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Ezell JM, Pho MT, Ajayi BP, Simek E, Shetty N, Goddard-Eckrich DA, Bluthenthal RN. Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model. Drug Alcohol Rev 2024; 43:1143-1159. [PMID: 38646735 DOI: 10.1111/dar.13832] [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: 08/29/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
ISSUES To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. APPROACH Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. KEY FINDINGS Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. IMPLICATIONS There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. CONCLUSION There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, USA
| | - Babatunde P Ajayi
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Elinor Simek
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Netra Shetty
- University of California Berkeley, Berkeley, USA
| | | | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
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2
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Harruff RC, Barbour WL, Yarid NA. Evaluation of in-house drug evidence testing by King County Medical Examiner's Office in "real-time" fatal overdose surveillance. J Forensic Sci 2024; 69:1350-1363. [PMID: 38647080 DOI: 10.1111/1556-4029.15526] [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: 01/30/2024] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
With the escalating overdose epidemic, many surveillance efforts have appeared. In 2018, King County Medical Examiner's Office (KCMEO) initiated a fatal overdose surveillance project aimed at expediting death certification and disseminating timely information. In this project, KCMEO investigators collected items of evidence of drug use from overdose death scenes, which were tested by five in-house methods, four using handheld devices: TruNarc Raman spectrometer, with and without the manufacture's H-Kit, Rigaku ResQ Raman spectrometer, and MX908 mass spectrometer. The fifth in-house method used fentanyl-specific urine test strips. Results from in-house testing were compared with results from Washington State Patrol (WSP) Materials Analysis Laboratory. From 2019 to 2022, there were 4244 evidence items of drugs and paraphernalia collected from 1777 deaths scenes. A total of 7526 in-house tests were performed on collected specimens, and 2153 tests were performed by the WSP laboratory using standard analytical methods. The WSP results served as reference standards to calculate performance metrics of the in-house methods. Sensitivities, specificities, and predictive values ranged from good to poor depending on the method, drug, and evidence type. Certain drugs were often associated with specific evidence types. Acetaminophen was frequently found in combination with fentanyl. Fentanyl test strips gave good scores for detecting fentanyl; otherwise, in-house methods using handheld devices had poor performance scores with novel drugs and drugs diluted in mixtures. The results showed that in-house testing of drug evidence has value for medical examiner overdose surveillance, but it is resource intensive, and success depends on collaboration with forensic laboratories.
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Affiliation(s)
| | | | - Nicole A Yarid
- King County Medical Examiner's Office, Seattle, Washington, USA
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3
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Glasgow L, Douglas C, Sprunger JG, Campbell ANC, Chandler R, Dasgupta A, Holloway J, Marks KR, Roberts SM, Martinez LS, Thompson K, Weiss RD, Aldridge A, Asman K, Barbosa C, Blevins D, Chassler D, Cogan L, Fanucchi L, Hall ME, Hunt T, Jadovich E, Levin FR, Lincourt P, Lofwall MR, Loukas V, McAlearney AS, Nunes E, Oga E, Oller D, Rudorf M, Sullivan AM, Talbert J, Taylor A, Teater J, Vandergrift N, Woodlock K, Zarkin GA, Freisthler B, Samet JH, Walsh SL, El-Bassel N. Effect of the Communities that HEAL intervention on receipt of behavioral therapies for opioid use disorder: A cluster randomized wait-list controlled trial. Drug Alcohol Depend 2024; 259:111286. [PMID: 38626553 PMCID: PMC11111326 DOI: 10.1016/j.drugalcdep.2024.111286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND The U.S. opioid overdose crisis persists. Outpatient behavioral health services (BHS) are essential components of a comprehensive response to opioid use disorder and overdose fatalities. The Helping to End Addiction Long-Term® (HEALing) Communities Study developed the Communities That HEAL (CTH) intervention to reduce opioid overdose deaths in 67 communities in Kentucky, Ohio, New York, and Massachusetts through the implementation of evidence-based practices (EBPs), including BHS. This paper compares the rate of individuals receiving outpatient BHS in Wave 1 intervention communities (n = 34) to waitlisted Wave 2 communities (n = 33). METHODS Medicaid data included individuals ≥18 years of age receiving any of five BHS categories: intensive outpatient, outpatient, case management, peer support, and case management or peer support. Negative binomial regression models estimated the rate of receiving each BHS for Wave 1 and Wave 2. Effect modification analyses evaluated changes in the effect of the CTH intervention between Wave 1 and Wave 2 by research site, rurality, age, sex, and race/ethnicity. RESULTS No significant differences were detected between intervention and waitlisted communities in the rate of individuals receiving any of the five BHS categories. None of the interaction effects used to test the effect modification were significant. CONCLUSIONS Several factors should be considered when interpreting results-no significant intervention effects were observed through Medicaid claims data, the best available data source but limited in terms of capturing individuals reached by the intervention. Also, the 12-month evaluation window may have been too brief to see improved outcomes considering the time required to stand-up BHS. TRIAL REGISTRATION Clinical Trials.gov http://www. CLINICALTRIALS gov: Identifier: NCT04111939.
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Affiliation(s)
| | | | - Joel G Sprunger
- University of Cincinnati College of Medicine, University of Cincinnati Center for Addiction Research, Cincinnati, OH, USA
| | - Aimee N C Campbell
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
| | - Redonna Chandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Anindita Dasgupta
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
| | | | - Katherine R Marks
- Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities, Frankfort, KY, USA
| | - Sara M Roberts
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Katherine Thompson
- University of Kentucky, Dr. Bing Zhang Department of Statistics, Lexington, KY, USA
| | - Roger D Weiss
- McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | | | - Kat Asman
- RTI International, Research Triangle Park, NC, USA
| | | | - Derek Blevins
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Lindsay Cogan
- New York State Department of Health, Office of Quality and Patient Safety, New York, NY, USA
| | - Laura Fanucchi
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Megan E Hall
- RTI International, Research Triangle Park, NC, USA
| | - Timothy Hunt
- Columbia University School of Social Work, New York, NY, USA
| | | | - Frances R Levin
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Patricia Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | | | | | | | - Edward Nunes
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
| | - Emmanuel Oga
- RTI International, Research Triangle Park, NC, USA
| | - Devin Oller
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Jeffery Talbert
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Angela Taylor
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Julie Teater
- Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | | | | | - Jeffrey H Samet
- Boston University and Boston Medical Center, Boston, MA, USA
| | - Sharon L Walsh
- University of Kentucky College of Medicine, Lexington, KY, USA
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Cance JD, Adams ET, D'Amico EJ, Palimaru A, Fernandes CSF, Fiellin LE, Bonar EE, Walton MA, Komro KA, Knight D, Knight K, Rao V, Youn S, Saavedra L, Ridenour TA, Deeds B. Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:30-39. [PMID: 37261635 PMCID: PMC10689575 DOI: 10.1007/s11121-023-01545-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.
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Affiliation(s)
- J D Cance
- RTI International, Research Triangle Park, Durham, NC, USA.
| | - E T Adams
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | | | | | - L E Fiellin
- Yale University School of Medicine, New Haven, CT, USA
| | - E E Bonar
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - M A Walton
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - K A Komro
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - D Knight
- Texas Christian University, Fort Worth, TX, USA
| | - K Knight
- Texas Christian University, Fort Worth, TX, USA
| | - V Rao
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S Youn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L Saavedra
- RTI International, Research Triangle Park, Durham, NC, USA
| | - T A Ridenour
- RTI International, Research Triangle Park, Durham, NC, USA
| | - B Deeds
- National Institute on Drug Abuse, MD, Bethesda, USA
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5
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Woodward CA, Issa FS, Caneva DC, Voskanyan A, Gadhia RA, Hart A, Hertelendy AJ, DiGregorio DA, Ciottone RG, Ciottone GR. Combating the Opioid Crisis and Its National Security Threat Through CReDO: A Multidisciplinary Solution With Disaster Medicine Implications. Disaster Med Public Health Prep 2023; 17:e509. [PMID: 37705279 DOI: 10.1017/dmp.2023.173] [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: 09/15/2023]
Abstract
For the first time in history, the United States surpassed 100 000 overdose-related deaths in a 12-month period, driven by synthetic opioids such as fentanyl. Also, for the first time, potential chemical weapons are readily available on the streets and the dark web. Opioids represent a rare trifecta, used for licit pain management, as an illicit drug of abuse, and with potential use as a weapon of terror. Community-based Response to Drug Overdose (CReDO) is an initiative to unite agencies, disciplines, government, and private partners in 1 coordinated opioid emergencies response plan under nationwide standards, and can be integrated into the disaster medicine discipline due to the risk of mass casualty incidents involving fentanyl or its derivatives. Attention to the opioid crisis through CReDO will save lives by promoting information sharing between disciplines, shortened response time to overdose clusters, community collaboration to identify criminal distribution networks, and holistic approaches to addiction.
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Affiliation(s)
- Christina Ann Woodward
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Fadi Salah Issa
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Duane Carl Caneva
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Amalia Voskanyan
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Raj Arvind Gadhia
- Department of Emergency Medicine, Signature Healthcare Brockton Hospital, Brockton, MA, USA
| | - Alexander Hart
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Hartford Hospital, Hartford, CT, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Attila Julius Hertelendy
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA
| | - David Anthony DiGregorio
- Hazardous Materials Emergency Response and Special Operations, Massachusetts Department of Fire Services, Stow, MA, USA
| | - Robert Gregory Ciottone
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Northeastern University, Post-Baccalaureate Pre-Medical Program, Boston, MA, USA
| | - Gregory Robert Ciottone
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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6
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Harruff RC, Yarid NA, Barbour WL, Martin YH. Medical examiner response to the drug overdose epidemic in King County Washington: "Real-time" surveillance, data science, and applied forensic epidemiology. J Forensic Sci 2023; 68:1632-1642. [PMID: 37417312 DOI: 10.1111/1556-4029.15329] [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: 02/27/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with "real-time" fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In-house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in-house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose-specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.
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Affiliation(s)
| | - Nicole A Yarid
- King County Medical Examiner's Office, Seattle, Washington, USA
| | | | - Yang H Martin
- King County Medical Examiner's Office, Seattle, Washington, USA
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Tang LA, Korona-Bailey J, Zaras D, Roberts A, Mukhopadhyay S, Espy S, Walsh CG. Using Natural Language Processing to Predict Fatal Drug Overdose From Autopsy Narrative Text: Algorithm Development and Validation Study. JMIR Public Health Surveill 2023; 9:e45246. [PMID: 37204824 PMCID: PMC10238956 DOI: 10.2196/45246] [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: 12/21/2022] [Revised: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Fatal drug overdose surveillance informs prevention but is often delayed because of autopsy report processing and death certificate coding. Autopsy reports contain narrative text describing scene evidence and medical history (similar to preliminary death scene investigation reports) and may serve as early data sources for identifying fatal drug overdoses. To facilitate timely fatal overdose reporting, natural language processing was applied to narrative texts from autopsies. OBJECTIVE This study aimed to develop a natural language processing-based model that predicts the likelihood that an autopsy report narrative describes an accidental or undetermined fatal drug overdose. METHODS Autopsy reports of all manners of death (2019-2021) were obtained from the Tennessee Office of the State Chief Medical Examiner. The text was extracted from autopsy reports (PDFs) using optical character recognition. Three common narrative text sections were identified, concatenated, and preprocessed (bag-of-words) using term frequency-inverse document frequency scoring. Logistic regression, support vector machine (SVM), random forest, and gradient boosted tree classifiers were developed and validated. Models were trained and calibrated using autopsies from 2019 to 2020 and tested using those from 2021. Model discrimination was evaluated using the area under the receiver operating characteristic, precision, recall, F1-score, and F2-score (prioritizes recall over precision). Calibration was performed using logistic regression (Platt scaling) and evaluated using the Spiegelhalter z test. Shapley additive explanations values were generated for models compatible with this method. In a post hoc subgroup analysis of the random forest classifier, model discrimination was evaluated by forensic center, race, age, sex, and education level. RESULTS A total of 17,342 autopsies (n=5934, 34.22% cases) were used for model development and validation. The training set included 10,215 autopsies (n=3342, 32.72% cases), the calibration set included 538 autopsies (n=183, 34.01% cases), and the test set included 6589 autopsies (n=2409, 36.56% cases). The vocabulary set contained 4002 terms. All models showed excellent performance (area under the receiver operating characteristic ≥0.95, precision ≥0.94, recall ≥0.92, F1-score ≥0.94, and F2-score ≥0.92). The SVM and random forest classifiers achieved the highest F2-scores (0.948 and 0.947, respectively). The logistic regression and random forest were calibrated (P=.95 and P=.85, respectively), whereas the SVM and gradient boosted tree classifiers were miscalibrated (P=.03 and P<.001, respectively). "Fentanyl" and "accident" had the highest Shapley additive explanations values. Post hoc subgroup analyses revealed lower F2-scores for autopsies from forensic centers D and E. Lower F2-score were observed for the American Indian, Asian, ≤14 years, and ≥65 years subgroups, but larger sample sizes are needed to validate these findings. CONCLUSIONS The random forest classifier may be suitable for identifying potential accidental and undetermined fatal overdose autopsies. Further validation studies should be conducted to ensure early detection of accidental and undetermined fatal drug overdoses across all subgroups.
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Affiliation(s)
- Leigh Anne Tang
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, TN, United States
| | - Jessica Korona-Bailey
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, TN, United States
| | - Dimitrios Zaras
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, TN, United States
| | - Allison Roberts
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, TN, United States
| | - Sutapa Mukhopadhyay
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, TN, United States
| | - Stephen Espy
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville, TN, United States
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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8
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Harruff R, Simpson CM, Gifford AL, Yarid N, Barbour WL, Heidere C. Evaluation of "Real-Time" Fatal Drug Overdose Surveillance by King County Medical Examiner's Office, Seattle, Washington. Am J Forensic Med Pathol 2023; 44:11-16. [PMID: 36165595 DOI: 10.1097/paf.0000000000000798] [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: 02/07/2023]
Abstract
ABSTRACT To address the challenges in monitoring the continuously accelerating drug overdose epidemic, the King County Medical Examiner's Office in Seattle, Washington, instituted a "real-time" fatal drug overdose surveillance project, depending on scene investigations, autopsy findings, and in-house testing of blood, urine, and drug evidence collected from death scenes. Validation of the project's rapid death certification methodology from 2019 through 2021 was performed at the following 3 levels: blood testing, urine testing, and death certification, and for the following 4 drugs: fentanyl, opiate, methamphetamine, and cocaine. For blood testing, sensitivity ranged from 90% to 99%, and specificity ranged from 86% to 97%. For urine testing, sensitivity ranged from 91% to 92%, and specificity ranged from 87% to 97%. The positive predictive value for cocaine was poor for both blood testing (57%) and urine testing (72%). Of 1034 deaths, 807 were certified as overdose by rapid methodology, and 803 (99.5%) were confirmed by formal toxicology results. Manners of death were changed from accident to natural in 3 of 1034 cases (0.29%). Results of this study indicate that the rapid overdose surveillance methodology described in this study offers benefits to families and provides useful, timely information for responding law enforcement and public health agencies.
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9
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Kuzmichev A, Harada NM, Griffith DM, Powell KM, Dean HD. Public Health Reports in 2021: Impact Factor Increase and New Article Collections on Racism and COVID-19. Public Health Rep 2022; 137:397-407. [PMID: 35435072 PMCID: PMC9109544 DOI: 10.1177/00333549221091785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Andrey Kuzmichev
- Public Health Reports,
Office of the Surgeon General, US Department of Health and Human Services,
Washington, DC, USA
| | - Noelle M. Harada
- Public Health Reports,
Office of the Surgeon General, US Department of Health and Human Services,
Washington, DC, USA
| | - Derek M. Griffith
- Racial Justice Institute, Center for
Men’s Health Equity, Department of Health Systems Administration, Georgetown
University, Washington, DC, USA
| | - Krista M. Powell
- CDR, US Public Health Service, US
Department of Veterans Affairs, Atlanta, GA, USA
| | - Hazel D. Dean
- Public Health Reports,
Office of the Surgeon General, US Department of Health and Human Services,
Washington, DC, USA
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