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M FM, Doug LM, Peter F, Vivian F G, Wiley J, P Todd K, William M, Mai P, David S, Tom S, Ryan W, William Z, M YA, Lf CH. Correlates of overdose among 2711 people who use drugs and live in 7 rural US sites. Drug Alcohol Depend 2024; 258:111261. [PMID: 38581919 DOI: 10.1016/j.drugalcdep.2024.111261] [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: 09/21/2023] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Overdose rates in rural areas have been increasing globally, with large increases in the United States. Few studies, however, have identified correlates of non-fatal overdose among rural people who use drugs (PWUD). The present analysis describes correlates of nonfatal overdose among a large multistate sample of rural PWUD. METHODS This is a cross-sectional analysis of data gathered via surveys with PWUD recruited through seven Rural Opioid Initiative (ROI) sites. Descriptive analyses were conducted to assess the prevalence of past 30-day overdose. Generalized estimating equations were used to estimate a series of multivariable models quantifying relationships of select factors to past-month overdose; factors were selected using the Risk Environment Framework. RESULTS The multisite sample included 2711 PWUD, 6% of whom reported overdosing in the past 30 days. In the fully adjusted model, houselessness (AOR=2.27, 95%CI[1.48, 3.48]), a positive test result for Hepatitis C infection (AOR=1.73 95%CI[1.18, 2.52]) and heroin/fentanyl use (AOR= 8.58 95%CI [3.01, 24.50]) were associated with an increased risk of reporting past 30-day overdose, while having a high-school education or less was associated with reduced odds of overdose (AOR=0.52, 95% CI[0.37, 0.74]). CONCLUSION As in urban areas, houselessness, Hepatitis C infection, and the use of heroin and fentanyl were significant correlates of overdose. Widespread access to overdose prevention interventions - including fentanyl test strips and naloxone - is critical in this rural context, with particular outreach needed to unhoused populations, people living with Hepatitis C, and people using opioids.
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Affiliation(s)
- Fadanelli Monica M
- Rollins School of Public Health, 1518 Clifton Dr, Atlanta, GA 30329, USA.
| | | | - Friedmann Peter
- UMass Chan Medical School - Baystate, 3601 Main Street, Springfield, MA 01199, USA
| | - Go Vivian F
- Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Jenkins Wiley
- SIU School of Medicine, 801 N Rutledge St., Springfield, IL 62702, USA
| | - Korthuis P Todd
- Oregon Health & Science University, School of Medicine, 3266 SW Research Dr, Portland, OR 97239, USA
| | - Miller William
- Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Pho Mai
- The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Seal David
- Tulane School of Public Health & Tropical Medicine, 1440 Canal St, New Orleans, LA 70112, USA
| | - Stopka Tom
- Tufts University School of Medicine, Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Westergaard Ryan
- University of Wisconsin, School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705-2281, USA
| | - Zule William
- Research Triangle Park, 3040 East Cornwallis Road, P.O. Box 12194, NC 27709-2194, USA
| | - Young April M
- University of Kentucky, College of Public Health, 111 Washington Ave., Lexington, KY 40536, USA
| | - Cooper Hannah Lf
- Rollins School of Public Health, 1518 Clifton Dr, Atlanta, GA 30329, USA
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Syrjanen R, Schumann J, Fitzgerald J, Gerostamoulos D, Abouchedid R, Rotella JA, Knott J, Maplesden J, Hollerer H, Hannon L, Bourke E, Hodgson SE, Greene SL. The Emerging Drugs Network of Australia - Victoria Clinical Registry: A state-wide illicit substance surveillance and alert network. Emerg Med Australas 2023; 35:82-88. [PMID: 36053993 DOI: 10.1111/1742-6723.14059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES With an increasingly dynamic global illicit drug market, including the emergence of novel psychoactive substances, many jurisdictions have moved to establish toxicosurveillance systems to enable timely detection of harmful substances in the community. This paper describes the methodology for the Emerging Drugs Network of Australia - Victoria (EDNAV) project, a clinical registry focused on the collection of high-quality clinical and analytical data from ED presentations involving illicit drug intoxications. Drug intelligence collected from the project is utilised by local health authorities with the aim to identify patterns of drug use and emerging drugs of concern. METHODS The project involves 10 public hospital EDs in Victoria, Australia. Patients 16 years and over, presenting to a network ED with a suspected illicit drug-related toxicity and a requirement for venepuncture are eligible for inclusion in the study under a waiver of consent. Clinical and demographic parameters are documented by site-based clinicians and comprehensive toxicological analysis is conducted on patient blood samples via specialised forensic services. All data are then deidentified and compiled in a project specific database. RESULTS Cases are discussed in weekly multidisciplinary team meetings, with a view to identify potentially harmful substances circulating in the community. High-risk signals are escalated to key stakeholders to produce timely and proportionate public health alerts with a focus on harm minimisation. CONCLUSIONS The EDNAV project represents the first centralised system providing near real-time monitoring of community drug use in Victoria and is fundamental in facilitating evidence-based public health intervention.
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Affiliation(s)
- Rebekka Syrjanen
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Schumann
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - John Fitzgerald
- Department of Criminology, School of Social and Political Sciences, Faculty of Arts, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachelle Abouchedid
- Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia.,Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Joe-Anthony Rotella
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, The Northern Hospital, Northern Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Victoria, Australia
| | - Jacqueline Maplesden
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Hans Hollerer
- Emergency Department, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
| | - Liam Hannon
- Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia
| | - Elyssia Bourke
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Ballarat Base Hospital, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Sarah E Hodgson
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Shaun L Greene
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
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Donnell A, Unnithan C, Tyndall J, Hanna F. Digital Interventions to Save Lives From the Opioid Crisis Prior and During the SARS COVID-19 Pandemic: A Scoping Review of Australian and Canadian Experiences. Front Public Health 2022; 10:900733. [PMID: 35903371 PMCID: PMC9314644 DOI: 10.3389/fpubh.2022.900733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe potential for digital initiatives for opioid harm reduction is boundless. Synthesized evidence on current interventions and their efficacy are emerging. This scoping review is an effort to aggregate Canadian and Australian digital health initiatives used to prevent opioid-related deaths and minimize harm, prior to and particularly during the pandemic of SARs-COVID-19, when the crisis escalated.MethodsThe Joanna Briggs Institute's methodological framework for conducting scoping reviews was used. Peer reviewed and gray literature published between January 2016 to October 2021 were included. Search translation was performed across CINAHL, Cochrane, SCOPUS, MEDLINE Complete, and ProQuest Public Health with consistent use of key search terms. Citation checks were also conducted. Studies included were written in English and reported on digital technologies to prevent opioid-related harm and/or mortality in participants aged 18 years or older in Australia and Canada.ResultsA total of 16 publications were included in the final analysis (Australia = 5; Canada = 11). The most frequently reported digital technologies were telehealth to support access to treatment (n = 3) and mobile applications for overdose monitoring and prevention (n = 3). Telehealth-delivered opioid replacement therapy demonstrated equal outcomes and treatment retention rates compared to in-person and mobile applications for overdose monitoring demonstrated lifesaving capability through direct linkages with emergency response services.ConclusionsDigital interventions to minimize opioid crisis related harm and overdose prevention are fast emerging in Australia and Canada. During the pandemic, the crisis escalated in both countries as a public health emergency, and different initiatives were trialed. Digital harm reduction solutions via mobile apps (or SaaS solutions) were found to have the potential to prevent accidental overdose deaths and save lives, if rendered through privacy preserved, secure and trust enabled methods that empower users. Knowledge sharing between the two countries, relating to suitable interventions, may add significant value in combatting the escalating opioid crisis in the post pandemic era.
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Affiliation(s)
- Andrea Donnell
- Program of Public Health, Department of Health, Torrens University Australia, Melbourne, VIC, Australia
- *Correspondence: Andrea Donnell
| | - Chandana Unnithan
- Program of Public Health, Department of Health, Torrens University Australia, Melbourne, VIC, Australia
| | - Jessica Tyndall
- Library & Learning Services, Torrens University Australia, Adelaide, SA, Australia
| | - Fahad Hanna
- Program of Public Health, Department of Health, Torrens University Australia, Melbourne, VIC, Australia
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Perananthan V, Tremonti C, Nash E, Jiranantakan T, Dawson AH. Rapid detection, toxicosurveillance and public health response to stimulant adulteration with acetyl fentanyl. Med J Aust 2021; 214:533-533.e1. [PMID: 34050540 DOI: 10.5694/mja2.51112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Varan Perananthan
- Royal Prince Alfred Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | - Chris Tremonti
- Royal Prince Alfred Hospital, Sydney, NSW.,Centre for Alcohol and Other Drugs, New South Wales Ministry of Health, Sydney, NSW
| | - Emily Nash
- Royal Prince Alfred Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | - Thanjira Jiranantakan
- Centre for Alcohol and Other Drugs, New South Wales Ministry of Health, Sydney, NSW.,NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, NSW
| | - Andrew H Dawson
- Royal Prince Alfred Hospital, Sydney, NSW.,NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, NSW
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