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Ishikawa M, Yokoyama T, Hemmi O. Aging-related changes in protein and fat intake and their related meal types factors by longitudinal birth cohort analysis using the National Health and Nutrition Survey in Japan from 2001 to 2019. J Nutr Health Aging 2024; 28:100351. [PMID: 39260015 DOI: 10.1016/j.jnha.2024.100351] [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: 06/07/2024] [Revised: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND To provide seamless nutritional support from early adulthood to late adulthood in Japan, this study aimed to identify aging-related changes in protein and fat intake and meal types. METHODS Birth cohort analysis was conducted in this study. The protein intake, protein-to-energy ratio, fat intake, and fat-to-energy ratio in men and women from their 20s to 60s in 2001 was calculated using the data of the National Health and Nutrition Survey in Japan between 2001 and 2019 (n = 139,876, 47.0% men, mean age: 54.9 and 55.4 years for men and women, respectively). The intakes were calculated for every subsequent year, the aging-related changes were identified by age group, and the 99 food groups were classified into staple-focused meal types through factor analysis. The weighted average component value per 1 g of each food group was calculated, multiplied by the food weight, and totaled to determine the mean intake by meal type and to confirm the aging-related changes. The year when the slope changed before and after was identified through Joinpoint regression analysis. RESULTS The protein intake, protein-to-energy ratio, fat intake, and fat-to-energy ratio initially declined or remained unchanged with aging in almost all generations (20s to 60s in 2001) but began to increase after 8-15 years. The food groups were classified into rice, noodle, and bread types. The protein and fat intake from the noodle type initially showed a decreasing trend but began to increase with aging after 8-15 years in almost all generations in both sexes (p < 0.05 for difference in slope). CONCLUSIONS The increase of protein intake and protein-to-energy ratio and fat intake and fat-to-energy ratio over time observed among Japanese adults may be related to the increased intake of food groups from noodle type meals. Thus, considering the type of staple food (i.e., rice, noodles, or bread) and its combination with other foods when adhering to a balanced diet is necessary.
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Affiliation(s)
- Midori Ishikawa
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - Osamu Hemmi
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
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Shiue KY, Austin AE, Naumann RB, Aiello AE, Marshall SW, Golightly YM. Age, period and cohort-related trends in prescription opioid use in the USA, 1999-2018. J Epidemiol Community Health 2023; 77:714-720. [PMID: 37507219 DOI: 10.1136/jech-2023-220701] [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] [Received: 04/06/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND To provide insight into the longitudinal dynamics of opioid use throughout the overdose crisis, this study estimated the separate influences of age, period and cohort on prescription opioid use during 1999-2018 in the USA. METHODS Data from 10 cycles of the cross-sectional National Health and Nutrition Examination Survey were used to conduct an age-period-cohort analysis of the prevalence of prescription opioid use (n=63 500 across 1999-2018). Temporal trends were graphically visualised. The median polish approach was used to estimate age, period and cohort-related effects on prescription opioid use. RESULTS Prescription opioid use broadly increased across the lifespan, with steeper prevalence increases observed from young adulthood to mid-adulthood. Period-related variation was consistent with recognised nationwide declines in opioid prescribing. While there was no evidence of systematic cohort effects, compared with individuals born in 1951-1954, those born during 1963-1966 had greater prescription opioid use (prevalence ratio (PR)=1.23, 95% CI: 1.05 to 1.43), whereas the 1991-1994 and 1999-2002 cohorts had lower prescription opioid use (PR91-94=0.70, 95% CI: 0.50 to 0.98; PR99-02=0.72, 95% CI: 0.63 to 0.81). CONCLUSION In the USA, longitudinal trends in prescription opioid use during 1999-2018 were predominantly driven by age and period influences. The cohort of youngest baby boomers experienced greater prescription opioid use, whereas recent-born cohorts have had lower use. As the overdose crisis continues evolving, such population-level characterisations of age, period and cohort dynamics are instrumental in understanding opioid use and can inform prevention and intervention approaches by identifying population groups more likely to use opioids who, thus, may also experience related outcomes.
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Affiliation(s)
- Kristin Y Shiue
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Rebecca B Naumann
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison E Aiello
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Stephen W Marshall
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yvonne M Golightly
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
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3
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Lin J, Arnovitz M, Kotbi N, Francois D. Substance Use Disorders in the Geriatric Population: a Review and Synthesis of the Literature of a Growing Problem in a Growing Population. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2023:1-20. [PMID: 37360959 PMCID: PMC10241125 DOI: 10.1007/s40501-023-00291-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
Purpose of review Substance use disorders are becoming increasingly prevalent in the geriatric population, necessitating an updated understanding of the existing literature. This review aims to describe the epidemiology, special considerations, and management of substance use disorders in older adults. Recent findings PubMed, Ovid MEDLINE, and PsychINFO databases were searched from their inception through June 2022 using the following keywords: "substance use disorder," "substance abuse," "abuse," "illicit substances," "illicit drugs," "addiction," "geriatric," "elderly," "older adults," "alcohol," "marijuana," "cannabis," "cocaine," "heroin," "opioid," and "benzodiazepine." Our findings suggest an increasing trend in substance use in older adults despite medical and psychiatric consequences when using such substances. The majority of older patients admitted to substance abuse treatment programs were not referred by healthcare providers, suggesting room for improvement in the screening and discussion of substance use disorders. Our review also suggests that there should be careful consideration of COVID-19 and racial disparities when screening, diagnosing, and treating substance use disorders in the older population. Summary This review provides updated information on epidemiology, special considerations, and management of substance use disorders in older adults. As substance use disorders become more prevalent in older adults, primary care physicians must be prepared to recognize and diagnose substance use disorders as well as collaborate with and refer patients to geriatric medicine, geriatric psychiatry, and addiction medicine.
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Affiliation(s)
- Jenny Lin
- Weill Cornell Medicine, New York, NY USA
| | - Mitchell Arnovitz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Nabil Kotbi
- Weill Cornell Medicine, New York Presbyterian/Westchester, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Dimitry Francois
- Weill Cornell Medicine, New York Presbyterian/Westchester, 21 Bloomingdale Road, White Plains, NY 10605 USA
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Asheh AM, Courchesne-Krak N, Kepner W, Marienfeld C. Adverse Childhood Experiences Are Associated With History of Overdose Among Patients Presenting for Outpatient Addiction Care. J Addict Med 2023; 17:333-338. [PMID: 37267182 PMCID: PMC10241414 DOI: 10.1097/adm.0000000000001126] [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] [Received: 03/02/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are associated with mental health issues and substance use. Having a substance use disorder increases the risk of overdose (OD). Research on ACEs and risk of OD is limited. This study examined the relationship between ACE scores and a self-reported history of OD among patients in an addiction and mental health outpatient setting. METHODS This single-center, cross-sectional design included adults in a dual-diagnosis addiction and mental health outpatient recovery and treatment program from November 2017 to August 2020. Patients (N = 115) were assessed with self-report questionnaires, which included ACEs and history of OD. Bivariate and multivariable logistic regression was used to determine factors associated with self-reported OD history. We assessed the reliability and validity of the ACEs scale. RESULTS Of the 115 participants, 26 (22.6%) reported a past OD at intake. The mean ACE score for participants with an OD history, as compared with those with no history of OD, was 4.0 (standard deviation, 2.7) vs 2.3 (standard deviation, 2.2). In the multivariable regression, a higher ACE score was associated with history of OD (adjusted odds ratio, 1.23; 95% confidence interval, 1.00-1.50; P = 0.0456). CONCLUSIONS Given the observed association between OD and higher ACE scores, patients presenting for treatment in outpatient dual-diagnosis clinics should be screened for ACEs and OD history, providing the opportunity for treatment with trauma-informed care and/or referral to appropriate services.
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Siddiqui MZ, Piserchio JP, Patel M, Park J, Foster ML, Desrosiers CE, Herbert J, Nichols SD, McCall KL, Piper BJ. Examination of multiple drug arrests reported to the Maine Diversion Alert Program. Forensic Sci Med Pathol 2022; 18:133-140. [PMID: 35094290 PMCID: PMC11095619 DOI: 10.1007/s12024-021-00454-1] [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] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Much of the responsibility for the increasing drug overdoses in the US has been attributed to opioids but most opioid overdoses also involve another drug. The objective of this study was to identify the drugs involved in polysubstance arrests. The substances that were more likely to be found in conjunction with other substances, using the drug arrests reported to Maine's Diversion Alert Program (DAP) were examined. METHODS Single and multiple drug arrests were quantified (N = 9,216). Multiple drug arrest percentages were compared to single drug arrest percentages to create a Multiple-to-Single Ratio (MSR) specific to each drug family and each drug to identify over (MSR > 1) and under-representation (MSR < 1). RESULTS Over three-fifths (63.8%) of all arrests involved a single drug. Opioids accounted for over-half (53.5%) of single arrests, followed by stimulants (27.7%) and hallucinogens (7.7%). Similarly, nearly two-fifths (39.6%) of multiple arrests were for opioids, followed by stimulants (30.8%) and miscellaneous (13.0%). Miscellaneous psychoactive prescription substances (e.g. clonidine, gabapentin, cyclobenzaprine, hydroxyzine) had the highest (1.51) MSR of any drug family. Conversely, stimulants (0.63), opioids (0.42), and hallucinogens (0.35) were significantly underrepresented in polysubstance arrests. Carisoprodol (8.80), amitriptyline (6.34), and quetiapine (4.69) had the highest MSR. Bath-salts (0.34), methamphetamine (0.44), and oxycodone (0.54) had the lowest MSR. CONCLUSION The misuse of opioids, both alone and in conjunction with another drug, deserves continued surveillance. In addition, common prescription drugs with less appreciated misuse potential, especially carisoprodol, amitriptyline, and quetiapine, require greater attention for their ability to enhance the effects of other drugs.
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Affiliation(s)
- Maaz Z Siddiqui
- University of Scranton, Scranton, PA, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | - Misha Patel
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Jino Park
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | | | | | | | | | - Brian J Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
- Center for Pharmacy Innovation and Outcomes, Forty Fort, PA, USA.
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Paul LA, Li Y, Leece P, Gomes T, Bayoumi AM, Herring J, Murray R, Brown P. Identifying the changing age distribution of opioid-related mortality with high-frequency data. PLoS One 2022; 17:e0265509. [PMID: 35442953 PMCID: PMC9020746 DOI: 10.1371/journal.pone.0265509] [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: 11/08/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Opioid-related mortality continues to rise across North America, and mortality rates have been further exacerbated by the COVID-19 pandemic. This study sought to provide an updated picture of trends of opioid-related mortality for Ontario, Canada between January 2003 and December 2020, in relation to age and sex. Methods Using mortality data from the Office of the Chief Coroner for Ontario, we applied Bayesian Poisson regression to model age/sex mortality per 100,000 person-years, including random walks to flexibly capture age and time effects. Models were also used to explore how trends might continue into 2022, considering both pre- and post-COVID-19 courses. Results From 2003 to 2020, there were 11,633 opioid-related deaths in Ontario. A shift in the age distribution of mortality was observed, with the greatest mortality rates now among younger individuals. In 2003, mortality rates reached maximums at 5.5 deaths per 100,000 person-years (95% credible interval: 4.0–7.6) for males around age 44 and 2.2 deaths per 100,000 person-years (95% CI: 1.5–3.2) for females around age 51. As of 2020, rates have reached maximums at 67.2 deaths per 100,000 person-years (95% CI: 55.3–81.5) for males around age 35 and 16.8 deaths per 100,000 person-years (95% CI: 12.8–22.0) for females around age 37. Our models estimate that opioid-related mortality among the younger population will continue to grow, and that current conditions could lead to male mortality rates that are more than quadruple those of pre-pandemic estimations. Conclusions This analysis may inform a refocusing of public health strategy for reducing rising rates of opioid-related mortality, including effectively reaching both older and younger males, as well as young females, with health and social supports such as treatment and harm reduction measures.
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Affiliation(s)
- Lauren A. Paul
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
| | - Ye Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
- * E-mail:
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Substance Use Service, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Herring
- Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
| | - Regan Murray
- Office of the Chief Coroner for Ontario, Toronto, Ontario, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Patrick Brown
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
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Keyes KM, Cerdá M. Dynamics of drug overdose in the 20th and 21st centuries: The exponential curve was not inevitable, and continued increases are preventable. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 104:103675. [DOI: 10.1016/j.drugpo.2022.103675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/25/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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Abstract
This paper is the forty-second consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2019 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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Gu J, Guo X, Veenstra G, Zhu Y, Fu Q. Adolescent Marijuana Use in the United States and Structural Breaks: An Age-Period-Cohort Analysis, 1991-2018. Am J Epidemiol 2021; 190:1056-1063. [PMID: 33324982 DOI: 10.1093/aje/kwaa269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/26/2022] Open
Abstract
To investigate temporal patterns, sociodemographic gradients, and structural breaks in adolescent marijuana use in the United States from 1991 to 2018, we used hierarchical age-period-cohort logistic regression models to distinguish temporal effects of marijuana use among 8th, 10th, and 12th graders from 28 waves of the Monitoring the Future survey (1991-2018). Structural breaks in period effects were further detected via a dynamic-programing-based method. Net of other effects, we found a clear age-related increase in the probability of marijuana use (10.46%, 23.17%, and 31.19% for 8th, 10th, and 12th graders, respectively). Period effects showed a substantial increase over time (from 16.23% in 2006 to 26.38% in 2018), while cohort effects remained stable throughout the study period. Risk of adolescent marijuana use varied by sex, racial group, family status, and parental education. Significant structural breaks during 1995-1996, 2006-2008, and 2011-2013 were identified in different subpopulations. A steady increase in marijuana use among adolescents during the latter years of this time period was identified. Adolescents who were male, were non-Black, lived in nonintact families, and had less educated parents were especially at risk of marijuana usage. Trends in adolescent marijuana use changed significantly during times of economic crisis.
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11
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Voon P, Wang L, Nosova E, Hayashi K, Milloy MJ, Wood E, Kerr T. Pain and Barriers to Accessing Health Services Among People Who Use Drugs. Pain Manag Nurs 2020; 22:133-140. [PMID: 33358486 DOI: 10.1016/j.pmn.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The opioid overdose crisis underscores the need for health services among people who use drugs (PWUD) with concurrent pain. AIMS Investigating the effect of pain on barriers to accessing health services among PWUD. DESIGN Prospective cohort study. SETTINGS A setting of universal access to no-cost medical care in Vancouver, Canada from June 2014 to May 2016. PARTICIPANTS/SUBJECTS PWUD who completed at least one study interview. METHODS Data derived from interviewer-administered questionnaires were used for multivariable generalized linear mixed-effects multiple regression (GLMM) analyses. RESULTS Among 1,348 PWUD, 469 (34.8%) reported barriers to accessing health services at least once during the study period. The median average pain severity was 3 (IQR: 0-6) out of 10. A dose-response relationship was observed between greater pain and increased odds of reporting barriers to accessing health services (adjusted odds ratio [AOR]: 1.59, 95% confidence interval [CI]: 1.15-2.21, p = .005 for mild versus no pain; AOR: 1.76, 95% CI: 1.30-2.37, p < .001 for moderate versus no pain; AOR: 2.55, 95% CI: 1.92-3.37, p < .001 for severe versus no pain). Common barriers included poor treatment by health professionals, socio-structural barriers such as transportation or mobility, and long wait lists or wait times. CONCLUSIONS Pain may be a significant risk factor associated with increased barriers to accessing health services among PWUD. Attention to pain management may improve access to health services, and reducing barriers to health services may conversely improve pain management and its related risks and harms.
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Affiliation(s)
- Pauline Voon
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Linwei Wang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; Centre for Urban Health Solutions, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Segel JE, Winkelman TNA. Persistence and Pervasiveness : Early Wave Opioid Overdose Death Rates Associated With Subsequent Overdose Death Rates. Public Health Rep 2020; 136:212-218. [PMID: 33301695 DOI: 10.1177/0033354920969171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Although trends in opioid-related death rates in the United States have been described, the association between state-level opioid overdose death rates in early waves and substance-related overdose death rates in later waves has not been characterized. We examined the relationship between state-level opioid overdose death rates at the beginning of the crisis (1999-2004) and overdose death rates for opioids and other substances in later years. METHODS Using 1999-2018 multiple cause of death data from the Centers for Disease Control and Prevention, we first categorized each state by quartile of baseline (1999-2004) opioid overdose death rates. By baseline opioid overdose death rates, we then compared states' annual overdose death rates from any opioid, heroin, synthetic opioids, sedatives, stimulants/methamphetamine, and cocaine from 2005 through 2018. To test the association between baseline opioid overdose death rates and subsequent substance-related overdose death rates for all 6 substances, we estimated unadjusted and adjusted linear models controlling for annual state-level unemployment, median household income, age, sex, and race/ethnicity. RESULTS Our results suggest 2 characteristics of the opioid crisis: persistence and pervasiveness. In adjusted analyses, we found that for each additional opioid overdose death per 100 000 population at baseline, states had 23.5 more opioid deaths, 4.4 more heroin deaths, 8.0 more synthetic opioid deaths, 9.2 more sedative deaths, 3.3 more stimulant deaths, and 4.6 more cocaine deaths per 100 000 population from 2005 to 2018. CONCLUSION These findings have important implications for continued surveillance to assist policy makers in deciding how to deploy resources to combat not just opioid use disorder but also polysubstance use disorder and broader problems of substance use disorder.
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Affiliation(s)
- Joel E Segel
- 8082 Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA.,8082 Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, USA
| | - Tyler N A Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA.,5532 Health, Homelessness, and Criminal Justice Laboratory, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
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13
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Venkataramani AS, O’Brien R, Whitehorn GL, Tsai AC. Economic influences on population health in the United States: Toward policymaking driven by data and evidence. PLoS Med 2020; 17:e1003319. [PMID: 32877406 PMCID: PMC7467305 DOI: 10.1371/journal.pmed.1003319] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Atheendar S. Venkataramani and colleagues discuss economic factors and population health in the United States.
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Affiliation(s)
- Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Rourke O’Brien
- Department of Sociology, Yale University, New Haven, Connecticut, United States of America
| | - Gregory L. Whitehorn
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
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14
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Alexander K, Short V, Gannon M, Goyal N, Naegle M, Abatemarco DJ. Identified gaps and opportunities in perinatal healthcare delivery for women in treatment for opioid use disorder. Subst Abus 2020; 42:552-558. [DOI: 10.1080/08897077.2020.1803178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Karen Alexander
- Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vanessa Short
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Megan Gannon
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Neera Goyal
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Madeline Naegle
- Rory Meyers College of Nursing, New York University, New York City, NY, USA
| | - Diane J. Abatemarco
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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15
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Fairman KA, Early NK. Treatment Needs and Service Utilization in Older U.S. Adults Evidencing High-Risk Substance Use. J Aging Health 2020; 32:1363-1375. [PMID: 32515637 DOI: 10.1177/0898264320929537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Because substance misuse by older adults poses clinical risks and has not been recently assessed, we examined substance use patterns, treatment needs, and service utilization in those evidencing high-risk use. Methods: We identified National Survey on Drug Use and Health respondents (2015-2018) aged ≥50 years reporting multiple-occasion binge drinking, illicit drug use, prescription drug misuse, or substance dependence. Past-year psychological symptoms were assessed using validated scales. Results: The sample, representing 10.2% of community-dwelling older U.S. adults, evidenced clinically important risks: 65.2% past-month binge drinking, 27.3% mental illness, 14.3% psychological distress, 10.6% combined alcohol/drug use, and 6.5% suicidality. Treatment receipt was uncommon (27.7%), positively associated with distress, and negatively associated with binge drinking. Of those not receiving treatment, 3.8% perceived treatment need. Discussion: Findings highlight the value of substance misuse screening and brief interventions, suggesting potential treatment referral opportunities for those evidencing psychological distress.
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Affiliation(s)
- Kathleen A Fairman
- 15474Midwestern University College of Pharmacy - Glendale, Glendale, AZ, US
| | - Nicole K Early
- 15474Midwestern University College of Pharmacy - Glendale, Glendale, AZ, US
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Fink BC, Uyttebrouck O, Larson RS. An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:249-258. [PMID: 32631181 DOI: 10.1177/1073110520935336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death.
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Affiliation(s)
- Brandi C Fink
- Brandi Fink, Ph.D., is a licensed clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of New Mexico Health Sciences. Dr. Fink's research focuses on identifying novel neurophysiological intervention targets to improve outcomes for patients with a variety of substance use related problems. Her clinical work focuses on the treatment of substance use disorders. Olivier Uyttebrouck is a Senior Scientific Writer for the University of New Mexico Health Sciences. Richard Larson, M.D., Ph.D., is the Executive Vice Chancellor, Vice Chancellor for Research, and Professor of Pathology at the University of New Mexico Health Sciences. As an established scholar and leader, Dr. Larson oversees an array of activities and programs at a $2.2 billion academic health center. These activities have spanned operational, clinical, educational and research missions
| | - Olivier Uyttebrouck
- Brandi Fink, Ph.D., is a licensed clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of New Mexico Health Sciences. Dr. Fink's research focuses on identifying novel neurophysiological intervention targets to improve outcomes for patients with a variety of substance use related problems. Her clinical work focuses on the treatment of substance use disorders. Olivier Uyttebrouck is a Senior Scientific Writer for the University of New Mexico Health Sciences. Richard Larson, M.D., Ph.D., is the Executive Vice Chancellor, Vice Chancellor for Research, and Professor of Pathology at the University of New Mexico Health Sciences. As an established scholar and leader, Dr. Larson oversees an array of activities and programs at a $2.2 billion academic health center. These activities have spanned operational, clinical, educational and research missions
| | - Richard S Larson
- Brandi Fink, Ph.D., is a licensed clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of New Mexico Health Sciences. Dr. Fink's research focuses on identifying novel neurophysiological intervention targets to improve outcomes for patients with a variety of substance use related problems. Her clinical work focuses on the treatment of substance use disorders. Olivier Uyttebrouck is a Senior Scientific Writer for the University of New Mexico Health Sciences. Richard Larson, M.D., Ph.D., is the Executive Vice Chancellor, Vice Chancellor for Research, and Professor of Pathology at the University of New Mexico Health Sciences. As an established scholar and leader, Dr. Larson oversees an array of activities and programs at a $2.2 billion academic health center. These activities have spanned operational, clinical, educational and research missions
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Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain. PLoS One 2020; 15:e0232538. [PMID: 32365132 PMCID: PMC7197848 DOI: 10.1371/journal.pone.0232538] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
Background After decades of increased opioid pain reliever prescribing, providers are rapidly reducing prescribing. We hypothesized that reduced access to prescribed opioid pain relievers among patients previously reliant upon opioid pain relievers would result in increased illicit opioid use. Methods and findings We conducted a retrospective cohort study among 602 publicly insured primary care patients who had been prescribed opioids for chronic non-cancer pain for at least three consecutive months in San Francisco, recruited through convenience sampling. We conducted a historical reconstruction interview and medical chart abstraction focused on illicit substance use and opioid pain reliever prescriptions, respectively, from 2012 through the interview date in 2017–2018. We used a nested-cohort design, in which patients were classified, based on opioid pain reliever dose change, into a series of nested cohorts starting with each follow-up quarter. Using continuation-ratio models, we estimated associations between opioid prescription discontinuation or 30% increase or decrease in dose, relative to no change, and subsequent frequency of heroin and non-prescribed opioid pain reliever use, separately. Models controlled for demographics, clinical and behavioral characteristics, and past use of heroin or non-prescribed opioid pain relievers. A total of 56,372 and 56,484 participant-quarter observations were included from the 597 and 598 participants available for analyses of heroin and non-prescribed opioid pain reliever outcomes, respectively. Participants discontinued from prescribed opioids were more likely to use heroin (Adjusted Odds Ratio (AOR) = 1.57, 95% CI: 1.25–1.97) and non-prescribed opioid pain relievers (AOR = 1.75, 1.45–2.11) more frequently in subsequent quarters compared to participants with unchanged opioid prescriptions. Participants whose opioid pain reliever dose increased were more likely to use heroin more frequently (AOR = 1.67, 1.32–2.12). Results held throughout sensitivity analyses. The main limitations were the observational nature of results and limited generalizability beyond safety-net settings. Conclusions Discontinuation of prescribed opioid pain relievers was associated with more frequent non-prescribed opioid pain reliever and heroin use; increased dose was also associated with more frequent heroin use. Clinicians should be aware of these risks in determining pain management approaches.
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Brenes F, Henriquez F. Hispanics, Addictions, and the Opioid Epidemic: Brief Report. HISPANIC HEALTH CARE INTERNATIONAL 2019; 18:40-43. [PMID: 31747797 DOI: 10.1177/1540415319888437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Opioid addiction is a public health concern. Opioid overdose death rates account for one third to a half of all global substance-related deaths. Opioid mortality rates increased nearly fivefold in the United States between 1999 and 2016. Recent research has found health care disparities in the United States among minority populations with opioid use disorder, particularly Hispanics. Current literature also suggests that a number of social and cultural factors, including the stigma linked to mental illness and treatment in the Hispanic culture, may further negatively contribute to the problem. This brief report pays close attention to the opioid epidemic in the United States and addresses issues related to the crisis among Hispanics. Recommendations for clinical practice, research, and health care policy are also discussed.
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Alexander K, Kronk R, Sekula K, Short V, Abatemarco D. Implementation of a Mindfulness Intervention for Women in Treatment for Opioid Use Disorder and Its Effects on Depression Symptoms. Issues Ment Health Nurs 2019; 40:690-696. [PMID: 31100036 DOI: 10.1080/01612840.2019.1585499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Many women in treatment for opioid use disorder (OUD) also experience mental health co-morbidities. Mindfulness intervention has demonstrated effectiveness for improving mental health in the general population, but has not been tested with female populations in OUD treatment. The purpose of this study was to describe characteristics associated with participation in a mindfulness intervention provided to women in treatment for OUD, and also to evaluate the effectiveness of a mindfulness intervention on depression symptoms. Aims: To evaluate participation characteristics associated with a mindfulness intervention and to assess the impact of a mindfulness intervention on depression symptoms for women with OUD. Methods: A secondary data analysis of a mindfulness intervention with women in treatment for OUD was accomplished. Bivariate analysis was conducted to determine any sociodemographic variables associated with intervention participation. Depression scores were assessed pre and post intervention using paired samples t tests for the intervention group (n = 65) and the control group (n = 8). Results: A 45% of women in the study reported moderate to severe depression symptoms at baseline, and 63% reported high levels of childhood trauma. There was a significant decrease in depression scores (M = 3.6 [1.2,6.1]) following the mindfulness intervention for the intervention group (t(64) = 3.1, p = .003). Participants entering the intervention group with moderate to severe depression scores experienced the most significant decrease in depression symptoms (M = 6.6, SD = 13.5), (t(64) = -2.1, p < .05). Conclusions: Women in treatment for OUD experience high levels of depression symptoms and past trauma, and mindfulness is a feasible intervention for OUD populations which may improve depression symptoms.
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Affiliation(s)
- Karen Alexander
- a Jefferson College of Nursing , Thomas Jefferson University , Philadelphia , PA , USA
| | - Rebecca Kronk
- b School of Nursing , Duquesne University , Pittsburgh , PA , USA
| | - Kathleen Sekula
- b School of Nursing , Duquesne University , Pittsburgh , PA , USA
| | - Vanessa Short
- c Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
| | - Diane Abatemarco
- c Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
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Krasowski MD, McMillin GA, Melanson SEF, Dizon A, Magnani B, Snozek CLH. Interpretation and Utility of Drug of Abuse Screening Immunoassays: Insights From Laboratory Drug Testing Proficiency Surveys. Arch Pathol Lab Med 2019; 144:177-184. [DOI: 10.5858/arpa.2018-0562-cp] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Urine drug testing is frequently ordered by health care providers. Immunoassays are widely used for drug testing, yet have potential limitations, including variable cross-reactivity. The last decade has seen worsening of a prescription drug abuse epidemic.
Objective.—
To use data from a College of American Pathologists proficiency testing survey, Urine Drug Testing, Screening, to determine and summarize the characteristics, performance, and limitations of immunoassays.
Design.—
Seven years of proficiency surveys were reviewed (2011–2017).
Results.—
Rapid growth was seen in participant volumes for specific immunoassays for synthetic opioids (eg, buprenorphine, fentanyl, oxycodone) and 3,4-methylenedioxymethamphetamine (“ecstasy”). Participant volumes remained high for immunoassays targeting less commonly abused drugs such as barbiturates and phencyclidine. For opiate immunoassays, the number of laboratories using a 2000 ng/mL positive cutoff remained stable, and an increasing number adopted a 100 ng/mL cutoff. Opiate and amphetamine immunoassays showed high variability in cross-reactivity for drugs other than the assay calibrator. Assays targeting a single drug or metabolite generally performed well on drug challenges.
Conclusions.—
Survey results indicate strong clinical interest in urine drug testing and some adoption of new assays. However, urine drug testing availability does not parallel prevailing patterns of drug prescribing and abuse patterns. In particular, specific immunoassays for synthetic opioids and a lower positive cutoff for opiate immunoassays may be underused, whereas immunoassays for barbiturates, methadone, propoxyphene, and phencyclidine may be overused. Laboratories are encouraged to review their test menu, cutoffs, and assay performance and adjust their test offerings based on clinical needs and technical capabilities.
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Affiliation(s)
- Matthew D. Krasowski
- From the Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City (Dr Krasowski); the Department of Pathology, University of Utah School of Medicine, ARUP Laboratories, Salt Lake City (Dr McMillin); the Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Melanson); the Proficiency Testing Division, College of American Pathol
| | - Gwendolyn A. McMillin
- From the Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City (Dr Krasowski); the Department of Pathology, University of Utah School of Medicine, ARUP Laboratories, Salt Lake City (Dr McMillin); the Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Melanson); the Proficiency Testing Division, College of American Pathol
| | - Stacy E. F. Melanson
- From the Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City (Dr Krasowski); the Department of Pathology, University of Utah School of Medicine, ARUP Laboratories, Salt Lake City (Dr McMillin); the Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Melanson); the Proficiency Testing Division, College of American Pathol
| | - Annabel Dizon
- From the Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City (Dr Krasowski); the Department of Pathology, University of Utah School of Medicine, ARUP Laboratories, Salt Lake City (Dr McMillin); the Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Melanson); the Proficiency Testing Division, College of American Pathol
| | - Barbarajean Magnani
- From the Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City (Dr Krasowski); the Department of Pathology, University of Utah School of Medicine, ARUP Laboratories, Salt Lake City (Dr McMillin); the Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Melanson); the Proficiency Testing Division, College of American Pathol
| | - Christine L. H. Snozek
- From the Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City (Dr Krasowski); the Department of Pathology, University of Utah School of Medicine, ARUP Laboratories, Salt Lake City (Dr McMillin); the Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Melanson); the Proficiency Testing Division, College of American Pathol
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Queeneth U, Bhimanadham NN, Mainali P, Onyeaka HK, Pankaj A, Patel RS. Heroin Overdose-Related Child and Adolescent Hospitalizations: Insight on Comorbid Psychiatric and Substance Use Disorders. Behav Sci (Basel) 2019; 9:E77. [PMID: 31337011 PMCID: PMC6680937 DOI: 10.3390/bs9070077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the association between psychiatric comorbidities, substance use disorders and heroin overdose-related hospitalizations (HOD). Next, to understand the demographic trend of HOD hospitalizations and comorbidities. METHODS Using the Nationwide Inpatient Sample (NIS), we included 27,442,808 child and adolescent hospitalizations, and 1432 inpatients (0.005%) were managed primarily for HOD. The odds ratio (OR) of the association of variables in HOD inpatients were measured using a logistic regression model. RESULTS Adolescents had 56 times higher odds (95% CI 43.36-73.30) for HOD-related hospitalizations compared to 4.6% children under 11 years. About three-fifth of the HOD inpatients were male, and they had 1.5-fold higher odds (95% CI 1.30-1.64) compared to 43% females in the study population. Whites were considerably higher in proportion (81%) than other race/ethnicities. A greater portion of HOD inpatients (40%) were from high-income families. Most common comorbid psychiatric disorders were mood (43.8%) and anxiety (20.4%). The prevalent comorbid substance use disorders were opioid (62.4%), tobacco (36.8%) and cannabis (28.5%) use disorders. CONCLUSION HOD-related hospitalizations were predominant in males, White and older adolescents (12-18 years). Prescription opioids are the bridge to heroin abuse, thereby increasing the vulnerability to other substance abuse. This requires more surveillance and should be explored to help reduce the heroin epidemic in children.
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Affiliation(s)
- Uwandu Queeneth
- Department of Psychiatry, Maastricht University, 4-6, 6211 LK Maastricht, The Netherlands
| | | | - Pranita Mainali
- Department of Psychiatry, Washington DC VA Medical Center, Washington, DC 20422, USA
| | | | - Amaya Pankaj
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Rikinkumar S Patel
- Department of Psychiatry, Griffin Memorial Hospital, Norman, OK 73071, USA.
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Neighbors CJ, Choi S, Healy S, Yerneni R, Sun T, Shapoval L. Age related medication for addiction treatment (MAT) use for opioid use disorder among Medicaid-insured patients in New York. Subst Abuse Treat Prev Policy 2019; 14:28. [PMID: 31238952 PMCID: PMC6593566 DOI: 10.1186/s13011-019-0215-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/30/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Medication for addiction treatment (MAT) has received much attention in recent years for treating individuals with opioid use disorders (OUD). However, these medications have been significantly underused among particular subgroups. In this paper, we describe the age distribution of treatment episodes for substance use disorder among Medicaid beneficiaries in New York and corresponding MAT use. METHODS Using New York Medicaid claims, we identified individuals with OUD that received treatment for substance use disorder in 2015. The type of substance use treatment is the primary outcome measure, which includes methadone, buprenorphine, naltrexone or other non-medication treatment. RESULTS A total of 88,637 individuals were diagnosed with OUD and received treatment for substance use disorder and 56,926 individuals received some type of MAT in 2015, with 40.2% receiving methadone, 21.9% receiving buprenorphine and 2.2% receiving naltrexone while 21.9% received non-medication based treatment. Young adults (ages 18-29) were a large proportion (25%) of individuals in treatment for OUD yet were the least likely to receive MAT. Relative to young adults, 30-39 year olds (adjusted odds ratio [AOR] = 1.62, 95% CI = 1.56-1.68), 40-49 year olds (AOR = 1.90, 95% CI = 1.82-1.99), 50-59 year olds (AOR = 2.65, 95% CI = 2.52-2.78), and 60-64 year olds (AOR = 5.03, 95% CI = 4.62-5.48) were more likely to receive MAT. CONCLUSIONS These preliminary findings highlight high numbers of young adults in treatment for OUD and low rates of MAT, which is not consistent with treatment guidelines. Significant differences exist in the type of medication prescribed across age. More attention is needed to address the treatment needs among individuals of different age, notably young adults.
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Affiliation(s)
| | - Sugy Choi
- Center on Addiction, New York, NY, USA
- Boston University School of Public Health, Boston, MA, USA
| | | | | | - Tong Sun
- New York State Office of Alcoholism and Substance Abuse Services (OASAS), Albany, NY, USA
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Opioid Use and Outcomes in Hospitalized Older Patients With Heart Failure Receiving and Not Receiving Hospice Referrals. Am J Ther 2019; 27:e356-e365. [PMID: 31145140 DOI: 10.1097/mjt.0000000000000987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of opioids is associated with poor outcomes. Less is known about this association in patients with heart failure (HF) and whether it varies by the receipt of hospice care. METHODS Of the 7467 patients hospitalized for HF without previous opioid use, 124 received discharge opioids. We matched 123 of these patients with 123 not receiving opioids based on their propensity scores for opioid use, thus assembling a matched cohort of 246 patients balanced on 30 baseline characteristics (mean age, 76 years, 60% women, and 11% African American). We repeated the process in hospice (n = 155; 20 received opioids) and nonhospice (n = 7298; 104 received opioids) subgroups, thus assembling 2 matched cohorts of 22 and 208 patients, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) associated with opioid use were estimated from matched cohorts. RESULTS During 8.6 (median, 1.4) years of follow-up, all-cause mortality occurred in 80% and 68% of matched patients in the opioid and nonopioid groups, respectively (HR, 1.49; 95% CI, 1.11-1.99; P = 0.008). There was evidence of heterogeneity in this association between hospice and nonhospice patients (P for interaction, 0.027). Among matched hospice and nonhospice patients, HRs (95% CIs) for mortality were 6.37 (2.06-19.69; P = 0.001) and 1.42 (1.03-1.96; P = 0.035), respectively. HRs (95% CIs) for 30-day and 1-year mortality were 1.98 (1.06-3.70; P = 0.033) and 1.72 (1.18-2.49; P = 0.004), respectively. HRs (95% CIs) for all-cause, HF, and non-HF readmissions were 1.31 (0.97-1.76; P = 0.079), 1.03 (0.71-1.49; P = 0.866), and 1.75 (1.05-2.91; P = 0.031), respectively. Readmission associations were similar among matched nonhospice patients. There was no readmission among matched hospice patients receiving opioids. CONCLUSIONS In older patients with HF, opioid use is associated with a higher risk of mortality, which is greater in the hospice subgroup, and a higher risk of non-HF readmission in the nonhospice subgroup.
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Peckham AM, Fairman KA, Awanis G, Early NK. High-risk opioid prescribing trends in the outpatient setting prior to issuance of federal guidance. Prev Med Rep 2019; 15:100892. [PMID: 31193830 PMCID: PMC6542766 DOI: 10.1016/j.pmedr.2019.100892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/01/2019] [Accepted: 05/12/2019] [Indexed: 02/03/2023] Open
Abstract
Co-prescription of opioid and benzodiazepine products increases the risk of overdose-related mortality four-fold due to respiratory depression. Accordingly, prevention of high-risk opioid prescribing (HROP) has become a focus over the past two decades and was the subject of a black-box warning (BBW) issued by the U.S. Food and Drug Administration (FDA) on August 31, 2016. Because older patients are at increased risk for these outcomes, we compared rates of HROP for older (aged ≥65 years) and younger (aged 18–64 years) adults using a repeated cross-sectional cohort design. Data from the National Ambulatory Medical Care Survey of U.S. office-based physician visits were accessed for 2006–2016 August. From 2006 to 2016, the opioid-prescribing rate increased by 40% among those aged 18–64 years and by 54% among those aged ≥65 years. From 2012–2013 to 2014–2016, the HROP rate, expressed as a proportion of all opioid-prescribing visits, increased to 26.6% among those aged 18–64 years but declined to 21.0% among those aged ≥65 years, primarily because of changes for patients aged ≥75 years. Prior to the FDA-issued BBW, the HROP prescribing rate trended upward for all adults, except in 2014–2016 when it began to decline among older adults. From 2006–07 to 2014–16, opioid prescribing rates increased among U.S. adults. Opioid use decreased for adults aged ≥75 in 2014–16 but grew for those aged 65–74 years. High-risk opioid-prescribing (HROP) for older adults began to decline in 2014–16. From 2012–13 to 2014–16, HROP continued to increase for those aged 18–64 years.
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Affiliation(s)
- Alyssa M Peckham
- 360 Huntington Ave, Boston, MA 02115, Bouvé College of Health Sciences, Northeastern University, USA.,55 Fruit St, Boston, MA 02114, Massachusetts General Hospital, Substance Use Disorders Initiative, USA
| | - Kathleen A Fairman
- 19555 N 59th Avenue, Glendale, AZ, USA, Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale
| | - Gina Awanis
- 19555 N 59th Avenue, Glendale, AZ, USA, Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale
| | - Nicole K Early
- 19555 N 59th Avenue, Glendale, AZ, USA, Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale
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Carliner H. Age, Period, and Cohort Effects to Predict the Future of Despair. Am J Public Health 2019; 109:658-660. [PMID: 30969839 DOI: 10.2105/ajph.2019.305049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Hannah Carliner
- Hannah Carliner is with the Department of Psychiatry, Columbia University, New York, NY and the New York State Psychiatric Institute, New York, NY
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Abstract
OBJECTIVE The main purpose of this study was to estimate the tax revenue lost by state and federal governments as a result of adverse labor market outcomes attributable to opioid misuse. METHODS We pair existing, plausibly causal estimates of the effect of opioid misuse on the decline in the labor force from 2000 to 2016 with a variety of data sources to compute tax revenues lost by state and federal governments using the online TAXSIM calculator. RESULTS We find that between 2000 and 2016, opioid misuse cost state governments $11.8 billion, including $1.7 billion in lost sales tax revenue and $10.1 billion in lost income tax revenue. In addition, the federal government lost $26.0 billion in income tax revenue. CONCLUSIONS By omitting lost tax revenue due to labor force exits, prior studies have missed an important component of opioid-related costs borne by state and federal governments. POLICY IMPLICATIONS As more states and the federal government contemplate litigation for opioid-related damages, lost tax revenue represents an important cost that could be recouped and allocated to opioid prevention and treatment programs.
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Gaither JR, Shabanova V, Leventhal JM. US National Trends in Pediatric Deaths From Prescription and Illicit Opioids, 1999-2016. JAMA Netw Open 2018; 1:e186558. [PMID: 30646334 PMCID: PMC6324338 DOI: 10.1001/jamanetworkopen.2018.6558] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE It is not yet known how many children and adolescents die each year from opioid poisonings and how mortality rates have changed over time. OBJECTIVE To examine national trends in pediatric deaths from prescription and illicit opioids. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional in which serial mortality data from the Centers for Disease Control and Prevention were analyzed. The population included 8986 children and adolescents (age, <20 years) who died in all US settings from opioid poisonings between 1999 and 2016. Data were collected and analyzed between June 1 and October 31, 2018. EXPOSURES All opioids. MAIN OUTCOMES AND MEASURES Age-specific mortality rates per 100 000 were estimated with smoothing spline Poisson regression. RESULTS Of the 8986 children and adolescents who died between 1999 and 2016 from prescription and illicit opioid poisonings, 6567 (73.1%) were male, 7921 (88.1%) were among adolescents aged 15 to 19 years, and 605 (6.7%) were among children aged 0 to 4 years. The overall pediatric mortality rate increased from 0.22 (95% CI, 0.19-0.25) to 0.81 (95% CI, 0.76-0.88) per 100 000, an increase of 268.2% (P for time effect <.001). The highest annual rates were among adolescents aged 15 to 19 years, but time trends revealed a steady linear increase among children aged 0 to 4 years and those aged 5 to 9 years as well as a steady linear increase until 2008 among the cohorts aged 10 to 14 years and 15 to 19 years, when rates briefly declined before rising again. Among adolescents aged 15 to 19 years, heroin was implicated in 1872 deaths: rates increased from 0.21 (95% CI, 0.17-0.25) to 1.06 (95% CI, 0.97-1.17), an increase of 404.8%, whereas rates for prescription opioids increased by 94.7% from 0.57 (95% CI, 0.49-0.66) to 1.11 (95% CI, 0.99-1.25) (all P for time effect <.001). Between 2014 and 2016, there were 1508 opioid deaths among adolescents aged 15 to 19 years; of these, 468 (31.0%) were attributed to synthetic opioids. Across time, 7263 (80.8%) of all pediatric deaths were unintentional, 5537 (61.6%) occurred outside of a medical facility, and 3419 (38.0%) children died at home or another residential setting. Among children younger than 5 years, 148 (24.5%) deaths were attributed to homicide. CONCLUSIONS AND RELEVANCE Over 18 years, nearly 9000 children and adolescents died from opioid poisonings, and the mortality rate increased nearly 3-fold. These findings suggest that the opioid epidemic is likely to remain a growing public health problem in the young unless legislators, public health officials, clinicians, and parents take a wider view of the opioid crisis and implement protective measures that are pediatric specific and family centered.
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Affiliation(s)
- Julie R. Gaither
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - John M. Leventhal
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Iwanicki JL, Severtson SG, Margolin Z, Dasgupta N, Green JL, Dart RC. Consistency Between Opioid-Related Mortality Trends Derived From Poison Center and National Vital Statistics System, United States, 2006-2016. Am J Public Health 2018; 108:1639-1645. [PMID: 30403501 PMCID: PMC6236735 DOI: 10.2105/ajph.2018.304728] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine the association between poison center opioid exposure calls and National Vital Statistics System (NVSS) deaths. METHODS We categorized Centers for Disease Control and Prevention NVSS mortality and the Researched Abuse, Diversion and Addiction-Related Surveillance System poison center program cases from 2006 to 2016 by International Classification of Diseases, Tenth Revision, codes (heroin [T40.1]; natural or semisynthetic opioids [T40.2]; methadone [T40.3]; synthetic opioids, other than methadone [T40.4]). We scaled rates by 100 000 population and calculated Pearson correlation coefficients. Sensitivity analysis excluded polysubstance cases involving either heroin or synthetic opioids as well as natural and semisynthetic opioids. RESULTS The NVSS mortality and poison center program exposure rates showed similar trends from 2006 to 2012, and diverged after 2012 for all opioids combined, natural and semisynthetic opioids, and synthetic opioids (r = -0.37, -0.12, and 0.30, respectively). Sensitivity analysis with removal of heroin or synthetic opioid polysubstance deaths markedly improved correlations for all opioids combined and natural and semisynthetic opioids (r = 0.87 and 0.36, respectively). CONCLUSIONS The NVSS mortality and poison center exposure rates showed similar trends from 2006 to 2012 then diverged, with sensitivity analysis suggesting polysubstance cases also involving heroin or illicit fentanyl as the cause. Public Health Implications. The NVSS and poison center program may provide complementary data when trends diverge. Public health interventions must include both licit and illicit opioids for maximal impact.
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Affiliation(s)
- Janetta L Iwanicki
- At the time of this study, all of the authors were affiliated with Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO
| | - S Geoff Severtson
- At the time of this study, all of the authors were affiliated with Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO
| | - Zachary Margolin
- At the time of this study, all of the authors were affiliated with Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO
| | - Nabarun Dasgupta
- At the time of this study, all of the authors were affiliated with Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO
| | - Jody L Green
- At the time of this study, all of the authors were affiliated with Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO
| | - Richard C Dart
- At the time of this study, all of the authors were affiliated with Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO
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Sauer T, Ebeling M, Rau R. The Fateful Cohorts. Am J Public Health 2018; 108:e1-e2. [PMID: 30207771 DOI: 10.2105/ajph.2018.304671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Roland Rau
- Torsten Sauer, Marcus Ebeling, and Roland Rau are with the Department of Sociology and Demography, University of Rostock, and the Laboratory of Mathematical and Actuarial Demography, Max Planck Institute for Demographic Research, Rostock, Germany
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Forjuoh SN. Injury control: using novel analytic methods to enhance advocacy and policy response. Int J Inj Contr Saf Promot 2018; 25:117-118. [PMID: 29616875 DOI: 10.1080/17457300.2018.1452310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Samuel N Forjuoh
- a Department of Family & Community Medicine Baylor Scott & White Health Texas A&M HSC College of Medicine Temple , TX 76504 , USA
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