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Takemoto E, Bolton A, Goetz CT. Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019-21. Addiction 2024; 119:1400-1409. [PMID: 38808397 DOI: 10.1111/add.16478] [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: 09/19/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
AIMS The aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity. DESIGN AND SETTING Analysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019-21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year. CASES The analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021. MEASUREMENTS Evidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) was based on the death certificate. FINDINGS In the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40-50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5-0.9; 2020: OR = 0.5, 95% CI = 0.4-0.7; 2021: OR = 0.6, 95% CI = 0.5-0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents. CONCLUSION After controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people.
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Affiliation(s)
- Erin Takemoto
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Ashley Bolton
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Carrie Thomas Goetz
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
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Chen S, Walt G, Aldrich A, McAlearney AS, Linas B, Amuchi B, Freedman DA, Goddard-Eckrich D, Gibson E, Hartman Ms J, Bosak J, Lunze K, Jones L, Christopher M, Salsberry P, Jackson R, Back S, Drainoni ML, Walker DM. A Qualitative Study of Health Equity's Role in Community Coalition Development. HEALTH EDUCATION & BEHAVIOR 2024; 51:613-624. [PMID: 37376998 DOI: 10.1177/10901981231179755] [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] [Indexed: 06/29/2023]
Abstract
Opioid overdose deaths are dramatically increasing in the United States and disproportionately affecting minority communities, with the increasing presence of fentanyl exacerbating this crisis. Developing community coalitions is a long-standing strategy used to address public health issues. However, there is a limited understanding of how coalitions operate amid a serious public health crisis. To address this gap, we leveraged data from the HEALing Communities Study (HCS)-a multisite implementation study aiming to reduce opioid overdose deaths in 67 communities. Researchers analyzed transcripts of 321 qualitative interviews conducted with members of 56 coalitions in the four states participating in the HCS. There were no a priori interests in themes, and emergent themes were identified through inductive thematic analysis and then mapped to the constructs of the Community Coalition Action Theory (CCAT). Themes emerged related to coalition development and highlighted the role of health equity in the inner workings of coalitions addressing the opioid epidemic. Coalition members reported seeing the lack of racial and ethnic diversity within their coalitions as a barrier to their work. However, when coalitions focused on health equity, they noted that their effectiveness and ability to tailor their initiatives to their communities' needs were strengthened. Based on our findings, we suggest two additions to enhance the CCAT: (a) incorporating health equity as an overarching construct that affects all stages of development, and (b) ensuring that data about individuals served are included within the pooled resource construct to enable monitoring of health equity.
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Affiliation(s)
- Sadie Chen
- The Ohio State University, Columbus, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sandi Back
- University of Kentucky, Lexington, KY, USA
| | - Mari-Lynn Drainoni
- Boston Medical Center, Boston, MA, USA
- Boston University, Boston, MA, USA
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3
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Ezell JM, Pho MT, Ajayi BP, Simek E, Shetty N, Goddard-Eckrich DA, Bluthenthal RN. Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model. Drug Alcohol Rev 2024; 43:1143-1159. [PMID: 38646735 DOI: 10.1111/dar.13832] [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: 08/29/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
ISSUES To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. APPROACH Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. KEY FINDINGS Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. IMPLICATIONS There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. CONCLUSION There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, USA
| | - Babatunde P Ajayi
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Elinor Simek
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Netra Shetty
- University of California Berkeley, Berkeley, USA
| | | | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
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4
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Szlyk HS, Constantino-Pettit A, Li X, Kasson E, Maranets E, Worku Y, Montayne M, Banks DE, Kelly JC, Cavazos-Rehg PA. Self-Identified Stage in Recovery and Substance-Use Behaviors among Pregnant and Postpartum Women and People with Opioid Use Disorder. Healthcare (Basel) 2023; 11:2392. [PMID: 37685426 PMCID: PMC10486579 DOI: 10.3390/healthcare11172392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Opioid use among pregnant and postpartum women and people (PPWP) has significant health repercussions. This study explores how substance-use behaviors may vary by stage in recovery among PPWP with opioid use disorder (OUD). We recruited 29 PPWP with OUD. "High-risk" participants self-identified as "not being engaged in treatment" or "new or early in their recovery" (n = 11); "low-risk" participants self-identified as being "well-established" or "in long-term recovery" (n = 18). Participants were queried regarding sociodemographic, mental health, and drug-misuse factors; urine drug screens were collected at baseline. Univariate group comparisons between high-risk and low-risk PPWP were conducted. High-risk PPWP were more likely to self-identify as non-Hispanic African American and more likely to report current opioid use, other illicit drugs, and tobacco. High-risk PPWP had higher opioid cravings versus low-risk PPWP. High-risk PPWP were more likely to screen positive on urine tests for non-opioid drugs and on concurrent use of both non-opioid drugs and opioids versus low-risk participants. PPWP earlier in recovery are at higher-risk for opioid and other illicit drug misuse but are willing to disclose aspects of their recent use. PPWP early in recovery are an ideal population for interventions that can help facilitate recovery during the perinatal period and beyond.
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Affiliation(s)
- Hannah S. Szlyk
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Anna Constantino-Pettit
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
- Brown School, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO 63130, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Emily Maranets
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Yoseph Worku
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Mandy Montayne
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Devin E. Banks
- Department of Psychological Sciences, University of Missouri–St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO 63121, USA;
| | - Jeannie C. Kelly
- Department of Obstetrics & Gynecology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA;
| | - Patricia A. Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
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5
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Winograd R, Budesa Z, Banks D, Carpenter R, Wood CA, Duello A, Thater P, Smith C. Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention. Subst Abus 2023; 44:184-195. [PMID: 37702074 PMCID: PMC10591854 DOI: 10.1177/08897077231186213] [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] [Indexed: 09/14/2023]
Abstract
BACKGROUND Since 2017, Missouri has increased access to medication for opioid use disorder (OUD) within the State's publicly-funded substance use specialty treatment system through a "Medication First" approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention. The current study, which focuses on the St. Louis region, the epicenter of Missouri's overdose crisis, examines whether improvements were experienced equally among Black and White clients. METHODS This study is a retrospective analysis using state-level billing records for individuals with OUD receiving services through publicly-funded substance use treatment programs between July 1, 2016, and June 30, 2019, with claimed services updated through November 1, 2020. Comparisons across time periods, treatment groups, and Black and White clients were assessed using chi-square tests of independence and multivariate negative binomial regressions. RESULTS White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients. CONCLUSION In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.
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Affiliation(s)
- Rachel Winograd
- University of Missouri – St. Louis, Missouri Institute of Mental Health
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Zach Budesa
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Devin Banks
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Ryan Carpenter
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Claire A. Wood
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Alex Duello
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Paul Thater
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Christine Smith
- Missouri Department of Mental Health, Division of Behavioral Health
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6
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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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7
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Rigg KK, Strickland S. Patterns of opioid misuse initiation among African-Americans. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2173050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Khary K. Rigg
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
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8
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Slavova S, Freeman PR, Rock P, Brancato C, Hargrove S, Liford M, Quesinberry D, Walsh SL. Changing Trends in Drug Overdose Mortality in Kentucky: An Examination of Race and Ethnicity, Age, and Contributing Drugs, 2016-2020. Public Health Rep 2023; 138:131-139. [PMID: 35184586 PMCID: PMC9730175 DOI: 10.1177/00333549221074390] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Increased drug overdose mortality among non-Hispanic Black people in the United States in the past 5 years highlights the need for better tailored programs and services. We evaluated (1) changes in drug overdose mortality for various racial and ethnic groups and (2) drug involvement to inform drug overdose prevention efforts in Kentucky. METHODS We used Kentucky death certificates and postmortem toxicology reports from 2016-2020 (provisional data) to estimate changes in age-adjusted drug overdose death rates per 100 000 standard population. RESULTS The age-adjusted drug overdose death rate per 100 000 standard population among non-Hispanic Black residents doubled from 2016 (21.2) to 2020 (46.0), reaching the rate among non-Hispanic White residents in 2020 (48.7; P = .48). From 2016 to 2020, about 80% of these drug overdose deaths involved opioids; heroin involvement declined about 20 percentage points; fentanyl involvement increased about 30 percentage points. The number of psychostimulant-involved drug overdose deaths increased 513% among non-Hispanic Black residents and 191% among non-Hispanic White residents. Cocaine-involved drug overdose deaths increased among non-Hispanic Black residents but declined among non-Hispanic White residents. Drug overdose death rates were significantly lower among Hispanic residents than among non-Hispanic White residents. CONCLUSIONS Increased opioid-involved overdose deaths among non-Hispanic Black residents in Kentucky in combination with rapidly expanding concomitant psychostimulant involvement require increased understanding of the social, cultural, and illicit market circumstances driving these rapid trend changes. Our findings underscore the urgent need to expand treatment and harm reduction services to non-Hispanic Black residents with substance use disorder.
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Affiliation(s)
- Svetla Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA
| | - Peter Rock
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, USA
| | - Candace Brancato
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Sarah Hargrove
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Madison Liford
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Sharon L. Walsh
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
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9
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Gray AC, Neitzke-Spruill L, Hughes C, O'Connell DJ, Anderson TL. Opioid-stimulant trends in overdose toxicology by race, ethnicity, & gender: An analysis in Delaware, 2013-2019. J Ethn Subst Abuse 2022:1-30. [PMID: 35973048 DOI: 10.1080/15332640.2022.2109790] [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: 10/15/2022]
Abstract
Recent upticks of stimulant presence in overdose deaths suggest the opioid epidemic is morphing, which raises questions about what drugs are involved and who is impacted. We investigate annual and growth rate trends in combined opioid-stimulant overdose toxicology between 2013 and 2019 for White, Black, and Hispanic male and female decedents in Delaware. During these years, toxicology shifted to illegal drugs for all with fentanyl leading the increase and opioid-cocaine combinations rising substantially. While combined opioid-cocaine toxicology grew among Black and Hispanic Delawareans, White males continue to report the highest rates overall. These findings depart from historical patterns and may challenge existing opioid epidemic policies.
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Affiliation(s)
| | | | | | - Daniel J O'Connell
- Center for Drug and Health Studies, University of Delaware, Newark, Delaware
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10
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Stanton MC, Ali SB, McCormick K. Harm reduction implementation among HIV service organizations (HSOs) in the U.S. south: a policy context analysis and results from a survey of HSOs. BMC Health Serv Res 2022; 22:913. [PMID: 35831861 PMCID: PMC9281157 DOI: 10.1186/s12913-022-08277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV service organizations are integral to serving communities disproportionately impacted by the HIV and opioid epidemics in the U.S. South. Addressing these intersecting epidemics requires implementation of evidence-based approaches, such as harm reduction. However, little is known about the extent to which Southern HIV service organizations implement harm reduction. This manuscript examines: 1) the implementation context of harm reduction in the South, 2) Southern HIV service organization implementation of harm reduction, and 3) the impact of different contexts within the South on HIV service organization implementation of harm reduction. METHODS To examine implementation context, authors analyzed nation-wide harm reduction policy and drug-related mortality data. To examine HIV service organization implementation of harm reduction, authors performed frequency distributions on survey data (n = 207 organizations). Authors then constructed logistic regressions, using state mortality data and policy context as predictors, to determine what contextual factors predicted HIV service organization implementation of harm reduction. RESULTS Drug-related mortality data revealed an increased need for harm reduction, and harm reduction policy data revealed an increased political openness to harm reduction. Frequency distributions revealed that approximately half of the HIV service organizations surveyed reported that their organizations reflect a harm reduction orientation, and only 26% reported providing harm reduction services. Despite low utilization rates, HIV service organizations indicated a strong interest in harm reduction. Logistic regressions revealed that while increased mortality rates do not predict HIV service organization implementation of harm reduction, a harm reduction-friendly policy context does. DISCUSSION This study highlights how regions within a high-income country can face unique barriers to healthcare and therefore require a unique understanding of implementation context. Study findings indicate a rapidly changing implementation context where increased need meets increased political opportunity to implement harm reduction, however there is a lag in HIV service organization adoption of harm reduction. Financial resources, capacity building, and continued policy advocacy are required for increased HIV service organization adoption of harm reduction.
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Affiliation(s)
- Megan C Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA.
| | - Samira B Ali
- Graduate College of Social Work, University of Houston, Houston, USA
| | - Katie McCormick
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA
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Daniulaityte R, Sweeney K, Ki S, Doebbeling BN, Mendoza N. "They say it's fentanyl, but they honestly look like Perc 30s": Initiation and use of counterfeit fentanyl pills. Harm Reduct J 2022; 19:52. [PMID: 35614447 PMCID: PMC9131678 DOI: 10.1186/s12954-022-00634-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worsening of the overdose crisis in the USA has been linked to the continuing proliferation of non-pharmaceutical fentanyl (NPF). The recent wave of NPF spread in the USA has been fueled by an increased presence of counterfeit pills that contain NPF. This qualitative study aims to characterize the motivation and practices of counterfeit NPF pill initiation and use among individuals using illicit opioids in Arizona. METHODS Between October 2020 and May 2021, semi-structured interviews were conducted with 22 individuals meeting the following eligibility criteria: (1) 18 years or older; (2) residence in Arizona; and (3) use of illicit opioids in the past 30 days and/or opioid use disorder treatment in the past 12 months. Participants were recruited through referrals by a harm reduction organization, craigslist ads, and referrals by other participants. Interviews were conducted virtually via Zoom. Qualitative interviews were transcribed and analyzed thematically using NVivo. RESULTS Out of 22 participants, 64% were male, and 45% were ethnic minorities. Age ranged between 25 and 51 years old. Participants noted significant recent increases in the availability of counterfeit NPF pills ("blues," "dirty oxys") that were most commonly used by smoking. The majority indicated first trying NPF pills in the past year, and the first use often occurred in situations of reduced access to heroin or pharmaceutical opioids. Participant decisions to switch over to more frequent NPF pill use or to maintain some levels of heroin use were shaped by local drug availability trends and personal experiences with NPF effects. They were also influenced by conflicting views of social acceptability of pharmaceutical-like drugs, perceived harms of NPF in terms of overdose risks and increased difficulty of quitting, and perceived benefits of switching to the non-injection route of opioid administration (e.g., from injecting heroin to smoking NPF pills). CONCLUSION Our findings highlight the need for the implementation of novel policy, treatment, and harm reduction approaches to address the growing unpredictability of drug supply and NPF pill-specific risks, attitudes, and behaviors.
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Affiliation(s)
- Raminta Daniulaityte
- College of Health Solutions, Arizona State University, 425 N 5th Street Arizona Biomedical Collaborative, Room 121, Phoenix, AZ, 85004, USA.
| | - Kaylin Sweeney
- College of Health Solutions, Arizona State University, 425 N 5th Street Arizona Biomedical Collaborative, Room 121, Phoenix, AZ, 85004, USA
| | - Seol Ki
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Bradley N Doebbeling
- College of Health Solutions, Arizona State University, 425 N 5th Street Arizona Biomedical Collaborative, Room 121, Phoenix, AZ, 85004, USA
| | - Natasha Mendoza
- Center for Applied Behavioral Health Policy, School of Social Work, Arizona State University, Phoenix, AZ, USA
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12
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Lee HY, Wang K, Choi E, Gajos JM, Won CR. Opioid Literacy Among African Americans Living in Rural Alabama: Findings From a Social Determinants of Health (SDH) Framework. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221093610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Limited research examining opioid literacy among African Americans (AAs) have been conducted. The current study examined the association between opioid literacy levels among AAs in rural Alabama using the social determinants of health framework. Three subscales in the Brief Opioid Overdose Knowledge questionnaire were used to measure opioid literacy. Among a sample of 253, limited opioid literacy was found. Social contact was found to be significantly associated with overall opioid literacy (B = .36, p < .05) and opioid general knowledge subscale (B = .14, p < .05). For the subscale of opioid overdose response knowledge, health insurance (B =−.59, p = .06) and social contact (B = .13, p = .07) emerged as marginally significant. The findings suggest that educational interventions are needed to increase opioid literacy among rural AAs, especially among those with limited social contact.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - Kun Wang
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - Eunyoung Choi
- Leonard Davis School of Gerontology, University of Southern California Los Angeles, Los Angeles, CA, USA
| | - Jamie M. Gajos
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, AL, USA
| | - Cho Rong Won
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
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Chang JE, Franz B, Cronin CE, Lindenfeld Z, Lai AY, Pagán JA. Racial/ethnic disparities in the availability of hospital based opioid use disorder treatment. J Subst Abuse Treat 2022; 138:108719. [DOI: 10.1016/j.jsat.2022.108719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 12/23/2022]
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Predictors of Safe Prescription Opioid Storage and Participation in Drug Take-Back Events: Results from a Statewide Survey. J Community Health 2021; 46:1000-1007. [PMID: 33797682 DOI: 10.1007/s10900-021-00983-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
Improper storage and disposal of prescribed opioids can lead to diversion or accidental poisonings. Studies of emergency department and cancer patients suggest prescription opioids are rarely stored securely or disposed of when unneeded. Safe storage and disposal practices reduce risks for others living in or visiting a household. The purpose of this study is thus to examine prescription opioid storage and participation in drug take-back events among Michigan adults. Participants (N = 702) were recruited through social media advertisements to complete an online survey in July and August 2018. Logistic regression was used to examine correlates of safe storage and disposal. 8.4% (n = 59) of participants reported always keeping opioids locked; 29.8% (n = 209) reported attending a drug take-back event. Black participants and those who believed that illegal drug use was a serious problem had greater odds of locking opioids; participants with higher levels of education or who knew someone who used heroin or misused prescription opioids had lesser odds of locking opioids. Age and race were associated with take-back event participation. Findings identify factors associated with safe prescription opioid storage/disposal and indicate safe storage/disposal seldom occurs. Education and provision of safe storage equipment should be designed for diverse ages, races/ethnicities, and levels of education. Drug take-back events not hosted by law enforcement may have broader appeal, as may those led by Black or other people of color. Wider use of drug donation boxes may facilitate increased disposal among those who do not wish to or cannot attend take-back events.
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Banks DE, Carpenter RW, Wood CA, Winograd RP. Commentary on Furr-Holden et al. : As opioid overdose deaths accelerate among Black Americans, COVID-19 widens inequities-a critical need to invest in community-based approaches. Addiction 2021; 116:686-687. [PMID: 33417278 PMCID: PMC7878302 DOI: 10.1111/add.15362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has exacerbated racial inequities in fatal opioid overdoses affecting Black Americans. To reduce overdose rates among Black Americans, funding and policy efforts should prioritize local strategies that build community trust, such as grassroots organizations already engaged in outreach, advocacy, and harm reduction services.
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Affiliation(s)
- Devin E Banks
- Department of Psychological Sciences, University of Missouri St Louis, St Louis, MO, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri St Louis, St Louis, MO, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, MO, USA
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Furr-Holden D, Milam AJ, Wang L, Sadler R. African Americans now outpace whites in opioid-involved overdose deaths: a comparison of temporal trends from 1999 to 2018. Addiction 2021; 116:677-683. [PMID: 32852864 DOI: 10.1111/add.15233] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/04/2020] [Accepted: 08/19/2020] [Indexed: 01/04/2023]
Abstract
AIMS To estimate racial differences in rates of opioid-involved overdose deaths (OOD) between whites and African Americans in the United States from 1999 to 2018 to (1) identify racial variation in the temporal trends of OOD during the 20-year period and (2) compare trends in OOD rates between whites and African Americans using the Centers for Disease Control and Prevention's (CDC) three defined OOD epidemic periods. METHODS Data were obtained from the CDC wide-ranging on-line data for epidemiological research, which combines OOD data from the National Vital Statistics System, and population data from the US Census Bureau. Joinpoint regression models were used to estimate age-adjusted annual percentage change (APC) in OOD by race from 1999 to 2018. RESULTS The temporal trends of OOD varied by race. African Americans had a persistently low rate of OOD and statistically non-significant rate of change in OOD from 1999 to 2012 (APC = 0.47; P > 0.05), with a statistically significant and rapid acceleration in OOD rates in 2012 that persisted to 2018 (APC = 26.16; P < 0.01). Whites had three statistically significant periods of acceleration in OOD rate from 1999 to 2006 (APC = 12.43; P < 0.01), 2006 to 2013 (APC = 4.34, P < 0.01) and the greatest increase from 2013 to 2016 (APC = 18.96; P < 0.01). Whites had a statistically non-significant decrease in OOD from 2016 to 2018 (P = 0.16). The trend for whites more closely aligned with the CDC-defined epidemic periods than for African Americans. During wave 1 (1999-2010), the average annual percentage change (AAPC) for African Americans was significantly lower than for whites (0.47 versus 9.42, P < 0.01); however, by wave 3 (2013-current; defined by the introduction of illicitly manufactured fentanyl), the AAPC was significantly higher in African Americans (26.16 versus 13.19, P < 0.01). CONCLUSIONS Despite historically lower rates of opioid misuse and opioid-involved overdose deaths among African Americans compared with whites, the growth in opioid-involved overdose deaths among African Americans now outpaces that of whites in the United States.
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Affiliation(s)
- Debra Furr-Holden
- Division of Public Health, Michigan State University College of Human Medicine, Flint, MI, USA
| | - Adam J Milam
- Division of Public Health, Michigan State University College of Human Medicine, Flint, MI, USA
| | - Ling Wang
- Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Richard Sadler
- Division of Public Health, Michigan State University College of Human Medicine, Flint, MI, USA
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