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Gibbons JB, Harris SJ, Solomon KT, Sugarman O, Hardy C, Saloner B. Increasing overdose deaths among Black Americans: a review of the literature. Lancet Psychiatry 2023; 10:719-726. [PMID: 37236218 DOI: 10.1016/s2215-0366(23)00119-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 05/28/2023]
Abstract
In 2020, opioid overdose fatalities among Black Americans surpassed those among White Americans for the first time in US history. This Review analyses the academic literature on disparities in overdose deaths to highlight potential factors that could explain these increases in overdose deaths among Black Americans. Overall, we find that differences in structural and social determinants of health; inequality in the access, use, and continuity of substance use disorder and harm reduction services; variability in fentanyl exposure and risk; and changes in social and economic circumstances since the onset of the COVID-19 pandemic are central to explaining this trend. We conclude with a discussion of opportunities for US policy reform and opportunities for future research.
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Affiliation(s)
- Jason B Gibbons
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Samantha J Harris
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Olivia Sugarman
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Hardy
- Maryland Recovery Organization Connecting Communities, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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2
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Winograd RP, Coffey B, Woolfolk C, Wood CA, Ilavarasan V, Liss D, Jain S, Stringfellow E. To Prescribe or Not to Prescribe?: Barriers and Motivators for Progressing Along Each Stage of the Buprenorphine Training and Prescribing Path. J Behav Health Serv Res 2023; 50:165-180. [PMID: 35060002 DOI: 10.1007/s11414-021-09783-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
This study aimed to identify the strongest barriers and motivators associated with each step toward buprenorphine prescribing (1. obtaining a waiver, 2. beginning to prescribe, and 3. prescribing to more people) among a sample of Missouri-based medical professionals (N = 130). Item weights (number of endorsements times mean rank of the item's importance) were calculated based on their responses. Across groups, lack of access to psychosocial support services, need for higher levels of care, and clinical complexity were strong barriers. Among non-prescribers (n = 57, 46.3%), administrative burden, potential of becoming an addiction clinic, and concern about misuse and diversion were most heavily weighted. Among prescribers (n = 66, 53.7%), patients' inability to afford medications was a barrier across phases. Prominent motivators among all groups were the effectiveness of buprenorphine, improvement in other health outcomes, and a personal interest in treating addiction. Only prescribers reported the presence of institutional support and mentors as significant motivators.
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Affiliation(s)
- Rachel P Winograd
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA.
| | - Bridget Coffey
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Candice Woolfolk
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Claire A Wood
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Vinith Ilavarasan
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - David Liss
- Department of Emergency Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Subodh Jain
- Spectrum Health, Division of Psychiatry and Behavioral Medicine, 2750 E Beltline NE, Grand Rapids, MI, 49525, USA
| | - Erin Stringfellow
- Massachusetts General Hospital Institute for Technology Assessment & Harvard Medical School, Boston, MA, USA
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Parker DG, Zentner D, Burack JA, Wendt DC. The impact of the COVID-19 pandemic on medications for opioid use disorder services in the U.S. and Canada: a scoping review. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2181147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Daniel G. Parker
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Daysi Zentner
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Jacob A. Burack
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Dennis C. Wendt
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
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Banks DE, Duello A, Paschke ME, Grigsby SR, Winograd RP. Identifying drivers of increasing opioid overdose deaths among black individuals: a qualitative model drawing on experience of peers and community health workers. Harm Reduct J 2023; 20:5. [PMID: 36639769 PMCID: PMC9839206 DOI: 10.1186/s12954-023-00734-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Black individuals in the USA face disproportionate increases in rates of fatal opioid overdose despite federal efforts to mitigate the opioid crisis. The aim of this study was to examine what drives increases in opioid overdose death among Black Americans based on the experience of key stakeholders. METHODS Focus groups were conducted with stakeholders providing substance use prevention services in Black communities in St. Louis, MO (n = 14). One focus group included peer advocates and volunteers conducting outreach-based services and one included active community health workers. Focus groups were held at community partner organizations familiar to participants. Data collection was facilitated by an interview guide with open-ended prompts. Focus groups were audio recorded and professionally transcribed. Transcripts were analyzed using grounded theory to abstract line-by-line codes into higher order themes and interpret their associations. RESULTS A core theme was identified from participants' narratives suggesting that opioid overdose death among Black individuals is driven by unmet needs for safety, security, stability, and survival (The 4Ss). A lack of The 4Ss was reflective of structural disinvestment and healthcare and social service barriers perpetuated by systemic racism. Participants unmet 4S needs are associated with health and social consequences that perpetuate overdose and detrimentally impact recovery efforts. Participants identified cultural and relationship-based strategies that may address The 4Ss and mitigate overdose in Black communities. CONCLUSIONS Key stakeholders working in local communities to address racial inequities in opioid overdose highlighted the importance of upstream interventions that promote basic socioeconomic needs. Local outreach efforts utilizing peer services can provide culturally congruent interventions and promote harm reduction in Black communities traditionally underserved by US health and social systems.
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Affiliation(s)
- Devin E. Banks
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA
| | - Alex Duello
- grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
| | - Maria E. Paschke
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA
| | - Sheila R. Grigsby
- grid.266757.70000000114809378College of Nursing, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
| | - Rachel P. Winograd
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA ,grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
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Wakeman SE, Lambert E, Kung S, Brisbon NM, Carroll AD, Hickman TT, Covahey C, Sequist TD, Weiner SG. Trends in buprenorphine treatment disparities during the COVID pandemic in Massachusetts. Subst Abus 2022; 43:1317-1321. [PMID: 35896001 DOI: 10.1080/08897077.2022.2095077] [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: 10/16/2022]
Abstract
Background: Racial, sex, and age disparities in buprenorphine treatment have previously been demonstrated. We evaluated trends in buprenorphine treatment disparities before and after the onset of the COVID pandemic in Massachusetts. Methods: This cross-sectional study used data from an integrated health system comparing 12-months before and after the March 2020 Massachusetts COVID state of emergency declaration, excluding March as a washout period. Among patients with a clinical encounter during the study periods with a diagnosis of opioid use disorder or opioid poisoning, we extracted outpatient buprenorphine prescription rates by age, sex, race and ethnicity, and language. Generating univariable and multivariable Poisson regression models, we calculated the probability of receiving buprenorphine. Results: Among 4,530 patients seen in the period before the COVID emergency declaration, 57.9% received buprenorphine. Among 3,653 patients seen in the second time period, 55.1% received buprenorphine. Younger patients (<24) had a lower likelihood of receiving buprenorphine in both time periods (adjusted prevalence ratio (aPR), 0.56; 95% CI, 0.42-0.75 before vs. aPR, 0.76; 95% CI, 0.60-0.96 after). Male patients had a greater likelihood of receiving buprenorphine compared to female patients in both time periods (aPR: 1.05; 95% CI, 1.00-1.11 vs. aPR: 1.09; 95% CI, 1.02-1.16). Racial disparities emerged in the time period following the COVID pandemic, with non-Hispanic Black patients having a lower likelihood of receiving buprenorphine compared to non-Hispanic white patients in the second time period (aPR, 0.85; 95% CI, 0.72-0.99). Conclusions: Following the onset of the COVID pandemic in Massachusetts, ongoing racial, age, and gender disparities were evident in buprenorphine treatment with younger, Black, and female patients less likely to be treated with buprenorphine across an integrated health system.
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Affiliation(s)
- Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Mass General Brigham, Office of the Chief Medical Officer, Boston, MA, USA
| | - Eugene Lambert
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sunny Kung
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Aleta D Carroll
- Mass General Brigham, Office of the Chief Medical Officer, Boston, MA, USA
| | - Thu-Trang Hickman
- Mass General Brigham, Office of the Chief Medical Officer, Boston, MA, USA
| | | | - Thomas D Sequist
- Harvard Medical School, Boston, MA, USA.,Mass General Brigham, Office of the Chief Medical Officer, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott G Weiner
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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What is the prevalence of and trend in opioid use disorder in the United States from 2010 to 2019? Using multiplier approaches to estimate prevalence for an unknown population size. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100052. [PMID: 35783994 PMCID: PMC9248998 DOI: 10.1016/j.dadr.2022.100052] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Opioid-related overdose deaths have increased since 2010 in the U.S., but information on trends in opioid use disorder (OUD) prevalence is limited due to unreliable data. Multiplier methods are a classical epidemiological technique to estimate prevalence when direct estimation is infeasible or unreliable. We used two different multiplier approaches to estimate OUD prevalence from 2010 to 2019. First, we estimated OUD in National Survey on Drug Use and Health (NSDUH), and based on existing capture-recapture studies, multiplied prevalence by 4.5x. Second, we estimated the probability of drug poisoning death among people with OUD (Meta-analysis indicates 0.52/100,000), and divided the number of drug poisoning deaths in the US by this probability. Estimates were weighted to account for increase in drug-related mortality in recent years due to fentanyl. Estimated OUD prevalence was lowest when estimated in NSDUH with no multiplier, and highest when estimated from vital statistics data without adjustment. Consistent findings emerged with two methods: NSDUH data with multiplier correction, and vital statistics data with multiplier and adjustment. From these two methods, OUD prevalence increased from 2010 to 2014; then stabilized and slightly declined annually (survey data with multiplier, highest prevalence of 4.0% in 2015; death data with a multiplier and correction, highest prevalence of 2.35% in 2016). The number of US adolescent and adult individuals with OUD in 2019 was estimated between 6.7-7.6 million. When multipliers and corrections are used, OUD may have stabilized or slightly declined after 2015. Nevertheless, it remains highly prevalent, affecting 6-7 million US adolescents and adults.
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Board AR, Kim S, Park J, Schieber L, Miller GF, Pike J, Cremer LJ, Asher A. Risk factors for COVID-19 among persons with substance use disorder (PWSUD) with hospital visits - United States, April 2020-December 2020. Drug Alcohol Depend 2022; 232:109297. [PMID: 35033956 PMCID: PMC8747842 DOI: 10.1016/j.drugalcdep.2022.109297] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Sociodemographic factors and chronic conditions associated with coronavirus disease 2019 (COVID-19) among persons with substance use disorder (PWSUD) are not well understood. We identified risk factors associated with COVID-19 among PWSUD with hospital visits. METHODS Using the Premier Healthcare Database Special COVID-19 Release, we conducted a case-control study using ICD-10-CM codes to identify PWSUD aged 12 years and older with hospital visits for any reason during April-December 2020. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to identify factors associated with COVID-19 diagnosis among PWSUD (age, sex, race/ethnicity, U.S. Census Region, urban/rural classification, insurance payor type, comorbidities, and substance use disorder [SUD] type), and then stratified by SUD type. RESULTS From April-December 2020, 18,298 (1.3%) of 1,429,154 persons with SUD in the database had a COVID-19 diagnosis. Among PWSUD, opioid use disorder (OUD; aOR = 1.24, 95% CI = 1.18-1.32), alcohol use disorder (AUD; aOR = 1.16, 95% CI = 1.11-1.22), cocaine or other stimulant use disorder (COUD; aOR = 1.28, 95% CI = 1.22-1.34), and multiple SUDs (aOR = 1.20, 95% CI = 1.15-1.26) were associated with higher odds of COVID-19, as were comorbidities such as chronic lower respiratory disease (aOR = 1.32, 95% CI = 1.26-1.37), chronic hepatitis (aOR = 1.45, 95% CI = 1.34-1.57), and diabetes (aOR = 1.78, 95% CI = 1.71-1.86). CONCLUSIONS Among a sample of PWSUD, OUD, AUD, COUD, multiple SUDs, and associated comorbidities were associated with COVID-19 diagnosis. Integration of COVID-related care, care of other comorbidities, and SUD treatment may benefit PWSUD. Future studies are needed to better understand COVID-19 prevention in this population and to reduce disparities among subpopulations at increased risk.
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Affiliation(s)
- Amy R. Board
- CDC COVID-19 Response, United States,Epidemic Intelligence Service, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States,Division of Overdose Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States,Corresponding author. Present address: Division for Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS-S106-3, Atlanta, GA 30341, United States
| | - Sunkyung Kim
- CDC COVID-19 Response, United States; Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, 1600 Clifton Rd., NE, Mailstop H24-10, Atlanta, GA 30333, United States.
| | - Joohyun Park
- CDC COVID-19 Response, United States; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, Mailstop S107-3, Atlanta, GA 30341, United States.
| | - Lyna Schieber
- CDC COVID-19 Response, United States; Division of Overdose Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States.
| | - Gabrielle F. Miller
- CDC COVID-19 Response, United States,Division of Injury Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States
| | - Jamison Pike
- CDC COVID-19 Response, United States; Immunization Services Division, National Center for Immunization and Respiratory Diseases, 1600 Clifton Rd., NE, Mailstop H24-4, Atlanta, GA 30333, United States.
| | - Laura J. Cremer
- CDC COVID-19 Response, United States,Division of Overdose Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop S106-8, Atlanta, GA 30341, United States
| | - Alice Asher
- CDC COVID-19 Response, United States; Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 12 Corp Sq Blvd, Mailstop US12-3, Atlanta, GA 30329, United States.
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Compton P, St Marie B. Coexisting Substance Use Disorder and Chronic Pain During COVID-19. Pain Manag Nurs 2022; 23:17-25. [PMID: 34620549 PMCID: PMC8418911 DOI: 10.1016/j.pmn.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/29/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Peggy Compton
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, 19104-4217.
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