Polysubstance mortality trends in White and Black Americans during the opioid epidemic, 1999-2018

BACKGROUND

Psychoactive drug combinations are increasingly contributing to overdose deaths among White and Black Americans. To understand the evolving nature of overdose crisis, inform policies, and develop tailored and equitable interventions, this study provides a comprehensive assessment of polysubstance mortality trends by race and sex during the opioid epidemic.

METHODS

We used serial cross-sectional US mortality data for White and Black populations from 1999 through 2018 to calculate annual age-adjusted death rates (AADR) involving any opioid, opioid subtypes, benzodiazepines, cocaine, psychostimulants, or combinations of these drugs, stratified by race and sex. Trend changes in AADR were analyzed using joinpoint regression models and expressed as average annual percent change (AAPC) during each period of the three waves of the opioid epidemic: 1999-2010 (wave 1), 2010-2013 (wave 2), and 2013-2018 (wave 3). Prevalence measures assessed the percent co-involvement of an investigated drug in the overall death from another drug.

RESULTS

Polysubstance mortality has shifted from a modest rise in death rates due to benzodiazepine-opioid overdoses among White persons (wave 1) to a substantial increase in death rates due to illicit drug combinations impacting both White and Black populations (wave 3). Concurrent cocaine-opioid use had the highest polysubstance mortality rates in 2018 among Black (5.28 per 100,000) and White (3.53 per 100,000) persons. The steepest increase in death rates during wave 3 was observed across all psychoactive drugs when combined with synthetic opioids in both racial groups. Since 2013, Black persons have died faster from cocaine-opioid and psychostimulant-opioid overdoses. Between 2013 and 2018, opioids were highly prevalent in cocaine-related deaths, increasing by 33% in White persons compared to 135% in Blacks. By 2018, opioids contributed to approximately half of psychostimulant and 85% of benzodiazepine fatal overdoses in both groups. The magnitude and type of drug combinations with the highest death rates differed by race and sex, with Black men exhibiting the highest overdose burden beginning in 2013.

CONCLUSIONS

The current drug crisis should be considered in the context of polysubstance use. Effective measures and policies are needed to curb synthetic opioid-involved deaths and address disparate mortality rates in Black communities.

Construction and evaluation of an online module addressing counseling patients with diabetes observing religious fasting

INTRODUCTION

Little research has been conducted on training students of different health professions to deliver culturally appropriate care to patients observing religious fasting. This study aimed to formulate an online educational module on caring for patients with diabetes observing religious fasting and evaluate the module's impact.

METHODS

Third-year doctor of pharmacy students participated in an online module at the end of their core pharmacist-patient communication class. The module involved discussions and case scenarios addressing Muslim, Jewish, and Hindu patients with diabetes considering fasting. Students were provided with Ramadan Communication (RAMCOM), a tool designed to facilitate counseling of patients on religious fasting and were encouraged to use principles of motivational interviewing in addressing cases. A 13-item questionnaire was administered before and after the module. Answers provided on an open-ended item addressing students' experiences with the module were analyzed qualitatively using conventional content analysis.

RESULTS

Of 140 students taking the class, all students completed the module and 135 completed both questionnaires. The module elicited a statistically significant improvement in confidence across all 13 survey items. The computed aggregate score increased from 2.65 (0.56) to 3.66 (0.50) (P < .001), with 71% of students finding the module to be useful or extremely useful. Qualitative analysis provided insight into students' experiences, including how the module produced an improvement in student confidence as well as opportunities for module improvement.

CONCLUSIONS

A brief online module significantly improved pharmacy students' confidence in working with patients from different cultures and religions considering religious fasting.