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Bozinoff N, Kleinman RA, Sloan ME, Kennedy MC, Nolan S, Selby P, Kalocsai C, Wood E. Rethinking Substance Use as Social History: Charting a Way Forward. J Gen Intern Med 2024; 39:1227-1232. [PMID: 38286971 PMCID: PMC11116325 DOI: 10.1007/s11606-024-08642-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
Physicians have traditionally asked about substance use within the Social History section of the consultation note. Drawing on social science theory and using the authors' own experiences as generalists and addiction scholars, we consider the possible unintended harms associated with this approach. The inclusion of the substance use history within the Social History reproduces the discourse of substance use disorders as "life-style choices" rather than medical conditions, and reinforces stigma among healthcare workers through the attribution of personal responsibility for complications associated with problematic substance use. The ongoing placement of the substance use history within the Social History may lead to a failure to diagnose and make appropriate management plans for clients with substance use disorders. These missed opportunities may include inadequate withdrawal management leading to discharge before medically advised, insufficient use of evidence-based pharmacotherapy and psychotherapy, polypharmacy, medical complications, and repeated admissions to hospital. We argue instead that the Substance Use History should be a stand-alone section within the consultation note. This new section would reduce the invisibility of substance use disorders within our medical systems and model that these chronic medical conditions are amenable to prevention, treatment and harm reduction through the application of evidence-based practices.
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Affiliation(s)
- Nikki Bozinoff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- British Columbia Centre On Substance Use, Vancouver, Canada.
| | - Robert A Kleinman
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Matthew E Sloan
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Mary Clare Kennedy
- British Columbia Centre On Substance Use, Vancouver, Canada
- School of Social Work, University of British Columbia Okanagan, Kelowna, Canada
| | - Seonaid Nolan
- British Columbia Centre On Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Peter Selby
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Csilla Kalocsai
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Evan Wood
- British Columbia Centre On Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Cadet T, Jalali A, Jeng PJ, Poole S, Woody G, Murphy SM. Determinants of health-related quality of life among individuals with opioid use disorder, recently released from incarceration. Addict Sci Clin Pract 2023; 18:34. [PMID: 37231479 DOI: 10.1186/s13722-023-00375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND\OBJECTIVES: Concomitant with low rates of pharmacotherapy for incarcerated individuals with OUD, there is a high rate of opioid overdose following re-entry into the community. Our research objective was to develop a better understanding of the factors that influence health-related quality-of-life (HRQoL) among this population during the high-risk transition period from incarceration to community. Few studies have assessed health-related quality-of-life (HRQoL) among individuals with OUD who are involved with the criminal-legal system, let alone over the period directly surrounding release from incarceration. METHODS Secondary longitudinal analysis of data from a clinical trial where participants were randomized 1:1 to pre-release extended-release naltrexone (XR-NTX) + referral to community XR-NTX, vs. referral only. We conducted individual, multivariable regressions of EQ-5D domains (mobility, pain/discomfort, anxiety/depression; usual activities and self-care were excluded due to insufficient variation in scores), and the overall preference/utility score. HRQoL data were subset to timepoints immediately before release (baseline) and 12 weeks post-release; treatment groups were collapsed across condition. Multiple imputation by chained equations was conducted to handle missing 3-month data in the dependent variables and covariates, ad hoc. RESULTS Greater severity in the psychiatric composite score was associated with substantially lower HRQoL, across all measures, following release from incarceration. Greater severity in the medical composite score was associated with lower pain/discomfort-related HRQoL. CONCLUSIONS Our findings highlight the importance of ensuring individuals with OUD are linked not only to MOUD, but also treatment for their comorbid conditions upon release from incarceration.
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Affiliation(s)
- Techna Cadet
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA.
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
| | - Sabrina Poole
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Woody
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
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Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System. J Addict Med 2022; 16:65-71. [PMID: 35120065 PMCID: PMC8817063 DOI: 10.1097/adm.0000000000000828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Coprescription of opioids and benzodiazepines (BDZ) is associated with adverse outcomes, including greater healthcare utilization and overdose risk. This study aims to examine opioid and BDZ coprescription, dosing, and mortality among patients with and without opioid use disorder (OUD) in a large healthcare system. METHODS Using data from the California state Prescription Drug Monitoring Program during 2010 to 2014 linked with a large healthcare system electronic health record database and mortality records from the Centers for Disease Control National Death Index, this study examined 5202 patients (1978 with OUD, 3224 controls). Multiple logistic regression analyses were conducted to examine relationships between most recent BDZ and opioid prescription, and their interaction with respect to mortality. RESULTS About 10.5% of the sample died on or before December 31, 2014. About 17.7% were prescribed BDZ during the final month of observation. Individuals with OUD were prescribed higher average BDZ and opioid doses than those without OUD. After adjusting for covariates, increased prescribed doses of BDZ (odds ratio [OR]=1.34, 95%CI: 1.15-1.55 per 10 mg/d increment) and opioids (OR = 1.04, 95%CI: 1.02-1.05 per 10 mg/d increment) were positively associated with mortality. Non-OUD patients who received both BDZ and opioid prescriptions had a higher mortality than those who received only BDZ or opioids (The ratio of odds ratio (ROR) = 3.83, 95%CI: 1.78-8.21). CONCLUSIONS Study findings highlight significant mortality associated with the coprescription of opioids and BDZ in a general healthcare setting. Further research is needed to elucidate factors associated with mortality among non-OUD patients who are co-prescribed opioids and BDZ.
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Sharareh N, Hess R, White S, Dunn A, Singer PM, Cochran J. A vulnerability assessment for the HCV infections associated with injection drug use. Prev Med 2020; 134:106040. [PMID: 32097755 DOI: 10.1016/j.ypmed.2020.106040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/22/2020] [Accepted: 02/22/2020] [Indexed: 12/27/2022]
Abstract
After the 2014-2015 HIV outbreak in Scott County, Indiana, United States Centers for Disease Control and Prevention (CDC) conducted a nationwide analysis to identify vulnerable counties to an outbreak of Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) and prevent such an outbreak in the future. We developed a jurisdiction-level vulnerability assessment for HCV infections associated with injection drug use (IDU) in Utah. We used three years of data (2015-2017) from 15 data sources to construct a regression model to identify significant indicators of IDU. A ZIP Code, county, or individual-level measure of IDU does not exist, therefore, CDC has suggested using HCV cases as a proxy for IDU. We used the Social Vulnerability Index to highlight vulnerable areas to HCV outbreaks and applied Geographical Information System (GIS) to identify hot spots of HCV infections (i.e. current/ongoing HCV transmissions). Rates of skin infection, buprenorphine prescription, administered naloxone, teen birth, and per capita income were associated with HCV infections. The opioid epidemic is dynamic and over time, it impacts different communities through its sequelae such as HCV outbreaks. We need to conduct this vulnerability assessment frequently, using updated data, to better target our resources. Moreover, we should consider evaluating whether the improvement of HCV screening has an impact on controlling HCV outbreaks. The analysis informs Utah's agencies and healthcare officials to target resources and interventions to prevent IDU-related HCV outbreaks. Our results inform policymakers at the national level on possible indicators of HCV outbreaks as well.
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Affiliation(s)
- Nasser Sharareh
- Health System Innovation and Research Division, Population Health Sciences Department, School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
| | - Rachel Hess
- Health System Innovation and Research Division, Population Health Sciences Department, School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
| | - Scott White
- Utah Department of Health, United States of America.
| | - Angela Dunn
- Utah Department of Health, United States of America.
| | - Phillip M Singer
- Political Science Department, University of Utah, Salt Lake City, UT, United States of America.
| | - Jerry Cochran
- Adult Psychiatry and Epidemiology Divisions, Internal Medicine Department, University of Utah, Salt Lake City, UT, United States of America.
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Yonkers KA, Sofuoglu M. The Opioid Crisis: Filling in the Picture. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2019; 1:2-3. [PMID: 36101565 PMCID: PMC9175864 DOI: 10.1176/appi.prcp.20180014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kimberly A. Yonkers
- Department of PsychiatrySchool of Epidemiology and Public HealthDepartment of Obstetrics, Gynecology, and Reproductive SciencesYale School of MedicineNew HavenCT
| | - Mehmet Sofuoglu
- Department of PsychiatrySchool of Epidemiology and Public HealthYale School of Medicine, and Veterans Affairs Connecticut Healthcare SystemWest HavenCT
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