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Slade E, Mangino AA, Daniels L, Liford M, Quesinberry D. Modelling overdose case fatality rates over time: The collaborative process. Stat (Int Stat Inst) 2023. [DOI: 10.1002/sta4.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Emily Slade
- Department of Biostatistics University of Kentucky Lexington Kentucky 40536 USA
| | - Anthony A. Mangino
- Department of Biostatistics University of Kentucky Lexington Kentucky 40536 USA
| | - Lara Daniels
- Kentucky Injury Prevention and Research Center University of Kentucky Lexington Kentucky 40536 USA
| | - Madison Liford
- Kentucky Injury Prevention and Research Center University of Kentucky Lexington Kentucky 40536 USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center University of Kentucky Lexington Kentucky 40536 USA
- Department of Health Management and Policy University of Kentucky Lexington Kentucky 40536 USA
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2
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Bunn TL, Costich JF, Mirzaian M, Daniels LK, Wang D, Quesinberry D. Interrupted time series analysis of drug overdose fatalities in service-related industries versus non-service-related industries during the COVID-19 pandemic, 2018-2021. Inj Prev 2023; 29:511-518. [PMID: 37648420 PMCID: PMC10715517 DOI: 10.1136/ip-2023-044894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Variation among industries in the association between COVID-19-related closing or reopening orders and drug overdose deaths is unknown. The objectives of this study were to compare drug overdose decedent demographics, annual drug overdose fatality rates and monthly drug overdose fatality rates by specific industry within the service-related industry sector, and to perform an interrupted time series analysis comparing weekly drug overdose mortality counts in service-related and non-service-related industries, examining the COVID-19 pre-pandemic and pandemic phases by Kentucky closing and reopening orders. METHODS Kentucky drug overdose death certificate and toxicology testing data for years 2018-2021 were analysed using Χ2 and interrupted time series methods. RESULTS Before the pandemic, annual drug overdose fatality rates in service-related industries were higher than in non-service-related industries. However, these trends reversed during the pandemic. Both service-related and non-service-related industry groups experienced increased fatal drug overdoses at change points associated with the gubernatorial business closure orders, although the magnitude of the increase differed between the two groups. Young, female and black workers in service-related industries had higher frequencies of drug overdose deaths compared with decedents in the non-service-related industries. CONCLUSION Spikes in drug overdose mortality in both service-related and non-service-related industries during the pandemic highlight the need to consider and include industries and occupations, as well as worker populations vulnerable to infectious diseases, as integral stakeholder groups when developing and implementing drug overdose prevention interventions, and implementing infectious disease surveillance systems.
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Affiliation(s)
- Terry L Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Julia F Costich
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Mira Mirzaian
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Lara K Daniels
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Dandan Wang
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, Kentucky, USA
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3
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Harris DR, Anthony N, Quesinberry D, Delcher C. Evidence of housing instability identified by addresses, clinical notes, and diagnostic codes in a real-world population with substance use disorders. J Clin Transl Sci 2023; 7:e196. [PMID: 37771412 PMCID: PMC10523293 DOI: 10.1017/cts.2023.626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Housing instability is a social determinant of health associated with multiple negative health outcomes including substance use disorders (SUDs). Real-world evidence of housing instability is needed to improve translational research on populations with SUDs. Methods We identified evidence of housing instability by leveraging structured diagnosis codes and unstructured clinical data from electronic health records of 20,556 patients from 2017 to 2021. We applied natural language processing with named-entity recognition and pattern matching to unstructured clinical notes with free-text documentation. Additionally, we analyzed semi-structured addresses containing explicit or implicit housing-related labels. We assessed agreement on identification methods by having three experts review of 300 records. Results Diagnostic codes only identified 58.5% of the population identifiable as having housing instability, whereas 41.5% are identifiable from addresses only (7.1%), clinical notes only (30.4%), or both (4.0%). Reviewers unanimously agreed on 79.7% of cases reviewed; a Fleiss' Kappa score of 0.35 suggested fair agreement yet emphasized the difficulty of analyzing patients having ambiguous housing situations. Among those with poisoning episodes related to stimulants or opioids, diagnosis codes were only able to identify 63.9% of those with housing instability. Conclusions All three data sources yield valid evidence of housing instability; each has their own inherent practical use and limitations. Translational researchers requiring comprehensive real-world evidence of housing instability should optimize and implement use of structured and unstructured data. Understanding the role of housing instability and temporary housing facilities is salient in populations with SUDs.
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Affiliation(s)
- Daniel R. Harris
- Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Nicholas Anthony
- Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Chris Delcher
- Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA
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4
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Oyler DR, Rojas-Ramirez MV, Nakamura A, Quesinberry D, Miller CS. Dental opioid prescription patterns in academic and community settings. J Public Health Dent 2023. [PMID: 36905202 DOI: 10.1111/jphd.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES Reports of interventions to improve dental opioid prescribing have come primarily from academic settings, but most opioid prescriptions are written by community dentists. This analysis compares prescription characteristics between these two groups to inform interventions to improve dental opioid prescribing in community settings. METHODS State prescription drug monitoring program data from 2013 to 2020 were used to compare opioid prescriptions from dentists at academic institutions (PDAI) to prescriptions from dentists in non-academic settings (PDNS). Linear regression was used to assess daily morphine milligram equivalents (MME), total MME, and days' supply, adjusting for year, age, sex, and rurality. RESULTS Prescriptions from dentists at the academic institution accounted for less than 2% of over 2.3 million dental opioid prescriptions analyzed. Over 80% of prescriptions in both groups were written for <50 MME per day and for ≤3 days' supply. On average, in the adjusted models, prescriptions from the academic institution were written for about 75 additional MME per prescription and nearly a full day longer duration. Compared to adults, adolescents were the only age group who received both higher daily doses and longer days' supply. CONCLUSIONS Prescriptions from dentists at academic institutions accounted for small percentage of opioid prescriptions, but prescription characteristics were clinically comparable between groups. Interventional targets to reduce opioid prescribing in academic institutions could be applied to community settings.
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Affiliation(s)
- Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Marcia V Rojas-Ramirez
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
| | - Aisaku Nakamura
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Dana Quesinberry
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA.,Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Craig S Miller
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
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5
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Slavova S, Freeman PR, Rock P, Brancato C, Hargrove S, Liford M, Quesinberry D, Walsh SL. Changing Trends in Drug Overdose Mortality in Kentucky: An Examination of Race and Ethnicity, Age, and Contributing Drugs, 2016-2020. Public Health Rep 2023; 138:131-139. [PMID: 35184586 PMCID: PMC9730175 DOI: 10.1177/00333549221074390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Increased drug overdose mortality among non-Hispanic Black people in the United States in the past 5 years highlights the need for better tailored programs and services. We evaluated (1) changes in drug overdose mortality for various racial and ethnic groups and (2) drug involvement to inform drug overdose prevention efforts in Kentucky. METHODS We used Kentucky death certificates and postmortem toxicology reports from 2016-2020 (provisional data) to estimate changes in age-adjusted drug overdose death rates per 100 000 standard population. RESULTS The age-adjusted drug overdose death rate per 100 000 standard population among non-Hispanic Black residents doubled from 2016 (21.2) to 2020 (46.0), reaching the rate among non-Hispanic White residents in 2020 (48.7; P = .48). From 2016 to 2020, about 80% of these drug overdose deaths involved opioids; heroin involvement declined about 20 percentage points; fentanyl involvement increased about 30 percentage points. The number of psychostimulant-involved drug overdose deaths increased 513% among non-Hispanic Black residents and 191% among non-Hispanic White residents. Cocaine-involved drug overdose deaths increased among non-Hispanic Black residents but declined among non-Hispanic White residents. Drug overdose death rates were significantly lower among Hispanic residents than among non-Hispanic White residents. CONCLUSIONS Increased opioid-involved overdose deaths among non-Hispanic Black residents in Kentucky in combination with rapidly expanding concomitant psychostimulant involvement require increased understanding of the social, cultural, and illicit market circumstances driving these rapid trend changes. Our findings underscore the urgent need to expand treatment and harm reduction services to non-Hispanic Black residents with substance use disorder.
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Affiliation(s)
- Svetla Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA
| | - Peter Rock
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, USA
| | - Candace Brancato
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Sarah Hargrove
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Madison Liford
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Sharon L. Walsh
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
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6
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Delcher C, Harris DR, Anthony N, Stoops WW, Thompson K, Quesinberry D. Substance use disorders and social determinants of health from electronic medical records obtained during Kentucky's "triple wave". Pharmacol Biochem Behav 2022; 221:173495. [PMID: 36427682 PMCID: PMC10082996 DOI: 10.1016/j.pbb.2022.173495] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Social determinants of health (SDOH) play a critical role in the risk of harmful drug use. Examining SDOH as a means of differentiating populations with multiple co-occurring substance use disorders (SUDs) is particularly salient in the era of prevalent opioid and stimulant use known as the "Third Wave". This study uses electronic medical records (EMRs) from a safety net hospital system from 14,032 patients in Kentucky from 2017 to 2019 in order to 1) define three types of SUD cohorts with shared/unique risk factors, 2) identify patients with unstable housing using novel methods for EMRs and 3) link patients to their residential neighborhood to obtain quantitative perspective on social vulnerability. We identified patients in three cohorts with statistically significant unique risk factors that included race, biological sex, insurance type, smoking status, and urban/rural residential location. Adjusting for these variables, we found a statistically significant, increasing risk gradient for patients experiencing unstable housing by cohort type: opioid-only (n = 7385, reference), stimulant-only (n = 4794, odds ratio (aOR) 1.86 95 % confidence interval (CI): 1.66-2.09), and co-diagnosed (n = 1853, aOR = 2.75, 95 % CI: 2.39 to 3.16). At the neighborhood-level, we used 8 different measures of social vulnerability and found that, for the most part, increasing proportions of patients with stimulant use living in a census tract was associated with more social vulnerability. Our study identifies potentially modifiable factors that can be tailored by substance type and demonstrates robust use of EMRs to meet national goals of enhancing research on social determinants of health.
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Affiliation(s)
- Chris Delcher
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America.
| | - Daniel R Harris
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America
| | - Nicholas Anthony
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America
| | - William W Stoops
- Departments of Behavioral Science and Psychiatry, College of Medicine, Department of Psychology, College of Arts & Sciences, University of Kentucky, United States of America
| | - Katherine Thompson
- Department of Statistics, College of Arts & Sciences, University of Kentucky, United States of America
| | - Dana Quesinberry
- Department of Health Management and Policy, College of Public Health, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America
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7
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Oyler DR, Rojas-Ramirez MV, Nakamura A, Quesinberry D, Bernard P, Surratt H, Miller CS. Factors influencing opioid prescribing after tooth extraction. J Am Dent Assoc 2022; 153:868-877. [PMID: 35691709 DOI: 10.1016/j.adaj.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tooth extractions account for most opioid prescriptions from dentists, but specific characteristics that influence likelihood are less established. Improving understanding can facilitate development of tailored interventions to reduce unnecessary opioid prescribing. METHODS The authors performed a retrospective review of patients 12 years and older undergoing tooth extraction at the College of Dentistry at the University of Kentucky from 2013 through 2020. The primary end point was issuance of an opioid prescription related to the encounter. RESULTS In 44,387 eligible records analyzed, 10,628 (23.9%) patients received an opioid prescription. Results of multivariable logistic regression found that the factors associated with an opioid prescription included receipt of a nonopioid analgesic prescription (adjusted odds ratio [aOR], 11.36; 95% CI, 10.37 to 12.44), receipt of an antibiotic prescription (aOR, 8.29; 95% CI, 7.57 to 9.08), procedural sedation (aOR, 2.11; 95% CI, 1.93 to 2.31), surgical extraction (aOR, 1.96; 95% CI, 1.84 to 2.10), and third molar extractions (1 tooth: aOR, 1.14; 95% CI 1.04 to 1.25; 2 teeth: aOR, 2.09; 95% CI, 2.87 to 2.34; 3 teeth: aOR, 2.73; 95% CI, 2.36 to 3.15; 4 teeth: aOR, 3.45; 95% CI, 3.10 to 3.83). Factors that decreased risk included having an appointment in 2018 or later (aOR, 0.31; 95% CI, 0.29 to 0.33), in a student (aOR, 0.57; 95% CI, 0.51 to 0.65) or resident (aOR, 0.33; 95% CI, 0.31 to 0.36) clinic, and on any day other than Friday (Monday: aOR, 0.83; 95% CI, 0.76 to 0.91; Tuesday: aOR, 0.90; 95% CI, 0.83 to 0.99; Wednesday: aOR, 0.89; 95% CI, 0.81 to 0.97; Thursday: aOR, 0.88; 95% CI 0.81 to 0.97). CONCLUSIONS Opioid prescriptions after tooth extraction were common in patients undergoing more extensive procedures. Provider perceptions, habits, and several clinical factors appeared to influence prescribing patterns. PRACTICAL IMPLICATIONS The decision to prescribe an opioid appears to be associated with habits and factors perceived to modulate postoperative pain, which may serve as targets for opioid reduction strategies.
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8
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Rock PJ, Quesinberry D, Singleton MD, Slavova S. Emergency Medical Services and Syndromic Surveillance: A Comparison With Traditional Surveillance and Effects on Timeliness. Public Health Rep 2021; 136:72S-79S. [PMID: 34726974 DOI: 10.1177/00333549211018673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Traditional public health surveillance of nonfatal opioid overdose relies on emergency department (ED) billing data, which can be delayed substantially. We compared the timeliness of 2 new data sources for rapid drug overdose surveillance-emergency medical services (EMS) and syndromic surveillance-with ED billing data. METHODS We used data on nonfatal opioid overdoses in Kentucky captured in EMS, syndromic surveillance, and ED billing systems during 2018-2019. We evaluated the time-series relationships between EMS and ED billing data and syndromic surveillance and ED billing data by calculating cross-correlation functions, controlling for influences of autocorrelations. A case example demonstrates the usefulness of EMS and syndromic surveillance data to monitor rapid changes in opioid overdose encounters in Kentucky during the COVID-19 epidemic. RESULTS EMS and syndromic surveillance data showed moderate-to-strong correlation with ED billing data on a lag of 0 (r = 0.694; 95% CI, 0.579-0.782; t = 9.73; df = 101; P < .001; and r = 0.656; 95% CI, 0.530-0.754; t = 8.73; df = 101; P < .001; respectively) at the week-aggregated level. After the COVID-19 emergency declaration, EMS and syndromic surveillance time series had steep increases in April and May 2020, followed by declines from June through September 2020. The ED billing data were available for analysis 3 months after the end of a calendar quarter but closely followed the trends identified by the EMS and syndromic surveillance data. CONCLUSION Data from EMS and syndromic surveillance systems can be reliably used to monitor nonfatal opioid overdose trends in Kentucky in near-real time to inform timely public health response.
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Affiliation(s)
- Peter J Rock
- 4530 Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- 50880 Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, USA
| | - Dana Quesinberry
- 4530 Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Michael D Singleton
- 4530 Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Svetla Slavova
- 4530 Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
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9
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Abstract
This cross-sectional study evaluates the changes in drug overdose mortality rates for Kentucky residents between 2019 and 2020.
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Affiliation(s)
- Svetla Slavova
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington
- Department of Biostatistics, University of Kentucky, Lexington
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington
- Department of Health Management and Policy, University of Kentucky, Lexington
| | - Sarah Hargrove
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington
| | - Peter Rock
- Center for Clinical and Translational Science, University of Kentucky, Lexington
| | | | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington
| | - Sharon L. Walsh
- Department of Behavioral Science, University of Kentucky, Lexington
- Center on Drug and Alcohol Research, University of Kentucky, Lexington
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10
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Hansen A, Quesinberry D, Akpunonu P, Martin J, Slavova S. Validation of ICD-10-CM codes for injuries complicating pregnancy, childbirth and the puerperium: a medical record review. Inj Prev 2021; 27:i9-i12. [PMID: 33674327 PMCID: PMC7948181 DOI: 10.1136/injuryprev-2019-043512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/09/2020] [Accepted: 09/26/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The purpose of this study was to estimate the positive predictive value (PPV) of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for injury, poisoning, physical or sexual assault complicating pregnancy, childbirth and the puerperium (PCP) to capture injury encounters within both hospital and emergency department claims data. METHODS A medical record review was conducted on a sample (n=157) of inpatient and emergency department claims from one Kentucky healthcare system from 2015 to 2017, with any diagnosis in the ICD-10-CM range O9A.2-O9A.4. Study clinicians reviewed medical records for the sampled cases and used an abstraction form to collect information on documented presence of injury and PCP complications. The study estimated the PPVs and the 95% CIs of O9A.2-O9A.4 codes for (1) capturing injuries and (2) capturing injuries complicating PCP. RESULTS The estimated PPV for the codes O9A.2-O9A.4 to identify injury in the full sample was 79.6% (95% CI 73.3% to 85.9%) and the PPV for capturing injuries complicating PCP was 72.0% (95% CI 65.0% to 79.0%). The estimated PPV for an inpatient principal diagnosis O9A.2-O9A.4 to capture injuries was 90.7% (95% CI 82.0% to 99.4%) and the PPV for capturing injuries complicating PCP was 88.4% (95% CI 78.4% to 98.4%). The estimated PPV for any mention of O9A.2-O9A.4 in emergency department data to capture injuries was 95.2% (95% CI 90.6% to 99.9%) and the PPV for capturing injuries complicating PCP was 81.0% (95% CI 72.4% to 89.5%). DISCUSSION The O9A.2-O9A.4 codes captured high percentage true injury cases among pregnant and puerperal women.
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Affiliation(s)
- Anna Hansen
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA.,Sociology, University of Kentucky, Lexington, Kentucky, USA.,College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA.,Health Management & Policy, University of Kentucky, Lexington, Kentucky, USA
| | - Peter Akpunonu
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Julia Martin
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Svetla Slavova
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA .,Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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11
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Slavova S, Rock P, Bush HM, Quesinberry D, Walsh SL. Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug Alcohol Depend 2020; 214:108176. [PMID: 32717504 PMCID: PMC7351024 DOI: 10.1016/j.drugalcdep.2020.108176] [Citation(s) in RCA: 282] [Impact Index Per Article: 70.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/06/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with opioid use disorder may be at heightened risk of opioid overdose during the COVID-19 period of social isolation, economic distress, and disrupted treatment services delivery. This study evaluated changes in daily number of Kentucky emergency medical services (EMS) runs for opioid overdose between January 14, 2020 and April 26, 2020. METHODS We evaluated the statistical significance of the changes in the average daily EMS opioid overdose runs in the 52 days before and after the COVID-19 state of emergency declaration, March 6, 2020. RESULTS Kentucky EMS opioid overdose daily runs increased after the COVID-19 state emergency declaration. In contrast, EMS daily runs for other conditions leveled or declined. There was a 17% increase in the number of EMS opioid overdose runs with transportation to an emergency department (ED), a 71% increase in runs with refused transportation, and a 50% increase in runs for suspected opioid overdoses with deaths at the scene. The average daily EMS opioid overdose runs with refused transportation increased significantly, doubled to an average of 8 opioid overdose patients refusing transportation every day during the COVID-19-related study period. CONCLUSIONS This Kentucky-specific study provides empirical evidence for concerns that opioid overdoses are rising during the COVID-19 pandemic and calls for sharing of observations and analyses from different regions and surveillance systems with timely data collection (e.g., EMS data, syndromic surveillance data for ED visits) to improve our understanding of the situation, inform proactive response, and prevent another big wave of opioid overdoses in our communities.
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Affiliation(s)
- Svetla Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States; Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, United States.
| | - Peter Rock
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, United States
| | - Heather M. Bush
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, United States,Department of Health Management and Policy, University of Kentucky, Lexington, KY, United States
| | - Sharon L. Walsh
- Department of Behavioral Science, University of Kentucky, Lexington, KY, United States,Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
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12
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Slavova S, Quesinberry D, Costich JF, Pasalic E, Martinez P, Martin J, Eustice S, Akpunonu P, Bunn TL. ICD-10-CM-Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study. Public Health Rep 2020; 135:262-269. [PMID: 32040923 DOI: 10.1177/0033354920904087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. METHODS We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). RESULTS First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. CONCLUSIONS The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.
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Affiliation(s)
- Svetla Slavova
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA.,Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA.,Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Julia F Costich
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA.,Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Emilia Pasalic
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pedro Martinez
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia Martin
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Sarah Eustice
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Peter Akpunonu
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Terry L Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA.,Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
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Quesinberry D, Bunn TL, Hargrove S, Slavova S. Impact of a Drug Overdose Decedent Toxicology Testing Legislative Mandate on Informing Coroner Death Investigation and Certification Practices. Acad Forensic Pathol 2019; 9:66-80. [PMID: 34394792 DOI: 10.1177/1925362119851127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/31/2019] [Indexed: 11/16/2022]
Abstract
Objective To (a) determine the impact of Kentucky's (KY's) mandate requiring postmortem toxicology testing of coroner cases; (b) identify the influence of coroner experience and training, jurisdiction size, budget, and location on postmortem testing requests; (c) identify facilitators/barriers for postmortem toxicology testing requests and listing the specific drugs involved in drug-poisoning deaths on death certificates. Methods A modified Dillman approach was used to deliver the survey to KY's elected coroners between April and May 2016. Responses stratified by identified influence factors were compared using χ2 tests and Fisher exact tests. Results Fifty-eight percent of coroners reported that drug overdose investigations had changed since the mandate was enacted. Statistically significant differences in responses were found when stratified. Sixty-three percent of coroners reported always using testing results to complete death certificates. Conclusions Uptake of the mandate for postmortem toxicology testing of all decedents is not yet complete. Policy Implication Without uptake of the mandate, surveillance efforts may result in undercounting of drug overdose deaths and the involvement of specific drugs. Mandates for enhanced training and modification of funding structure for medico-legal death investigations could facilitate uptake.
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Costich JF, Quesinberry D. Opioid-Related Legislation in Kentucky and West Virginia: Assessing Policy Impact. J Law Med Ethics 2019; 47:36-38. [PMID: 31298116 DOI: 10.1177/1073110519857313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Kentucky and West Virginia are among the states most severely affected by opioid poisonings and deaths. The legislatures of both states have enacted a broad range of bills intended to address related issues. We present an overview of legislation enacted in 2017 and 2018, along with an approach to analysis of practitioner response to one type of legislation.
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Affiliation(s)
- Julia F Costich
- Julia Costich, J.D., Ph.D., is a Professor in the Dept. of Health Management & Policy and Associate Director of the Kentucky Injury Prevention and Research Center at the University of Kentucky College of Public Health. Dana Quesinberry, J.D., is a Program Evaluator and Dr.P.H. student at the Kentucky Injury Prevention and Research Center
| | - Dana Quesinberry
- Julia Costich, J.D., Ph.D., is a Professor in the Dept. of Health Management & Policy and Associate Director of the Kentucky Injury Prevention and Research Center at the University of Kentucky College of Public Health. Dana Quesinberry, J.D., is a Program Evaluator and Dr.P.H. student at the Kentucky Injury Prevention and Research Center
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15
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Bunn TL, Quesinberry D, Jennings T, Kizewski A, Jackson H, McKee S, Eustice S. Timely linkage of individuals to substance use disorder treatment: development, implementation, and evaluation of FindHelpNowKY.org. BMC Public Health 2019; 19:177. [PMID: 30744608 PMCID: PMC6371481 DOI: 10.1186/s12889-019-6499-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Substance use disorders (SUD) have steadily increased over the last two decades. Seeking SUD treatment involves searching SUD treatment facility types (inpatient, outpatient and intensive outpatient, residential and family residential, and detoxification facilities) that offer specialized SUD treatment depending on individual needs and preferences. Referrals to SUD treatment require innovative strategies that rapidly link individuals to SUD treatment when they are at the critical stage of readiness. The aim of this study was to develop, implement, and evaluate a user-friendly SUD treatment facility opening availability website called FindHelpNowKY.org. The objectives of the study were to 1) recruit SUD treatment facility and partner participation; 2) develop platform, content, and analytics for the FindHelpNowKY.org website intervention with an information repository; 3) assess barriers and facilitators to implementation; and 4) evaluate the development and implementation of FindHelpNowKY.org. Methods Website development stakeholders were identified and the website concept was developed. The logic model for FindHelpNowKY.org outlined resources, activities, and outputs as well as the associated short-term, medium-term, and long-term objectives, along with a website evaluation plan. Website usability and focus group testing was conducted. Information repository resource documents were compiled and categorized. An inventory of Kentucky-based SUD treatment facilities was compiled using various state and federal resources. Results Development/implementation barriers were addressed, facilitators were identified, and the website was implemented; 83% of SUD treatment facilities were indexed on the website, and average website user time was 7 min. From February to October 2018, there were 29,000 visitors, and 30,000 unique searches. The most common website query was a friend or family member seeking long-term residential or outpatient treatment facilities accepting Medicaid or Medicare. Conclusions FindHelpNowKY.org has the potential to fill a critical need for timely access to available SUD treatment in the state. The website may be a valuable resource for health professionals that can enhance clinical workflow and reduce staff time conducting phone and website searches for available SUD treatment. The website is a promising tool for assessing current SUD treatment capacity vs. SUD treatment need. The FindHelpNow model can be used by other states to increase timely access to SUD treatment.
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Affiliation(s)
- Terry Lee Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA. .,Department of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, 111 Washington Ave, Lexington, KY, 40536, USA.
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Tyler Jennings
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Amber Kizewski
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Heather Jackson
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Sarah McKee
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Sarah Eustice
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
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Slavova S, Costich JF, Bunn TL, Luu H, Singleton M, Hargrove SL, Triplett JS, Quesinberry D, Ralston W, Ingram V. Corrigendum to "Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance" [International Journal of Drug Policy 46 (2017) 120-129]. Int J Drug Policy 2018; 58:92. [PMID: 29886383 DOI: 10.1016/j.drugpo.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Svetla Slavova
- Kentucky Injury Prevention and Research Center, University of Kentucky, Bona Fide Agent for the Kentucky Department for Public Health, Lexington, KY, USA.
| | - Julia F Costich
- Kentucky Injury Prevention and Research Center, University of Kentucky, Bona Fide Agent for the Kentucky Department for Public Health, Lexington, KY, USA
| | - Terry L Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, Bona Fide Agent for the Kentucky Department for Public Health, Lexington, KY, USA
| | - Huong Luu
- Kentucky Injury Prevention and Research Center, University of Kentucky, Bona Fide Agent for the Kentucky Department for Public Health, Lexington, KY, USA
| | - Michael Singleton
- Kentucky Injury Prevention and Research Center, University of Kentucky, Bona Fide Agent for the Kentucky Department for Public Health, Lexington, KY, USA
| | - Sarah L Hargrove
- Kentucky Injury Prevention and Research Center, University of Kentucky, Bona Fide Agent for the Kentucky Department for Public Health, Lexington, KY, USA
| | - Jeremy S Triplett
- Kentucky State Police Central Forensic Laboratory, Frankfort, KY, USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Bona Fide Agent for the Kentucky Department for Public Health, Lexington, KY, USA
| | - William Ralston
- Kentucky Office of the Chief Medical Examiner, Louisville, KY, USA
| | - Van Ingram
- Kentucky Office of Drug Control Policy, Frankfort, KY, USA
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Hargrove SL, Bunn TL, Slavova S, Quesinberry D, Corey T, Ralston W, Singleton MD, Ingram V. Establishment of a comprehensive drug overdose fatality surveillance system in Kentucky to inform drug overdose prevention policies, interventions and best practices. Inj Prev 2017; 24:60-67. [DOI: 10.1136/injuryprev-2016-042308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/25/2017] [Accepted: 06/13/2017] [Indexed: 11/04/2022]
Abstract
BackgroundAccording to the National Center for Health Statistics, Kentucky had the third highest drug overdose fatality rate in the nation in 2015 at 29.9 drug overdose fatalities per 100 000 population.ObjectiveThe elevated drug overdose fatality rate necessitated the development and implementation of a comprehensive multisource drug overdose fatality surveillance system (DOFSS).MethodsDOFSS stakeholder work group members and data sources were identified, and memorandums of understanding were established. The following data sources were used to establish DOFSS: (1) death certificates; (2) autopsy reports; (3) toxicology result reports; (4) coroner reports; and (5) Kentucky All Schedule Prescription Electronic Reporting (KASPER) (prescription drug monitoring programme) data. Drug overdose poisonings were defined using Injury Surveillance Workgroup 7 definitions. Analyses were performed to investigate possible drug overdose-related health disparities for disabled drug overdose decedents and to characterise gabapentin in drug overdose deaths.ResultsDOFSS identified 2106 drug overdose poisoning fatalities in Kentucky for 2013–2014. Identification of specific drugs involved in drug overdose deaths increased from 75.8% using a single data source to 97.5% using multiple data sources. Disabled drug overdose decedents were significantly more likely to have an active prescription for drugs identified in their system compared with the non-disabled drug overdose decedents. Toxicology data showed increased gabapentin involvement in drug overdose deaths from 2.9% in 2013 to 17% in 2014. Alprazolam was found most often in combination with gabapentin (41%), along with various other benzodiazepines and prescription opioids.ConclusionsA comprehensive multisource DOFSS improved drug overdose fatality surveillance by increasing completeness of data and data quality. DOFSS is a model that can be considered by other states to enhance their efforts in tracking drug overdose fatalities, identifying new and emerging trends, and informing policies and best practices, to address and reduce drug overdoses.
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