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Schmidt RA, Everett K, Perez-Brumer A, Strike C, Rush B, Gomes T. A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy. Addiction 2024; 119:1111-1122. [PMID: 38476027 DOI: 10.1111/add.16459] [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: 07/28/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND AIMS Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. DESIGN This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. SETTING AND PARTICIPANTS The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. MEASUREMENTS We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. FINDINGS Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). CONCLUSION Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.
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Affiliation(s)
- Rose A Schmidt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- ICES, Toronto, Canada
| | | | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Brian Rush
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Tara Gomes
- ICES, Toronto, Canada
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Management and Evaluation at the University of Toronto, Institute of Health Policy, Toronto, Ontario, Canada
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Fowler EF, Moore ST, Floyd B, Yao J, Neumann M, Lewis NA, Niederdeppe J, Gollust SE. Invoking Identity? Partisan Polarization in Discussions of Race, Racism, and Gender in 2022 Midterm Advertising in the United States. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2024; 49:505-537. [PMID: 37987197 DOI: 10.1215/03616878-11066296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
CONTEXT Media messaging matters for public opinion and policy, and analyzing patterns of campaign strategy can provide important windows into policy priorities. METHODS The authors used content analysis supplemented with keyword-based text analysis to assess the volume, proportion, and distribution of media attention to race-related issues in comparison to gender-related issues during the general election period of the 2022 midterm campaigns for federal office in the United States. FINDINGS Race-related mentions in campaign advertising were overwhelmingly focused on crime and law and order, with very little attention to racism, racial injustice, and the structural barriers that lead to widespread inequities. In stark contrast to mentions of gender, racial appeals were less identity focused and were competitively contested between the parties in their messaging, but they were much more likely to be led by Republicans. CONCLUSIONS The results suggest that discussions of race and gender were highly polarized, with consequences for public understanding of and belief in disparities and policies important to population health.
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Piqué-Buisan J, Baños JE, Cambra-Badii I. Telling the story of the opioid crisis: A narrative analysis of the TV series Dopesick. PLoS One 2024; 19:e0301681. [PMID: 38574095 PMCID: PMC10994355 DOI: 10.1371/journal.pone.0301681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
Dopesick (2021) is the first TV series whose plot deals exclusively with the opioid crisis in the United States. The current study uses narrative analysis and framing theory to explore this series, discussing its portrayal of the people and themes involved in the opioid crisis. Our analysis found that although Dopesick attempts to portray multiple dimensions of the opioid crisis, its narrative oversimplifies the story in attributing the cause of the problem almost exclusively to Purdue Pharma and its director Richard Sackler, while downplaying other factors that contributed to the opioid crisis. Thus, the narrative in this TV series tends to offer simple explanations to a complex problem for which simple solutions are likely to be inadequate.
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Affiliation(s)
- Joel Piqué-Buisan
- Faculty of Medicine, Universitat de Vic–Universitat Central de Catalunya, Vic, Spain
- Observatory of Humanities in Medicine, Hospital d’Olot i Comarcal de la Garrotxa Foundation, Olot, Spain
| | - Josep-E Baños
- Faculty of Medicine, Universitat de Vic–Universitat Central de Catalunya, Vic, Spain
| | - Irene Cambra-Badii
- Faculty of Medicine, Universitat de Vic–Universitat Central de Catalunya, Vic, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), Universitat de Vic–Universitat Central de Catalunya, Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
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Harper CR, Treves-Kagan S. Transformational narrative changes as a community-level approach to the prevention of adverse childhood experiences and substance use. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38469946 DOI: 10.1002/ajcp.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
There is increasing scientific evidence linking substance use, childhood adversity, and social determinants of health. However, little research has considered the evaluation of community-level strategies to reduce substance use by increasing awareness and implementation of evidence-based strategies for preventing adverse childhood experiences (ACEs). This article lays out the conceptual framework for a $2.9 million demonstration project designed to raise awareness of the impact of ACEs on substance use, including primary prevention strategies. Communities used transformational narrative change-with an emphasis on the voices of those most impacted by ACEs and substance use-to highlight the importance of addressing social determinants of health along with primary prevention strategies. The conceptual background highlighted in this article informed media, public health, and local efforts in the three accompanying articles and invited commentary. These findings may help inform future efforts to promote community-level strategies and strengthen the evidence-base for transformational narrative change efforts.
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Affiliation(s)
- Christopher R Harper
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Treves-Kagan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Salomon A, Bartlett M, Chenery M, Jauncey M, Roxburgh A. Outrage and algorithms: Shifting drug-related stigma in a digital world. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104224. [PMID: 37857181 DOI: 10.1016/j.drugpo.2023.104224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Illicit drug dependence is one of the most stigmatised health conditions worldwide and the harmful impacts of stigma for people who use drugs are well documented. The use of stigmatising language about drugs in traditional media is also well documented. The increasing use of digital media platforms has revolutionised the way we communicate, and extended the reach of our messages. However, there are issues specific to the ways in which these platforms operate that have the potential to increase drug-related stigma. This paper outlines the importance of language, narrative, and imagery in reducing this stigma. It discusses the challenges digital media platforms present to achieving this goal, including the use of engagement strategies that trigger fear and increase stigma, the potential for amplifying stigmatising messages by using algorithms, and the potential for dissemination of misinformation. Key strategies to frame conversations about drug use are presented including 1) appeal to values of fairness and equity rather than scaring people; 2) avoid correcting misinformation as it strengthens unhelpful stigmatising frames of drug use; and 3) create a new narrative, focusing on the diversity of experiences of people who use drugs. Internationally we are at a critical juncture with respect to drug policy reform, and efforts to reduce drug-related stigma are central to building support for these reforms. The extensive reach of digital media platforms represents an important opportunity to communicate about illicit drug use. The challenge is to do so in a way that minimises stigma. If we are to achieve change, a narrative that puts values, people, health care and equity at the centre of the conversation is critical.
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Affiliation(s)
| | - Mark Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | | | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia; Discipline of Addiction Medicine, the Central Clinical School, Sydney Medical School, the Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Amanda Roxburgh
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia; Discipline of Addiction Medicine, the Central Clinical School, Sydney Medical School, the Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
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Morris H, Wild TC, Giovannoni M, Haines-Saah R, Koziel J, Schulz P, Bwala H, Kunyk D, Bubela T, Hyshka E. Canadian newspaper coverage on harm reduction featuring bereaved mothers: A mixed methods analysis. PLoS One 2023; 18:e0294608. [PMID: 38011175 PMCID: PMC10681218 DOI: 10.1371/journal.pone.0294608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
A growing body of evidence suggests that news media which includes a sympathetic portrayal of a mother bereaved by substance use can increase public support for harm reduction initiatives. However, the extent to which such news media coverage occurs in Canada is unknown, and research has not documented how the news media in Canada covers such stories. We undertook a mixed-method secondary analyses of 5681 Canadian newspaper articles on harm reduction (2000-2016). Quantitative analyses described the volume and content of harm reduction reporting featuring a mother whose child's death was related to substance use while qualitative thematic analysis provided in-depth descriptions of the discourses underlying such news reporting. Newspaper articles featuring a mother whose child's death was related to substance use were rarely published (n = 63; 1.1% of total harm reduction media coverage during the study period). Deductive content analysis of these 63 texts revealed that coverage of naloxone distribution (42.9%) and supervised drug consumption services (28.6%) were prioritized over other harm reduction services. Although harm reduction (services or policies) were advocated by the mother in most (77.8%) of these 63 texts, inductive thematic analysis of a subset (n = 52) of those articles revealed that mothers' advocacy was diminished by newspaper reporting that emphasized their experiences of grief, prioritized individual biographies over structural factors contributing to substance use harms, and created rhetorical divisions between different groups of people who use drugs (PWUD). Bereaved mothers' advocacy in support of harm reduction programs and services may be minimized in the process of reporting their stories for newspaper readers. Finding ways to report bereaved mothers' stories in ways that are inclusive of all PWUD while highlighting the role of broad, structural determinants of substance use has the potential to shift public opinion and government support in favour of these life-saving services.
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Affiliation(s)
- Heather Morris
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), University of Alberta, Edmonton, AB, Canada
| | - T. Cameron Wild
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Marina Giovannoni
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rebecca Haines-Saah
- Cummings School of Medicine, University of Calgary, Calgary , Alberta, Canada
| | | | - Petra Schulz
- Moms Stop the Harm, RPO Broadmead, Victoria, BC, Canada
| | - Hauwa Bwala
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Diane Kunyk
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), University of Alberta, Edmonton, AB, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Elaine Hyshka
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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Vickers-Smith R, Justice AC, Becker WC, Rentsch CT, Curtis B, Fernander A, Hartwell EE, Ighodaro ET, Kember RL, Tate J, Kranzler HR. Racial and Ethnic Bias in the Diagnosis of Alcohol Use Disorder in Veterans. Am J Psychiatry 2023; 180:426-436. [PMID: 37132202 PMCID: PMC10238581 DOI: 10.1176/appi.ajp.21111097] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Studies show that racially and ethnically minoritized veterans have a higher prevalence of alcohol use disorder (AUD) than White veterans. The investigators examined whether the relationship between self-reported race and ethnicity and AUD diagnosis remains after adjusting for alcohol consumption, and if so, whether it varies by self-reported alcohol consumption. METHODS The sample included 700,012 Black, White, and Hispanic veterans enrolled in the Million Veteran Program. Alcohol consumption was defined as an individual's maximum score on the consumption subscale of the Alcohol Use Disorders Identification Test (AUDIT-C), a screen for unhealthy alcohol use. A diagnosis of AUD, the primary outcome, was defined by the presence of relevant ICD-9 or ICD-10 codes in electronic health records. Logistic regression with interactions was used to assess the association between race and ethnicity and AUD as a function of maximum AUDIT-C score. RESULTS Black and Hispanic veterans were more likely than White veterans to have an AUD diagnosis despite similar levels of alcohol consumption. The difference was greatest between Black and White men; at all but the lowest and highest levels of alcohol consumption, Black men had 23%-109% greater odds of an AUD diagnosis. The findings were unchanged after adjustment for alcohol consumption, alcohol-related disorders, and other potential confounders. CONCLUSIONS The large discrepancy in the prevalence of AUD across groups despite a similar distribution of alcohol consumption levels suggests that there is racial and ethnic bias, with Black and Hispanic veterans more likely than White veterans to receive an AUD diagnosis. Efforts are needed to reduce bias in the diagnostic process to address racialized differences in AUD diagnosis.
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Affiliation(s)
- Rachel Vickers-Smith
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Philadelphia, PA 19104
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, KY 40536
| | - Amy C. Justice
- Yale School of Medicine, New Haven, CT 06511
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
| | - William C. Becker
- Yale School of Medicine, New Haven, CT 06511
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
| | - Christopher T. Rentsch
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK WC1E 7HT
| | - Brenda Curtis
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD 21224
| | - Anita Fernander
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL 33431
| | - Emily E. Hartwell
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Philadelphia, PA 19104
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | | | - Rachel L. Kember
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Philadelphia, PA 19104
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Janet Tate
- Yale School of Medicine, New Haven, CT 06511
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
| | - Henry R. Kranzler
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Philadelphia, PA 19104
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
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Pytell JD, Chander G, Thakrar AP, Ogunwole SM, McGinty EE. Does a Survivorship Model of Opioid Use Disorder Improve Public Stigma or Policy Support? A General Population Randomized Experiment. J Gen Intern Med 2023; 38:1638-1646. [PMID: 36394698 PMCID: PMC10212853 DOI: 10.1007/s11606-022-07865-y] [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: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The chronic disease model of opioid use disorder (OUD) is promoted by many public health authorities, yet high levels of stigma persist along with low support for policies that would benefit people with OUD. OBJECTIVE Determine if a survivorship model of OUD, which does not imply a chronic, relapsing disease state, compared to a chronic disease model improves public stigma and support for opioid-related policies. Explore if race or gender moderates any effect. DESIGN Online, vignette-based randomized study. PARTICIPANTS US adults recruited through a market research firm. INTERVENTION Participants viewed one of 8 vignettes depicting a person with OUD in sustained remission. Vignettes varied in terms of the OUD model (survivorship, chronic disease) and vignette individual's race (Black, White) and gender (man, woman). MAIN MEASURES (1) Public stigma measured by desire for social distance, perceptions of dangerousness, and overall feelings toward the vignette individual. (2) Support for 7 opioid-related policies. Overall feelings were measured on a feelings thermometer (0/cold-100/warm). Stigma and policy support responses were measured on Likert scales dichotomized to indicate a positive (4, 5) or negative/indifferent (1-3) response. KEY RESULTS Of 1440 potential participants, 1172 (81%) were included in the analysis. Exposure to the survivorship model resulted in warmer feelings (mean 72, SD 23) compared to the chronic disease (mean 67, SD 23; difference 4, 95%CI 1-6). There was no effect modification from the vignette individual's race or gender. There was no significant difference between OUD models on other measures of public stigma or support for policies. CONCLUSIONS The survivorship model of OUD improved overall feelings compared to the chronic disease model, but we did not detect an effect of this model on other domains of public stigma or support for policies. Further refinement and testing of this novel, survivorship model of OUD could improve public opinions.
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Affiliation(s)
- Jarratt D Pytell
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Department of Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 E. 17th Ave, Aurora, CO, 80045, USA.
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ashish P Thakrar
- National Clinician Scholars Program at the Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - S Michelle Ogunwole
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Stokes EK, Pickens CM, Wilt G, Liu S, David F. County-level social vulnerability and nonfatal drug overdose emergency department visits and hospitalizations, January 2018-December 2020. Drug Alcohol Depend 2023; 247:109889. [PMID: 37148633 DOI: 10.1016/j.drugalcdep.2023.109889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/13/2023] [Accepted: 04/16/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Nonfatal drug overdoses (NFODs) are often attributed to individual behaviors and risk factors; however, identifying community-level social determinants of health (SDOH) associated with increased NFOD rates may allow public health and clinical providers to develop more targeted interventions to address substance use and overdose health disparities. CDC's Social Vulnerability Index (SVI), which aggregates social vulnerability data from the American Community Survey to produce ranked county-level vulnerability scores, can help identify community factors associated with NFOD rates. This study aims to describe associations between county-level social vulnerability, urbanicity, and NFOD rates. METHODS We analyzed county-level 2018-2020 emergency department (ED) and hospitalization discharge data submitted to CDC's Drug Overdose Surveillance and Epidemiology system. Counties were ranked in vulnerability quartiles based on SVI data. We used crude and adjusted negative binomial regression models, by drug category, to calculate rate ratios and 95% confidence intervals comparing NFOD rates by vulnerability. RESULTS Generally, as social vulnerability scores increased, ED and hospitalization NFOD rates increased; however, the magnitude of the association varied across drugs, visit type, and urbanicity. SVI-related theme and individual variable analyses highlighted specific community characteristics associated with NFOD rates. CONCLUSIONS The SVI can help identify associations between social vulnerabilities and NFOD rates. Development of an overdose-specific validated index could improve translation of findings to public health action. The development and implementation of overdose prevention strategies should consider a socioecological perspective and address health inequities and structural barriers associated with increased risk of NFODs at all levels of the social ecology.
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Affiliation(s)
- Erin K Stokes
- Centers for Disease Control and Prevention, Division of Overdose Prevention, 4770 Buford Hwy MS-S106-8, Atlanta, GA30341, USA.
| | - Cassandra M Pickens
- Centers for Disease Control and Prevention, Division of Overdose Prevention, 4770 Buford Hwy MS-S106-8, Atlanta, GA30341, USA
| | - Grete Wilt
- Agency for Toxic Substances and Disease Registry, 4470 Buford Hwy NE, Atlanta, GA30341, USA
| | - Stephen Liu
- Centers for Disease Control and Prevention, Division of Overdose Prevention, 4770 Buford Hwy MS-S106-8, Atlanta, GA30341, USA
| | - Felicita David
- Centers for Disease Control and Prevention, Division of Overdose Prevention, 4770 Buford Hwy MS-S106-8, Atlanta, GA30341, USA
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The pharmacist as safety net: an interview-based study of the intersecting dependencies between doctors and pharmacists. J Pharm Policy Pract 2023; 16:40. [PMID: 36894977 PMCID: PMC9999512 DOI: 10.1186/s40545-023-00536-1] [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: 10/27/2022] [Accepted: 02/11/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Social science research has demonstrated how health practitioners negotiate and contest professional roles and jurisdictions in practice, and in ways that reflect the power dynamics that permeate medicine. This article further explores these relational dynamics by examining how general practitioners (GPs) in Aotearoa New Zealand frame their working relationships with pharmacists. METHODS We conducted semi-structured interviews with 16 GPs from around the country. Interviews had a mean duration of 46 min, and were thematically analysed. RESULTS GPs saw and used pharmacists as a key source of information about both medicines and patients; thus it was not only pharmacists' training and expertise, but also their community setting and patient proximity, that made them a useful resource to doctors. Furthermore, GPs framed pharmacists as a critical 'safety net' due to their role in catching errors and checking prescribing details. The pharmacy 'safety net' also came through in participants' comments on discount pharmacies, which have introduced pronounced cost-cutting logics to Aotearoa New Zealand's pharmaceutical landscape; in their reflections on these organisations, prescribers express the importance of robust pharmacy practice to their own work. CONCLUSIONS Whilst the literature often foregrounds tensions in how health providers reinscribe their professional roles, this research highlights the interdependence that doctors identify with pharmacists, and their aspirations for working together. Both professional groups navigate a pressed health system that presents a set of common challenges to good medicines practice.
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11
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Deutsch-Link S, Belcher AM, Massey E, Cole TO, Wagner MA, Billing AS, Greenblatt AD, Weintraub E, Wish ED. Race-based differences in drug use prior to onset of opioid use disorder. J Ethn Subst Abuse 2023; 22:89-105. [PMID: 33554763 PMCID: PMC9573766 DOI: 10.1080/15332640.2021.1879702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Rates of opioid use disorder (OUD) have increased dramatically over the past two decades, a rise that has been accompanied by changing demographics of those affected. Early exposure to drugs is a known risk factor for later development of opioid use disorder; but how and whether this risk factor may differ between racial groups is unknown. Our study seeks to identify race differences in self-report of current and past substance use in OUD-diagnosed treatment-seeking individuals. Patients (n = 157) presenting for methadone maintenance treatment at a racially diverse urban opioid treatment program were approached and consented for study involvement. Participants were administered substance use history questionnaires and urine drug screening at intake. Chi-square, t-tests, and rank-sum were used to assess race differences in demographic variables. Logistic and linear regressions assessed the relationship between race and substance use for binary and continuous variables, respectively. 61% of the population identified as Black and 39% as White. Black participants were significantly older; age was thus included as a covariate. Logistic regressions demonstrated that despite similar urine toxicology at intake, White participants were significantly more likely to report having used prescription opioids and psychedelic, stimulant, and sedative substance classes prior to their first use of non-pharmaceutical opioids. Compared to Black participants, White treatment-seeking OUD-diagnosed individuals reported using a wider range of substances ever and prior to first use of non-pharmaceutical opioids. There were no differences, however, in presentation for OUD treatment, suggesting different pathways to OUD, which may carry important clinical implications.
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Affiliation(s)
| | | | | | - Thomas O. Cole
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Eric Weintraub
- University of Maryland School of Medicine, Baltimore, MD, USA
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12
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Linas BP, Morgan JR, Murphy SM, Walley AY, Schackman BR, Marshall BDL. Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts. Drug Alcohol Depend 2022; 241:109668. [PMID: 36309001 PMCID: PMC9833886 DOI: 10.1016/j.drugalcdep.2022.109668] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. METHODS We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and "other" (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. RESULTS From 2016-2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. CONCLUSION We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA; The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI 02906, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA.
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Staben OE, Infurna FJ, Lachman ME, Gerstorf D. Examining Racial Disparities in Historical Change of Mental and Physical Health Across Midlife and Old Age in the United States. J Gerontol B Psychol Sci Soc Sci 2022; 77:1978-1989. [PMID: 34928351 PMCID: PMC9683502 DOI: 10.1093/geronb/gbab232] [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: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine whether racial disparities are narrowing or widening with historical time among U.S. middle-aged and older adults, and test the extent to which educational attainment moderates racial disparities over historical time. METHODS Multilevel models were applied to longitudinal data on middle-aged (ages 40-65) and older adults (ages 66 and older) from the Health and Retirement Study. Historical change was indexed as cohort or birth year. The outcomes of focus were depressive symptoms, episodic memory, health conditions, functional limitations, and self-rated health. RESULTS Results revealed a differential pattern of racial disparities in historical change between midlife and old age. Across midlife and old age, on average, Blacks and Hispanics reported poorer levels of mental and physical health, compared with Whites. In midlife, racial disparities narrowed with historical time; later-born cohorts of Hispanics but not Whites reported fewer depressive symptoms than their earlier-born peers. Likewise, historical improvements in health were stronger among Hispanics and Blacks than Whites. Conversely, in old age, later-born cohorts across race consistently showed historical improvements in each of the outcomes examined. Regarding educational attainment, we observed little consistent evidence that health-promoting effects of educational attainment differ across race and cohort. Examining questions about heterogeneity, results revealed that in midlife and old age there was greater heterogeneity between race across each of the outcomes. DISCUSSION Our discussion elaborates on reasons behind the documented racial differences in historical changes among U.S. middle-aged and older adults, and how the protective role of education is changing over time.
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Affiliation(s)
- Omar E Staben
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Frank J Infurna
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Margie E Lachman
- Department of Psychology, Brandeis University, Waltham, Massachusetts, USA
| | - Denis Gerstorf
- Department of Psychology, Humboldt University, Berlin, Germany
- Human Development and Family Studies, Pennsylvania State University, State College, Pennsylvania, USA
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Patient experiences of prescription drug monitoring programs: a qualitative analysis from an Australian pharmaceutical helpline. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103847. [PMID: 36067724 DOI: 10.1016/j.drugpo.2022.103847] [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: 07/01/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prescription Drug Monitoring Programs (PDMP) are electronic databases that are used to track and monitor the prescribing and dispensing of controlled substances, such as opioid analgesics and benzodiazepines. PDMP have been used widely throughout North America and have recently been implemented in Australia. Several unintended harms have been associated with PDMP in North America, including increased stigma, discrimination, and dismissal from care for patients prescribed these medications. AIMS This study aimed to better understand how people who use prescription medications extramedically and their loved ones give meaning to their consumption and their treatment experiences and concerns in the context of a newly implemented real-time PDMP in Victoria, Australia. METHOD Nineteen audio recordings of telephone calls made to the PDMP Pharmaceutical Helpline were transcribed and thematically analysed. RESULTS Patients and their families were hopeful that PDMP would stop the extra medical use of medications. However, many were deeply concerned about how they would cope with withdrawal or life stressors without the support these medications afforded. Patients reported experiences of stigma and strained therapeutic relationships associated with PDMP implementation. CONCLUSION PDMP have the potential to both assist and harm patients whose prescription medication use has been identified as 'risky' by the PDMP. The findings from this study suggest that clear and open communication, as well as reflection on unconscious bias and stigma may assist healthcare providers to facilitate better patient experiences and outcomes in the context of prescription medication dependence.
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15
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O’Gurek DT, Leasy MJ. Guidelines and Policies. Prim Care 2022; 49:507-515. [DOI: 10.1016/j.pop.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Adams ET, Buchbinder M. Narratives of prevention and redemption in opioid overdose obituaries. MEDICAL HUMANITIES 2022; 48:e5. [PMID: 35228266 DOI: 10.1136/medhum-2021-012143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
Obituaries of people who died from an opioid overdose represent a new territory for understanding cultural narratives of the US opioid epidemic. Drawing on textual analysis of 30 opioid overdose obituaries published on Legacy.com between 2015 and 2020, we describe a prototypical narrative conveyed through opioid overdose obituaries, which renders symbolic meaning through the voices of the bereaved. Obituary authors reimagine their subjects as tragic heroes and reconstitute opioid addiction as a curse, plight or affliction that befalls its victims. Many of these obituaries invoke the language of public health, calling for reform, action or general awareness so other families might avoid the havoc and heartbreak of opioid addiction. We argue that obituaries contribute to broader cultural narratives of opioid addiction by reproducing tragic storylines, vindicating and humanising the deceased, framing opioid addiction as a societal, rather than individual, problem, and medicalising addiction as a brain disease beyond a person's control. Obituary texts thus intertwine a personal story with a broader societal health crisis, transforming stories of the deceased into cautionary tales and public health warnings.
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Affiliation(s)
- Elizabeth Troutman Adams
- Center for Communication Science, RTI International, Research Triangle Park, North Carolina, USA
| | - Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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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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18
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Pyra M, Taylor B, Flanagan E, Hotton A, Johnson O, Lamuda P, Schneider J, Pollack HA. Support for evidence-informed opioid policies and interventions: The role of racial attitudes, political affiliation, and opioid stigma. Prev Med 2022; 158:107034. [PMID: 35339585 PMCID: PMC9153069 DOI: 10.1016/j.ypmed.2022.107034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 11/17/2022]
Abstract
Political affiliation, racial attitudes, and opioid stigma influence public support for public health responses to address opioid use disorders (OUD). Prior studies suggest public perceptions of the opioid epidemic are less racialized and less politically polarized than were public perceptions of the crack cocaine epidemic. Analyzing a cross-sectional, nationally representative sample (n = 1161 U.S. adults) from the October 2020 AmeriSpeak survey, we explored how political affiliation, racial attitudes (as captured in the Color-Blind Racial Attitudes Scale [CoBRAS]), and OUD stigma were associated with respondents' expressed views regarding four critical domains. Respondents with unfavorable attitudes towards Black Americans were less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and distributing naloxone for overdose prevention. Democratic Party affiliation was associated with greater support for all three of the above measures, and increased support for mandatory treatment, which may be seen as a substitute for more punitive interventions. Black respondents were also less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and of distributing naloxone. Our finding suggest that negative attitudes towards African-Americans and political differences remain important factors of public opinion on responding to the OUD epidemic, even after controlling for opioid stigma. Our findings also suggest that culturally-competent dialogue within politically conservative and Black communities may be important to engage public support for evidence-informed treatment and prevention.
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Affiliation(s)
- Maria Pyra
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Bruce Taylor
- NORC at the University of Chicago, Chicago, IL, United States of America
| | - Elizabeth Flanagan
- NORC at the University of Chicago, Chicago, IL, United States of America
| | - Anna Hotton
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - O'Dell Johnson
- University of Arkansas Faye Boozman College of Public Health Southern Public Health and Criminal Justice Research Center, Little Rock, AR, United States of America
| | - Phoebe Lamuda
- NORC at the University of Chicago, Chicago, IL, United States of America
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, United States of America; Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States of America; Department of Public Health Sciences, University of Chicago, Chicago, IL, United States of America
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States of America; Department of Public Health Sciences, University of Chicago, Chicago, IL, United States of America; Urban Health Lab, University of Chicago, Chicago, IL, United States of America.
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19
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Shelton RC, Philbin MM, Ramanadhan S. Qualitative Research Methods in Chronic Disease: Introduction and Opportunities to Promote Health Equity. Annu Rev Public Health 2022; 43:37-57. [PMID: 34936827 PMCID: PMC10580302 DOI: 10.1146/annurev-publhealth-012420-105104] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Public health research that addresses chronic disease has historically underutilized and undervalued qualitative methods. This has limited the field's ability to advance (a) a more in-depth understanding of the factors and processes that shape health behaviors, (b) contextualized explanations of interventions' impacts (e.g., why and how something did or did not work for recipients and systems), and (c) opportunities for building and testing theories. We introduce frameworks and methodological approaches common to qualitative research, discuss how and when to apply them in order to advance health equity, and highlight relevant strengths and challenges. We provide an overview of data collection, sampling, and analysis for qualitative research, and we describe research questions that can be addressed by applying qualitative methods across the continuum of chronic disease research. Finally, we offer recommendations to promote the strategic application of rigorous qualitative methods, with an emphasis on priority areas to enhance health equity across the evidence generation continuum.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
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20
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Baker EA, Hamilton M, Culpepper D, McCune G, Silone G. The effect of person‐first language on attitudes toward people with addiction. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2022. [DOI: 10.1002/jaoc.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emily A. Baker
- College of Pharmacy The Ohio State University Columbus Ohio USA
| | - Mark Hamilton
- College of Pharmacy The Ohio State University Columbus Ohio USA
| | | | - Grace McCune
- College of Pharmacy The Ohio State University Columbus Ohio USA
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21
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Chatterjee A, Glasgow L, Bullard M, Sabir M, Hamilton G, Chassler D, Stevens-Watkins DJ, Goddard-Eckrich D, Rodgers E, Chaya J, Rodriguez S, Gutnick DN, Oga EA, Salsberry P, Martinez LS. Placing Racial Equity at the Center of Substance Use Research: Lessons From the HEALing Communities Study. Am J Public Health 2022; 112:204-208. [PMID: 35080947 PMCID: PMC8802575 DOI: 10.2105/ajph.2021.306572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Avik Chatterjee
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - LaShawn Glasgow
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Mackenzie Bullard
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Mariah Sabir
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Greer Hamilton
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Deborah Chassler
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Danelle J. Stevens-Watkins
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Dawn Goddard-Eckrich
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Emma Rodgers
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Joan Chaya
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Sandra Rodriguez
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Damara N. Gutnick
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Emmanuel A. Oga
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Pamela Salsberry
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
| | - Linda Sprague Martinez
- Avik Chatterjee is with Boston University School of Medicine and Boston Medical Center, Boston, MA. LaShawn Glasgow and Emmanuel A. Oga are with RTI International, Research Triangle Park, NC. Mackenzie Bullard is with Boston University School of Medicine. At the time of study, Mariah Sabir was with Boston University School of Medicine. Greer Hamilton, Deborah Chassler, and Linda Sprague Martinez are with the Boston University School of Social Work. Danelle Stevens-Watkins is with the University of
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22
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Chatterjee A, Yan S, Xuan Z, Waye KM, Lambert AM, Green TC, Stopka TJ, Pollini RA, Morgan JR, Walley AY. Broadening access to naloxone: Community predictors of standing order naloxone distribution in Massachusetts. Drug Alcohol Depend 2022; 230:109190. [PMID: 34864356 PMCID: PMC8714703 DOI: 10.1016/j.drugalcdep.2021.109190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Naloxone is a prescription medication that reverses opioid overdoses. Allowing naloxone to be dispensed directly by a pharmacist without an individual prescription under a naloxone standing order (NSO) can expand access. The community-level factors associated with naloxone dispensed under NSO are unknown. METHODS Using a dataset comprised of pharmacy reports of naloxone dispensed under NSO from 70% of Massachusetts retail pharmacies, we examined relationships between community-level demographics, rurality, measures of treatment for opioid use disorder, and overdose deaths with naloxone dispensed under NSO per ZIP Code-quarter from 2014 until 2018. We used a multi-variable zero-inflated negative binomial model, assessing odds of any naloxone dispensed under NSO, as well as a multi-variable negative binomial model assessing quantities of naloxone dispensed under NSO. RESULTS From 2014-2018, quantities of naloxone dispensed under NSO and the number of pharmacies dispensing any naloxone under NSO increased over time. However, communities with greater percentages of people with Hispanic ethnicity (aOR 0.91, 95% CI 0.86-0.96 per 5% increase), and rural communities compared to urban communities (aOR 0.81, 95% CI 0.73-0.90) were less likely to dispense any naloxone by NSO. Communities with more individuals treated with buprenorphine dispensed more naloxone under NSO, as did communities with more opioid-related overdose deaths. CONCLUSION Naloxone dispensing has substantially increased, in part driven by standing orders. A lower likelihood of naloxone being dispensed under NSO in communities with larger Hispanic populations and in more rural communities suggests the need for more equitable access to, and uptake of, lifesaving medications like naloxone.
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Affiliation(s)
- Avik Chatterjee
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA.
| | - Shapei Yan
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, 801 Massachusetts Ave, Crosstown Building 4th Floor, Boston, MA 02118, USA
| | - Katherine M Waye
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA
| | - Audrey M Lambert
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA
| | - Traci C Green
- The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, 415 South St, MS 035, Waltham, MA 02453, USA
| | - Thomas J Stopka
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111, USA
| | - Robin A Pollini
- West Virginia University School of Medicine, Department of Behavioral Medicine and Psychiatry and West Virginia University School of Public Health, Department of Epidemiology and Biostatistics, 1 Medical Center Dr, Morgantown, WV 26506, USA
| | - Jake R Morgan
- Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany St, Talbot Building Floor 2 West, Boston, MA 02118, USA
| | - Alexander Y Walley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA
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Suen LW, Castellanos S, Joshi N, Satterwhite S, Knight KR. "The idea is to help people achieve greater success and liberty": A qualitative study of expanded methadone take-home access in opioid use disorder treatment. Subst Abuse 2022; 43:1143-1150. [PMID: 35499469 PMCID: PMC9710250 DOI: 10.1080/08897077.2022.2060438] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Prior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California. Methods: We interviewed 10 providers (including two physicians, five social worker associates, and three nurse practitioners) and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes. Results: Patient participants were middle-aged (median age 51 years) and were predominantly men (53%). Providers discussed clinical decision-making processes and experiences providing take-homes. Implementation of expanded take-home policies was cautious. Providers reported making individualized decisions, using patient factors to decide if benefits outweighed risks of overdose and misuse. Decision-making factors included patient drug use, overdose risk, housing status, and vulnerability to COVID-19. New patient groups started receiving take-homes and providers noted few adverse events. Patients who received take-homes reported increased autonomy and treatment flexibility, which in turn increased likelihood of treatment stabilization and engagement. Patients who remained ineligible for take-homes, usually due to ongoing non-prescribed opioid or benzodiazepine use, desired greater transparency and shared decision-making. Conclusion: Federal exemptions in response to COVID-19 led to the unprecedented expansion of access to MOUD take-homes within OTPs. Providers and patients perceived benefits to expanding access to take-homes and experienced few adverse outcomes, suggesting expanded take-home policies should remain post-COVID-19. Future studies should explore whether these findings are generalizable to other OTPs and assess larger samples to quantify patient-level outcomes resulting from expanded take-home policies.
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Affiliation(s)
- Leslie W. Suen
- UCSF National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States,San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Stacy Castellanos
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, United States,Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Neena Joshi
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Shannon Satterwhite
- Department of Family and Community Medicine, University of California, Davis, Davis, CA, United States
| | - Kelly R. Knight
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
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Abstract
Medicine's acceptance of addiction as a medical concept has waxed and waned over time. Addiction, as a disease, fits with modern disease definitions and scientific advances in elucidating the interactions between neurobiology and environment. Definitions of addiction need to acknowledge the complex interactions of brain circuits, genetics, environmental factors, and individual life experiences. Addiction aligns with diagnostic categories of substance use disorders that do not rely on tolerance and withdrawal as defining characteristics. Shifts in social and political views of addiction continue to propel and mirror changes in addiction treatment approaches and terminology within the medical community.
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Affiliation(s)
- Yngvild Olsen
- Institutes for Behavior Resources, Inc/REACH Health Services, 2104 Maryland Avenue, Baltimore, MD 21218, USA.
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25
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Dineen KK, Pendo E. Engaging Disability Rights Law to Address the Distinct Harms at the Intersection of Race and Disability for People with Substance Use Disorder. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:38-51. [PMID: 35244002 DOI: 10.1017/jme.2022.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article examines the unique disadvantages experienced by Black people and other people of color with substance use disorder in health care, and argues that an intersectional approach to enforcing disability rights laws offer an opportunity to ameliorate some of the harms of oppression to this population.
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Genberg BL, Gicquelais RE, Astemborski J, Knight J, Buresh M, Sun J, German D, Thomas DL, Kirk GD, Mehta SH. Trends in fatal and nonfatal overdose by race among people who inject drugs in Baltimore, Maryland from 1998 to 2019. Drug Alcohol Depend 2021; 229:109152. [PMID: 34749056 PMCID: PMC8665116 DOI: 10.1016/j.drugalcdep.2021.109152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study was to examine trends in fatal and nonfatal overdose in a community-based sample of current and former people who inject drugs (PWID). METHODS Data from 4826 current and former PWID from the AIDS Linked to the IntraVenous Experience (ALIVE) observational cohort study in Baltimore, Maryland, were used to characterize fatal and nonfatal overdose rates from 1998 to 2019. Poisson regression was used to examine factors associated with nonfatal overdose and differences by race among 1052 PWID between 2014 and 2019. RESULTS Fatal overdose rates reached a high of 13 per 1000 person-years in 2018. Among 1052 current and former PWID, of whom 75% were Black and one-third were female, the nonfatal overdose rate of 529 per 1000 person-years in 2019 was 8 times higher than 2014 (incidence rate ratio [IRR]=7.76, 95% CI: 3.35, 18.0). The annual adjusted increase in nonfatal overdose rate was 53% among Black PWID (IRR=1.53, 95% CI: 1.34, 1.75), compared to 14% among White PWID (IRR=1.14, 95% CI: 0.88, 1.46). Urban residence, opioid use, depressive symptoms, and hepatitis C infection were positively associated with nonfatal overdose among Black PWID. Recent injection drug use and tranquilizer use was associated with increased overdose among Black and White PWID. CONCLUSIONS Rates of fatal and nonfatal overdose were high and increased from 2014 to 2019 among current and former PWID, with the most dramatic increases in nonfatal overdose observed among Black PWID. These findings highlight the urgent need for additional resources to reduce the differential harms associated with opioids by race.
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Affiliation(s)
- Becky L. Genberg
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Rachel E. Gicquelais
- University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, 53705 USA
| | - Jacquie Astemborski
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Jennifer Knight
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Megan Buresh
- Johns Hopkins School of Medicine, Division of Addiction Medicine, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd floor, Baltimore, MD 21224 USA
| | - Jing Sun
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Danielle German
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - David L. Thomas
- Johns Hopkins University School of Medicine, Division of Infectious Diseases, Baltimore, MD 21205 USA
| | - Gregory D. Kirk
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205 USA, Johns Hopkins University School of Medicine, Division of Infectious Diseases, Baltimore, MD 21205 USA
| | - Shruti H. Mehta
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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McCuistian C, Burlew K, Espinosa A, Ruglass LM, Sorrell T. Advancing Health Equity through Substance Use Research. J Psychoactive Drugs 2021; 53:379-383. [PMID: 34706637 PMCID: PMC8692385 DOI: 10.1080/02791072.2021.1994673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 02/06/2023]
Abstract
Several health inequities exist among racial/ethnic minoritized populations (REMPs) who use substances including disparities in use patterns, inequities in health and legal consequences of use, as well as in treatment access and effectiveness. To address these inequities, more research is needed to examine the associated factors and identify areas for improving treatment. Divided into three categories, this special issue includes papers that examine the social and contextual factors that are associated with substance use among REMPs, papers that consider the role of racism and discrimination on substance use, and papers that explore racial/ethnic differences in treatment access and outcomes. Recommendations for advancing health equity in substance use research are also included.
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Affiliation(s)
- Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kathy Burlew
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Adriana Espinosa
- Department of Psychology, The City College of New York, CUNY, New York, NY, USA
| | - Lesia M Ruglass
- Department of Psychology, The City College of New York, CUNY, New York, NY, USA
| | - Tanya Sorrell
- Department of Psychiatry and Behavioral Sciences, Rush University College of Medicine, Chicago, IL, USA
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Textor L, Schlesinger W. Treating risk, risking treatment: experiences of iatrogenesis in the HIV/AIDS and opioid epidemics. Anthropol Med 2021; 28:239-254. [PMID: 34190020 DOI: 10.1080/13648470.2021.1926916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper explores how poor health outcomes in the HIV/AIDS and opioid epidemics in the United States are undergirded by iatrogenesis. Data are drawn from two projects in Southern California: one among men who have sex with men (MSM) engaging with pre-exposure prophylaxis to HIV (PrEP) and the other in a public hospital system encountering patients with chronic pain and opioid use disorder (OUD). Ethnographic evidence demonstrates how efforts to minimize risk via PrEP and opioid prescription regulation paradoxically generate new forms of risk. Biomedical risk management paradigms engaged across the paper's two ethnographic field sites hinge on the production and governance of deserving patienthood, which is defined by providers and experienced by patients through moral judgments about risk underlying both increased surveillance and abandonment. This paper argues that the logic of deservingness disconnects clinical evaluations of risk from patients' lived, intersectional experiences of race, class, gender, and sexuality. This paper's analysis thus re-locates patients in the context of broader historical and sociopolitical trajectories to highlight how notions of clinical risk designed to protect patients can in fact imperil them. Misalignment between official, clinical constructions of risk and the embodied experience of risk borne by patients produces iatrogenesis.
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Affiliation(s)
- Lauren Textor
- Department of Anthropology and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - William Schlesinger
- Department of Anthropology and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Valles D. Chill Pills Panic: Legal Constructions of Play, Race, and the Policing of Care in California's Administrative Courts. POLAR-POLITICAL AND LEGAL ANTHROPOLOGY REVIEW 2021. [DOI: 10.1111/plar.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Structural Racism and the Opioid Overdose Epidemic: The Need for Antiracist Public Health Practice. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 26:201-205. [PMID: 32235203 DOI: 10.1097/phh.0000000000001168] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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31
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Dittmer SJ, Davenport DL, Oyler DR, Bernard AC. The Influence of the Opioid Epidemic on Firearm Violence in Kentucky Counties. J Surg Res 2021; 264:186-193. [PMID: 33838402 DOI: 10.1016/j.jss.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/26/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The opioid crisis is a major public health emergency. Current data likely underestimate the full impact on mortality due to limitations in reporting and toxicology screening. We explored the relationship between opioid overdose and firearm-associated emergency department visits (ODED & FAED, respectively). METHODS For the years 2010 to 2017, we analyzed county-level ODED and FAED visits in Kentucky using Office of Health Policy and US Census Bureau data. Firearm death certificate data were analyzed along with high-dose prescriptions from the Kentucky All Schedule Prescription Electronic Reporting records. Socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate. RESULTS ODED and FAED visits were correlated (Rho = 0.29, P< 0.01) and both increased over the study period, remarkably so after 2013 (P < 0.001). FAED visits were higher in rural compared to metro counties (P < 0.001), while ODED visits were not. In multivariable analysis, FAED visits were associated with ODED visits (Std. B = 0.24, P= 0.001), high-dose prescriptions (0.21, P = 0.008), rural status (0.19, P = 0.012), percentage white race (-0.28, P = 0.012), and percentage high school graduates (-0.68, P < 0.001). Unemployment and earnings were bivariate correlates with FAED visits (Rho = 0.42, P < 0.001 and -0.32, P < 0.001, respectively) but were not significant in the multivariable model. CONCLUSIONS In addition to recognized nonfatal consequences of the opioid crisis, firearm violence appears to be a corollary impact, particularly in rural counties. Firearm injury prevention efforts should consider the contribution of opioid use and abuse.
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Affiliation(s)
- Sarah J Dittmer
- University of Kentucky College of Medicine; Lexington, Kentucky
| | - Daniel L Davenport
- Department of Surgery, Division of Healthcare Outcomes and Optimal Patient Services, University of Kentucky, Lexington, Kentucky
| | - Douglas R Oyler
- University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, Lexington, Kentucky
| | - Andrew C Bernard
- Department of Surgery, Division of Acute Care Surgery, Trauma and Surgical Critical Care, University of Kentucky, Lexington, Kentucky.
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Dineen KK, Pendo E. Ending the War on People with Substance Use Disorders in Health Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:20-22. [PMID: 33825650 DOI: 10.1080/15265161.2021.1891353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Choflet A, Davidson J, Lee KC, Ye G, Barnes A, Zisook S. A comparative analysis of the substance use and mental health characteristics of nurses who complete suicide. J Clin Nurs 2021; 30:1963-1972. [PMID: 33763857 DOI: 10.1111/jocn.15749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To describe the substance use and mental health characteristics of nurses who complete suicide compared to non-nurses. BACKGROUND Nurses are at higher risk of suicide than the general population. The relationship between substance use, mental health and suicide in a large sample of nurses in the USA has not been previously described. DESIGN Retrospective observational quantitative analysis. METHODS Suicide data were retrospectively analysed in the Centers for Disease Control and Prevention National Violent Death Reporting System from 2003 to 2017. Data were compared between nurses who died by suicide (n = 2,306) and non-nurses who died by suicide (n = 185,620) using odds ratios calculations and chi-square test of proportions to detect independent risk factors of suicide completion in nurses. This study followed the STROBE guidelines. RESULTS Significant differences between nurses and non-nurses were found. Among decedents for whom substances were implicated as a cause of death, nurses were far more likely to be positive at the time of death for almost all substance classifications. Both male and female nurses were more likely than non-nurses to have a mental health problem reported. Among both female and male nurses, job problems were more prevalent compared to non-nurses (12.8% and 19.9% versus 7.2% and 11.9%, respectively). Female nurses were more likely to have a physical health problem compared to female non-nurses, male nurses and male non-nurses (26.2% versus 21.3%, 22% and 20.4%). CONCLUSION Unique relationships between substance use and mental health exist among nurses who complete suicide which may offer specific opportunities for interventions to reduce suicide. RELEVANCE TO CLINICAL PRACTICE Efforts to address workplace stress, facilitate self-referral for risky substance use, encourage mental health treatment and reduce the stigma associated with seeking help all offer potential interventions to reduce nurse suicide.
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Affiliation(s)
| | - Judy Davidson
- University of California San Diego, San Diego, CA, USA
| | - Kelly C Lee
- University of California San Diego, San Diego, CA, USA
| | - Gordon Ye
- University of California San Diego, San Diego, CA, USA
| | | | - Sidney Zisook
- University of California San Diego, San Diego, CA, USA
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34
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Stalcup M, Wallace Y. Careful Practices: Ethics and the Anethical in Canadian Addiction Trajectories. Med Anthropol 2021; 40:417-431. [PMID: 33703966 DOI: 10.1080/01459740.2021.1892667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A drug overdose epidemic in North America has sped the expansion of harm reduction services. Drawing on fieldwork in Ottawa, Ontario, we examine forms of care among people offering and accessing these resources. Notably, our interlocutors do not always characterize harm reduction as caring for oneself. Thus, we differentiate between the ethics of care through which one enters desired subject positions, and anethical careful practices. Harm reduction is sometimes anethical, enacted through minor gestures that do not constitute ethical work but allow for its future realization.
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Affiliation(s)
- Meg Stalcup
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | - Yvonne Wallace
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
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35
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Ondocsin J, Mars SG, Howe M, Ciccarone D. Hostility, compassion and role reversal in West Virginia's long opioid overdose emergency. Harm Reduct J 2020; 17:74. [PMID: 33046092 PMCID: PMC7549084 DOI: 10.1186/s12954-020-00416-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background West Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state’s drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services have been active in the state but in 2018 Charleston’s needle and syringe program was forced to close. This paper considers the risk environment in which the state’s drug-related loss of life, and those attempting to prevent it, exist. Methods This rapid ethnographic study involved semi-structured interviews (n = 21), observation and video recordings of injection sequences (n = 5), initially recruiting people who inject heroin/fentanyl (PWIH) at the Charleston needle and syringe program. Snowball sampling led the research team to surrounding towns in southern West Virginia. Telephone interviews (n = 2) with individuals involved in service provision were also carried out. Results PWIH in southern West Virginia described an often unsupportive, at times hostile risk environment that may increase the risk of overdose fatalities. Negative experiences, including from some emergency responders, and fears of punitive legal consequences from calling these services may deter PWIH from seeking essential help. Compassion fatigue and burnout may play a part in this, along with resentment regarding high demands placed by the overdose crisis on impoverished state resources. We also found low levels of knowledge about safe injection practices among PWIH. Conclusions Hostility faced by PWIH may increase their risk of overdose fatalities, injection-related injury and the risk of HIV and hepatitis C transmission by deterring help-seeking and limiting the range of harm reduction services provided locally. Greater provision of overdose prevention education and naloxone for peer distribution could help PWIH to reverse overdoses while alleviating the burden on emergency services. Although essential for reducing mortality, measures that address drug use alone are not enough to safeguard longer-term public health. The new wave of psychostimulant-related deaths underline the urgency of addressing the deeper causes that feed high-risk patterns of drug use beyond drugs and drug use.
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Affiliation(s)
- Jeff Ondocsin
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA
| | - Sarah G Mars
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA
| | - Mary Howe
- Homeless Youth Alliance, PO Box 170427, San Francisco, CA, 94117, USA
| | - Daniel Ciccarone
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA.
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Webster F, Rice K, Katz J, Bhattacharyya O, Dale C, Upshur R. An ethnography of chronic pain management in primary care: The social organization of physicians' work in the midst of the opioid crisis. PLoS One 2019; 14:e0215148. [PMID: 31042733 PMCID: PMC6493733 DOI: 10.1371/journal.pone.0215148] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study reports on physicians' experiences with chronic pain management. For over a decade prescription opioids have been a primary treatment for chronic pain in North America. However, the current opioid epidemic has complicated long-standing practices for chronic pain management which historically involved prescribing pain medication. Caring for patients with chronic pain occurs within a context in which a growing proportion of patients suffer from chronic rather than acute conditions alongside rising social inequities. METHODS Our team undertook an ethnographic approach known as institutional ethnography in the province of Ontario, Canada in order to explore the social organization of chronic pain management from the standpoint of primary care physicians. This paper reports on a subset of this study data, specifically interviews with 19 primary care clinicians and 8 nurses supplemented by 40 hours of observations. The clinicians in our sample were largely primary care physicians and nurses working in urban, rural and Northern settings. FINDINGS In their reflections on providing care for patients with chronic pain, many providers describe being most challenged by the work involved in helping patients who also struggled with poverty, mental health and addiction. These frustrations were often complicated by concerns that they could lose their license for inappropriate prescribing, thus shifting their work from providing treatment and care to policing their patients for malingering and opioid abuse. INTERPRETATION Our findings show that care providers find the treatment of patients with chronic pain-especially those patients also experiencing poverty-to be challenging at best, and at worst frustrating and overwhelming. In many instances, their narratives suggested experiences of depersonalization, loss of job satisfaction and emotional exhaustion in relation to providing care for these patients, key dimensions of burnout. In essence, the work that they performed in relation to their patients' social rather than medical needs seems to contribute to these experiences. Their experiences were further exacerbated by the fact that restricting and reducing opioid dosing in patients with chronic pain has become a major focus of care provision.
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Affiliation(s)
- Fiona Webster
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Kathleen Rice
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Toronto, ON, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Ross Upshur
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Kaiser BN, Kohrt BA. Why Psychiatry Needs the Anthropologist: A Reflection on 80 Years of Culture in Mental Health. Psychiatry 2019; 82:205-215. [PMID: 31566521 PMCID: PMC6777847 DOI: 10.1080/00332747.2019.1653142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
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