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Gray AC, Neitzke-Spruill L, Hughes C, O'Connell DJ, Anderson TL. Opioid-stimulant trends in overdose toxicology by race, ethnicity, & gender: An analysis in Delaware, 2013-2019. J Ethn Subst Abuse 2024; 23:471-500. [PMID: 35973048 DOI: 10.1080/15332640.2022.2109790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Recent upticks of stimulant presence in overdose deaths suggest the opioid epidemic is morphing, which raises questions about what drugs are involved and who is impacted. We investigate annual and growth rate trends in combined opioid-stimulant overdose toxicology between 2013 and 2019 for White, Black, and Hispanic male and female decedents in Delaware. During these years, toxicology shifted to illegal drugs for all with fentanyl leading the increase and opioid-cocaine combinations rising substantially. While combined opioid-cocaine toxicology grew among Black and Hispanic Delawareans, White males continue to report the highest rates overall. These findings depart from historical patterns and may challenge existing opioid epidemic policies.
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Affiliation(s)
| | | | | | - Daniel J O'Connell
- Center for Drug and Health Studies, University of Delaware, Newark, Delaware
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Shearer RD, Segel JE, Howell BA, Jones AA, Khatri UG, da Silva DT, Vest N, Winkelman TN. Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources-United States, 2010-2019. Med Care 2024; 62:151-160. [PMID: 38180005 PMCID: PMC10922552 DOI: 10.1097/mlr.0000000000001969] [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: 01/06/2024]
Abstract
BACKGROUND As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources. OBJECTIVE To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances. RESEARCH DESIGN We conducted a longitudinal, cross-sectional analysis comparing trends. SUBJECTS We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files. MEASURES We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019. RESULTS Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. CONCLUSIONS Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.
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Affiliation(s)
- Riley D. Shearer
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joel E. Segel
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA
| | - Benjamin A. Howell
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA
| | - Utsha G. Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Teixeira da Silva
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Noel Vest
- Department of Anesthesia Stanford university School of Medicine, Stanford, CA
| | - Tyler N.A. Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN
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Segel JE, Shearer RD, Jones AA, Khatri UG, Howell BA, Crowley DM, Sterner G, Vest N, Teixeira da Silva D, Winkelman TNA. Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants. Subst Use Misuse 2024; 59:558-566. [PMID: 38037904 PMCID: PMC10923074 DOI: 10.1080/10826084.2023.2287220] [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: 12/02/2023]
Abstract
BACKGROUND As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. METHODS A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. RESULTS There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. CONCLUSION Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.
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Affiliation(s)
- Joel E Segel
- Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
| | - Riley D Shearer
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Abenaa A Jones
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
| | - Utsha G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA
| | - D Max Crowley
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
- Evidence-to-Impact Collaborative, Penn State University, University Park, Pennsylvania, USA
| | - Glenn Sterner
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
- Department of Criminal Justice, Penn State Abington, Abington, Pennsylvania, USA
| | - Noel Vest
- Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tyler N A Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Health, Homelessness, and Criminal Justice Laboratory, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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Böttcher L, Chou T, D’Orsogna MR. Forecasting drug-overdose mortality by age in the United States at the national and county levels. PNAS NEXUS 2024; 3:pgae050. [PMID: 38725534 PMCID: PMC11079616 DOI: 10.1093/pnasnexus/pgae050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 05/12/2024]
Abstract
The drug-overdose crisis in the United States continues to intensify. Fatalities have increased 5-fold since 1999 reaching a record high of 108,000 deaths in 2021. The epidemic has unfolded through distinct waves of different drug types, uniquely impacting various age, gender, race, and ethnic groups in specific geographical areas. One major challenge in designing interventions and efficiently delivering treatment is forecasting age-specific overdose patterns at the local level. To address this need, we develop a forecasting method that assimilates observational data obtained from the CDC WONDER database with an age-structured model of addiction and overdose mortality. We apply our method nationwide and to three select areas: Los Angeles County, Cook County, and the five boroughs of New York City, providing forecasts of drug-overdose mortality and estimates of relevant epidemiological quantities, such as mortality and age-specific addiction rates.
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Affiliation(s)
- Lucas Böttcher
- Department of Computational Science and Philosophy, Frankfurt School of Finance and Management, 60322 Frankfurt am Main, Germany
| | - Tom Chou
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1766, USA
| | - Maria R D’Orsogna
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1766, USA
- Department of Mathematics, California State University at Northridge, Los Angeles, CA 91330-8313, USA
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Borquez A, Martin NK. Fatal overdose: Predicting to prevent. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 104:103677. [PMID: 35550852 DOI: 10.1016/j.drugpo.2022.103677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/31/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Annick Borquez
- Division of Infectious Disease Epidemiology and Global Public Health, Department of Medicine, University of California, San Diego, United States.
| | - Natasha K Martin
- Division of Infectious Disease Epidemiology and Global Public Health, Department of Medicine, University of California, San Diego, United States
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Chen Q, Sterner G, Segel J, Feng Z. Trends in opioid-related crime incidents and comparison with opioid overdose outcomes in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 101:103555. [PMID: 35026674 DOI: 10.1016/j.drugpo.2021.103555] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/15/2021] [Accepted: 11/28/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The opioid epidemic in the United States remains a critically important public health issue and continues to worsen. While healthcare data and outcomes are commonly used to characterize the state of the epidemic and evaluate the impact of policy changes, criminal justice data is under-utilized in research despite its high relevance and unique role in the opioid crisis. Our objective is to understand temporal trends in opioid-related crime incidents and the comparability with the dynamic patterns in health-related outcomes. METHODS We used incident-level crime data from the National Incident-Based Reporting System (NIBRS) during 2005-2018. We identified all incidents involving opioids, which were grouped by opioid type (illicit and prescription opioids), and by drug-related criminal activity (possession and distribution). We estimated annual opioid-related crime incident rates per 100,000 residents. Joinpoint analysis was performed to examine the significant changes in the temporal trends of crime incident rates. We examined the association between opioid-related crime incidents and health outcomes using state fixed effects regression models. RESULTS Among the NIBRS covered population, incident rates of all opioid-related crimes increased significantly from 32.0 to 91.4 per 100,000 between 2005 and 2016, followed by a moderate decrease to 78.3 per 100,000 by 2018. The initial increase in incident rates was predominantly driven by prescription opioid-related incidents which increased by 19.6% per year from 2005 to 2010. Between 2010 and 2015, most of the increase came from illicit opioid-related incidents which accelerated to an increase of 21.6% per year. Opioid-related crime incident rates were found to be significantly and positively associated with rates of opioid-related emergency department visits, inpatient hospitalization, and overdose mortality. CONCLUSION Crime data describe temporal trends and shifting patterns in the opioid epidemic that are highly consistent with health-related data. Criminal justice data could be a potentially powerful tool to understand the changing landscape of opioid and substance use.
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Affiliation(s)
- Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA.
| | - Glenn Sterner
- Criminal Justice Research Center and Department of Criminal Justice, The Pennsylvania State University Abington Campus, Abington, PA, USA
| | - Joel Segel
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Zixuan Feng
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA
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