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Qeadan F, McCunn A, Tingey B, Price R, Bobay KL, Saeed AI. Investigating the association between asthma and opioid use disorder with interactions of anxiety and depression among a national sample of the US population. J Asthma 2024; 61:594-607. [PMID: 38088813 DOI: 10.1080/02770903.2023.2294911] [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: 07/06/2023] [Accepted: 12/10/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Previous studies have not examined the association between asthma and opioid use disorder (OUD) in a comprehensive national sample of the U.S. population. This study aims to investigate such an association. METHODS This is a matched retrospective cohort study, with a follow-up period of two years, utilizing longitudinal electronic medical records of a comprehensive national healthcare database in the U.S.-Cerner-Real World DataTM. Patients selected for analysis were ≥12 years old with a hospital encounter between January 2000 and June 2020. Adjusted risk ratios (aRRs) of incident OUD for those with asthma compared to those without asthma were calculated using a modified Poisson regressions with robust standard errors via the Huber-White sandwich estimator, and results were stratified by comorbid mental illnesses. RESULTS Individuals with asthma had a greater risk of OUD compared to those without asthma (aRR = 2.12; 95% CI 2.03-2.23). When stratified by anxiety and depression status, individuals with asthma and no anxiety or depression had a greater risk of incident OUD compared to individuals with asthma and either anxiety, depression, or both. Additionally, individuals with asthma medication had 1.29 (95% CI: 1.24, 1.35) greater overall risk for incident OUD compared to those without medication. Independent of comorbid mental illnesses, individuals with asthma medication had greater risk for incident OUD compared to those without medication among individuals without severe/obstructive asthma. CONCLUSIONS Individuals with asthma face a higher OUD risk compared to those without asthma. Comorbid mental illnesses modulate this risk. Caution is advised in opioid prescribing for asthma patients.
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Affiliation(s)
- Fares Qeadan
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Ashlie McCunn
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Benjamin Tingey
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Ron Price
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Kathleen L Bobay
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Ali Imran Saeed
- Interventional Pulmonary and Advanced Diagnostics, Dignity Health Norton Thoracic Institute, Phoenix, AZ, USA
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Raeisy L, Masoompour SM, Rezaianzadeh A. Evaluation of the prevalence of asthma and chronic obstructive pulmonary disease among opium users, and cigarette smokers and comparison with normal population in Kharameh: a cross-sectional study. BMC Pulm Med 2023; 23:419. [PMID: 37914995 PMCID: PMC10619218 DOI: 10.1186/s12890-023-02734-8] [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: 07/20/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Recent studies have suggested that opium use may increase mortality from pulmonary diseases. However, there are limited comprehensive studies regarding the prevalence of Asthma and Chronic Obstructive Pulmonary Disease (COPD) among tobacco and opium users has been published. We aimed to determine the prevalence of respiratory disease among tobacco and opium users. METHODS This cross-sectional study of tobacco and opium users and matched controls was conducted in the Kharameh Cohort, Fars, Iran. The prevalence of COPD and asthma, along with the participants demographical and spirometry data were examined. RESULTS The average age of participants was 57 ± 8 years. Never smokers had a significant higher BMI (26.6 vs. 24.8), FEV1 (91% vs. 82%) and FVC (96% vs. 88%) values compared to participants with a positive smoking status. There was a statistical difference in the prevalence of COPD, asthma, and asthma COPD overlap (ACO) based on the participants smoking status, with the highest prevalence among opium and cigarette smokers, followed by opium users alone. Based on multivariate analysis, higher age, lower BMI, lower education than under diploma, cigarette smoking and opium use were significantly correlated with higher COPD prevalence; while lower age, cigarette smoking and opium use were significantly correlated with higher asthma prevalence. Illiterate participants had a significantly higher prevalence of COPD (23.6%), asthma (22%), and ACO (7.9%) among the educational groups. Regarding the prevalence of asthma, the higher socio-economic group had the lowest prevalence. CONCLUSIONS Opium and tobacco users had a significantly higher prevalence of respiratory diseases, along with lower lung function tests based on spirometry evaluation.
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Affiliation(s)
- Laleh Raeisy
- Student Research committee of medical school, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Masoom Masoompour
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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3
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Sánchez-Valdivia N, Barbaglia MG, Olivella-Cirici M, Girona Marcos N, Gotsens M, Garrido Albaina A, Rius C, Bartroli M, Pérez G. Community outbreak of COVID-19 among people who use drugs attending a harm reduction centre in Barcelona, Spain. Harm Reduct J 2023; 20:74. [PMID: 37316829 PMCID: PMC10264877 DOI: 10.1186/s12954-023-00804-y] [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: 02/13/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic particularly affected the health of vulnerable population, such as people who use drugs. Due to compromised baseline health status, certain drug uses and settings and socioeconomic deprivation related to poverty and homelessness, drug users faced higher risk of COVID-19 infection. They had difficulty in adhering to the public health measures (i.e. physical distancing, hand hygiene and mask use). Also, the struggle to implement non-pharmaceutical actions (i.e. test-trace-isolate-quarantine strategy) among SARS-COV-2-infected drug users and their close contacts challenged the public health response. Therefore, this study aimed to describe a community COVID-19 outbreak and its approach among drug users of a harm reduction programme in an outpatient drug treatment centre in Barcelona, Spain. METHODS We conducted an observational descriptive study of an outbreak of COVID-19 among people who use drugs attending the harm reduction programme of an outpatient drug treatment centre in the city of Barcelona, between July and October 2021 (n = 440). A passive search for cases was carried out with rapid antigens tests targeting symptomatic users who attended the facilities. RESULTS Nineteen positive COVID-19 cases were identified among symptomatic drug users, between July and October 2021, with an attack rate of 4.3%. Specific measures were taken to control the outbreak, such as offering accommodation to self-isolate in a low-threshold residential resource to homeless drug users who tested positive and intensifying the vaccination strategy. The management of the outbreak was carried out in close collaboration between the outpatient centre and the main public health stakeholders in the city of Barcelona. CONCLUSIONS This study shows the complexity of managing and investigating COVID-19 outbreaks in vulnerable population groups. Epidemiological control measures, such as the test-trace-isolate-quarantine strategy, were challenging to implement due to technology-related barriers and socioeconomic vulnerabilities, especially homelessness. Community-based interventions, cooperation among stakeholders and housing-related policies were helpful in tackling outbreaks among people who use drugs. When addressing vulnerable and hidden populations, the perspective of inequalities should be included in epidemiological surveillance and outbreak control strategies.
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Affiliation(s)
| | - Maria Gabriela Barbaglia
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain.
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Madrid, Spain.
| | - Marc Olivella-Cirici
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Noelia Girona Marcos
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Madrid, Spain
| | | | - Cristina Rius
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Madrid, Spain
| | - Gloria Pérez
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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4
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Substance use disorders and COVID-19: An analysis of nation-wide Veterans Health Administration electronic health records. Drug Alcohol Depend 2022; 234:109383. [PMID: 35279457 PMCID: PMC8891118 DOI: 10.1016/j.drugalcdep.2022.109383] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Substance use disorders (SUD) elevate the risk for COVID-19 hospitalization, but studies are inconsistent on the relationship of SUD to COVID-19 mortality. METHODS Veterans Health Administration (VHA) patients treated in 2019 and evaluated in 2020 for COVID-19 (n=5,556,315), of whom 62,303 (1.1%) tested positive for COVID-19 (COVID-19+). Outcomes were COVID-19+ by 11/01/20, hospitalization, ICU admission, or death within 60 days of a positive test. Main predictors were any ICD-10-CM SUDs, with substance-specific SUDs (cannabis, cocaine, opioid, stimulant, sedative) explored individually. Logistic regression produced unadjusted and covariate-adjusted odds ratios (OR; aOR). RESULTS Among COVID-19+ patients, 19.25% were hospitalized, 7.71% admitted to ICU, and 5.84% died. In unadjusted models, any SUD and all substance-specific SUDs except cannabis use disorder were associated with COVID-19+(ORs=1.06-1.85); adjusted models produced similar results. Any SUD and all substance-specific SUDs were associated with hospitalization (aORs: 1.24-1.91). Any SUD, cocaine and opioid disorder were associated with ICU admission in unadjusted but not adjusted models. Any SUD, cannabis, cocaine, and stimulant disorders were inversely associated with mortality in unadjusted models (OR=0.27-0.46). After adjustment, associations with mortality were no longer significant. In ad hoc analyses, adjusted odds of mortality were lower among the 49.9% of COVID-19+ patients with SUD who had SUD treatment in 2019, but not among those without such treatment. CONCLUSIONS In VHA patients, SUDs are associated with COVID-19 hospitalization but not COVID-19 mortality. SUD treatment may provide closer monitoring of care, ensuring that these patients received needed medical attention, enabling them to ultimately survive serious illness.
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5
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Tas B, Kalk NJ, Lozano-García M, Rafferty GF, Cho P, Kelleher M, Moxham J, Strang J, Jolley CJ. Undetected Respiratory Depression in People with Opioid Use Disorder. Drug Alcohol Depend 2022; 234:109401. [PMID: 35306391 DOI: 10.1016/j.drugalcdep.2022.109401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Opioid-related deaths are increasing globally. Respiratory complications of opioid use and underlying respiratory disease in people with Opioid Use Disorder (OUD) are potential contributory factors. Individual variation in susceptibility to overdose is, however, incompletely understood. This study investigated the prevalence of respiratory depression (RD) in OUD treatment and compared this to patients with chronic obstructive pulmonary disease (COPD) of equivalent severity. We also explored the contribution of opioid agonist treatment (OAT) dosage, and type, to the prevalence of RD. METHODS There were four groups of participants: 1) OUD plus COPD ('OUD-COPD', n = 13); 2) OUD without COPD ('OUD', n = 7); 3) opioid-naïve COPD patients ('COPD'n = 13); 4) healthy controls ('HC'n = 7). Physiological indices, including pulse oximetry (SpO2%), end-tidal CO2 (ETCO2), transcutaneous CO2 (TcCO2), respiratory airflow and second intercostal space parasternal muscle electromyography (EMGpara), were recorded continuously over 40 min whilst awake at rest. Significant RD was defined as: SpO2%< 90% for > 10 s, ETCO2 per breath > 6.6 kPa, TcCO2 overall mean > 6 kPa, respiratory pauses > 10 s RESULTS: At least one indicator was observed in every participant with OUD (n = 20). This compared to RD episode occurrence in only 2/7 HC and 2/13 COPD participants (p < 0.05,Fisher's exact test). The occurrence of RD was similar in OUD participants prescribed methadone (n = 6) compared to those prescribed buprenorphine (n = 12). CONCLUSIONS Undetected RD is common in OUD cohorts receiving OAT and is significantly more severe than in opioid-naïve controls. RD can be assessed using simple objective measures. Further studies are required to determine the association between RD and overdose risk.
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Affiliation(s)
- B Tas
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK.
| | - N J Kalk
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - M Lozano-García
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST) & Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) & Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Barcelona, Spain
| | - G F Rafferty
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
| | - Psp Cho
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, King's Health Partners, London SE5 9RS, UK
| | - M Kelleher
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - J Moxham
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
| | - J Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - C J Jolley
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
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6
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Krausz RM, Wong JSH, Westenberg JN, Choi F, Schütz CG, Jang KL. Canada's Response to the Dual Public Health Crises: A Cautionary Tale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:349-353. [PMID: 33567889 PMCID: PMC8044624 DOI: 10.1177/0706743721993634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Reinhard M Krausz
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - James S H Wong
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean N Westenberg
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Fiona Choi
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian G Schütz
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry L Jang
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
The emergence of the COVID-19 pandemic has presented the addiction services with an unprecedented set of challenges. Opioid users are particularly vulnerable because of their high level of pre-existing health problems and lifestyle factors. In order to minimise their risks to self and to others in the current Covid-19 crisis, addiction services sought to urgently identify vulnerable individuals, and induct them into opioid substitution treatment (OST) promptly. Additionally, several guidelines were created and regularly updated by the health and safety executive (HSE) for any healthcare staff working with opioid users. These include guidance documents, to facilitate prompt induction of patients onto the OST programme, the prescribing of naloxone to all patients at risk of overdose, eConsultation, medication management for those in self-isolation, and the delivery of injecting equipment. The guidance documents and resources will provide a template for a new way of working for the sector during these challenging times and into the future.
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8
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Nelson EUE, Dumbili EW, Odeigah OW. Drug use treatment during COVID-19 pandemic: community-based services in Nigeria. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1838640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Ediomo-Ubong Ekpo Nelson
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
- International Blue Cross, Nigeria
| | - Emeka W. Dumbili
- Institute for Therapy and Health Research, Kiel, Germany
- Department of Sociology and Anthropology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ogochukwu Winifred Odeigah
- Department of Psychology, University of Ibadan, Ibadan, Nigeria
- Department of Psychology, College of Arts, Management and Social Sciences, Chrisland University, Abeokuta Nigeria
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O'Carroll A, Duffin T, Collins J. Harm reduction in the time of COVID-19: Case study of homelessness and drug use in Dublin, Ireland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102966. [PMID: 33166825 PMCID: PMC7647898 DOI: 10.1016/j.drugpo.2020.102966] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
Abstract
Dublin appears to have performed very well as compared to various scenarios for COVID-19 mortality amongst homeless and drug using populations. The experience, if borne out by further research, provides important lessons for policy discussions on the pandemic, as well as broader lessons about pragmatic responses to these key client groups irrespective of COVID-19. The overarching lesson seems that when government policy is well coordinated and underpinned by a science-driven and fundamentally pragmatic approach, morbidity and mortality can be reduced. Within this, the importance of strategic clarity and delivery, housing, lowered thresholds to methadone provision, Benzodiazepine (BZD) provision and Naloxone availability were key determinants of policy success. Further, this paper argues that the rapid collapse in policy barriers to these interventions that COVID-19 produced should be secured and protected while further research is conducted.
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Affiliation(s)
- Austin O'Carroll
- COVID-19 Clinical Lead for Homelessness in Dublin, Grangegorman Upper, Arran Quay, Dublin, Ireland
| | - Tony Duffin
- CEO of Ana Liffey Drug Project, 48 Middle Abbey St, North City, Dublin 1, D01 TY74, Ireland.
| | - John Collins
- Director of Academic Engagement, the Global Initiative Against Transnational Organized Crime, Schwarzenbergplatz 1, 1010 Vienna, Austria.
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10
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Melamed OC, Hauck TS, Buckley L, Selby P, Mulsant BH. COVID-19 and persons with substance use disorders: Inequities and mitigation strategies. Subst Abus 2020; 41:286-291. [PMID: 32697172 DOI: 10.1080/08897077.2020.1784363] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The COVID-19 pandemic disproportionately disrupts the daily lives of marginalized populations. Persons with substance use disorders are a particularly vulnerable population because of their unique social and health care needs. They face significant harm from both the pandemic itself and its social and economic consequences, including marginalization in health care and social systems. Hence, we discuss: (1) why persons with substance use disorders are at increased risk for infection with COVID-19 and a severe illness course; (2) anticipated adverse consequences of COVID-19 in persons with substance use disorders; (3) challenges to health care delivery and substance use treatment programs during and after the COVID-19 pandemic; and (4) the potential impact on clinical research in substance use disorders. We offer recommendations for clinical, public health, and social policies to mitigate these challenges and to prevent negative outcomes.
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Affiliation(s)
- Osnat C Melamed
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tanya S Hauck
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Buckley
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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MARSDEN JOHN, DARKE SHANE, HALL WAYNE, HICKMAN MATT, HOLMES JOHN, HUMPHREYS KEITH, NEALE JOANNE, TUCKER JALIE, WEST ROBERT. Mitigating and learning from the impact of COVID-19 infection on addictive disorders. Addiction 2020; 115:1007-1010. [PMID: 32250482 PMCID: PMC9364227 DOI: 10.1111/add.15080] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic and the measures required to address it are cutting a swathe through people’s lives and the global economy. People with addictive disorders are particularly badly affected as a result of poverty, physical and mental health vulnerabilities and disruption of access to services. The pandemic may well increase the extent and severity of some addictive disorders. Current research is suffering from the termination of face-to-face data collection and other restrictions. There is an urgent need to coordinate efforts nationally and internationally to mitigate these problems and to find innovative ways of continuing to provide clinical and public health services to help people with addictive disorders.
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Affiliation(s)
| | - SHANE DARKE
- University of New South Wales, Kensington, NSW, Australia
| | - WAYNE HALL
- University of Queensland, Brisbane, QLD, Australia
| | | | | | - KEITH HUMPHREYS
- Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA, USA
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12
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Substance misuse during COVID-19: protecting people who use drugs. Public Health 2020; 183:63. [PMID: 32405098 PMCID: PMC7218358 DOI: 10.1016/j.puhe.2020.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 11/22/2022]
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13
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COPD and asthma in patients with opioid dependency: a cross-sectional study in primary care. NPJ Prim Care Respir Med 2020; 30:4. [PMID: 31937808 PMCID: PMC6959319 DOI: 10.1038/s41533-019-0161-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 11/29/2019] [Indexed: 11/15/2022] Open
Abstract
Patients treated for drug addiction have high asthma and COPD prevalence rates. The relative contributions of cigarette smoking, smoking intensity and possible smoking of other substances has not been described. We aimed to describe the prevalence and determinants of asthma and COPD in patients prescribed methadone as opioid substitution therapy (OST). In a cross-sectional study of an anonymised patient-level primary care dataset of UK inner-city general practices (n = 46), 321,395 patients aged ≥18 years were identified. A total of 676 (0.21%) had a record of a methadone ever issued in primary care. The association between respiratory disease and methadone prescribing was examined using logistic regression. Models were adjusted for potential effects of clustering by practice. A total of 97.3% of patients prescribed methadone were cigarette smokers, either current (81.2%) or ex-smokers (16.1%). The prevalences of asthma and COPD were higher in methadone patients (14.2% and 12.4%, respectively) compared to non-methadone patients (4.4% and 1.1%, respectively). Methadone was an independent determinant of asthma, adjusting for smoking status (OR 3.21; 95% CI: 2.52, 4.10) or for smoking intensity (3.08; 2.27, 4.19), and of COPD, adjusting for smoking status (6.00; 4.61, 7.80) or for smoking intensity (5.80; 4.12, 8.17). COPD and asthma prevalence were substantially higher in those prescribed methadone compared to those never prescribed methadone. Prescription of methadone was an independent predictor for both COPD and asthma, even after adjustment for smoking status and smoking intensity. Possible explanations include confounding by association with smoking of heroin or crack cocaine, both of which may have a causal association with COPD and asthma.
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14
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Zaami S, Marinelli E, Varì MR. New Trends of Substance Abuse During COVID-19 Pandemic: An International Perspective. Front Psychiatry 2020; 11:700. [PMID: 32765328 PMCID: PMC7378810 DOI: 10.3389/fpsyt.2020.00700] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/03/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Rosaria Varì
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
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15
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Matheson C, Hamilton E, Wallace J, Liddell D. Exploring the health and social care needs of older people with a drug problem. DRUGS: EDUCATION, PREVENTION AND POLICY 2019. [DOI: 10.1080/09687637.2018.1490390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Timko C, Kong C, Vittorio L, Cucciare MA. Screening and brief intervention for unhealthy substance use in patients with chronic medical conditions: a systematic review. J Clin Nurs 2016; 25:3131-3143. [PMID: 27140392 DOI: 10.1111/jocn.13244] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This systematic review describes studies evaluating screening tools and brief interventions for addressing unhealthy substance use in primary care patients with hypertension, diabetes or depression. BACKGROUND Primary care is the main entry point to the health care system for most patients with comorbid unhealthy substance use and chronic medical conditions. Although of great public health importance, systematic reviews of screening tools and brief interventions for unhealthy substance use in this population that are also feasible for use in primary care have not been conducted. DESIGN Systematic review. METHODS We systematically review the research literature on evidence-based tools for screening for unhealthy substance use in primary care patients with depression, diabetes and hypertension, and utilising brief interventions with this population. RESULTS Despite recommendations to screen for and intervene with unhealthy substance use in primary care patients with chronic medical conditions, the review found little indication of routine use of these practices. Limited evidence suggested the Alcohol Use Disorders Identification Test and Alcohol Use Disorders Identification Test-C screeners had adequate psychometric characteristics in patients with the selected chronic medical conditions. Screening scores indicating more severe alcohol use were associated with health-risk behaviours and poorer health outcomes, adding to the potential usefulness of screening for unhealthy alcohol use in this population. CONCLUSIONS Studies support brief interventions' effectiveness with patients treated for hypertension or depression who hazardously use alcohol or cannabis, for both substance use and chronic medical condition outcomes. RELEVANCE TO CLINICAL PRACTICE Although small, the international evidence base suggests that screening with the Alcohol Use Disorders Identification Test or Alcohol Use Disorders Identification Test-C and brief interventions for primary care patients with chronic medical conditions, delivered by nurses or other providers, are effective for identifying unhealthy substance use and associated with healthy behaviours and improved outcomes. Lacking are studies screening for illicit drug use, and using single-item screening tools, which could be especially helpful for frontline primary care providers including nurses.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA. .,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Calvin Kong
- Yale School of Public Health, New Haven, CT, USA
| | - Lisa Vittorio
- Research & Development, Veterans Affairs Boston Healthcare System, Brockton, MA, USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
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Guydish J, Passalacqua E, Pagano A, Martínez C, Le T, Chun J, Tajima B, Docto L, Garina D, Delucchi K. An international systematic review of smoking prevalence in addiction treatment. Addiction 2016; 111:220-30. [PMID: 26392127 PMCID: PMC4990064 DOI: 10.1111/add.13099] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/30/2015] [Accepted: 08/06/2015] [Indexed: 11/27/2022]
Abstract
AIMS Smoking prevalence is higher among people enrolled in addiction treatment compared with the general population, and very high rates of smoking are associated with opiate drug use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are observed internationally. METHODS PubMed, PsycINFO and the Alcohol and Alcohol Problems Science Database were searched for papers reporting smoking prevalence among addiction treatment samples, published in English, from 1987 to 2013. Search terms included tobacco use, cessation and substance use disorders using and/or Boolean connectors. For 4549 papers identified, abstracts were reviewed by multiple raters; 239 abstracts met inclusion criteria and these full papers were reviewed for exclusion. Fifty-four studies, collectively comprising 37,364 participants, were included. For each paper we extracted country, author, year, sample size and gender, treatment modality, primary drug treated and smoking prevalence. RESULTS The random-effect pooled estimate of smoking across people in addiction treatment was 84% [confidence interval (CI) = 79, 88%], while the pooled estimate of smoking prevalence across matched population samples was 31% (CI = 29, 33%). The difference in the pooled estimates was 52% (CI = 48%, 57%, P < .0001). Smoking rates were higher in programs treating opiate use compared with alcohol use [odds ratio (OR) = 2.52, CI = 2.00, 3.17], and higher in ORT compared to out-patient programs (OR = 1.42, CI = 1.19, 1.68). CONCLUSIONS Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. Smoking rates are also higher in people being treated for opiate dependence compared with people being treated for alcohol use disorder.
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Affiliation(s)
- Joseph Guydish
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Emma Passalacqua
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Anna Pagano
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Prevention and Control Department, Catalan Institute of Oncology-Institut d'Investigació Biomèdica de Bellvitge – IDIBELL, Barcelona, Spain
| | - Thao Le
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - JongSerl Chun
- Department of Social Welfare, Ewha Womans University, 11-1 Daehyun-Dong, Seodaemun-Gu, Seoul, 120-750, South Korea
| | - Barbara Tajima
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Lindsay Docto
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Daria Garina
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118
| | - Kevin Delucchi
- University of California, San Francisco, Department of Psychiatry, University of California San Francisco, San Francisco, CA
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Jolley CJ, Bell J, Rafferty GF, Moxham J, Strang J. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin. PLoS One 2015; 10:e0140995. [PMID: 26495843 PMCID: PMC4619694 DOI: 10.1371/journal.pone.0140995] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/02/2015] [Indexed: 11/18/2022] Open
Abstract
Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% < 90% for >10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.
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Affiliation(s)
- Caroline J. Jolley
- Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King’s College London, King’s Health Partners, Denmark Hill, London, United Kingdom
| | - James Bell
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, King’s Health Partners, Denmark Hill, London, United Kingdom
- Addictions Services, South London & Maudsley NHS Foundation Trust, King’s Health Partners, Denmark Hill, London, United Kingdom
| | - Gerrard F. Rafferty
- Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King’s College London, King’s Health Partners, Denmark Hill, London, United Kingdom
| | - John Moxham
- Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King’s College London, King’s Health Partners, Denmark Hill, London, United Kingdom
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, King’s Health Partners, Denmark Hill, London, United Kingdom
- Addictions Services, South London & Maudsley NHS Foundation Trust, King’s Health Partners, Denmark Hill, London, United Kingdom
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Hospital readmissions with exacerbation of obstructive pulmonary disease in illicit drug smokers. Lung 2014; 192:669-73. [PMID: 25097097 DOI: 10.1007/s00408-014-9632-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Patients with obstructive pulmonary disease (asthma or chronic obstructive pulmonary disease-COPD) who smoke illicit drugs are at an increased risk of hospital admissions. We compared hospital readmission rates due to exacerbations of obstructive pulmonary disease amongst patients who were current/ex-illicit drug smokers versus current/ex-tobacco smokers. METHODS We reviewed all the admissions between January 2009 and September 2011 with a presumptive diagnosis of an 'exacerbation of COPD' retrospectively from our COPD admission database. RESULTS There were 950 sequential hospital admissions in 709 patients over a 33-month period; 250 ex-tobacco smokers, 370 current tobacco smokers and 89 current/ex-illicit drug smokers. Recurrent hospital admission rates with exacerbation of obstructive pulmonary disease were higher in the illicit drug smokers compared with current/ex-tobacco smokers (1.00 versus 0.22/0.26, p < 0.001). Illicit drug smokers were younger [50 versus 72.9/69.9 (mean 71.2) years, p < 0.001] and had shorter length of hospital stay [7.44 versus 9.28/10.69 (mean 9.87) days, p = 0.038]. Illicit drug smokers with FEV1 < 1 litre (L) had higher readmissions than ex/current tobacco smokers with FEV1 < 1 L (p < 0.001). Admissions requiring non-invasive ventilation for type 2 respiratory failure were more common in illicit drug smokers (8.4 versus 3 %, p < 0.002). CONCLUSION We have shown that readmission rates in illicit drug smokers with FEV1 < 1 L are higher than in tobacco smokers. Studies are needed to determine whether targeting these illicit drug users with an intensive community intervention package (to include early therapy, pulmonary rehabilitation) will reduce readmission rates in this often neglected population.
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O’Toole J, Hambly R, Cox AM, O’Shea B, Darker C. Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity, and use health services more intensively than matched controls. Eur J Gen Pract 2014; 20:275-80. [DOI: 10.3109/13814788.2014.905912] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Management of opioid addiction in primary care: a pragmatic approach prioritising wellbeing not ideology. Br J Gen Pract 2014; 63:231-2. [PMID: 23643204 DOI: 10.3399/bjgp13x665396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Kim TW, Samet JH. Co-morbidity is the norm, not the exception: chronic respiratory diseases in chronic drug users. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:364-365. [PMID: 23138843 PMCID: PMC6548044 DOI: 10.4104/pcrj.2012.00094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/28/2012] [Indexed: 01/05/2024]
Affiliation(s)
- Theresa W Kim
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, UK
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, UK
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, UK
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