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Brinzo PN, Martins SS. Racial/ethnic trends in opioid and polysubstance opioid overdose mortality in adolescents and young adults, 1999-2020. Addict Behav 2024; 156:108065. [PMID: 38772226 PMCID: PMC11179956 DOI: 10.1016/j.addbeh.2024.108065] [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: 11/27/2023] [Revised: 04/21/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES Previous reports have described variations in opioid overdose mortalities among different race/ethnicity groups. We have analyzed racial/ethnicity trends in opioid and polysubstance opioid overdose mortalities in adolescents and young adults to further characterize differences and potential sub-epidemics within this specific population. METHODS We used mortality data from the U.S. Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death file from 1999 to 2020. Drug overdose mortalities were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Joinpoint regression was used to examine mortality rates for all opioids, opioids with a stimulant, opioids with benzodiazepines, and opioids with alcohol among racial/ethnic groups (non-Hispanic white, non-Hispanic Black, Hispanic, non-Hispanic other) in adolescents and young adults. RESULTS The Average Annual Percent Change (AAPC) for mortality due to opioid and polysubstance opioid overdose increased for all racial/ethnic groups where data was available for analysis from 1999 to 2020. For mortality due to any opioid and any opioid with a stimulant, the greatest AAPC was seen among non-Hispanic Blacks. CONCLUSIONS Unprecedented increases in mortality due to opioid overdose occurred in the last two decades among adolescents and young adults. Heterogenous trends support the notion that the previously defined opioid overdose epidemic "waves" may not accurately depict the effects of the crisis in all race/ethnicity groups. Additionally, alarming increases in opioid-stimulant overdose mortality starting in 2012 further characterize the interrelated effects of the third and fourth waves.
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Affiliation(s)
- Paige N Brinzo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York NY, USA.
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York NY, USA
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Rouhani S, Zhang L, Winiker AK, Sherman SG, Bandara S. Emerging models of de facto drug policy reforms in the United States. Drug Alcohol Depend 2024; 260:111341. [PMID: 38815292 DOI: 10.1016/j.drugalcdep.2024.111341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion-or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD). METHODS We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach. RESULTS Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability. CONCLUSIONS Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.
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Affiliation(s)
- Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health, United States; Center for Anti-racism, Social Justice and Public Health, New York University School of Global Public Health, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Leanne Zhang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
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Rivera BD, Friedman SR. What would it really take to solve the overdose epidemic in the United States? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104435. [PMID: 38729061 DOI: 10.1016/j.drugpo.2024.104435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024]
Abstract
The high overdose mortality rates in the United States poses several questions: Why have they been increasing exponentially since 1979? Why are they so high? And how can they be greatly reduced? Building on past research, the causes of the increase seem to be deeply rooted in US social and economic structures and processes, rather than due only to opioid prescription patterns or the advent of synthetic opioids. Given this, we consider what changes might be needed to reverse the exponentially-increasing overdose mortality. We use a path dependency argument to argue that the United States political, economic, and public health systems have helped create this crisis and, unfortunately, continue to heighten it. These same systems suggest that proposals to expand harm reduction and drug treatment capacity, to decriminalize or legalize drugs, or to re-industrialize the country sufficiently to reduce "communities of despair" will not be enacted at a scale sufficient to end the overdose crisis. We thus suggest that in the United States serious improvements in overdose rates and related policies and structures require massive social movements with a broad social change agenda.
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Affiliation(s)
- Bianca D Rivera
- SUNY Downstate Health Sciences University School of Public Health, Brooklyn, NY, USA
| | - Samuel R Friedman
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, USA.
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Kennedy-Hendricks A, Ettman CK, Gollust SE, Bandara SN, Abdalla SM, Castrucci BC, Galea S. Experience of Personal Loss Due to Drug Overdose Among US Adults. JAMA HEALTH FORUM 2024; 5:e241262. [PMID: 38819798 PMCID: PMC11143465 DOI: 10.1001/jamahealthforum.2024.1262] [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: 01/19/2024] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
Importance Since 1999, over 1 million people have died of a drug overdose in the US. However, little is known about the bereaved, meaning their family, friends, and acquaintances, and their views on the importance of addiction as a policy priority. Objectives To quantify the scope of the drug overdose crisis in terms of personal overdose loss (ie, knowing someone who died of a drug overdose) and to assess the policy implications of this loss. Design, Setting, and Participants This cross-sectional study used data from a nationally representative survey of US adults (age ≥18 years), the fourth wave of the COVID-19 and Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, which was conducted from March to April 2023. Main Outcomes and Measures Respondents reported whether they knew someone who died of a drug overdose and the nature of their relationship with the decedent(s). They also reported their political party affiliation and rated the importance of addiction as a policy issue. Logistic regression models estimated the associations between sociodemographic characteristics and political party affiliation and the probability of experiencing a personal overdose loss and between the experience of overdose loss and the perceived salience of addiction as a policy issue. Survey weights adjusted for sampling design and nonresponse. Results Of the 7802 panelists invited to participate, 2479 completed the survey (31.8% response rate); 153 were excluded because they did not know whether they knew someone who died of a drug overdose, resulting in a final analytic sample of 2326 (51.4% female; mean [SD] age, 48.12 [0.48] years). Of these respondents, 32.0% (95% CI, 28.8%-34.3%) reported any personal overdose loss, translating to 82.7 million US adults. A total of 18.9% (95% CI, 17.1%-20.8%) of all respondents, translating to 48.9 million US adults, reported having a family member or close friend die of drug overdose. Personal overdose loss was more prevalent among groups with lower income (<$30 000: 39.9%; ≥$100 000: 26.0%). The experience of overdose loss did not differ across political party groups (Democrat: 29.0%; Republican: 33.0%; independent or none: 34.2%). Experiencing overdose loss was associated with a greater odds of viewing addiction as an extremely or very important policy issue (adjusted odds ratio, 1.37; 95% CI, 1.09-1.72) after adjustment for sociodemographic and geographic characteristics and political party affiliation. Conclusions and Relevance This cross-sectional study found that 32% of US adults reported knowing someone who died of a drug overdose and that personal overdose loss was associated with greater odds of endorsing addiction as an important policy issue. The findings suggest that mobilization of this group may be an avenue to facilitate greater policy change.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine K. Ettman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah E. Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Sachini N. Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Salma M. Abdalla
- Department of Epidemiology and Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Winston TR, Reed M, Roberts M, Panjwani A, Farfalla J, Pless V, Miles A, Rooks-Peck C, Underwood NL. Implementing a Needs Assessment to Advance Health Equity in Overdose Prevention and Surveillance Initiatives. Public Health Rep 2024:333549241239905. [PMID: 38519872 DOI: 10.1177/00333549241239905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVES State, local, and federal agencies have expanded efforts to address the root causes of overdoses, including health inequity and related social determinants of health. As an Overdose Data to Action (OD2A) technical assistance provider, the Association of State and Territorial Health Officials (ASTHO) conducted the first national needs assessment to understand capacity and technical assistance needs of OD2A jurisdictions in advancing health equity. METHODS ASTHO designed and disseminated the OD2A Recipient Health Equity Needs Assessment (RHENA) to 66 OD2A-funded jurisdictions from February to March 2022. OD2A principal investigators and staff were contacted via email and asked to complete the needs assessment within 6 weeks. One coder manually coded open-ended responses, conducted a thematic analysis on the qualitative data, and performed a simple frequency analysis on the quantitative data. RESULTS Fifty-two jurisdictions (78.8%) responded, including 36 states, 12 cities/counties, and 2 territories. Most jurisdictions (n = 46; 88.5%) reported having a formal or informal health equity lead in place. Common barriers included a lack of access to data sources (n = 37; 71.2%), lack of partnerships (n = 20; 38.5%), and lack of funding (n = 14; 26.9%). Respondents reported needing more information sharing among jurisdictions and partner organizations, coaching on best practices, and routine discussions such as peer-to-peer learning sessions. CONCLUSION Findings suggest that gaps remain in programmatic policies and principles to address inequities in overdose prevention. Results are being used to identify additional technical assistance opportunities, jurisdictional capacity, and approaches to advance health equity.
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Affiliation(s)
- Tiffany R Winston
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Minda Reed
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marissa Roberts
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aashna Panjwani
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Jennifer Farfalla
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Victoria Pless
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Ayana Miles
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cherie Rooks-Peck
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natasha L Underwood
- Office of the Director, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Allen B, Schell RC, Jent VA, Krieger M, Pratty C, Hallowell BD, Goedel WC, Basta M, Yedinak JL, Li Y, Cartus AR, Marshall BDL, Cerdá M, Ahern J, Neill DB. PROVIDENT: Development and Validation of a Machine Learning Model to Predict Neighborhood-level Overdose Risk in Rhode Island. Epidemiology 2024; 35:232-240. [PMID: 38180881 PMCID: PMC10842082 DOI: 10.1097/ede.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Drug overdose persists as a leading cause of death in the United States, but resources to address it remain limited. As a result, health authorities must consider where to allocate scarce resources within their jurisdictions. Machine learning offers a strategy to identify areas with increased future overdose risk to proactively allocate overdose prevention resources. This modeling study is embedded in a randomized trial to measure the effect of proactive resource allocation on statewide overdose rates in Rhode Island (RI). METHODS We used statewide data from RI from 2016 to 2020 to develop an ensemble machine learning model predicting neighborhood-level fatal overdose risk. Our ensemble model integrated gradient boosting machine and super learner base models in a moving window framework to make predictions in 6-month intervals. Our performance target, developed a priori with the RI Department of Health, was to identify the 20% of RI neighborhoods containing at least 40% of statewide overdose deaths, including at least one neighborhood per municipality. The model was validated after trial launch. RESULTS Our model selected priority neighborhoods capturing 40.2% of statewide overdose deaths during the test periods and 44.1% of statewide overdose deaths during validation periods. Our ensemble outperformed the base models during the test periods and performed comparably to the best-performing base model during the validation periods. CONCLUSIONS We demonstrated the capacity for machine learning models to predict neighborhood-level fatal overdose risk to a degree of accuracy suitable for practitioners. Jurisdictions may consider predictive modeling as a tool to guide allocation of scarce resources.
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Affiliation(s)
- Bennett Allen
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Robert C Schell
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Victoria A Jent
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Maxwell Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Claire Pratty
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Benjamin D Hallowell
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Melissa Basta
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI, USA
| | - Jesse L Yedinak
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Yu Li
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Abigail R Cartus
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Magdalena Cerdá
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Daniel B Neill
- Center for Urban Science and Progress, New York University, New York, NY, USA
- Department of Computer Science, Courant Institute for Mathematical Sciences, New York University, New York, NY, USA
- Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA
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Cesare N, Lines LM, Chandler R, Gibson EB, Vickers-Smith R, Jackson R, Bazzi AR, Goddard-Eckrich D, Sabounchi N, Chisolm DJ, Vandergrift N, Oga E. Development and validation of a community-level social determinants of health index for drug overdose deaths in the HEALing Communities Study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209186. [PMID: 37866438 DOI: 10.1016/j.josat.2023.209186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Social determinants of health (SDoH), such as socioeconomic status, education level, and food insecurity, are believed to influence the opioid crisis. While global SDoH indices such as the CDC's Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) combine the explanatory power of multiple social factors for understanding health outcomes, they may be less applicable to the specific challenges of opioid misuse and associated outcomes. This study develops a novel index tailored to opioid misuse outcomes, tests the efficacy of this index in predicting drug overdose deaths across contexts, and compares the explanatory power of this index to other SDoH indices. METHODS Focusing on four HEALing Communities Study (HCS) states (Kentucky, Massachusetts, New York and Ohio; encompassing 4269 ZIP codes), we identified multilevel SDoH potentially associated with opioid misuse and aggregated publicly available data for each measure. We then leveraged a random forest model to develop a composite measure that predicts age-adjusted drug overdose mortality rates based on SDoH. We used this composite measure to understand HCS and non-HCS communities in terms of overdose risk across areas of varying racial composition. Finally, we compared variance in drug overdose deaths explained by this index to variance explained by the SVI and ADI. RESULTS Our composite measure included 28 SDoH measures and explained approximately 89 % percent of variance in age-adjusted drug overdose mortality across HCS states. Health care measures, including emergency department visits and primary care provider availability, were top predictors within the index. Index accuracy was robust within and outside of HCS communities and states. This measure identified high levels of overdose mortality risk in segregated communities. CONCLUSIONS Existing SDoH indices fail to explain much variation in area-level overdose mortality rates. Having tailored composite indices can help us to identify places in which residents are at highest risk based on their composite contexts. A comprehensive index can also help to develop effective community interventions for programs such as HCS by considering the context in which people live.
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Affiliation(s)
- Nina Cesare
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street Suite 906, Boston, MA, USA.
| | - Lisa M Lines
- RTI International, 3040 East Cornwallis Road, PI Box 12194, Research Triangle Park, NC, USA.
| | - Redonna Chandler
- National Institute on Drug Abuse, C/O NIH Mail Center 3WFN 16071 Industrial Dr, Gaithersburg, MD, USA.
| | - Erin B Gibson
- Boston Medical Center, 850 Harrison Ave., Boston, MA, USA.
| | | | - Rebecca Jackson
- Ohio State University Medical Center, 410 West Ave, Columbus, OH, USA.
| | - Angela R Bazzi
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92161, USA.
| | | | - Nasim Sabounchi
- CUNY Graduate School of Public Health & Health Policy, 55 W 125th St., New York, NY, USA.
| | - Deena J Chisolm
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, USA.
| | - Nathan Vandergrift
- RTI International, 3040 East Cornwallis Road, PI Box 12194, Research Triangle Park, NC, USA.
| | - Emmanuel Oga
- RTI International, 3040 East Cornwallis Road, PI Box 12194, Research Triangle Park, NC, USA.
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8
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Davis A, Stringer KL, Drainoni ML, Oser CB, Knudsen HK, Aldrich A, Surratt HL, Walker DM, Gilbert L, Downey DL, Gardner SD, Tan S, Lines LM, Vandergrift N, Mack N, Holloway J, Lunze K, McAlearney AS, Huerta TR, Goddard-Eckrich DA, El-Bassel N. Community-level determinants of stakeholder perceptions of community stigma toward people with opioid use disorders, harm reduction services and treatment in the HEALing Communities Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104241. [PMID: 37890391 PMCID: PMC10841835 DOI: 10.1016/j.drugpo.2023.104241] [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: 07/17/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Community stigma toward people with opioid use disorder (OUD) can impede access to harm reduction services and treatment with medications for opioid use disorder (MOUD). Such community OUD stigma is partially rooted in community-level social and economic conditions, yet there remains a paucity of large-scale quantitative data examining community-level factors associated with OUD stigma. We examined whether rurality, social inequity, and racialized segregation across communities from four states in the HEALing Communities Study (HCS) were associated with 1) greater perceived community stigma toward people treated for OUD, 2) greater perceived intervention stigma toward MOUD, and 3) greater perceived intervention stigma toward naloxone by community stakeholders in the HCS. METHODS From November 2019-January 2020, a cross-sectional survey about community OUD stigma was administered to 801 members of opioid overdose prevention coalitions across 66 communities in four states prior to the start of HCS intervention activities. Bivariate analyses assessed pairwise associations between community rural/urban status and each of the three stigma variables, using linear mixed effect modeling to account for response clustering within communities, state, and respondent sociodemographic characteristics. We conducted similar bivariate analyses to assess pairwise associations between racialized segregation and social inequity. RESULTS On average, the perceived community OUD stigma scale score of stakeholders from rural communities was 4% higher (β=1.57, SE=0.7, p≤0.05), stigma toward MOUD was 6% higher (β=0.28, SE=0.1, p≤0.05), and stigma toward naloxone was 10% higher (β=0.46, SE=0.1, p≤0.01) than among stakeholders from urban communities. No significant differences in the three stigma variables were found among communities based on racialized segregation or social inequity. CONCLUSION Perceived community stigma toward people treated for OUD, MOUD, and naloxone was higher among stakeholders in rural communities than in urban communities. Findings suggest that interventions and policies to reduce community-level stigma, particularly in rural areas, are warranted.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, New York, NY, United States.
| | - Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, United States
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Alison Aldrich
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Hilary L Surratt
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Louisa Gilbert
- Columbia University School of Social Work, New York, NY, United States
| | - Dget L Downey
- Columbia University School of Social Work, New York, NY, United States
| | - Sam D Gardner
- Columbia University School of Social Work, New York, NY, United States
| | - Sylvia Tan
- RTI International, Research Triangle Park, NC, United States
| | - Lisa M Lines
- RTI International, Research Triangle Park, NC, United States
| | | | - Nicole Mack
- RTI International, Research Triangle Park, NC, United States
| | - JaNae Holloway
- RTI International, Research Triangle Park, NC, United States
| | - Karsten Lunze
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
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Condie AW, Judd H, Yaugher AC. Opioid Use Disorder Community Education Events: Rural Public Health Implications. HEALTH EDUCATION & BEHAVIOR 2023; 50:728-737. [PMID: 36382806 DOI: 10.1177/10901981221135506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2023]
Abstract
The opioid overdose epidemic continues to disproportionately impact underserved rural areas throughout the nation, with many of these rural areas experiencing greater opioid-related mortality rates than their urban counterparts. With limited treatment infrastructure and resources, two rural communities in Southeast Utah utilized community-based participatory research collaboration principles to develop, implement, and evaluate a series of evidence-based community opioid education events. This practical and quantitative study surveying 123 participants describes the collaborative efforts of two rural communities in addressing the devastating impacts of the opioid overdose epidemic and reflects on the success of the events via descriptive analysis of summary data. These events increased participants' reported perceptions of and knowledge in four main education areas: stigma reduction, prevention and treatment awareness, naloxone education and use, and resource location awareness. Post-event surveys further supported these results, revealing improved learning in each of these four areas, indicating increased knowledge toward opioid use disorder treatments and stigma reduction. In addition, participants identified key takeaways such as local resource awareness and dismantling stigma as effective strategies to reduce the negative effects of the opioid overdose epidemic. This model for rural community education supports previous research and serves as an effective strategy of public health practice to address the opioid overdose epidemic on a local level.
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Affiliation(s)
| | - Hailey Judd
- Utah State University Extension, HEART Initiative, Logan, UT, USA
| | - Ashley C Yaugher
- Utah State University Extension, HEART Initiative, Logan, UT, USA
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10
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Valdez CA, Rosales JA, Vu AK, Leif RN. Detection and confirmation of fentanyls in high clay-content soil by electron ionization gas chromatography-mass spectrometry. J Forensic Sci 2023; 68:2138-2152. [PMID: 37568257 DOI: 10.1111/1556-4029.15354] [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: 05/19/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023]
Abstract
Detection of illicit drugs in the environment, particularly in soils, often suggests the present or past location of a clandestine production center for these substances. Thus, development of efficient methods for the analysis and detection of these chemicals is of paramount importance in the field of chemical forensics. In this work, a method involving the extraction and retrospective confirmation of fentanyl, acetylfentanyl, thiofentanyl, and acetylthiofentanyl using trichloroethoxycarbonylation chemistry in a high clay-content soil is presented. The soil was spiked separately with each fentanyl at two concentrations (1 and 10 μg/g) and their extraction accomplished using ethyl acetate and aqueous NH4 OH (pH ~ 11.4) with extraction recoveries ranging from ~56% to 82% for the high-concentration (10 μg/g) samples while ranging from ~68% to 83% for the low-concentration (1 μg/g) samples. After their extraction, residues containing each fentanyl were reacted with 2,2,2-trichloroethoxycarbonyl chloride (Troc-Cl) to generate two unique and predictable products from each opioid that can be used to retrospectively confirm their presence and identity using EI-GC-MS. The method's limit of detection (MDL/LOD) for Troc-norfentanyl and Troc-noracetylfentanyl were estimated to be 29.4 and 31.8 ng/mL in the organic extracts. In addition, the method's limit of quantitation for Troc-norfentanyl and Troc-noracetylfentanyl were determined to be 88.2 and 95.5 ng/mL, respectively. Collectively, the results presented herein strengthen the use of chloroformate chemistry as an additional chemical tool to confirm the presence of these highly toxic and lethal substances in the environment.
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Affiliation(s)
- Carlos A Valdez
- Global Security Directorate, Lawrence Livemore National Laboratory, Livermore, California, USA
- Physical and Life Sciences Directorate, Lawrence Livemore National Laboratory, Livermore, California, USA
- Nuclear and Chemical Sciences Division, Lawrence Livemore National Laboratory, Livermore, California, USA
- Forensic Science Center, Lawrence Livemore National Laboratory, Livermore, California, USA
| | - José A Rosales
- Global Security Directorate, Lawrence Livemore National Laboratory, Livermore, California, USA
- Nuclear and Chemical Sciences Division, Lawrence Livemore National Laboratory, Livermore, California, USA
- Forensic Science Center, Lawrence Livemore National Laboratory, Livermore, California, USA
- NNSA-MSIIP Summer Fellow, University of Texas, El Paso, Texas, USA
| | - Alexander K Vu
- Global Security Directorate, Lawrence Livemore National Laboratory, Livermore, California, USA
- Physical and Life Sciences Directorate, Lawrence Livemore National Laboratory, Livermore, California, USA
- Nuclear and Chemical Sciences Division, Lawrence Livemore National Laboratory, Livermore, California, USA
- Forensic Science Center, Lawrence Livemore National Laboratory, Livermore, California, USA
| | - Roald N Leif
- Global Security Directorate, Lawrence Livemore National Laboratory, Livermore, California, USA
- Physical and Life Sciences Directorate, Lawrence Livemore National Laboratory, Livermore, California, USA
- Nuclear and Chemical Sciences Division, Lawrence Livemore National Laboratory, Livermore, California, USA
- Forensic Science Center, Lawrence Livemore National Laboratory, Livermore, California, USA
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11
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Liao S, Jang S, Tharp JA, Lester NA. Relationship between medication adherence for opioid use disorder and health care costs and health care events in a claims dataset. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209139. [PMID: 37574167 DOI: 10.1016/j.josat.2023.209139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/29/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Medication for opioid use disorder (MOUD) has well-documented benefits for treating OUD, though its efficacy depends on patient adherence. We know little about outcomes of MOUD nonadherence compared to treatment regimens without MOUD, and this article aims to address the gap. This analysis focused on office-based MOUD treatment (buprenorphine and naltrexone) to evaluate the long-term impact of adherence on subsequent health care costs and health care events. METHODS With claims data from 2017 to 2019, we used propensity score (PS) weighting to create three comparable cohorts of patients: 1) Adherent: filled MOUD prescription & ≧80 % of days covered by MOUD (N = 1045); 2) Nonadherent: filled MOUD & < 80 % of days covered (N = 1116), 3) did not fill MOUD (N = 16,784). The study defined three time intervals based on a patient's most recent MOUD episode: A 6-month baseline period before initiation of MOUD or random index date for those with MOUD; a 6-month treatment period, during which adherence or nonadherence was established; and a 12-month follow-up period to evaluate outcome measures. The study used generalized PS methodology to examine the effect of proportion of days covered (PDC) as a continuous measure of adherence. RESULTS Among patients who filled MOUD, adherence to MOUD was significantly predicted by having less severe OUD, being older, having fewer inpatient visits and lower outpatient costs before the start of treatment. Adherent patients displayed significantly lower health care costs in the follow-up period compared to nonadherent MOUD patients, and lower odds of experiencing health care events. The nonadherent MOUD group displayed significantly higher odds of health care events compared to patients who had no evidence of receiving MOUD in claims data (NO-MOUD). Among patients prescribed MOUD, each 10 % increase in PDC was associated with a significant decrease in inpatient/outpatient costs and in odds of health care events. CONCLUSIONS This analysis aligns with previous findings about the importance of maintaining long-term adherence to MOUD in supporting patient outcomes. The results also suggest a novel finding that despite confounder control via PS methods, nonadherent patients display poorer outcomes compared to similar NO-MOUD patients.
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Affiliation(s)
- Shirley Liao
- Verily, 269 E Grand Ave, South San Francisco, CA, United States of America.
| | - Steve Jang
- Verily, 269 E Grand Ave, South San Francisco, CA, United States of America
| | - Jordan A Tharp
- Verily, 269 E Grand Ave, South San Francisco, CA, United States of America
| | - Natalie A Lester
- Verily, 269 E Grand Ave, South San Francisco, CA, United States of America; OneFifteen, 6636 Longshore St, Dublin, OH, United States of America
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12
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Allen B, Neill DB, Schell RC, Ahern J, Hallowell BD, Krieger M, Jent VA, Goedel WC, Cartus AR, Yedinak JL, Pratty C, Marshall BDL, Cerdá M. Translating Predictive Analytics for Public Health Practice: A Case Study of Overdose Prevention in Rhode Island. Am J Epidemiol 2023; 192:1659-1668. [PMID: 37204178 PMCID: PMC10558193 DOI: 10.1093/aje/kwad119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/09/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023] Open
Abstract
Prior applications of machine learning to population health have relied on conventional model assessment criteria, limiting the utility of models as decision support tools for public health practitioners. To facilitate practitioners' use of machine learning as a decision support tool for area-level intervention, we developed and applied 4 practice-based predictive model evaluation criteria (implementation capacity, preventive potential, health equity, and jurisdictional practicalities). We used a case study of overdose prevention in Rhode Island to illustrate how these criteria could inform public health practice and health equity promotion. We used Rhode Island overdose mortality records from January 2016-June 2020 (n = 1,408) and neighborhood-level US Census data. We employed 2 disparate machine learning models, Gaussian process and random forest, to illustrate the comparative utility of our criteria to guide interventions. Our models predicted 7.5%-36.4% of overdose deaths during the test period, illustrating the preventive potential of overdose interventions assuming 5%-20% statewide implementation capacities for neighborhood-level resource deployment. We describe the health equity implications of use of predictive modeling to guide interventions along the lines of urbanicity, racial/ethnic composition, and poverty. We then discuss considerations to complement predictive model evaluation criteria and inform the prevention and mitigation of spatially dynamic public health problems across the breadth of practice. This article is part of a Special Collection on Mental Health.
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Affiliation(s)
- Bennett Allen
- Correspondence to Dr. Bennett Allen, Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, 180 Madison Avenue, 4th Floor, Room 4-15, New York, NY 10016 (e-mail: )
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13
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Sud A, Chiu K, Friedman J, Dupouy J. Buprenorphine deregulation as an opioid crisis policy response - A comparative analysis between France and the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104161. [PMID: 37619440 DOI: 10.1016/j.drugpo.2023.104161] [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: 02/16/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND In passing the Maintstreaming Addiction Treatment Act, the United States has abolished its federal X waiver, considered a major barrier to the wider buprenorphine prescribing needed to respond to opioid-related harms. Advocates for this policy have drawn on the French response of deregulating buprenorphine prescribing to address increasing overdose mortality around the turn of the millennium. So far, such policy advocacy has incompletely accounted for contextual and health system differences between the two countries. METHODS Using the health system dynamics framework, this analysis compares France from 1995 to 2003 (the relevant period of buprenorphine reform) to the US from 2018 until today (the comparison period to explore potential impacts of reform). We used it to guide examination of a) contextual issues relating to opioid use epidemiology and b) health system factors including prescriber supply, sector organization, and insurance coverage for primary care to draw relevant policy learning for the contemporary US. RESULTS We identified that the US had a 22.5-fold higher mortality rate and a 2.3-fold higher opioid use disorder (OUD) rate compared to France, despite having rates of prescribed buprenorphine per-capita higher than, and per-person with OUD comparable to, than that of France. These wide gulfs between the scales and nature of the problems between France and the US suggest that relaxing restrictions on buprenorphine prescribing through abolishing the X waiver will be insufficient for achieving hoped-for reductions in overdose mortality. CONCLUSION Health system strengthening with a focus on improvements in primary care prescriber supply, coverage, and coordination are likely higher yield policy complements to relaxing buprenorphine regulation. Such an approach would better prepare the US to adapt to ongoing dynamics and uncertainties in the opioid crisis and to optimize the already relatively high levels of buprenorphine prescribing.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Humber River Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Kellia Chiu
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, United States
| | - Julie Dupouy
- University Department of General Medicine, University of Toulouse, Faculty of Medicine, Toulouse, France; Inserm UMR1295, University of Toulouse III, Faculty of Medicine, Toulouse, France
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Manzotti A, Avery-Desmarais S, Ducharme M, Elliott K, Misto K. Improving Nurses' Attitudes Toward Substance Use Disorder: Screening, Brief Intervention, and Referral to Treatment. J Addict Nurs 2023; 34:266-272. [PMID: 38015577 DOI: 10.1097/jan.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Patients with substance use disorder (SUD) encounter many barriers to healthcare, including negative attitudes of healthcare personnel. Compared with other healthcare professions, nurses have been reported as having less tolerant attitudes toward patients with SUD. Knowledge acquisition combined with role support has been shown to improve therapeutic attitudes of nurses toward patients with SUD. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based educational intervention aimed to improve the outcomes of patients at risk and with SUD. SBIRT education has been shown as an effective educational tool with licensed nurses. Therefore, the aim of this study was to evaluate whether a 2-hour educational session on SBIRT (Mitchell et al., 2013) improved the therapeutic attitudes of nurses toward patients with SUD. Peplau's theory of interpersonal relations guided this study with an emphasis on the nurse-patient relationship. A quasi-experimental pretest/posttest design was used to evaluate nurses' attitudes pre and post a 2-hour educational session. Participants included 65 registered nurses employed in a 247-bed teaching hospital in New England. Attitudes were measured before and after the educational session using the 20-item, five-subscale Drug and Drug Problems Perceptions Questionnaire. A paired t test was performed, showing statistically significant improvements in attitudes postintervention. Prior education on SUD significantly correlated with baseline attitudes. A standard regression model, with practice setting, family history of SUD, and prior education as dependent variables, was not predictive of baseline attitudes. The results suggest conducting SBIRT should be considered a mandatory nursing competency, both in undergraduate curriculum and among licensed nurses.
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López-Ramírez E, Huber MJ, Matías-Pérez D, Santos-López G, García-Montalvo IA. Opioid harm reduction and stigma: proposed methods to improve the perception of people with addiction. Front Psychiatry 2023; 14:1197305. [PMID: 37636822 PMCID: PMC10447975 DOI: 10.3389/fpsyt.2023.1197305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Enrique López-Ramírez
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México/Instituto Tecnológico de Oaxaca, Oaxaca, Mexico
| | - Mary J. Huber
- Clinical Rehabilitation Program, Wright State University, Dayton, OH, United States
| | - Diana Matías-Pérez
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México/Instituto Tecnológico de Oaxaca, Oaxaca, Mexico
- Facultad de Medicina y Cirugía, Universidad Regional del Sureste, Oaxaca, Mexico
| | - Gonzalo Santos-López
- Departamento de Ingeniería en Desarrollo Comunitario, Tecnológico Nacional de México/Instituto Tecnológico del Valle de Etla, Oaxaca, Mexico
| | - Iván Antonio García-Montalvo
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México/Instituto Tecnológico de Oaxaca, Oaxaca, Mexico
- Facultad de Medicina y Cirugía, Universidad Regional del Sureste, Oaxaca, Mexico
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16
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Park JH, Kim SJ, Grajeda L, Ramirez A, Chang J. Does Opioid Use Disorder Matter for Health Care Utilization Among Lung Cancer Patients? Evidence from U.S. Hospitals During 2016-2020. Clin Drug Investig 2023; 43:635-642. [PMID: 37540484 DOI: 10.1007/s40261-023-01297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVE: The number of hospitalizations due to opioid use disorders in the USA increased steadily from 62,010 in 1998-2000 to 136,240 in 2015-2016; however, no health care utilization of lung cancer patients with opioid use disorder has been reported. The purpose of this paper is to investigate health care utilization due to opioid use disorder among lung cancer patients and to investigate additional charge status due to this disorder. METHODS The National Inpatient Sample of the USA was used to identify lung cancer patients (n = 11,418, weighted n = 557,090) from 2016 to 2020. The characteristics of patient samples, temporal trend of opioid use disorder, and its association with health care utilization measured by hospital charges were thoroughly examined by the multivariate survey linear regression model. RESULTS Among 557,090 lung cancer patients, 2.4% had opioid use disorder. The proportion of opioid use disorder among lung cancer patients during the study periods had continuously grown. Hospital charges also continued to increase during the study period and were higher among lung cancer patients with opioid use disorder. Survey linear results showed that opioid use disorder was associated with 12.6% higher hospital charges. Analysis of subgroups revealed that this trend was similar across p < the majority of social groups; however, it was significantly higher among Caucasian individuals (0.001) and self-pay groups (p = 0.035) than among others. CONCLUSIONS Research conducted has identified gaps in care in rural and suburban areas and a lack of equal care given to minority and low-income patients. These vulnerable groups access health care less often, are charged more for the care they receive, and often face multiple barriers to treatment. Unless these issues are addressed with a focus on socioeconomic factors, race, and region, the opioid epidemic will continue to negatively decimate these populations.
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Affiliation(s)
- Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Health care Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Lily Grajeda
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, 1114 TAMU, College Station, TX, U77843, USA
| | - Alexiya Ramirez
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, 1114 TAMU, College Station, TX, U77843, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, 1114 TAMU, College Station, TX, U77843, USA.
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17
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Parker RD, Meyer JA, Abram MA. National Data and the Applicability to Understanding Rural and Remote Substance Use. JOURNAL OF PREVENTION (2022) 2023; 44:491-500. [PMID: 37076724 PMCID: PMC10115368 DOI: 10.1007/s10935-023-00734-2] [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: 04/09/2023] [Indexed: 04/21/2023]
Abstract
Responding to increases in overdose, addiction, and substance misuse, local public health experts need accurate data to plan and implement evidence-based prevention and treatment programs. In many countries, national data are the tool most readily available for these efforts. In the United States, the National Study on Drug Use and Health and the Treatment Episode Data Set are data sources used by states to determine the extent of addiction. This project sought to determine if these national data sources are applicable for local use in addiction prevention and program planning. NSDUH prevalence estimates from 2015 to 2019 were applied to the state population to determine the number of persons estimated to be substance users. The prevalence estimates were compared over time with the population data and substance use treatment admissions to assess the covariance and population change as an indicator of efficacy. The primary drivers of fatal overdose in Alaska are fentanyl, heroin, and methamphetamine. Fentanyl use was not assessed in either dataset. When applying the estimated use prevalence to the population, heroin users varied annually by 1777 persons and methamphetamine varied up to 2143 persons. These observed variances did not correspond with state population changes nor any trend in the persons seeking treatment for these substances. Our analyses do not support the use of NSDUH data for planning in rural and remote areas. The methods used in NSDUH data collection exclude ~ 20% of the state population, mostly Native persons, based on location and language. The annual prevalence estimates applied to the population did not correspond with changes in population nor changes in treatment. Fentanyl, which causes the most overdoses in Alaska and is of primary concern locally, was not assessed.
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Affiliation(s)
- R D Parker
- Center for Alcohol and Addiction Studies, University of Alaska, 3211 Providence Drive, Anchorage, AK, 99508, USA.
| | - J A Meyer
- Division of Population Health Sciences, University of Alaska, Anchorage, AK, USA
| | - M A Abram
- Psychiatric Nurse Practitioner Program, College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
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Creanga-Murariu I, Filipiuc LE, Cuciureanu M, Tamba BI, Alexa-Stratulat T. Should oncologists trust cannabinoids? Front Pharmacol 2023; 14:1211506. [PMID: 37521486 PMCID: PMC10373070 DOI: 10.3389/fphar.2023.1211506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Cannabis enjoyed a "golden age" as a medicinal product in the late 19th, early 20th century, but the increased risk of overdose and abuse led to its criminalization. However, the 21st century have witnessed a resurgence of interest and a large body of literature regarding the benefits of cannabinoids have emerged. As legalization and decriminalization have spread around the world, cancer patients are increasingly interested in the potential utility of cannabinoids. Although eager to discuss cannabis use with their oncologist, patients often find them to be reluctant, mainly because clinicians are still not convinced by the existing evidence-based data to guide their treatment plans. Physicians should prescribe cannabis only if a careful explanation can be provided and follow up response evaluation ensured, making it mandatory for them to be up to date with the positive and also negative aspects of the cannabis in the case of cancer patients. Consequently, this article aims to bring some clarifications to clinicians regarding the sometimes-confusing various nomenclature under which this plant is mentioned, current legislation and the existing evidence (both preclinical and clinical) for the utility of cannabinoids in cancer patients, for either palliation of the associated symptoms or even the potential antitumor effects that cannabinoids may have.
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Affiliation(s)
- Ioana Creanga-Murariu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Oncology Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Leontina Elena Filipiuc
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Magda Cuciureanu
- Pharmacology Department, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Bogdan-Ionel Tamba
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Pharmacology Department, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
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Stonner MM, Skladman R, Bettlach CLR, Kennedy C, Mackinnon SE. Recruiting hand therapists improves disposal of unused opioid medication. J Hand Ther 2023; 36:507-513. [PMID: 35909068 DOI: 10.1016/j.jht.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Opioids often remain unused after upper extremity surgery, and leftover prescriptions are frequently diverted. When administered in a hand surgery clinic, an educational brochure outlining a simple method of opioid disposal has been shown to improve disposal rates after surgery. PURPOSE To understand whether administration of an opioid disposal educational brochure in a hand therapy clinic would increase opioid disposal rates, compared to a hand surgery clinic. STUDY DESIGN Prospective cohort study. METHODS Patients who presented to a hand therapy clinic postoperatively were recruited to participate in this prospective cohort study. An educational brochure outlining a simple method of opioid disposal was made available at the hand therapy and surgery clinics. A questionnaire was later issued to obtain: location of brochure receipt, demographic information, pre- and post-operative opioid use history, and opioid disposal patterns. Chi-square tests and multivariable binary logistic regression assessed associations between medication disposal and explanatory variables. RESULTS Patients who received the brochure were significantly more likely to dispose of excess opioid medication, compared to those who did not receive the brochure (57.1% vs 10.8%, p < .001). Patients who received the brochure at the hand therapy clinic were significantly more likely to dispose of excess opioids (86.4%) compared to those who received the brochure at the surgery clinic (25.0%). Older age was predictive of increased disposal (p =.028*). There were no significant associations between gender, length of follow-up, or surgery type with the incidence of opioid disposal. CONCLUSION Recruiting both hand therapists and surgeons in the distribution of a simple, educational brochure on opioid disposal can increase disposal rates. Patients who received the brochure from the hand therapist were more likely to dispose of excess opioids. The longstanding patient-therapist relationship creates an opportunity for educational initiatives and discussion of stigmatized topics, such as opioid use.
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Affiliation(s)
- Macyn M Stonner
- Program in Occupational Therapy, Milliken Hand Rehabilitation Center, Washington University School of Medicine, St. Louis, MO, USA.
| | - Rachel Skladman
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Carrie L Roth Bettlach
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Carie Kennedy
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Allen B, Urmanche A. NYC RxStat: Stakeholder perspectives on a national model public health and public safety partnership to reduce overdose deaths. EVALUATION AND PROGRAM PLANNING 2023; 98:102275. [PMID: 36924570 DOI: 10.1016/j.evalprogplan.2023.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/14/2023] [Accepted: 03/08/2023] [Indexed: 05/17/2023]
Abstract
NYC RxStat, the United States' first public health and public safety partnership aiming to reduce overdose deaths, began in 2012 and established a national model for cross-sector partnerships. The partnership aimed to integrate data-driven policing with actionable public health interventions and surveillance to develop and implement cross-sector overdose responses. With federal support, jurisdictions nationally have implemented public health and public safety partnerships modeled on RxStat. To inform partnership replication efforts, we conducted a stakeholder evaluation of RxStat. We conducted in-depth, semi-structured interviews with 25 current and former RxStat stakeholders. Interviews probed stakeholder perceptions of RxStat's successes, challenges, and opportunities for growth. Interview data were iteratively coded and thematically analyzed. Stakeholders reported certainty about the need for cross-sector collaboration and described cross-disciplinary tensions, challenges to collaboration and implementation, and opportunities for partnership optimization and growth. Findings informed 12 strategies to improve RxStat and partnerships in its model, organized into three opportunity areas: (1) ensure stakeholder and agency accountability; (2) build secure and mutually beneficial data systems; and (3) structure partnerships to facilitate equitable collaboration. Cross-sector partnerships offer a promising strategy to integrate the public health and safety sectors, but disciplinary tensions in approach may hamper implementation. Findings can inform efforts to implement and scale cross-sector partnerships.
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Affiliation(s)
- Bennett Allen
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, United States.
| | - Adelya Urmanche
- Department of Psychiatry, Mount Sinai Beth Israel, United States
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Kroelinger CD, Ellick KL, Levecke M, Rice ME, Mueller T, Akbarali S, Pliska E, Ko JY, Cox S, Barfield WD. Assessing Sustainability of State-Led Action Plans for the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community, 2018-2021. J Womens Health (Larchmt) 2023; 32:503-512. [PMID: 37159557 PMCID: PMC10563031 DOI: 10.1089/jwh.2023.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Objective(s): The opioid crisis affects the health and health care of pregnant and postpartum people and infants prenatally exposed to substances. A Learning Community (LC) among 15 states was implemented to improve services for these populations. States drafted action plans with goals, strategies, and activities. Materials and Methods: Qualitative data from action plans were analyzed to assess how reported activities aligned with focus areas each year. Year 2 focus areas were compared with year 1 to identify shifts or expansion of activities. States self-assessed progress at the LC closing meeting, reported goal completion, barriers and facilitators affecting goal completion, and sustainment strategies. Results: In year 2, many states included activities focused on access to and coordination of quality services (13 of 15 states) and provider awareness and training (11 of 15). Among 12 states participating in both years of the LC, 11 expanded activities to include at least one additional focus area, adding activities in financing and coverage of services (n = 6); consumer awareness and education (n = 5); or ethical, legal, and social considerations (n = 4). Of the 39 goals developed by states, 54% were completed, and of those not completed, 94% had ongoing activities. Barriers to goal completion included competing priorities and pandemic-related constraints, whereas facilitators involving use of the LC as a forum for information-sharing and leadership-supported goal completion. Sustainability strategies were continued provider training and partnership with Perinatal Quality Collaboratives. Conclusion: State LC participation supported sustainment of activities to improve health and health care for pregnant and postpartum people with opioid use disorder and infants prenatally exposed to substances.
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Affiliation(s)
- Charlan D. Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Promotion and Health Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kecia L. Ellick
- Centers for Disease Control and Prevention Foundation, Atlanta, Georgia, USA
| | - Madison Levecke
- Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Marion E. Rice
- Centers for Disease Control and Prevention Foundation, Atlanta, Georgia, USA
| | - Trisha Mueller
- Division of Reproductive Health, National Center for Chronic Disease Promotion and Health Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sanaa Akbarali
- Association of State and Territorial Health Officials, Arlington, Virginia, USA
| | - Ellen Pliska
- Association of State and Territorial Health Officials, Arlington, Virginia, USA
| | - Jean Y. Ko
- Division of Reproductive Health, National Center for Chronic Disease Promotion and Health Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Promotion and Health Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wanda D. Barfield
- Division of Reproductive Health, National Center for Chronic Disease Promotion and Health Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Rubel SK, Eisenstat M, Wolff J, Calevski M, Mital S. Scope of, Motivations for, and Outcomes Associated with Buprenorphine Diversion in the United States: A Scoping Review. Subst Use Misuse 2023; 58:685-697. [PMID: 36803159 PMCID: PMC10961708 DOI: 10.1080/10826084.2023.2177972] [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] [Indexed: 02/22/2023]
Abstract
BACKGROUND Expanding access to medications to treat opioid use disorder (OUD), such as buprenorphine, is an evidence-based response to the mounting drug overdose crisis. However, concerns about buprenorphine diversion persist and contribute to limited access. METHODS To inform decisions about expanding access, a scoping review was conducted on publications describing the scope of, motivations for, and outcomes associated with diverted buprenorphine in the U.S. RESULTS In the 57 included studies, definitions for diversion were inconsistent. Most studied use of illicitly-obtained buprenorphine. Across studies, the scope of buprenorphine diversion ranged from 0% to 100%, varying by sample type and recall period. Among samples of people receiving buprenorphine for OUD treatment, diversion peaked at 4.8%. Motivations for using diverted buprenorphine were self-treatment, management of drug use, to get high, and when drug of choice was unavailable. Associated outcomes examined trended toward positive or neutral, including improved attitudes toward and retention in MOUD. CONCLUSIONS Despite inconsistent definitions of diversion, studies reported a low scope of diversion among people receiving MOUD, with inability to access treatment as a motivating factor for using diverted buprenorphine, and increased retention in MOUD as an outcome associated with use of diverted buprenorphine. Future research should explore reasons for diverted buprenorphine use in the context of expanded treatment availability to address persistent barriers to evidence-based treatment for OUD.
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Affiliation(s)
- Stephanie K Rubel
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew Eisenstat
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Wolff
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Calevski
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sasha Mital
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Healthcare Provider Reports on Social Determinants of Health in Opioid Treatment. PSYCH 2023. [DOI: 10.3390/psych5010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Opioid overdose and death from overdose continue to present a pressing problem in the United States. It is well-established that a range of social and economic factors, often referred to as social determinants of health (SDOH), are associated with increased opioid overdose and death. Few studies have examined healthcare provider reports on social and economic barriers to opioid treatment. Healthcare providers (N = 161) participating in opioid Project ECHO (Extension for Community Healthcare Outcomes) programs were surveyed on the portion of their patients experiencing 15 different SDOH. Results indicated that multiple determinants were experienced by the majority of their patients, with poverty as the most commonly experienced social determinant (72%). Regression analyses indicated that physicians generally reported a lower portion of patients experiencing SDOH compared with social workers, nurse practitioners, and other healthcare providers. Results suggest that SDOH are widely experienced by patients seeking opioid treatment and that professional backgrounds may be related to reports of SDOH at the point of care. Multi-disciplinary teams involving social workers, nurse practitioners, and other healthcare providers may improve the identification of social and economic barriers to opioid treatment.
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Bailey A, Evans EA. Holyoke Early Access to Recovery and Treatment (HEART): A case study of a court-based intervention to reduce opioid overdose. J Ethn Subst Abuse 2023:1-23. [PMID: 36715087 PMCID: PMC10387124 DOI: 10.1080/15332640.2023.2172758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The District Court in Holyoke, Massachusetts, is among the first courts nationwide to provide access to medications for opioid use disorder (MOUD) and other treatment. The program uses an innovative multisectoral approach to serve a primarily Latinx population living in communities of concentrated poverty with high opioid overdose rates. We document the origins, adaptations, and current status of program operations, including the use of on-site peer recovery specialists and robust data collection efforts. From August 16, 2021, to February 28, 2022, of the 1040 individuals who entered the court for an arraignment, 47.9% (n = 498) were eligible for program participation. Of those 498 individuals, 54.2% (n = 270) spoke with a recovery specialist. Many self-identified as Latinx (53.0%) and male (69.3%). Over one-fourth (27.0%) were connected to a long-term peer recovery specialist and 11.5% were directly connected to a MOUD provider. Semi-structured interviews with key implementers and participants revealed a shared appreciation for the life-saving efforts of the program. We conclude with practical and theoretical considerations required to offer linkage to MOUD in court-based contexts. Future efforts will assess participant outcomes to determine whether the program is an effective and feasible intervention that can be adopted by other court-based settings.
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Affiliation(s)
- Amelia Bailey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst
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Bailey A, Harrington C, Evans EA. A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes. HEALTH & JUSTICE 2023; 11:3. [PMID: 36707446 PMCID: PMC9883127 DOI: 10.1186/s40352-022-00201-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND An emergent intervention to address the opioid epidemic is the use of multidisciplinary outreach teams which connect an individual in the community to healthcare resources after the experience of an opioid overdose. While these interventions are receiving federal funding, less is known empirically to inform future interventions. Understanding the process and outcomes of these interventions is advisable due to the novel partnerships of public health and law enforcement agencies who sometimes hold divergent goals. The objective of the present review was to describe program structure and evaluated outcomes of community-based post-overdose interventions. RESULTS A search of PubMed, PsycInfo, and Web of Science yielded 5 peer-reviewed articles that detail the implementation and outcomes of interventions delivered in the United States published from 2001 to July 2021. Most interventions used a multidisciplinary outreach team and referenced first responder data to contact individuals who recently experienced an overdose at their residence. Services offered often included referral to substance use treatment, recovery coaches, and social services. Method of outreach, evaluation measures, and outcomes varied. From the available literature, facilitators of program engagement included communication, information sharing, and leadership buy-in among multidisciplinary partners. CONCLUSIONS Future studies could benefit from exploration of service provision in rural areas, for family affected by overdose, and for minoritized populations. Community-based post-overdose interventions utilizing a law enforcement partnership are emergent with promising yet limited examples in empirical literature.
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Affiliation(s)
- Amelia Bailey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02912 USA
| | - Calla Harrington
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
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26
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Cobb CD, Allen SN, Cusimano JM, Ding M, Eloma AS, Ott CA, Tallian KB. Social Determinants of Health in People Living with Psychiatric Disorders: The Role of Pharmacists. Health Equity 2023; 7:223-234. [PMID: 37096056 PMCID: PMC10122249 DOI: 10.1089/heq.2022.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/26/2023] Open
Abstract
Introduction Social determinants of health (SDOH) affect outcomes of people living with psychiatric disorders, including substance use disorders. As experts in medication optimization, pharmacists play a vital role in identifying and addressing medication-related problems associated with SDOH. However, there is a paucity of literature on how pharmacists can be part of the solution. Objective The purpose of this article is to provide a narrative review and commentary on the intersection between SDOH, medication-related outcomes in people living with psychiatric disorders, and the role of pharmacists in addressing them. Method The American Association of Psychiatric Pharmacists appointed an expert panel to research the issue, identify barriers, and develop a framework for including pharmacists in addressing medication therapy problems associated with SDOH in people with psychiatric disorders. The panel used Healthy People 2030 as the framework and sought input from public health officials to propose solutions for their commentary. Results We identified potential connections between SDOH and their impact on medication use in people with psychiatric disorders. We provide examples of how comprehensive medication management can afford opportunities for pharmacists to mitigate medication-related problems associated with SDOH. Conclusion Public health officials should be aware of the vital role that pharmacists play in addressing medication therapy problems associated with SDOH to improve health outcomes and to incorporate them in health promotion programs.
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Affiliation(s)
- Carla D. Cobb
- Capital Consulting, Billings, Montana, USA
- Address correspondence to: Carla D. Cobb, PharmD, BCPP, Capital Consulting, 8055 O Street, Suite S113, Lincoln, NE 68510, USA.
| | | | - Joseph M. Cusimano
- Pharmacy Practice Department, Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, Virginia, USA
| | | | - Amanda S. Eloma
- Kings County Hospital, NYC Health + Hospitals, Brooklyn, New York, USA
| | - Carol A. Ott
- Department of Pharmacy Practice, Purdue University/Eskenazi Health, Indianapolis, Indiana, USA
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Bartholomew JB, Bute JJ. Exploring Internal Medicine Interns' Educational Experiences on Opioid Addiction: A Narrative Analysis. HEALTH COMMUNICATION 2023; 38:169-176. [PMID: 34114896 DOI: 10.1080/10410236.2021.1939232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Increased efforts to educate physicians on addiction are crucial based on widespread addiction rates and the ongoing opioid crisis. Physicians in the United States hesitate to adopt medication-assisted treatment (MAT) due to a lack of addiction education. For this study, we used a narrative framework to understand how internal medicine interns (first-year residents) recount their educational experiences on addiction during their medical school education and early residency. In using a sensemaking function, our results revealed four types of narratives: dearth, futility, priority, and impact. We found that the narratives were interrelated and indicated that interns understood addiction as a disease yet felt unprepared to treat it. We also discovered that interns did not fully appreciate the nuances of addiction. Their attempts to engage patients in substance recovery or reduction were often unsuccessful, leaving them feeling disappointed. Interns had mixed feelings when working with addiction-related issues as patients' addiction was rarely ever addressed. Interns also encountered "eye-opening" events leaving them astonished. Thus, shaping their views on the opioid crisis, and by extension, addiction. Increasing medical students' and residents' competency through practical education and training may improve physician comfort and confidence leading to the adoption of opioid addiction treatment such as MAT, potentially reducing the opioid epidemic.
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Affiliation(s)
| | - Jennifer J Bute
- Department of Communication Studies, Indiana University-Purdue University
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Bolivar D, Hartung D, Silcox J, Bratberg J, Boggis J, Rabin M, Green TC. Examining the effects of COVID-19 on pharmacy dispensing of naloxone and syringes sales across Massachusetts and New Hampshire. J Am Pharm Assoc (2003) 2023; 63:330-335.e1. [PMID: 36369076 PMCID: PMC9574786 DOI: 10.1016/j.japh.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) lockdowns disrupted access to harm reduction supplies and services known to be effective in overdose prevention and contributed to a worsening of the opioid crisis. However, because pharmacies can provide naloxone and sell over-the-counter (OTC) sterile syringes, their continued operation throughout the pandemic potentially reinforced a public health role as a distribution hub for safer use supplies. OBJECTIVES The objective of this analysis was to examine patterns of naloxone and OTC syringe sale volume at 463 community pharmacies in 2 states with high overdose rates during the COVID-19 pandemic. METHODS We analyzed weekly pharmacy-level dispensing data from January 5, 2020, to December 31, 2020, from one corporate community pharmacy chain in Massachusetts (n = 415 pharmacies) and New Hampshire (n = 48 pharmacies). Descriptive statistics and visualizations over the analytical period were generated as initial explorations of the outcome. Zero-inflated Poisson and negative binomial models were used to analyze distribution data along with county-level COVID-19 case rates and store-level COVID-19 testing location status during the same time. Interactions tested the effect of COVID-19 case rates on naloxone and OTC syringe sales. RESULTS Pharmacies that reported selling nonprescription syringes and dispensing naloxone during the study period averaged 210.13 OTC syringes sold and 0.53 naloxone prescriptions per week. Pharmacies in communities that experienced greater COVID-19 case burden also exhibited higher naloxone dispensing and OTC syringe sales during this period. The odds of selling OTC syringes increased over time but naloxone dispensing remained constant over the pandemic year. Pharmacies hosting COVID-19 testing tended to have lower OTC syringe sales and naloxone provision than nontesting sites. CONCLUSION During the COVID-19 pandemic, pharmacies provided harm reduction services and dispensed lifesaving medications by quickly adapting to fulfill community needs without disrupting co-located services for COVID-19 response.
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Affiliation(s)
| | | | | | | | | | | | - Traci C. Green
- Correspondence: Traci C. Green, PhD, MSc, Professor, Heller School for Social Policy and Management, Brandeis University, Heller-Brown Bldg., 415 South St., Waltham, MA 02453
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Clark R, Kuffel RL, Neylan TC, Maguen S, Li Y, Boscardin WJ, Byers AL. Posttraumatic stress disorder, suicide, and unintended overdose death in later life: A national cohort study of veterans aged 50 and older. J Am Geriatr Soc 2022; 71:1462-1472. [PMID: 36573640 DOI: 10.1111/jgs.18199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/02/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES Although studies have shown posttraumatic stress disorder (PTSD) associated with risk of suicide, the relationship in later life, especially for overdose death, remains unclear. Thus, the aim of the current study was to determine associations between PTSD, suicide, and unintended overdose death in mid- to late-life. METHODS A nationwide cohort study integrating Department of Veterans Affairs' (VA) data, Centers for Medicare & Medicaid Services data, and national cause-specific mortality data. Participants were US veterans aged ≥50 years with PTSD diagnoses at baseline (2012-2013) and were propensity-matched 1:1 with patients without PTSD based on sociodemographics, Charlson Comorbidity Index, and neuropsychiatric disorders (N = 951,018). Information on suicide attempts and unintended death by overdose through December 31, 2017 was provided by the VA's National Suicide Prevention Applications Network (non-fatal attempts) and Mortality Data Repository (death). RESULTS Veterans with PTSD (N = 475,509) had increased risk of suicide attempt (Hazard Ratio [HR], 1.59; 95% CI, 1.54-1.65; p < 0.001), non-fatal attempt (HR, 1.74; 95% CI, 1.67-1.81; p < 0.001), drug overdose death overall (HR, 1.32; 95% CI, 1.22-1.42; p < 0.001), and suicide overdose death (HR, 1.44; 95% CI, 1.15-1.80; p = 0.002), even after adjusting for sociodemographics, Charlson comorbidity index, and neuropsychiatric disorders. We found increased risk for overdose death by narcotics (HR, 1.30; 95% CI, 1.15-1.46; p < 0.001), antiepileptic/sedative-hypnotics (HR, 1.29; 95% CI, 1.02-1.62; p = 0.032), and for other/unspecified drugs (HR, 1.35; 95% CI, 1.20-1.51; p < 0.001), the last category indicative of polydrug. Results remained robust when examined for unintentional, suicide, and undetermined intent for cause-specific death by other/unspecified drugs. CONCLUSIONS PTSD persists throughout mid- to late-life with considerable increased risk for non-fatal suicide attempts and suicide overdose death. These findings suggest the importance of drug-monitoring in preventing late-life suicide.
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Affiliation(s)
- Ryan Clark
- Northern California Institute for Research and Education San Francisco California USA
- San Francisco Veterans Affairs Health Care System San Francisco California USA
| | - Randall L. Kuffel
- Northern California Institute for Research and Education San Francisco California USA
- San Francisco Veterans Affairs Health Care System San Francisco California USA
| | - Thomas C. Neylan
- San Francisco Veterans Affairs Health Care System San Francisco California USA
- Department of Psychiatry and Behavioral Sciences University of California, San Francisco San Francisco California USA
- Department of Neurology University of California, San Francisco San Francisco California USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System San Francisco California USA
- Department of Psychiatry and Behavioral Sciences University of California, San Francisco San Francisco California USA
| | - Yixia Li
- Northern California Institute for Research and Education San Francisco California USA
- San Francisco Veterans Affairs Health Care System San Francisco California USA
| | - W. John Boscardin
- San Francisco Veterans Affairs Health Care System San Francisco California USA
- Department of Medicine, Division of Geriatrics University of California, San Francisco San Francisco California USA
- Department of Epidemiology & Biostatistics University of California, San Francisco San Francisco California USA
| | - Amy L. Byers
- San Francisco Veterans Affairs Health Care System San Francisco California USA
- Department of Psychiatry and Behavioral Sciences University of California, San Francisco San Francisco California USA
- Department of Medicine, Division of Geriatrics University of California, San Francisco San Francisco California USA
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Wallace B, van Roode T, Burek P, Hore D, Pauly B. Everywhere and for everyone: proportionate universalism as a framework for equitable access to community drug checking. Harm Reduct J 2022; 19:143. [PMID: 36539747 PMCID: PMC9763810 DOI: 10.1186/s12954-022-00727-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Illicit drug overdoses have reached unprecedented levels, exacerbated by the COVID-19 pandemic. Responses are needed that address the increasingly potent and unpredictable drug supply with better reach to a wide population at risk for overdose. Drug checking is a potential response offered mainly within existing harm reduction services, but strategies are needed to increase reach and improve equitable delivery of drug checking services. METHODS The purpose of this qualitative study was to explore how to extend the reach of drug checking services to a wide population at risk of overdose. We conducted 26 in-depth interviews with potential service users to identify barriers to service use and strategies to increase equitable delivery of drug checking services. Our analysis was informed by theoretical perspectives on equity, and themes were developed relevant to equitable delivery through attention to quality dimensions of service use: accessibility, appropriateness, effectiveness, safety, and respect. RESULTS Barriers to equitable service delivery included criminalization and stigma, geographic and access issues, and lack of cultural appropriateness that deter service use for a broad population with diverse needs. Strategies to enhance equitable access include 1ocating services widely throughout communities, integrating drug checking within existing health care services, reframing away from risk messaging, engaging peers from a broad range of backgrounds, and using discrete methods of delivery to help create safer spaces and better reach diverse populations at risk for overdose. CONCLUSIONS We propose proportionate universalism in drug checking as a guiding framework for the implementation of community drug checking as an equity-oriented harm reduction intervention and as a population health response. Both a universal equity-oriented approach and multiple tailored approaches are required to facilitate drug checking services that maximize reach and appropriateness to respond to diverse needs.
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Affiliation(s)
- Bruce Wallace
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada ,grid.143640.40000 0004 1936 9465School of Social Work, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Thea van Roode
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Piotr Burek
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Dennis Hore
- grid.143640.40000 0004 1936 9465Department of Chemistry, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC Canada ,grid.143640.40000 0004 1936 9465Department of Computer Science, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Bernadette Pauly
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
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Luo Z, Roychoudhury C, Pompos WS, DiMaria J, Robinette CM, Gore PH, Roychoudhury R, Beecroft W. Prevention of 90-day inpatient detoxification readmission for opioid use disorder by a community-based life-changing individualized medically assisted evidence-based treatment (C.L.I.M.B.) program: A quasi-experimental study. PLoS One 2022; 17:e0278208. [PMID: 36520863 PMCID: PMC9754176 DOI: 10.1371/journal.pone.0278208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Evidence for community-based strategies to reduce inpatient detoxification readmission for opioid use disorder (OUD) is scant. A pilot program was designed to provide individualized structured treatment plans, including addressing prolonged withdrawal symptoms, family/systems assessment, and contingency management, to reduce readmission after the index inpatient detoxification. METHODS A non-randomized quasi-experimental design was used to compare the pilot facilities (treatment) and comparison facilities before and after the program started, i.e., a simple difference-in-differences (DID) strategy. Adults 18 years and older who met the Diagnostic and Statistical Manual of Mental Disorders version 5 criteria for OUD and had an inpatient detoxification admission at any OUD treatment facility in two study periods between 7/2016 and 3/2020 were included. Readmission for inpatient detoxification in 90-days after the index stay was the primary outcome, and partial hospitalization, intensive outpatient care, outpatient services, and medications for OUD were the secondary outcomes. Six statistical estimation methods were used to triangulate evidence and adjust for potential confounding factors between treatment and comparison groups. RESULTS A total of 2,320 unique patients in the pilot and comparison facilities with 2,443 index inpatient detoxification admissions in the pre- and post-periods were included. Compared with patients in comparison facilities, patients in the C.L.I.M.B. facilities had higher readmission in the pre-period (unadjusted readmission 17.0% vs. 10.6%), but similar rates in the post-period (12.3% vs. 10.6%) after the implementation of the pilot program. For 90-day readmission, all DID estimates were not statistically significant (adjusted estimates ranged from 6 to 9 percentage points difference favoring the C.L.I.M.B. program). There was no significant improvement in the secondary outcomes of utilizations in lower level of care and medications for OUD in C.L.I.M.B. facilities. CONCLUSIONS We found a reduction in readmission in the pilot facilities between the two periods, but the results were not statistically significant compared with the comparison facilities and the utilization of lower level of care services remained low. Even though providers in the pilot OUD treatment facilities actively worked with health plans to standardize care for patients with OUD, more strategies are needed to improve treatment engagement and retention after an inpatient detoxification.
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Affiliation(s)
- Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
- * E-mail:
| | - Canopy Roychoudhury
- Health Care Value Business Analytics Services, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - William S. Pompos
- Behavioral Health Strategy & Planning, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - James DiMaria
- Health Care Value Business Analytics Services, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - Cynthia M. Robinette
- Health Care Value Business Analytics Services, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - Purva H. Gore
- Health Care Value Business Analytics Services, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - Rohon Roychoudhury
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - William Beecroft
- Behavioral Health Strategy & Planning, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
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Gamble MC, Williams BR, Singh N, Posa L, Freyberg Z, Logan RW, Puig S. Mu-opioid receptor and receptor tyrosine kinase crosstalk: Implications in mechanisms of opioid tolerance, reduced analgesia to neuropathic pain, dependence, and reward. Front Syst Neurosci 2022; 16:1059089. [PMID: 36532632 PMCID: PMC9751598 DOI: 10.3389/fnsys.2022.1059089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 07/30/2023] Open
Abstract
Despite the prevalence of opioid misuse, opioids remain the frontline treatment regimen for severe pain. However, opioid safety is hampered by side-effects such as analgesic tolerance, reduced analgesia to neuropathic pain, physical dependence, or reward. These side effects promote development of opioid use disorders and ultimately cause overdose deaths due to opioid-induced respiratory depression. The intertwined nature of signaling via μ-opioid receptors (MOR), the primary target of prescription opioids, with signaling pathways responsible for opioid side-effects presents important challenges. Therefore, a critical objective is to uncouple cellular and molecular mechanisms that selectively modulate analgesia from those that mediate side-effects. One such mechanism could be the transactivation of receptor tyrosine kinases (RTKs) via MOR. Notably, MOR-mediated side-effects can be uncoupled from analgesia signaling via targeting RTK family receptors, highlighting physiological relevance of MOR-RTKs crosstalk. This review focuses on the current state of knowledge surrounding the basic pharmacology of RTKs and bidirectional regulation of MOR signaling, as well as how MOR-RTK signaling may modulate undesirable effects of chronic opioid use, including opioid analgesic tolerance, reduced analgesia to neuropathic pain, physical dependence, and reward. Further research is needed to better understand RTK-MOR transactivation signaling pathways, and to determine if RTKs are a plausible therapeutic target for mitigating opioid side effects.
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Affiliation(s)
- Mackenzie C. Gamble
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
- Molecular and Translational Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Benjamin R. Williams
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
| | - Navsharan Singh
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
| | - Luca Posa
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
| | - Zachary Freyberg
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ryan W. Logan
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
- Center for Systems Neuroscience, Boston University, Boston, MA, United States
| | - Stephanie Puig
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
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Tormohlen KN, McCourt AD, Schmid I, Stone EM, Stuart EA, Davis C, Bicket MC, McGinty EE. State prescribing cap laws' association with opioid analgesic prescribing and opioid overdose. Drug Alcohol Depend 2022; 240:109626. [PMID: 36115221 PMCID: PMC9893520 DOI: 10.1016/j.drugalcdep.2022.109626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In response to the role of opioid prescribing in the U.S. opioid crisis, states have enacted laws intended to curb high risk opioid prescribing practices. This study assessed the effects of state prescribing cap laws that limit the dose and/or duration of dispensed opioid prescriptions on opioid prescribing patterns and opioid overdose. METHODS We identified 1,414,908 adults from a large U.S. administrative insurance claims database. Treatment states included 32 states that implemented a prescribing cap law between 2017 and 2019. Comparison states included 16 states and DC without a prescribing cap law by 2019. A difference-in-differences approach with staggered policy adoption was used to assess effects of these laws on opioid analgesic prescribing and opioid overdose. RESULTS State opioid prescribing cap laws were not associated with changes in the proportion of people receiving opioid analgesic prescriptions, the dose or duration of opioid prescriptions, or opioid overdose. States with laws that imposed days' supply limits only versus days' supply and dosage limits, as well as with specific law provisions also showed no association with opioid prescribing or opioid overdose outcomes. CONCLUSIONS State opioid prescribing cap laws did not appear to impact outcomes related to opioid analgesic prescribing or opioid overdose. These findings are potentially due to the limited scope of these laws, which often apply only to a subset of opioid prescriptions and include professional judgment exemptions.
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Affiliation(s)
- Kayla N Tormohlen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 357, Baltimore, MD 21205, USA.
| | - Alex D McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Elizabeth A Stuart
- Departments of Mental Health, Biostatistics, Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 839, Baltimore, MD 21205, USA.
| | - Corey Davis
- Harm Reduction Legal Project, Network for Public Health Law, 7101 York Avenue South, #270, Edina, MN 55435, USA.
| | - Mark C Bicket
- Departments of Anesthesiology, Health Management and Policy, University of Michigan, School of Public Health, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5048, USA.
| | - Emma E McGinty
- Department of Health Policy and Management, Center for Mental Health and Addiction Policy, ALACRITY Center for Health and Longevity in Mental Illness, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, USA.
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Buckley C, Ye Y, Kerr WC, Mulia N, Puka K, Rehm J, Probst C. Trends in mortality from alcohol, opioid, and combined alcohol and opioid poisonings by sex, educational attainment, and race and ethnicity for the United States 2000-2019. BMC Med 2022; 20:405. [PMID: 36280833 PMCID: PMC9590383 DOI: 10.1186/s12916-022-02590-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The ongoing opioid epidemic and increases in alcohol-related mortality are key public health concerns in the USA, with well-documented inequalities in the degree to which groups with low and high education are affected. This study aimed to quantify disparities over time between educational and racial and ethnic groups in sex-specific mortality rates for opioid, alcohol, and combined alcohol and opioid poisonings in the USA. METHODS The 2000-2019 Multiple Cause of Death Files from the National Vital Statistics System (NVSS) were used alongside population counts from the Current Population Survey 2000-2019. Alcohol, opioid, and combined alcohol and opioid poisonings were assigned using ICD-10 codes. Sex-stratified generalized least square regression models quantified differences between educational and racial and ethnic groups and changes in educational inequalities over time. RESULTS Between 2000 and 2019, there was a 6.4-fold increase in opioid poisoning deaths, a 4.6-fold increase in combined alcohol and opioid poisoning deaths, and a 2.1-fold increase in alcohol poisoning deaths. Educational inequalities were observed for all poisoning outcomes, increasing over time for opioid-only and combined alcohol and opioid mortality. For non-Hispanic White Americans, the largest educational inequalities were observed for opioid poisonings and rates were 7.5 (men) and 7.2 (women) times higher in low compared to high education groups. Combined alcohol and opioid poisonings had larger educational inequalities for non-Hispanic Black men and women (relative to non-Hispanic White), with rates 8.9 (men) and 10.9 (women) times higher in low compared to high education groups. CONCLUSIONS For all types of poisoning, our analysis indicates wide and increasing gaps between those with low and high education with the largest inequalities observed for opioid-involved poisonings for non-Hispanic Black and White men and women. This study highlights population sub-groups such as individuals with low education who may be at the highest risk of increasing mortality from combined alcohol and opioid poisonings. Thereby the findings are crucial for the development of targeted public health interventions to reduce poisoning mortality and the socioeconomic inequalities related to it.
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Affiliation(s)
- Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health & Department of Psychiatry, University of Toronto, Toronto, Canada.,Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada. .,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation. .,Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Butler KE, Baker ES. A High-Throughput Ion Mobility Spectrometry-Mass Spectrometry Screening Method for Opioid Profiling. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2022; 33:1904-1913. [PMID: 36136315 PMCID: PMC9616473 DOI: 10.1021/jasms.2c00186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In 2017, the United States Department of Health and Human Services declared the widespread misuse and abuse of prescription and illicit opioids an epidemic. However, this epidemic dates back to the 1990s when opioids were extensively prescribed for pain management. Currently, opioids are still recommended for pain management, and given their abuse potential, rapid screening is imperative for patient treatment. Of particular importance is assessing pain management patient compliance, where evaluating drug use is crucial for preventing opioid abuse and potential overdoses. In this work, we utilized drift tube ion mobility spectrometry coupled with mass spectrometry (DTIMS-MS) to develop a rapid screening method for 33 target opioids and opioid urinary metabolites. Collision cross section values were determined for all target molecules using a flow-injection DTIMS-MS method, and clear differentiation of 27 out of the 33 opioids without prior chromatographic separation was observed when utilizing a high resolution demultiplexing screening approach. An automated solid phase extraction (SPE) platform was then coupled to DTIMS-MS for 10 s sample-to-sample analyses. This SPE-IMS-MS approach enabled the rapid screening of urine samples for opioids and presents a major improvement in sample throughput compared to traditional chromatographic analyses coupled with MS, which routinely take several minutes per sample. Overall, this vast reduction in analysis time facilitates a faster turn-around for patient samples, providing great benefits to clinical applications.
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Affiliation(s)
- Karen E Butler
- Department of Chemistry, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Erin S Baker
- Department of Chemistry, North Carolina State University, Raleigh, North Carolina 27695, United States
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina 27695, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27695, United States
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36
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Messinger JC, Ikeda DJ, Sarpatwari A. Civil commitment for opioid misuse: do short-term benefits outweigh long-term harms? JOURNAL OF MEDICAL ETHICS 2022; 48:608-610. [PMID: 34045279 DOI: 10.1136/medethics-2020-107160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment-the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalise proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.
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Affiliation(s)
| | | | - Ameet Sarpatwari
- Program On Regulation, Therapuetics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Israel B, Wiprovnick AE, Belcher AM, Kleinman MB, Ramprashad A, Spaderna M, Weintraub E. Practical Considerations for Treating Comorbid Posttraumatic Stress Disorder in the Addictions Clinic: Approaches to Clinical Care, Leadership, and Alleviating Shame. Psychiatr Clin North Am 2022; 45:375-414. [PMID: 36055729 DOI: 10.1016/j.psc.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
A practical, common-sense framework for recognizing and addressing comorbid posttraumatic stress disorder (PTSD) in the substance use disorder (SUD) clinic is outlined. The article focuses on strategies that can help establish trauma-informed care or augment an existing approach. Interventions are organized around the task of ameliorating shame (or shame sensitivity), which represents a transdiagnostic mediator of psychopathology and, potentially, capacity for change. Countershaming strategies can guide a trauma-responsive leadership approach. Considering the striking rate of underdiagnosis of PTSD among patients with SUD, implementing routine systematic PTSD screening likely represents the single most consequential trauma-informed intervention that SUD clinics can adopt.
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Affiliation(s)
- Benjamin Israel
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 4801 Yellowwood Ave, Ste 2E1, Baltimore, MD 21209, USA.
| | - Alicia E Wiprovnick
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| | - Mary B Kleinman
- Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, 4094 Campus Drive, College Park, MD 20742, USA
| | - Avinash Ramprashad
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| | - Max Spaderna
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
| | - Eric Weintraub
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
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38
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Krawczyk N, Allen ST, Schneider KE, Solomon K, Shah H, Morris M, Harris SJ, Sherman SG, Saloner B. Intersecting substance use treatment and harm reduction services: exploring the characteristics and service needs of a community-based sample of people who use drugs. Harm Reduct J 2022; 19:95. [PMID: 36002850 PMCID: PMC9400571 DOI: 10.1186/s12954-022-00676-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Substance use treatment and harm reduction services are essential components of comprehensive strategies for reducing the harms of drug use and overdose. However, these services have been historically siloed, and there is a need to better understand how programs that serve people who use drugs (PWUD) are integrating these services. In this study, we compared treatment and harm reduction services offered by a multistate sample of substance use service providers and assessed how well they align with characteristics and needs of clients they serve early in the COVID-19 pandemic. Methods We recruited a convenience sample of programs that deliver harm reduction and/or treatment services in ten US states. Program directors participated in a survey assessing the services offered at their program. We also recruited clients of these programs to participate in a survey assessing a range of sociodemographic and health characteristics, substance use behaviors, and health service utilization. We then cross-compared client characteristics and behaviors relative to services being offered through these programs. Results We collected and analyzed data from 511 clients attending 18 programs that we classified as either offering treatment with medications for opioid use disorder (MOUD) (N = 6), syringe service programs (SSP) (N = 8), or offering both MOUD and SSP (N = 4). All programs delivered a range of treatment and harm reduction services, with MOUD & SSP programs delivering the greatest breadth of services. There were discrepancies between services provided and characteristics and behaviors reported by clients: 80% of clients of programs that offered MOUD without SSP actively used drugs and 50% injected drugs; 40% of clients of programs that offered SSP without MOUD sought drug treatment services. Approximately half of clients were unemployed and unstably housed, but few programs offered direct social services. Conclusions In many ways, existing programs are not meeting the service needs of PWUD. Investing in innovative models that empower clients and integrate a range of accessible and flexible treatment, harm reduction and social services can pave the way for a more effective and equitable service system that considers the long-term health of PWUD.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, USA.
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kristin E Schneider
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Keisha Solomon
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hridika Shah
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Miles Morris
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Samantha J Harris
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Social Status and Opioid Drugged Driving. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221121121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the effects of social status on opioid drugged driving fatalities in the context of the ongoing opioid mortality crisis. Broad criminological insights are leveraged to understand how position in the age, race, and sex status hierarchies impacts opioid use by drivers. Analysis of data from the Fatality Analysis Reporting System shows that fatally injured drivers who used opioids prior to the crash were more often male, White, non-Hispanic, and older compared to other statuses. Moreover, the social statuses of opioid drugged drivers are dissimilar to those who used opioids in drug overdose deaths. Results suggest that social status-informed and driver-focused initiatives may be particularly effective in reducing opioid use by drivers.
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Sud A, Strang M, Buchman DZ, Spithoff S, Upshur REG, Webster F, Grundy Q. How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis. BMJ Open 2022; 12:e059561. [PMID: 35820738 PMCID: PMC9277368 DOI: 10.1136/bmjopen-2021-059561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Pharmaceutical industry involvement in medical education, research and clinical practice can lead to conflicts of interest. Within this context, this study examined how the 'Suboxone Education Programme', developed and delivered by a pharmaceutical company as part of a federally regulated risk management program, was presented as a solution to various kinds of risks relating to opioid use in public documents from medical institutions across Canada. SETTING These documents were issued during the Canadian opioid crisis, a time when the involvement of industry in health policy was being widely questioned given industry's role in driving the overprescribing of opioid analgesics and contributing to population-level harms. DESIGN A critical discourse analysis of 69 documents collected between July 2020 and May 2021 referencing the Suboxone Education Program spanning 13 years (2007-2021) from medical, nursing and pharmacy institutions sourced from every Canadian province and territory. Discursive themes were identified through iterative and duplicate analyses using a semistructured data extraction instrument. RESULTS Documents characterised the Programme as addressing iatrogenic risks from overprescribing opioid analgesics, environmental risks from a toxic street drug supply and pharmacological risks relating to the dominant therapeutic alternative of methadone. The programme was identified as being able to address these risks by providing mechanisms to surveil healthcare professionals and to facilitate the prescribing of Suboxone. Medical institutions legitimised the Suboxone Education Programme by lending their regulatory, epidemiological and professional authority. CONCLUSIONS Addressing risk is considered as a central, moral responsibility of contemporary healthcare services. In this case, moral imperatives to address opioid crisis-related risks overrode other ethical concerns regarding conflicts of interest between industry and public welfare. Failing to address these conflicts potentially imperils efforts of mitigating population health harms by propagating an important driving force of the opioid crisis.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
| | - Matthew Strang
- Department of Sociology, York University, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Bioethics Program, University Health Network, Toronto, Ontario, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Ross E G Upshur
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Quinn Grundy
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Twenty Years of Addiction and Mental Illness in Alaska: Using the National Survey on Drug Use and Health to Understand Addiction in a Low Population and Rural State. J Community Health 2022; 47:680-686. [PMID: 35567711 DOI: 10.1007/s10900-022-01098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
Understanding changes in substance use in a small population state is challenging. Many national datasets restrict data to reduce the probability of identifying persons. Alaska is a small population state (731,000 residents) with a large geographic region (25% the size of the lower 48), a diverse population, and highly variable seasons, with fewer than 10% of the state being road accessible. Given the uniqueness of Alaska, this project sought to understand what could be learned about addiction and its relationships with unemployment and median income in Alaska. National Survey on Drug Use and Health, State and Small Area Estimates (1999-2020) data were analyzed to measure prevalence changes. Outcome prevalence were independently correlated with median income and annual unemployment rate as the annual collection periods varied. Analyses were limited to simple bivariate analyses due to the data restrictions. Median income was found to have stronger correlational relationships and significant relationships with more negative outcomes compared to unemployment. While annual unemployment rates had statistically significant relationships with substance use outcomes, negative mental health outcomes appeared more related to unemployment than median income. Alcohol use in the past month, cigarette and tobacco use, and pain reliever misuse declined while binge drinking in the past month and illicit drug use increased. More people reported depression, serious mental illness, and suicidal ideation and planning over time peaking in the last year of data collection. While NSDUH data provide some idea of the changes in drug use over time, their effectiveness in Alaska is unknown. Many data sources claim they are nationally representative, but these statements cannot be objectively measured. We will use these outcomes and data as a baseline for future studies where we will explore state specific data sources.
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Morales-Gómez A, McVie S, Pantoja F. Controlled Delivery of Illegal Drug Parcels in Scotland: Does Policing Practice Align With a Public Health Approach Focused on Drug-Related Harm? JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221098986] [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
An increase in the flow of drugs into the UK via international postal systems poses challenges for law enforcement. ‘Controlled delivery’ can be used to disrupt supply networks and secure intelligence for prosecution; however, critics argue that law enforcement should instead focus on reducing drug-related harm. In Scotland, national drugs strategy adopts a public health approach but it is unclear whether this extends to policing practice. Therefore, this paper examines whether controlled delivery of drug parcels aligns with a public health policing approach. We find evidence of alignment in terms of potential harm to individual users, particularly in relation to legal highs, but not in terms of drug-related harms within the communities to which parcels were destined. We argue that further investigation is required in order to assess the extent to which political intent and policing practice in Scotland align around the principles of harm reduction and public health.
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Affiliation(s)
| | - Susan McVie
- School of Law, University of Edinburgh, Edinburgh, Scotland, UK
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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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The Potential of Methocinnamox as a Future Treatment for Opioid Use Disorder: A Narrative Review. PHARMACY 2022; 10:pharmacy10030048. [PMID: 35645327 PMCID: PMC9149874 DOI: 10.3390/pharmacy10030048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 02/01/2023] Open
Abstract
The opioid epidemic is an ongoing public health crisis, and the United States health system is overwhelmed with increasing numbers of opioid-related overdoses. Methocinnamox (MCAM) is a novel mu opioid receptor antagonist with an extended duration of action. MCAM has potential to reduce the burden of the opioid epidemic by being used as an overdose rescue treatment and a long-term treatment for opioid use disorder (OUD). The currently available treatments for OUD include naloxone, naltrexone, and methadone. These treatments have certain limitations, which include short duration of action, patient non-compliance, and diversion. A narrative review was conducted using PubMed and Google Scholar databases covering the history of the opioid epidemic, pain receptors, current OUD treatments and the novel drug MCAM. MCAM could potentially be used as both a rescue and long-term treatment for opioid misuse. This is due to its pseudo-irreversible antagonism of the mu opioid receptor, abnormally long duration of action of nearly two weeks, and the possibility of using kappa or delta opioid receptor agonists for pain management during OUD treatment. MCAM’s novel pharmacokinetic and pharmacodynamic properties open a new avenue for treating opioid misuse.
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Khan GK, Harvey L, Johnson S, Long P, Kimmel S, Pierre C, Drainoni ML. Integration of a community-based harm reduction program into a safety net hospital: a qualitative study. Harm Reduct J 2022; 19:35. [PMID: 35414072 PMCID: PMC9002225 DOI: 10.1186/s12954-022-00622-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background Community-based harm reduction programs reduce morbidity and mortality associated with drug use. While hospital-based inpatient addiction consult services can also improve outcomes for patients using drugs, inpatient clinical care is often focused on acute withdrawal and the medical management of substance use disorders. There has been limited exploration of the integration of community-based harm reduction programs into the hospital setting. We conducted a qualitative study to describe provider perspectives on the implementation of a harm reduction in-reach program.
Methods We conducted 24 semi-structured interviews with providers from three different primary work sites within a safety net hospital in Boston, MA, in 2021. Interviews explored perceived facilitators and barriers to the implementation of the harm reduction in-reach program in the hospital setting and solicited recommendations for potential improvements to the harm reduction in-reach program. Interviews were analyzed using an inductive approach that incorporated principles of grounded theory methodology to identify prevailing themes. Results Twenty-four participants were interviewed from the harm reduction in-reach program, inpatient addiction consult service, and the hospital observation unit. Thematic analysis revealed seven major themes and multiple facilitators and barriers to the implementation of the harm reduction in-reach program. Participants highlighted the impact of power differences within the medical hierarchy on inter-team communication and clinical care, the persistence of addiction-related stigma, the importance of coordination and role delineation between care team members, and the benefits of a streamlined referral process. Conclusions Harm reduction programs offer accessible, patient-centered, low-barrier care to patients using drugs. The integration of community-based harm reduction programs into the inpatient setting is a unique opportunity to bridge inpatient and outpatient care and expand the provision of harm reduction services. Trial registration: Not applicable.
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Affiliation(s)
- Ghulam Karim Khan
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd floor, Boston, MA, 02118, USA.
| | - Leah Harvey
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd floor, Boston, MA, 02118, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Samantha Johnson
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Project TRUST, Boston Medical Center, Boston, MA, USA
| | - Paul Long
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd floor, Boston, MA, 02118, USA
| | - Simeon Kimmel
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd floor, Boston, MA, 02118, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Project TRUST, Boston Medical Center, Boston, MA, USA
| | - Cassandra Pierre
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Infection Control, Boston Medical Center, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Lie AK, Hansen H, Herzberg D, Mold A, Jauffret-Roustide M, Dussauge I, Roberts SK, Greene J, Campbell N. The Harms of Constructing Addiction as a Chronic, Relapsing Brain Disease. Am J Public Health 2022; 112:S104-S108. [PMID: 35349310 PMCID: PMC8965190 DOI: 10.2105/ajph.2021.306645] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Anne K Lie
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
| | - Helena Hansen
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
| | - David Herzberg
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
| | - Alex Mold
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
| | - Marie Jauffret-Roustide
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
| | - Isa Dussauge
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
| | - Samuel K Roberts
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
| | - Jeremy Greene
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
| | - Nancy Campbell
- Anne K. Lie and Isa Dussauge are with the Department of Community Medicine and Global Health, University of Oslo, Norway. Helena Hansen is with the Department of Psychiatry and with Research Theme in Health Equity and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. David Herzberg is with the Department of History, University at Buffalo, State University of New York. Alex Mold is with the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Marie Jauffret-Roustide is with the Center for the Study of Social Movements (CNRS UMR 8044/INSERM U1276/EHESS) in Paris, France and with the Baldy Center for Law and Social Policy, University at Buffalo. Samuel K. Roberts is with the Departments of History and Sociomedical Sciences, Columbia University, New York, NY. Jeremy Greene is with the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine at Johns Hopkins University School of Medicine, Baltimore, MD. Nancy Campbell is with the Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, NY. Helena Hansen and Marie Jauffret-Roustide are also Guest Editors of this supplement issue
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Macassa G. Can the interconnection between public health and social work help address current and future population health challenges? A public health viewpoint. J Public Health Res 2022. [DOI: 10.1177/22799036221102653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The debate over the function and role of public health in all societies (high, middle, and low-income) still continues today. Public health needs to interact with the social and translational sciences to achieve the best possible scientific evidence and practice aimed at development of effective policies for individual and population health practices. As a field, public health is most suited for development of transdisciplinary education, research and practice—improving population health would entail embedding with a variety of other disciplines including social work. Public health and social work in many ways share the same beginnings as well as their role in advocacy for social and health equity. For this reason, the transdisciplinary profession of public health social work is well placed to develop and build the inter-professional and cross-sectoral collaboration that is needed to address the many health challenges of the 21st century, based on theories, knowledge and interventions from both public health and social work. Furthermore, the profession can help in attempting to close the health inequalities gap, address social isolation, family violence and homelessness, advance long and productive lives, create social responses to the changing environment, reduce economic inequality, harness technology for social good, and work toward the achievement of justice and equality of opportunity.
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Affiliation(s)
- Gloria Macassa
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Gävle, Sweden
- EPI Unit–Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Marshall BDL, Alexander-Scott N, Yedinak JL, Hallowell BD, Goedel WC, Allen B, Schell RC, Li Y, Krieger MS, Pratty C, Ahern J, Neill DB, Cerdá M. Preventing Overdose Using Information and Data from the Environment (PROVIDENT): protocol for a randomized, population-based, community intervention trial. Addiction 2022; 117:1152-1162. [PMID: 34729851 PMCID: PMC8904285 DOI: 10.1111/add.15731] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS In light of the accelerating drug overdose epidemic in North America, new strategies are needed to identify communities most at risk to prioritize geographically the existing public health resources (e.g. street outreach, naloxone distribution efforts). We aimed to develop PROVIDENT (Preventing Overdose using Information and Data from the Environment), a machine learning-based forecasting tool to predict future overdose deaths at the census block group (i.e. neighbourhood) level. DESIGN Randomized, population-based, community intervention trial. SETTING Rhode Island, USA. PARTICIPANTS All people who reside in Rhode Island during the study period may contribute data to either the model or the trial outcomes. INTERVENTION Each of the state's 39 municipalities will be randomized to the intervention (PROVIDENT) or comparator condition. An interactive, web-based tool will be developed to visualize the PROVIDENT model predictions. Municipalities assigned to the treatment arm will receive neighbourhood risk predictions from the PROVIDENT model, and state agencies and community-based organizations will direct resources to neighbourhoods identified as high risk. Municipalities assigned to the control arm will continue to receive surveillance information and overdose prevention resources, but they will not receive neighbourhood risk predictions. MEASUREMENTS The primary outcome is the municipal-level rate of fatal and non-fatal drug overdoses. Fatal overdoses will be defined as unintentional drug-related death; non-fatal overdoses will be defined as an emergency department visit for a suspected overdose reported through the state's syndromic surveillance system. Intervention efficacy will be assessed using Poisson or negative binomial regression to estimate incidence rate ratios comparing fatal and non-fatal overdose rates in treatment vs. control municipalities. COMMENTS The findings will inform the utility of predictive modelling as a tool to improve public health decision-making and inform resource allocation to communities that should be prioritized for prevention, treatment, recovery and overdose rescue services.
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Affiliation(s)
- Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - Jesse L. Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - William C. Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Bennett Allen
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Robert C. Schell
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Maxwell S. Krieger
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Claire Pratty
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Daniel B. Neill
- Center for Urban Science and Progress, New York University, New York, NY, USA,Courant Institute of Mathematical Sciences, Department of Computer Science, New York University, New York, NY, USA,Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
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Ghosh A, Mahintamani T, Rana DK, Basu D, Mattoo SK. Six-month buprenorphine-naloxone treatment is associated with neurocognitive function improvement in opioid dependence. Indian J Psychiatry 2022; 64:199-208. [PMID: 35494328 PMCID: PMC9045353 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_792_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/24/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIM The number of longitudinal studies on cognitive functions in patients on buprenorphine-based agonist treatment is limited. Our objective was to assess the change in neurocognitive functions over the first 6 months of buprenorphine-naloxone (BNX) treatment for opioid dependence (OD) and compare cognitive functions on BNX and controls. METHODS We selected 60 patients with OD aged 18 to 55 years and 20 sex-matched controls; and excluded patients with other substance dependence, human immunodeficiency virus (HIV), head injury, epilepsy, and severe mental illness. We assessed patients thrice: at baseline, 3, and 6 months and Controls once. Cognitive tests included Wisconsin card sorting test (WCST), Iowa gambling task (IGT), trail making tests A and B (TMT-A and B), verbal and visual N-back test (NBT), and standard progressive matrices (SPM). We measured with-in group effect size with Cohen's D (d). RESULTS A total of 24 participants completed at least one follow-up; 17 completed both follow-up assessments. All participants were men. At baseline, the patients performed worse than healthy controls in IGT, TMT-A, and B, and visual and verbal NBT. At 3 months, the performance of visual NBT improved significantly (d = 1.2 for NBT1; 1.3 for NBT2). At 6 months, additional performance improvements were seen in WCST ("perseverative error" d = 1.2), IGT ("net total score" d = 1.2), TMT-A (d = 1.1), and verbal NBT ("omission error" d = 1.7). Except for visual-NBT, results did not differ between patients and controls at both follow-ups. CONCLUSION Cognitive flexibility, decision making, attention, working memory, and psychomotor speed showed improvements over 6 months of a stable dose of BNX.
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Affiliation(s)
- Abhishek Ghosh
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tathagata Mahintamani
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devender K Rana
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surendra K Mattoo
- Community Mental Health Clinic, Cumbria Northumberland Tyne and Wear Foundation NHS Trust, Molineux NHS Centre, Molineux Street, Byker, Newcastle Upon Tyne NE 6 1SG, United Kingdom
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50
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Adams ZW, Agley J, Pederson CA, Bell LA, Aalsma MC, Jackson T, Grant MT, Ott CA, Hulvershorn LA. Use of Project ECHO to promote evidence based care for justice involved adults with opioid use disorder. Subst Abus 2022; 43:336-343. [PMID: 34283701 PMCID: PMC8889500 DOI: 10.1080/08897077.2021.1941518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: People with opioid use disorders (OUDs) are at heightened risk for involvement with the criminal justice system. Growing evidence supports the safety and effectiveness of providing empirically supported treatments for OUD, such as medications for OUD (M-OUD), to people with criminal justice involvement including during incarceration or upon reentry into the community. However, several barriers limit availability and accessibility of these treatment options for people with OUDs, including a shortage of healthcare and justice professionals trained in how to implement them. This study evaluated a novel education program, the Indiana Jail OUD Treatment ECHO, designed to disseminate specialty knowledge and improve attitudes about providing M-OUD in justice settings. Methods: Through didactic presentations and case-based learning (10 bimonthly, 90-min sessions), a multidisciplinary panel of specialists interacted with a diverse group of community-based participants from healthcare, criminal justice, law enforcement, and related fields. Participants completed standardized surveys about OUD knowledge and attitudes about delivering M-OUD in correctional settings. Thematic analysis of case presentations was conducted. Results: Among 43 participants with pre- and post-series evaluation data, knowledge about OUD increased and treatment was viewed as more practical after the ECHO series compared to before. Cases presented during the program typically involved complicated medical and psychiatric comorbidities, and recommendations addressed several themes including harm reduction, post-release supports, and integration of M-OUD and non-pharmacological interventions. Conclusions: Evaluation of future iterations of this innovative program should address attendance and provider behavior change as well as patient and community outcomes associated with ECHO participation.
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Affiliation(s)
- Zachary W. Adams
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jon Agley
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Casey A. Pederson
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lauren A. Bell
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew C. Aalsma
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - TiAura Jackson
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | | | - Carol A. Ott
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA,Purdue University College of Pharmacy, West Lafayette, IN, USA
| | - Leslie A. Hulvershorn
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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