHealth technologies that attempt to prevent, detect or respond to opioid overdose. APPROACH A systematic scoping review of literature was conducted up to October 2022. APA PsychInfo, Embase, Web of Science and Medline databases were searched. INCLUSION CRITERIA articles had to report on (i) mHealth technologies that deal with (ii) opioid (iii) overdose. KEY FINDINGS A total of 348 records were identified, with 14 studies eligible for this review across four domains: (i) technologies that require intervention/response from others (four); (ii) devices that use biometric data to detect overdose (five); (iii) devices that automatically respond to an overdose with administration of an antidote (three); (iv) acceptability/willingness to use overdose-related technologies/devices (five). IMPLICATIONS There are multiple routes in which these technologies may be deployed, but several factors impact acceptability (e.g., discretion or size) and accuracy of detection (e.g., sensitive parameter/threshold with low false positive rate). CONCLUSION mHealth technologies for opioid overdose may play a crucial role in responding to the ongoing global opioid crises. This scoping review identifies vital research that will determine the future success of these technologies.
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Affiliation(s)
- Basak Tas
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elena V Traykova
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca A S Evans
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Barbara Murvai
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hollie Walker
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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5
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Schneider KE, Allen ST, Rouhani S, Morris M, Haney K, Saloner B, Sherman SG. Increased solitary drug use during COVID-19: An unintended consequence of social distancing. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103923. [PMID: 36521196 PMCID: PMC9678832 DOI: 10.1016/j.drugpo.2022.103923] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/29/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, overdose rates substantially increased in the United States. One possible contributor to this phenomenon may be solitary drug use resulting from social distancing efforts to prevent COVID-19 transmission. METHODS We surveyed 458 people who use drugs (PWUD) who were recruited from harm reduction and drug treatment providers located in nine states and the District of Columbia. We assessed if solitary drug use had increased since the start of COVID-19. Associations between increased solitary drug use and sociodemographic characteristics, drug use characteristics, and COVID-19 prevention behaviors were examined using multiple logistic regression. RESULTS Half the sample identified as men (52.7%), White (49.7%), and single (49.3%). The average age was 43.2 (SD:11.8) years. Two-thirds (66.8%) recently injected drugs. 44% reported increased solitary drug use since COVID-19. Significant correlates of increased solitary drug use included being single (adjusted Odds Ratio [aOR]=1.99, 95% Confidence Interval [CI]: 1.33, 2.98), increasing drug use (aOR=2.74, 95% CI: 1.72, 4.37), using more in private locations (aOR=1.91, 95% CI: 1.34, 2.72), and social distancing behaviors (aOR=1.31, 95% CI: 1.11, 1.54). Experiencing homelessness (aOR=0.45, 95% CI: 0.31, 0.65) and identifying as a sexual minority (aOR=0.53, 95% CI: 0.31, 0.93) were associated with being less likely to increase solitary drug use. CONCLUSIONS Solitary drug use increased during the COVID-19 pandemic. Increases in solitary drug use, in the context of a drug market increasingly permeated by fentanyl, indicates an urgent need for comprehensive harm reduction interventions to reduce overdose mortality.
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Affiliation(s)
- Kristin E. Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA,Corresponding author
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA,School of Global Public Health, New York University, 708 Broadway, New York, NY 10003, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Katherine Haney
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
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6
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Rosen JG, Glick JL, Zhang L, Cooper L, Olatunde PF, Pelaez D, Rouhani S, Sue KL, Park JN. Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection. Addiction 2022; 118:847-854. [PMID: 36468191 PMCID: PMC10073256 DOI: 10.1111/add.16103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/11/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Solitary drug use (SDU) can amplify risks of fatal overdose. We examined competing risks and drivers of SDU, as well as harm reduction strategies implemented during SDU episodes, among women who inject drugs (WWID). DESIGN A cross-sectional qualitative study, including telephone and face-to-face in-depth interviews. SETTING Baltimore City, MD, USA. PARTICIPANTS Twenty-seven WWID (mean age = 39 years, 67% white, 74% injected drugs daily) recruited via outreach and street intercept (April-September 2021). MEASUREMENTS Interviews explored the physical (i.e. indoor/private, outdoor/public) and social (i.e. alone, accompanied) risk environments in which drug use occurred. Guided by the principles of emergent design, we used thematic analysis to interrogate textual data, illuminating women's preferences/motivations for SDU and strategies for minimizing overdose risks when using alone. FINDINGS Many participants reported experiences with SDU, despite expressed preferences for accompanied drug use. SDU motivations clustered around three primary drivers: (1) avoiding opioid withdrawal, (2) preferences for privacy when using drugs and (3) safety concerns, including threats of violence. Participants nevertheless acknowledged the dangers of SDU and, at times, took steps to mitigate overdose risk, including naloxone possession, communicating to peers when using alone ('spotting') and using drugs in public spaces. CONCLUSIONS WWID appear to engage frequently in SDU due to constraints of the physical and social environments in which they use drugs. They express a preference for accompanied drug use in most cases and report implementing strategies to mitigate their overdose risk, especially when using drugs alone.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Praise F Olatunde
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kimberly L Sue
- National Harm Reduction Coalition, New York, New York, USA.,Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Department of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Center of Biomedical Research Excellent on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
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7
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Gicquelais RE, Genberg BL, Maksut JL, Bohnert ASB, Fernandez AC. Prevalence and correlates of using opioids alone among individuals in a residential treatment program in Michigan: implications for overdose mortality prevention. Harm Reduct J 2022; 19:135. [PMID: 36463189 PMCID: PMC9719663 DOI: 10.1186/s12954-022-00723-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Avoiding use of opioids while alone reduces overdose fatality risk; however, drug use-related stigma may be a barrier to consistently using opioids in the presence of others. METHODS We described the frequency of using opioids while alone among 241 people reporting daily heroin use or non-prescribed use of opioid analgesic medications (OAMs) in the month before attending a substance use disorder treatment program in the Midwestern USA. We investigated drug use-related stigma as a correlate of using opioids while alone frequently (very often vs. less frequently or never) and examined overdose risk behaviors associated with using opioids while alone frequently, adjusted for sociodemographic and clinical characteristics. RESULTS The sample was a median age of 30 years, 34% female, 79% white, and nearly all (91%) had experienced an overdose. Approximately 63% had used OAMs and 70% used heroin while alone very often in the month before treatment. High levels of anticipated stigma were associated with using either opioid while alone very often (adjusted PR: 1.20, 95% CI: 1.04-1.38). Drinking alcohol and taking sedatives within two hours of OAMs very often (vs. less often or never) and using OAMs in a new setting very often (vs. less often or never) were associated with using OAMs while alone very often. Taking sedatives within two hours of using heroin and using heroin in a new setting very often (vs. less often or never) were associated with using heroin while alone very often. CONCLUSION Anticipated stigma, polysubstance use, and use in a new setting were associated with using opioids while alone. These findings highlight a need for enhanced overdose harm reduction options, such as overdose detection services that can initiate an overdose response if needed. Addressing stigmatizing behaviors in communities may reduce anticipated stigma and support engagement and trust in these services.
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Affiliation(s)
- Rachel E. Gicquelais
- grid.14003.360000 0001 2167 3675School of Nursing, University of Wisconsin–Madison, 4257 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI 53705 USA
| | - Becky L. Genberg
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Jessica L. Maksut
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Amy S. B. Bohnert
- grid.214458.e0000000086837370Department of Anesthesiology, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109 USA ,grid.497654.d0000 0000 8603 8958Veterans Affairs Center for Clinical Management Research, 2215 Fuller Rd., Ann Arbor, MI 48105 USA
| | - Anne C. Fernandez
- grid.214458.e0000000086837370Department of Psychiatry, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109 USA
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8
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Li Y, Miller HJ, Root ED, Hyder A, Liu D. Understanding the role of urban social and physical environment in opioid overdose events using found geospatial data. Health Place 2022; 75:102792. [PMID: 35366619 DOI: 10.1016/j.healthplace.2022.102792] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 01/05/2023]
Abstract
Opioid use disorder is a serious public health crisis in the United States. Manifestations such as opioid overdose events (OOEs) vary within and across communities and there is growing evidence that this variation is partially rooted in community-level social and economic conditions. The lack of high spatial resolution, timely data has hampered research into the associations between OOEs and social and physical environments. We explore the use of non-traditional, "found" geospatial data collected for other purposes as indicators of urban social-environmental conditions and their relationships with OOEs at the neighborhood level. We evaluate the use of Google Street View images and non-emergency "311" service requests, along with US Census data as indicators of social and physical conditions in community neighborhoods. We estimate negative binomial regression models with OOE data from first responders in Columbus, Ohio, USA between January 1, 2016, and December 31, 2017. Higher numbers of OOEs were positively associated with service request indicators of neighborhood physical and social disorder and street view imagery rated as boring or depressing based on a pre-trained random forest regression model. Perceived safety, wealth, and liveliness measures from the street view imagery were negatively associated with risk of an OOE. Age group 50-64 was positively associated with risk of an OOE but age 35-49 was negative. White population, percentage of individuals living in poverty, and percentage of vacant housing units were also found significantly positive however, median income and percentage of people with a bachelor's degree or higher were found negative. Our result shows neighborhood social and physical environment characteristics are associated with likelihood of OOEs. Our study adds to the scientific evidence that the opioid epidemic crisis is partially rooted in social inequality, distress and underinvestment. It also shows the previously underutilized data sources hold promise for providing insights into this complex problem to help inform the development of population-level interventions and harm reduction policies.
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Affiliation(s)
- Yuchen Li
- Department of Geography, The Ohio State University, United States.
| | - Harvey J Miller
- Department of Geography, The Ohio State University, United States; Center for Urban and Regional Analysis, The Ohio State University, United States
| | - Elisabeth D Root
- Department of Geography, The Ohio State University, United States; College of Public Health, The Ohio State University, United States
| | - Ayaz Hyder
- College of Public Health, The Ohio State University, United States
| | - Desheng Liu
- Department of Geography, The Ohio State University, United States
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9
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Kanter K, Gallagher R, Eweje F, Lee A, Gordon D, Landy S, Gasior J, Soto-Calderon H, Cronholm PF, Cocchiaro B, Weimer J, Roth A, Lankenau S, Brenner J. Willingness to use a wearable device capable of detecting and reversing overdose among people who use opioids in Philadelphia. Harm Reduct J 2021; 18:75. [PMID: 34301246 PMCID: PMC8299455 DOI: 10.1186/s12954-021-00522-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023] Open
Abstract
Background The incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic. Naloxone can reverse opioid overdose, lower death rates, and enable a transition to medication for opioid use disorder. Though current formulations for community use of naloxone have been shown to be safe and effective public health interventions, they rely on bystander presence. We sought to understand the preferences and minimum necessary conditions for wearing a device capable of sensing and reversing opioid overdose among people who regularly use opioids. Methods We conducted a combined cross-sectional survey and semi-structured interview at a respite center, shelter, and syringe exchange drop-in program in Philadelphia, Pennsylvania, USA, during the COVID-19 pandemic in August and September 2020. The primary aim was to explore the proportion of participants who would use a wearable device to detect and reverse overdose. Preferences regarding designs and functionalities were collected via a questionnaire with items having Likert-based response options and a semi-structured interview intended to elicit feedback on prototype designs. Independent variables included demographics, opioid use habits, and previous experience with overdose. Results A total of 97 adults with an opioid use history of at least 3 months were interviewed. A majority of survey participants (76%) reported a willingness to use a device capable of detecting an overdose and automatically administering a reversal agent upon initial survey. When reflecting on the prototype, most respondents (75.5%) reported that they would wear the device always or most of the time. Respondents indicated discreetness and comfort as important factors that increased their chance of uptake. Respondents suggested that people experiencing homelessness and those with low tolerance for opioids would be in greatest need of the device. Conclusions The majority of people sampled with a history of opioid use in an urban setting were interested in having access to a device capable of detecting and reversing an opioid overdose. Participants emphasized privacy and comfort as the most important factors influencing their willingness to use such a device. Trial registration NCT04530591. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00522-3.
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Affiliation(s)
- Katie Kanter
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Ryan Gallagher
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Feyisope Eweje
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alexander Lee
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - David Gordon
- Ballinger, 833 Chestnut Street, Suite 1400, Philadelphia, PA, 19107, USA
| | - Stephen Landy
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Julia Gasior
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Haideliza Soto-Calderon
- Penn Department of Medicine Clinical Trials Unit, Anatomy-Chemistry Building, 1st Floor, Philadelphia, PA, 19104, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Ben Cocchiaro
- Prevention Point Philadelphia, 2913-15 Kensington Ave, Philadelphia, PA, 19134, USA.,Penn State College of Medicine, 500 University Dr, Hershey, PA, 17033, USA
| | - James Weimer
- Department of Computer and Information Science, University of Pennsylvania, Levine Hall, 3330 Walnut St, Philadelphia, PA, USA
| | - Alexis Roth
- Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Stephen Lankenau
- Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Jacob Brenner
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Christie NC. The role of social isolation in opioid addiction. Soc Cogn Affect Neurosci 2021; 16:645-656. [PMID: 33681992 PMCID: PMC8259283 DOI: 10.1093/scan/nsab029] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 12/23/2022] Open
Abstract
Humans are social animals: social isolation hurts people both psychologically and physically. Strong, positive social bonds help people to live longer and healthier lives compared with their more isolated peers. Opioid use disorder is associated with feelings of social isolation, an increased risk of suicide and, at the community level, lower social capital. I propose a psychobiological mechanistic explanation that contributes to the association between opioid use and social isolation. The endogenous opioid system plays a central role in the formation and maintenance of social bonds across the life span and has been investigated primarily through the framework of the brain opioid theory of social attachment. In primates, maternal-infant bonding and social play are both impaired by the administration of naltrexone (an opioid antagonist), and in humans, the chronic use of opioids appears to be particularly (relative to other drugs) corrosive to close relationships. Social isolation may play a role in the development and exacerbation of opioid use disorder. Taken together, work on the brain’s opioid system suggests a possible mechanistic basis for bidirectional causal links between social isolation and opioid use disorder. Evaluation of this hypothesis would benefit from longitudinal psychosocial and neuropsychopharmacological investigations.
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Affiliation(s)
- Nina C Christie
- Department of Psychology, University of Southern California, Los Angeles, CA, USA., USC Brain and Creativity Institute, University of Southern California, Los Angeles, CA, USA
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PARK JUNYEONG, ROUHANI SABA, BELETSKY LEO, VINCENT LOUISE, SALONER BRENDAN, SHERMAN SUSANG. Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework. Milbank Q 2020; 98:700-746. [PMID: 32808709 PMCID: PMC7482387 DOI: 10.1111/1468-0009.12470] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug-related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. CONTEXT Drug overdose is the leading cause of injury-related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. METHODS In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The "continuum of overdose risk" framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. FINDINGS De-escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. CONCLUSIONS Without recognizing the full drug-use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.
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Affiliation(s)
| | | | - LEO BELETSKY
- School of Law and Bouvé College of Health SciencesNortheastern University
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