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Nielsen S, Barratt M, Hiley S, Bartlett M, Latimer J, Jauncey M, Roux C, Morelato M, Clark N, Kowalski M, Gilbert M, Francia L, Shipton A, Gerostamoulos D, Glowacki L, Lam T. Monitoring for fentanyl within Australian supervised injecting facilities: Findings from feasibility testing of novel methods and collaborative workshops. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104015. [PMID: 37043848 DOI: 10.1016/j.drugpo.2023.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/31/2023] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Australia is yet to see widespread fentanyl-contaminated heroin, despite the established presence of fentanyl in other countries. International mortality trends alongside a local cluster of fentanyl-related deaths prompted interest in developing methods to monitor for fentanyl and other potentially harmful novel psychoactive substances (NPS) in Australia. METHODS We tested novel methods to monitor for fentanyl and other NPS. From 2017-2021, clients from supervised injecting facilities (SIFs) in Melbourne and Sydney, Australia, contributed urine screens (UDS) with BTNX Rapid Response™ fentanyl test strips (FTS) paired with surveys, and injecting equipment associated with opioid overdoses for laboratory analysis. A single site piloted drug checking using FTS with laboratory confirmation. Two workshops were conducted with SIF staff, content experts and people with lived experience to determine how results can inform practices within SIFs. RESULTS Of the 911 UDS with FTS conducted, less than 1% (n=8) yielded positive results that were not explained by self-reported pharmaceutical fentanyl use, with two laboratory confirmed fentanyl positive results. Injecting equipment from 59 overdoses was tested and neither fentanyl nor other NPS were identified. Drug checking with FTS (n=34) indicated the presence of fentanyl on three tests. Two specimens were subsequently sent for laboratory testing and classified as false positives as the presence of fentanyl was not confirmed. Workshop participants (n=21) felt routine monitoring with FTS currently had limited value. A process for using pre-defined signals to trigger surveillance was developed. CONCLUSION The high false positive rates with FTS, relative to the small number of positive results and potential for them to undermine confidence in FTS emphasised the need for confirmatory testing. The role of routine surveillance was unclear within the current low-fentanyl context, however, a process was developed to upscale testing should signals of increased fentanyl prevalence in the Australian heroin market emerge.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia.
| | - Monica Barratt
- National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia; Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, VIC, Australia
| | - Sarah Hiley
- Medically Supervised Injecting Room, North Richmond Community Health, VIC, Australia
| | - Mark Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Julie Latimer
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Claude Roux
- Centre for Forensic Science, University of Technology Sydney, NSW, Australia
| | - Marie Morelato
- Centre for Forensic Science, University of Technology Sydney, NSW, Australia
| | - Nico Clark
- Medically Supervised Injecting Room, North Richmond Community Health, VIC, Australia
| | | | | | - Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
| | - Alexandra Shipton
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia; Department of Forensic Medicine, Monash University, VIC, Australia
| | - Linda Glowacki
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
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Scott CK, Dennis ML, Grella CE, Mischel AF, Carnevale J. The impact of the opioid crisis on U.S. state prison systems. HEALTH & JUSTICE 2021; 9:17. [PMID: 34304335 PMCID: PMC8310396 DOI: 10.1186/s40352-021-00143-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/28/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD). METHODS A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance. RESULTS MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications. CONCLUSION Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.
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Affiliation(s)
- Christy K. Scott
- Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | | | | | | | - John Carnevale
- Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 USA
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Been F, Lai FY, Kinyua J, Covaci A, van Nuijs ALN. Profiles and changes in stimulant use in Belgium in the period of 2011-2015. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 565:1011-1019. [PMID: 27251771 DOI: 10.1016/j.scitotenv.2016.05.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 06/05/2023]
Abstract
Adapting illicit drug policy strategies requires detailed knowledge on types and amounts of substances consumed by the target population. In this study, we applied wastewater-based epidemiology to detect spatio-temporal changes in the relative amounts of stimulants (amphetamine, methamphetamine, methylenedioxymethamphetamine (MDMA), cocaine) used in seven locations in Belgium over 2011-2015. Clear geographical differences were observed with stimulant users in large cities (Antwerp, Brussels) showing a preference for cocaine, while amphetamine use was most abundant in smaller cities (Geraardsbergen, Koksijde, Lier, Ninove, Ostend). Results obtained across õdifferent years revealed that the investigated substances had a stable share in the total amount of stimulants used, suggesting that habits of stimulant use remained constant, although differences in absolute amounts were observed across years. Investigation of the weekly pattern in stimulant use showed an increase in the use of MDMA on the weekends compared to cocaine and amphetamine.
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Affiliation(s)
- Frederic Been
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp (UA), Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Foon Yin Lai
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp (UA), Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Juliet Kinyua
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp (UA), Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Adrian Covaci
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp (UA), Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Alexander L N van Nuijs
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp (UA), Universiteitsplein 1, 2610 Antwerp, Belgium.
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Burke JG, Lich KH, Neal JW, Meissner HI, Yonas M, Mabry PL. Enhancing dissemination and implementation research using systems science methods. Int J Behav Med 2015; 22:283-91. [PMID: 24852184 DOI: 10.1007/s12529-014-9417-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dissemination and implementation (D&I) research seeks to understand and overcome barriers to adoption of behavioral interventions that address complex problems, specifically interventions that arise from multiple interacting influences crossing socio-ecological levels. It is often difficult for research to accurately represent and address the complexities of the real world, and traditional methodological approaches are generally inadequate for this task. Systems science methods, expressly designed to study complex systems, can be effectively employed for an improved understanding about dissemination and implementation of evidence-based interventions. PURPOSE The aims of this study were to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity. METHOD Case examples of three systems science methods-system dynamics modeling, agent-based modeling, and network analysis-are used to illustrate how each method can be used to address D&I challenges. RESULTS The case studies feature relevant behavioral topical areas: chronic disease prevention, community violence prevention, and educational intervention. To emphasize consistency with D&I priorities, the discussion of the value of each method is framed around the elements of the established Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. CONCLUSION Systems science methods can help researchers, public health decision makers, and program implementers to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity.
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Gruenewald PJ, Ponicki WR, Remer LG, Waller LA, Zhu L, Gorman DM. Mapping the spread of methamphetamine abuse in California from 1995 to 2008. Am J Public Health 2012; 103:1262-70. [PMID: 23078474 DOI: 10.2105/ajph.2012.300779] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES From 1983 to 2008, the incidence of methamphetamine abuse and dependence (MA) presenting at hospitals in California increased 13-fold. We assessed whether this growth could be characterized as a drug epidemic. METHODS We geocoded MA discharges to residential zip codes from 1995 through 2008. We related discharges to population and environmental characteristics using Bayesian Poisson conditional autoregressive models, correcting for small area effects and spatial misalignment and enabling an assessment of contagion between areas. RESULTS MA incidence increased exponentially in 3 phases interrupted by implementation of laws limiting access to methamphetamine precursors. MA growth from 1999 through 2008 was 17% per year. MA was greatest in areas with larger White or Hispanic low-income populations, small household sizes, and good connections to highway systems. Spatial misalignment was a source of bias in estimated effects. Spatial autocorrelation was substantial, accounting for approximately 80% of error variance in the model. CONCLUSIONS From 1995 through 2008, MA exhibited signs of growth and spatial spread characteristic of drug epidemics, spreading most rapidly through low-income White and Hispanic populations living outside dense urban areas.
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Affiliation(s)
- Paul J Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA 94704, USA.
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