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Freibott CE, Jalali A, Murphy SM, Walley AY, Linas BP, Jeng PJ, Bratberg J, Marshall BDL, Zang X, Green TC, Morgan JR. The association between naloxone claims and proportion of independent vs. chain pharmacies: A longitudinal analysis of naloxone claims in the US. J Am Pharm Assoc (2003) 2024:102093. [PMID: 38604474 DOI: 10.1016/j.japh.2024.102093] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Expanding access to naloxone through pharmacies is an important policy goal. Our objective was to characterize national county-level naloxone dispensing of chain versus independent pharmacies. METHODS The primary exposure in our longitudinal analysis was the proportion of chain pharmacies in a county, identified through the US Department of Homeland Security 2010 Infrastructure Foundation-Level Data. We defined counties as having "higher proportion" of chain pharmacies if at least 50% of pharmacies were large national chains. The primary outcome was quarter-year (2016Q1-2019Q2) rate of pharmacy naloxone claims per 100,000 persons from Symphony Health at the county-level. We compared the naloxone dispensing rate between county types using two-sample t-tests. We estimated the association between county-level chain pharmacy proportion and rate of naloxone claims using a linear model with year-quarter fixed effects. RESULTS Nearly one third of counties (n=946) were higher proportion. Higher proportion counties had a significantly higher rate of naloxone claims across the study period, in 4 of 6 urban-rural classifications, and in counties with and without naloxone access laws. The linear model confirmed that higher proportion counties had a significantly higher rate of naloxone claims, adjusting for urban/rural designation, income, population characteristics, opioid mortality rate, co-prescribing laws and naloxone access laws. CONCLUSION In this national study, we found an association between naloxone dispensing rates and the county-level proportion of chain (versus independent) pharmacies. Incentivizing naloxone dispensing through educational, regulatory, or legal efforts may improve naloxone availability and dispensing rates - particularly in counties with proportionately high numbers of independent pharmacies.
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Affiliation(s)
- Christina E Freibott
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Benjamin P Linas
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Jeffrey Bratberg
- The University of Rhode Island, College of Pharmacy, Kingston, RI, USA
| | - Brandon D L Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA; COBRE on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Xiao Zang
- University of Minnesota, School of Public Health, Division of Health Policy and Management, Minneapolis, MN, USA
| | - Traci C Green
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA; COBRE on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA; Brandeis University Heller School for Social Policy and Management; Rhode Island Hospital, RI, USA
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
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Rosenfield MN, Beaudoin FL, Gaither R, Hallowell BD, Daly MM, Marshall BDL, Chambers LC. Association between comorbid chronic pain or prior hospitalization for mental illness and substance use treatment among a cohort at high risk of opioid overdose. J Subst Use Addict Treat 2024; 159:209273. [PMID: 38113996 DOI: 10.1016/j.josat.2023.209273] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/25/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Chronic pain and serious mental illness increase risk of opioid use, and opioid use can exacerbate both conditions. Substance use disorder (SUD) treatment can be lifesaving, but chronic pain and serious mental illness may make recovery challenging. We evaluated the association between current chronic pain and prior hospitalization for mental illness and 90-day SUD treatment engagement, among emergency department (ED) patients at high risk of opioid overdose. METHODS We conducted a cohort analysis of 648 ED patients enrolled in a randomized controlled trial in Rhode Island. We linked baseline study data on chronic pain and prior hospitalization for mental illness to statewide administrative data on state-licensed treatment programs (including methadone) and buprenorphine treatment via prescription. We defined treatment engagement as initiation of a state-licensed treatment program, transfer between state-licensed programs/providers, or a buprenorphine prescription (re-)fill. We used modified Poisson models to estimate the association between each baseline comorbidity and treatment engagement within 90 days following the ED visit, adjusted for a priori potential confounders. In an exploratory analysis, models were stratified by baseline treatment status. RESULTS The mean age of participants was 37 years; 439 (68 %) were male, and 446 (69 %) had been recently unhoused. Overall, 278 participants (43 %) engaged in treatment within 90 days of the ED visit. Participants with prior hospitalization for mental illness were more likely to engage in treatment than those without (adjusted risk ratio [ARR] = 1.24, 95 % confidence interval [CI] = 1.01-1.53), although this association was only among those already accessing treatment at baseline (ARR = 1.58, 95 % CI = 1.10-2.27). Chronic pain was not associated with 90-day treatment engagement overall (ARR = 1.12, 95 % CI = 0.91-1.38) or within baseline treatment subgroups. CONCLUSIONS Among ED patients at high risk of opioid overdose and accessing treatment at baseline, those with prior hospitalization for mental illness (but not chronic pain) were more likely to engage in treatment following the ED visit, which may reflect disproportionate initiation of additional treatment programs, transfer between programs/providers, or ongoing buprenorphine treatment. Touchpoints within the medical system should be leveraged to ensure that everyone, including those with serious mental illness, can access high-quality SUD treatment at the desired intensity level.
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Affiliation(s)
- Maayan N Rosenfield
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Rachel Gaither
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | | | - Mackenzie M Daly
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Providence, RI, United States
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Laura C Chambers
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States.
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Pielech M, Modrowski C, Yeh J, Clark MA, Marshall BDL, Beaudoin FL, Becker SJ, Miranda R. Provider perceptions of systems-level barriers and facilitators to utilizing family-based treatment approaches in adolescent and young adult opioid use disorder treatment. Addict Sci Clin Pract 2024; 19:20. [PMID: 38515214 PMCID: PMC10958911 DOI: 10.1186/s13722-024-00437-x] [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: 05/02/2023] [Accepted: 01/05/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Amidst increasing opioid-related fatalities in adolescents and young adults (AYA), there is an urgent need to enhance the quality and availability of developmentally appropriate, evidence-based treatments for opioid use disorder (OUD) and improve youth engagement in treatment. Involving families in treatment planning and therapy augments medication-based OUD treatment for AYA by increasing treatment engagement and retention. Yet, uptake of family-involved treatment for OUD remains low. This study examined systems-level barriers and facilitators to integrating families in AYA OUD treatment in Rhode Island. METHODS An online survey was administered to clinic leaders and direct care providers who work with AYA in programs that provide medication and psychosocial treatments for OUD. The survey assessed attitudes towards and experiences with family-based treatment, barriers and facilitators to family-based treatment utilization, as well as other available treatment services for AYA and family members. Findings were summarized using descriptive statistics. RESULTS A total of 104 respondents from 14 distinct treatment programs completed the survey. Most identified as White (72.5%), female (72.7%), and between 25 and 44 years of age (59.4%). Over half (54.1%) of respondents reported no experience with family based treatment and limited current opportunities to involve families. Barriers perceived as most impactful to adopting family-based treatment were related to limited available resources (i.e. for staff training, program expansion) and lack of prioritization of family-based treatment in staff productivity requirements. Barriers perceived as least impactful were respondent beliefs and attitudes about family-based treatment (e.g., perception of the evidence strength and quality of family-based treatment, interest in implementing family-based treatment) as well as leadership support of family-based treatment approaches. Respondents identified several other gaps in availability of comprehensive treatment services, especially for adolescents (e.g. services that increase social recovery capital). CONCLUSIONS Family-based treatment opportunities for AYA with OUD in Rhode Island are limited. Affordable and accessible training programs are needed to increase provider familiarity and competency with family-based treatment. Implementation of programming to increase family involvement in treatment (i.e. psychoeducational and skills-based groups for family members) rather than adopting a family-based treatment model may be a more feasible step to better meet the needs of AYA with OUD. TRIAL REGISTRATION not applicable.
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Affiliation(s)
- Melissa Pielech
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA.
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Crosby Modrowski
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
- Bradley Hasbro Children's Research Center, Providence, RI, USA
| | - Jasper Yeh
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Melissa A Clark
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Robert Miranda
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
- E. P. Bradley Hospital, Riverside, RI, USA
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Allen B, Schell RC, Jent VA, Krieger M, Pratty C, Hallowell BD, Goedel WC, Basta M, Yedinak JL, Li Y, Cartus AR, Marshall BDL, Cerdá M, Ahern J, Neill DB. PROVIDENT: Development and Validation of a Machine Learning Model to Predict Neighborhood-level Overdose Risk in Rhode Island. Epidemiology 2024; 35:232-240. [PMID: 38180881 PMCID: PMC10842082 DOI: 10.1097/ede.0000000000001695] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Drug overdose persists as a leading cause of death in the United States, but resources to address it remain limited. As a result, health authorities must consider where to allocate scarce resources within their jurisdictions. Machine learning offers a strategy to identify areas with increased future overdose risk to proactively allocate overdose prevention resources. This modeling study is embedded in a randomized trial to measure the effect of proactive resource allocation on statewide overdose rates in Rhode Island (RI). METHODS We used statewide data from RI from 2016 to 2020 to develop an ensemble machine learning model predicting neighborhood-level fatal overdose risk. Our ensemble model integrated gradient boosting machine and super learner base models in a moving window framework to make predictions in 6-month intervals. Our performance target, developed a priori with the RI Department of Health, was to identify the 20% of RI neighborhoods containing at least 40% of statewide overdose deaths, including at least one neighborhood per municipality. The model was validated after trial launch. RESULTS Our model selected priority neighborhoods capturing 40.2% of statewide overdose deaths during the test periods and 44.1% of statewide overdose deaths during validation periods. Our ensemble outperformed the base models during the test periods and performed comparably to the best-performing base model during the validation periods. CONCLUSIONS We demonstrated the capacity for machine learning models to predict neighborhood-level fatal overdose risk to a degree of accuracy suitable for practitioners. Jurisdictions may consider predictive modeling as a tool to guide allocation of scarce resources.
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Affiliation(s)
- Bennett Allen
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Robert C Schell
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Victoria A Jent
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Maxwell Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Claire Pratty
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Benjamin D Hallowell
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Melissa Basta
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI, USA
| | - Jesse L Yedinak
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Yu Li
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Abigail R Cartus
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Magdalena Cerdá
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Daniel B Neill
- Center for Urban Science and Progress, New York University, New York, NY, USA
- Department of Computer Science, Courant Institute for Mathematical Sciences, New York University, New York, NY, USA
- Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA
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Samuels EA, Goedel WC, Jent V, Conkey L, Hallowell BD, Karim S, Koziol J, Becker S, Yorlets RR, Merchant R, Keeler LA, Reddy N, McDonald J, Alexander-Scott N, Cerda M, Marshall BDL. Characterizing opioid overdose hotspots for place-based overdose prevention and treatment interventions: A geo-spatial analysis of Rhode Island, USA. Int J Drug Policy 2024; 125:104322. [PMID: 38245914 DOI: 10.1016/j.drugpo.2024.104322] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/10/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Examine differences in neighborhood characteristics and services between overdose hotspot and non-hotspot neighborhoods and identify neighborhood-level population factors associated with increased overdose incidence. METHODS We conducted a population-based retrospective analysis of Rhode Island, USA residents who had a fatal or non-fatal overdose from 2016 to 2020 using an environmental scan and data from Rhode Island emergency medical services, State Unintentional Drug Overdose Reporting System, and the American Community Survey. We conducted a spatial scan via SaTScan to identify non-fatal and fatal overdose hotspots and compared the characteristics of hotspot and non-hotspot neighborhoods. We identified associations between census block group-level characteristics using a Besag-York-Mollié model specification with a conditional autoregressive spatial random effect. RESULTS We identified 7 non-fatal and 3 fatal overdose hotspots in Rhode Island during the study period. Hotspot neighborhoods had higher proportions of Black and Latino/a residents, renter-occupied housing, vacant housing, unemployment, and cost-burdened households. A higher proportion of hotspot neighborhoods had a religious organization, a health center, or a police station. Non-fatal overdose risk increased in a dose responsive manner with increasing proportions of residents living in poverty. There was increased relative risk of non-fatal and fatal overdoses in neighborhoods with crowded housing above the mean (RR 1.19 [95 % CI 1.05, 1.34]; RR 1.21 [95 % CI 1.18, 1.38], respectively). CONCLUSION Neighborhoods with increased prevalence of housing instability and poverty are at highest risk of overdose. The high availability of social services in overdose hotspots presents an opportunity to work with established organizations to prevent overdose deaths.
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Affiliation(s)
- Elizabeth A Samuels
- Department of Emergency Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Drug Overdose Prevention Program, Rhode Island Department of Health, Providence, RI, USA.
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Victoria Jent
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York University, New York City, NY, USA
| | - Lauren Conkey
- Drug Overdose Prevention Program, Rhode Island Department of Health, Providence, RI, USA
| | - Benjamin D Hallowell
- Drug Overdose Prevention Program, Rhode Island Department of Health, Providence, RI, USA
| | - Sarah Karim
- Drug Overdose Prevention Program, Rhode Island Department of Health, Providence, RI, USA
| | - Jennifer Koziol
- Drug Overdose Prevention Program, Rhode Island Department of Health, Providence, RI, USA
| | - Sara Becker
- Center for Dissemination and Implementation Science, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rachel R Yorlets
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Population Studies and Training Center, Brown University, Providence, RI, USA
| | - Roland Merchant
- Department of Emergency Medicine, Mount Sinai, New York City, NY, USA
| | - Lee Ann Keeler
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Neha Reddy
- Department of Obstetrics and Gynecology, UChicago Medicine, Chicago, IL, USA
| | - James McDonald
- Drug Overdose Prevention Program, Rhode Island Department of Health, Providence, RI, USA
| | - Nicole Alexander-Scott
- Drug Overdose Prevention Program, Rhode Island Department of Health, Providence, RI, USA
| | - Magdalena Cerda
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York University, New York City, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Tan M, Park C, Goldman J, Biello KB, Buxton J, Hadland SE, Park JN, Sherman SG, Macmadu A, Marshall BDL. Association between willingness to use an overdose prevention center and probation or parole status among people who use drugs in Rhode Island. Harm Reduct J 2024; 21:54. [PMID: 38424553 PMCID: PMC10905878 DOI: 10.1186/s12954-024-00969-0] [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: 12/15/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Overdose prevention centers (OPCs) are being implemented in the United States as a strategy to reduce drug-related mortality and morbidity. Previous studies have suggested that people who use drugs (PWUD) with a history of criminal legal system (CLS) involvement (e.g. current probation/parole) are at greater risk of overdose but may also encounter significant barriers to OPC use. The objective of this study was to explore the association between willingness to use an OPC and probation/parole status in a sample of PWUD in Rhode Island. METHODS This study utilized data from the Rhode Island Prescription and Illicit Drug Study, which enrolled adult PWUD from August 2020 to February 2023. We used Pearson's chi-square and Wilcoxon rank-sum tests to assess bivariate associations between willingness to use an OPC and probation/parole status (current/previous/never), as well as other sociodemographic and behavioral characteristics. In multivariable Poisson analyses, we examined the association between willingness to use an OPC and probation/parole status, adjusting for key sociodemographic and behavioral characteristics. RESULTS Among 482 study participants, 67% were male, 56% identified as white, 20% identified as Hispanic/Latine, and the median age was 43 (IQR 35-53). Nearly a quarter (24%) had never been on probation/parole, 44% were not currently on probation/parole but had a lifetime history of probation and parole, and 32% were currently on probation/parole. Most participants (71%) reported willingness to use an OPC, and in both bivariate and multivariable analyses, willingness to use an OPC did not vary by probation/parole status. Crack cocaine use and lifetime non-fatal overdose were associated with greater willingness to use an OPC (all p < 0.05). CONCLUSIONS These data demonstrate high willingness to use OPC among PWUD in Rhode Island regardless of CLS-involvement. As OPCs begin to be implemented in Rhode Island, it will be imperative to engage people with CLS-involvement and to ensure access to the OPC and protection against re-incarceration due to potential barriers, such as police surveillance of OPCs.
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Affiliation(s)
- Michael Tan
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Carolyn Park
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Jacqueline Goldman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Katie B Biello
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Scott E Hadland
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ju Nyeong Park
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
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Rosen JG, Thompson E, Tardif J, Collins AB, Marshall BDL, Park JN. "Make yourself un-NIMBY-able": stakeholder perspectives on strategies to mobilize public and political support for overdose prevention centers in the United States of America. Harm Reduct J 2024; 21:40. [PMID: 38355641 PMCID: PMC10868085 DOI: 10.1186/s12954-024-00955-6] [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: 11/07/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Overdose prevention centers (OPCs), also known as supervised injection facilities and safe consumption sites, are evidenced-based interventions for preventing overdose deaths and drug-related morbidities. The pathways to legalizing OPCs in the USA have confronted multiple social, political, and legal obstacles. We conducted a multi-site, qualitative study to explore heterogeneities in these pathways in four jurisdictions, as well as to understand stakeholder perspectives on valuable strategies for galvanizing political and public support for OPCs. METHODS From July 2022 to February 2023, we conducted 17 semi-structured, in-depth interviews with OPC policymakers, service providers, advocates, and researchers from California, New York City, Philadelphia, and Rhode Island, where efforts have been undertaken to authorize OPCs. Using inductive thematic analysis, we identified and compared contextually relevant, salient approaches for increasing support for OPCs. RESULTS Participants described several strategies clustering around five distinct domains: (1) embedding OPC advocacy into broader overdose prevention coalitions to shape policy dialogs; (2) building rapport with a plurality of powerbrokers (e.g., lawmakers, health departments, law enforcement) who could amplify the impact of OPC advocacy; (3) emphasizing specific benefits of OPCs to different audiences in different contexts; (4) leveraging relationships with frontline workers (e.g., emergency medicine and substance use treatment providers) to challenge OPC opposition, including 'NIMBY-ism,' and misinformation; and (5) prioritizing transparency in OPC decision-making to foster public trust. CONCLUSION While tailored to the specific socio-political context of each locality, multiple OPC advocacy strategies have been deployed to cultivate support for OPCs in the USA. Advocacy strategies that are multi-pronged, leverage partnerships with stakeholders at multiple levels, and tailor communications to different audiences and settings could yield the greatest impact in increasing support for, and diffusing opposition to, future OPC implementation.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5031, Baltimore, MD, 21205, USA.
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, 1125 North Main Street, Providence, RI, 02904, USA
| | - Jessica Tardif
- Harm Reduction Innovation Lab, Rhode Island Hospital, 1125 North Main Street, Providence, RI, 02904, USA
| | - Alexandra B Collins
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Ju Nyeong Park
- Harm Reduction Innovation Lab, Rhode Island Hospital, 1125 North Main Street, Providence, RI, 02904, USA
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
- Department of General Internal Medicine, Warren Alpert Medical School, Brown University, 593 Eddy Street, Providence, RI, 02903, USA
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Henry SG, Fang SY, Crawford AJ, Wintemute GJ, Tseregounis IE, Gasper JJ, Shev A, Cartus AR, Marshall BDL, Tancredi DJ, Cerdá M, Stewart SL. Impact of 30-day prescribed opioid dose trajectory on fatal overdose risk: A population-based, statewide cohort study. J Gen Intern Med 2024; 39:393-402. [PMID: 37794260 PMCID: PMC10897080 DOI: 10.1007/s11606-023-08419-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Both increases and decreases in patients' prescribed daily opioid dose have been linked to increased overdose risk, but associations between 30-day dose trajectories and subsequent overdose risk have not been systematically examined. OBJECTIVE To examine the associations between 30-day prescribed opioid dose trajectories and fatal opioid overdose risk during the subsequent 15 days. DESIGN Statewide cohort study using linked prescription drug monitoring program and death certificate data. We constructed a multivariable Cox proportional hazards model that accounted for time-varying prescription-, prescriber-, and pharmacy-level factors. PARTICIPANTS All patients prescribed an opioid analgesic in California from March to December, 2013 (5,326,392 patients). MAIN MEASURES Dependent variable: fatal drug overdose involving opioids. Primary independent variable: a 16-level variable denoting all possible opioid dose trajectories using the following categories for current and 30-day previously prescribed daily dose: 0-29, 30-59, 60-89, or ≥90 milligram morphine equivalents (MME). KEY RESULTS Relative to patients prescribed a stable daily dose of 0-29 MME, large (≥2 categories) dose increases and having a previous or current dose ≥60 MME per day were associated with significantly greater 15-day overdose risk. Patients whose dose decreased from ≥90 to 0-29 MME per day had significantly greater overdose risk compared to both patients prescribed a stable daily dose of ≥90 MME (aHR 3.56, 95%CI 2.24-5.67) and to patients prescribed a stable daily dose of 0-29 MME (aHR 7.87, 95%CI 5.49-11.28). Patients prescribed benzodiazepines also had significantly greater overdose risk; being prescribed Z-drugs, carisoprodol, or psychostimulants was not associated with overdose risk. CONCLUSIONS Large (≥2 categories) 30-day dose increases and decreases were both associated with increased risk of fatal opioid overdose, particularly for patients taking ≥90 MME whose opioids were abruptly stopped. Results align with 2022 CDC guidelines that urge caution when reducing opioid doses for patients taking long-term opioid for chronic pain.
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Affiliation(s)
- Stephen G Henry
- University of California Davis Center for Healthcare Policy and Research; University of California, Davis, California, Sacramento, USA.
- Department of Internal Medicine, University of California, Davis, California, Sacramento, USA.
| | - Shao-You Fang
- University of California Davis Center for Healthcare Policy and Research; University of California, Davis, California, Sacramento, USA
| | - Andrew J Crawford
- Violence Prevention Research Program; University of California, Davis, California, Sacramento, USA
- Department of Emergency Medicine, University of California, Davis, California, Sacramento, USA
| | - Garen J Wintemute
- Violence Prevention Research Program; University of California, Davis, California, Sacramento, USA
- Department of Emergency Medicine, University of California, Davis, California, Sacramento, USA
| | - Iraklis Erik Tseregounis
- University of California Davis Center for Healthcare Policy and Research; University of California, Davis, California, Sacramento, USA
- Department of Internal Medicine, University of California, Davis, California, Sacramento, USA
| | - James J Gasper
- Department of Family and Community Medicine, University of California, San Francisco, California, San Francisco, USA
| | - Aaron Shev
- Violence Prevention Research Program; University of California, Davis, California, Sacramento, USA
- Department of Emergency Medicine, University of California, Davis, California, Sacramento, USA
| | - Abigail R Cartus
- Department of Epidemiology, Brown University School of Public Health, Rhode Island, Providence, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Rhode Island, Providence, USA
| | - Daniel J Tancredi
- University of California Davis Center for Healthcare Policy and Research; University of California, Davis, California, Sacramento, USA
- Department of Pediatrics, University of California, Davis, California, Sacramento, USA
| | - Magdalena Cerdá
- Department of Population Health, Center for Opioid Epidemiology and Policy; New York University Grossman School of Medicine, New York City, New York, USA
| | - Susan L Stewart
- Department of Public Health Sciences, University of California, Davis, California, Davis, USA
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Zang X, Walley AY, Chatterjee A, Kimmel SD, Morgan JR, Murphy SM, Linas BP, Nolen S, Reilly B, Urquhart C, Schackman BR, Marshall BDL. Changes to opioid overdose deaths and community naloxone access among Black, Hispanic and White people from 2016 to 2021 with the onset of the COVID-19 pandemic: An interrupted time-series analysis in Massachusetts, USA. Addiction 2023; 118:2413-2423. [PMID: 37640687 PMCID: PMC10986189 DOI: 10.1111/add.16324] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIMS The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a surge in opioid overdose deaths in Massachusetts, particularly affecting racial and ethnic minority communities. We aimed to compare the impact of the pandemic on opioid overdose fatalities and naloxone distribution from community-based programs across racial and ethnic groups in Massachusetts. DESIGN Interrupted time-series. SETTING AND CASES Opioid overdose deaths (OODs) among non-Hispanic White, non-Hispanic Black, Hispanic and non-Hispanic other race people in Massachusetts, USA (January 2016 to June 2021). MEASUREMENTS Rate of OODs per 100 000 people, rate of naloxone kits distributed per 100 000 people and ratio of naloxone kits per opioid overdose death as a measure of naloxone availability. We applied five imputation strategies using complete data in different periods to account for missingness of race and ethnicity for naloxone data. FINDINGS Before COVID-19 (January 2016 to February 2020), the rate of OODs declined among non-Hispanic White people [0.2% monthly reduction (95% confidence interval = 0.0-0.4%)], yet was relatively constant among all other population groups. The rate of naloxone kits increased across all groups (0.8-1.2% monthly increase) and the ratio of naloxone kits per OOD death among non-Hispanic White was 1.1% (0.8-1.4%) and among Hispanic people was 1.0% (0.2-1.8%). After the onset of the pandemic (March 2020+), non-Hispanic Black people experienced an immediate increase in the rate of OODs [63.6% (16.4-130%)], whereas rates among other groups remained similar. Trends in naloxone rescue kit distribution did not substantively change among any groups, and the ratio of naloxone kits per OOD death for non-Hispanic Black people did not compensate for the surge in OODs deaths in this group. CONCLUSIONS With the onset of the COVID-19 pandemic, there was a surge in opioid overdose deaths among non-Hispanic Black people in Massachusetts, USA with no compensatory increase in naloxone rescue kit distribution. For non-Hispanic White and Hispanic people, opioid overdose deaths remained stable and naloxone kit distribution continued to increase.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Avik Chatterjee
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Simeon D Kimmel
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brittni Reilly
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
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Folk JB, Ramaiya M, Holloway E, Ramos L, Marshall BDL, Kemp K, Li Y, Bath E, Mitchell DK, Tolou-Shams M. The Association Between Expanded ACEs and Behavioral Health Outcomes Among Youth at First Time Legal System Contact. Res Child Adolesc Psychopathol 2023; 51:1857-1870. [PMID: 36565372 PMCID: PMC10290175 DOI: 10.1007/s10802-022-01009-w] [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] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
A growing body of literature has documented high rates of adverse childhood experiences (ACEs) and their effects on behavioral health among adolescents impacted by the juvenile legal system. Most research with justice-impacted youth assesses the ten standard ACEs, encompassing abuse, neglect, and household dysfunction. This body of work has largely ignored the five expanded ACEs which assess social and community level adversity. Justice-impacted youth commonly experience expanded ACEs (racial discrimination, placement in foster care, living in a disadvantaged neighborhood, witnessing violence, bullying), and inclusion of these adversities may enhance predictive utility of the commonly used ACEs score. The current study examined the prospective impact of total ACEs (standard and expanded) on alcohol and cannabis use, substance-related consequences, and psychiatric symptoms during the year following first ever contact with the juvenile court. Results indicate justice-impacted youth experience multiple expanded ACEs prior to first court contact. The expanded ACEs did not predict any of the behavioral health outcomes assessed, over and above the standard ACEs. Inclusion of expanded ACEs in the standard ACEs score may not increase utility in identifying prospective behavioral health outcomes among youth in first time contact with the juvenile legal system.
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Affiliation(s)
- Johanna B Folk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Megan Ramaiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Evan Holloway
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lili Ramos
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kathleen Kemp
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Eraka Bath
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Daphne Koinis Mitchell
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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11
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Zang X, Piske M, Humphrey L, Enns B, Sui Y, Marshall BDL, Goedel WC, Feaster DJ, Metsch LR, Sullivan PS, Tookes HE, Nosyk B. Estimating the epidemiological impact of reaching the objectives of the Florida integrated HIV prevention and care plan in Miami-Dade County. Lancet Reg Health Am 2023; 27:100623. [PMID: 37928440 PMCID: PMC10624567 DOI: 10.1016/j.lana.2023.100623] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
Background The US Ending the HIV Epidemic (EHE) initiative aims to reduce national HIV incidence 90% by 2030 and to address the disproportionate burden of HIV among different racial/ethnic populations. Florida's state-wide 2022-2026 Integrated HIV Prevention and Care Plan outlines objectives for reaching EHE goals. In Miami-Dade County, we determined the epidemiological impact of achieving the integrated plan's objectives individually and jointly. Methods We adapted an HIV transmission model calibrated to Miami-Dade County adjusting access to HIV testing, pre-exposure prophylaxis (PrEP) and antiretroviral treatment to model the effects of each objective between 2022 and 2030. We compared two service scale-up approaches: (a) scale-up proportionally to existing racial/ethnic group access levels, and (b) scale-up according to new diagnoses across racial/ethnic groups (equity-oriented). We estimated reductions in new HIV infections by each objective and approach, compared to the EHE's incidence reduction target. Findings The single most influential strategy was reducing new HIV diagnoses in Hispanic/Latinx men who have sex with men through increased PrEP uptake, resulting in 907/2444 (37.1%) fewer annual new HIV infections in 2030. Achieving all objectives jointly would result in 1537/2444 (62.9%) and 1553/2444 (63.5%) fewer annual new HIV infections with the proportional and equity-oriented approaches, respectively. Interpretation Achieving the goals of Florida's integrated care plan would significantly reduce HIV incidence in Miami-Dade County; however, further efforts are required to achieve EHE targets. Structural changes in service delivery and a focus on effective implementation of available interventions to address racial/ethnic disparities will be crucial to ending the HIV epidemic. Funding This work was supported by the National Institutes of Health/National Institute on Drug Abuse grant no. R01-DA041747.
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Affiliation(s)
- Xiao Zang
- Division of Health Policy and Management, School of Public Health, University of Minnesota, A302 Mayo Building, MMC 729, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Micah Piske
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z1Y6, Canada
| | - Lia Humphrey
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z1Y6, Canada
| | - Benjamin Enns
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z1Y6, Canada
| | - Yi Sui
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z1Y6, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M Miller School of Medicine, University of Miami, 1120 NW 14th Street, CRB 919, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE Atlanta, GA, 30322, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL, 33136, USA
| | - Bohdan Nosyk
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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12
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Nolen S, Trinidad AJ, Jordan AE, Green TC, Jalali A, Murphy SM, Zang X, Marshall BDL, Schackman BR. Racial/ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City. Harm Reduct J 2023; 20:152. [PMID: 37853481 PMCID: PMC10585909 DOI: 10.1186/s12954-023-00891-x] [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: 05/14/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC). METHODS We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White, and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group. RESULTS Non-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate, and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents. CONCLUSIONS This study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA
| | - Andrew J Trinidad
- Department of Health & Mental Hygiene, Bureau of Alcohol & Drug Use Prevention, Care, & Treatment, 42-09 28Th St, Queens, New York, NY, 11101, USA
| | - Ashly E Jordan
- Department of Health & Mental Hygiene, Bureau of Alcohol & Drug Use Prevention, Care, & Treatment, 42-09 28Th St, Queens, New York, NY, 11101, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
- Center of Biomedical Research Excellence On Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI, 02906, USA
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
| | - Xiao Zang
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA.
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
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Allen B, Neill DB, Schell RC, Ahern J, Hallowell BD, Krieger M, Jent VA, Goedel WC, Cartus AR, Yedinak JL, Pratty C, Marshall BDL, Cerdá M. Translating Predictive Analytics for Public Health Practice: A Case Study of Overdose Prevention in Rhode Island. Am J Epidemiol 2023; 192:1659-1668. [PMID: 37204178 PMCID: PMC10558193 DOI: 10.1093/aje/kwad119] [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: 09/23/2022] [Revised: 03/09/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023] Open
Abstract
Prior applications of machine learning to population health have relied on conventional model assessment criteria, limiting the utility of models as decision support tools for public health practitioners. To facilitate practitioners' use of machine learning as a decision support tool for area-level intervention, we developed and applied 4 practice-based predictive model evaluation criteria (implementation capacity, preventive potential, health equity, and jurisdictional practicalities). We used a case study of overdose prevention in Rhode Island to illustrate how these criteria could inform public health practice and health equity promotion. We used Rhode Island overdose mortality records from January 2016-June 2020 (n = 1,408) and neighborhood-level US Census data. We employed 2 disparate machine learning models, Gaussian process and random forest, to illustrate the comparative utility of our criteria to guide interventions. Our models predicted 7.5%-36.4% of overdose deaths during the test period, illustrating the preventive potential of overdose interventions assuming 5%-20% statewide implementation capacities for neighborhood-level resource deployment. We describe the health equity implications of use of predictive modeling to guide interventions along the lines of urbanicity, racial/ethnic composition, and poverty. We then discuss considerations to complement predictive model evaluation criteria and inform the prevention and mitigation of spatially dynamic public health problems across the breadth of practice. This article is part of a Special Collection on Mental Health.
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Affiliation(s)
- Bennett Allen
- Correspondence to Dr. Bennett Allen, Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, 180 Madison Avenue, 4th Floor, Room 4-15, New York, NY 10016 (e-mail: )
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14
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Chatterjee A, Yan S, Lambert A, Morgan JR, Green TC, Jeng PJ, Jalali A, Xuan Z, Krieger M, Marshall BDL, Walley AY, Murphy SM. Comparison of a national commercial pharmacy naloxone data source to state and city pharmacy naloxone data sources-Rhode Island, Massachusetts, and New York City, 2013-2019. Health Serv Res 2023; 58:1141-1150. [PMID: 37408299 PMCID: PMC10480090 DOI: 10.1111/1475-6773.14200] [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: 07/07/2023] Open
Abstract
OBJECTIVE Accurate naloxone distribution data are critical for planning and prevention purposes, yet sources of naloxone dispensing data vary by location, and completeness of local datasets is unknown. We sought to compare available datasets in Massachusetts, Rhode Island, and New York City (NYC) to a commercially available pharmacy national claims dataset (Symphony Health Solutions). DATA SOURCES AND STUDY SETTING We utilized retail pharmacy naloxone dispensing data from NYC (2018-2019), Rhode Island (2013-2019), and Massachusetts (2014-2018), and pharmaceutical claims data from Symphony Health Solutions (2013-2019). STUDY DESIGN We conducted a descriptive, retrospective, and secondary analysis comparing naloxone dispensing events (NDEs) captured via Symphony to NDEs captured by local datasets from the three jurisdictions between 2013 and 2019, when data were available from both sources, using descriptive statistics, regressions, and heat maps. DATA COLLECTION/EXTRACTION METHODS We defined an NDE as a dispensing event documented by the pharmacy and assumed that each dispensing event represented one naloxone kit (i.e., two doses). We extracted NDEs from local datasets and the Symphony claims dataset. The unit of analysis was the ZIP Code annual quarter. PRINCIPAL FINDINGS NDEs captured by Symphony exceeded those in local datasets for each time period and location, except in RI following legislation requiring NDEs to be reported to the PDMP. In regression analysis, absolute differences in NDEs between datasets increased substantially over time, except in RI before the PDMP. Heat maps of NDEs by ZIP code quarter showed important variations reflecting where pharmacies may not be reporting NDEs to Symphony or local datasets. CONCLUSIONS Policymakers must be able to monitor the quantity and location of NDEs in order to combat the opioid crisis. In regions where NDEs are not required to be reported to PDMPs, proprietary pharmaceutical claims datasets may be useful alternatives, with a need for local expertise to assess dataset-specific variability.
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Affiliation(s)
- Avik Chatterjee
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal MedicineBoston Medical Center/Boston University School of MedicineBostonMassachusettsUSA
| | - Shapei Yan
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal MedicineBoston Medical Center/Boston University School of MedicineBostonMassachusettsUSA
| | - Audrey Lambert
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal MedicineBoston Medical Center/Boston University School of MedicineBostonMassachusettsUSA
| | - Jake R. Morgan
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Traci C. Green
- The Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - Philip J. Jeng
- Department of Population Health SciencesWeill Cornell Medical CollegeNew York CityNew YorkUSA
| | - Ali Jalali
- Department of Population Health SciencesWeill Cornell Medical CollegeNew York CityNew YorkUSA
| | - Ziming Xuan
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Maxwell Krieger
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Brandon D. L. Marshall
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal MedicineBoston Medical Center/Boston University School of MedicineBostonMassachusettsUSA
| | - Sean M. Murphy
- Department of Population Health SciencesWeill Cornell Medical CollegeNew York CityNew YorkUSA
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15
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Bhondoekhan F, Marshall BDL, Shireman TI, Trivedi AN, Merlin JS, Moyo P. Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD. JAMA Netw Open 2023; 6:e2333251. [PMID: 37698860 PMCID: PMC10498328 DOI: 10.1001/jamanetworkopen.2023.33251] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/03/2023] [Indexed: 09/13/2023] Open
Abstract
Importance Nonpharmacologic treatments are important for managing chronic pain among persons with opioid use disorder (OUD), for whom opioid and other pharmacologic therapies may be particularly harmful. Racial and ethnic minority individuals with chronic pain and OUD are vulnerable to suboptimal pain management due to systemic inequities and structural racism, highlighting the need to understand their receipt of guideline-recommended nonpharmacologic pain therapies, including physical therapy (PT) and chiropractic care. Objective To assess differences across racial and ethnic groups in receipt of PT or chiropractic care for chronic low back pain (CLBP) among persons with comorbid OUD. Design, Setting, and Participants This retrospective cohort study used a 20% random sample of national Medicare administrative data from January 1, 2016, to December 31, 2018, to identify fee-for-service community-dwelling beneficiaries with a new episode of CLBP and comorbid OUD. Data were analyzed from March 1, 2022, to July 30, 2023. Exposures Race and ethnicity as a social construct, categorized as American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic, non-Hispanic White, and unknown or other. Main Outcomes and Measures The main outcomes were receipt of PT or chiropractic care within 3 months of CLBP diagnosis. The time (in days) to receiving these treatments was also assessed. Results Among 69 362 Medicare beneficiaries analyzed, the median age was 60.0 years (IQR, 51.5-68.7 years) and 42 042 (60.6%) were female. A total of 745 beneficiaries (1.1%) were American Indian or Alaska Native; 444 (0.6%), Asian or Pacific Islander; 9822 (14.2%), Black or African American; 4124 (5.9%), Hispanic; 53 377 (77.0%); non-Hispanic White; and 850 (1.2%), other or unknown race. Of all beneficiaries, 7104 (10.2%) received any PT or chiropractic care 3 months after a new CLBP episode. After adjustment, Black or African American (adjusted odds ratio, 0.46; 95% CI, 0.39-0.55) and Hispanic (adjusted odds ratio, 0.54; 95% CI, 0.43-0.67) persons had lower odds of receiving chiropractic care within 3 months of CLBP diagnosis compared with non-Hispanic White persons. Median time to chiropractic care was longest for American Indian or Alaska Native (median, 8.5 days [IQR, 0-44.0 days]) and Black or African American (median, 7.0 days [IQR, 0-42.0 days]) persons and shortest for Asian or Pacific Islander persons (median, 0 days [IQR, 0-6.0 days]). No significant racial and ethnic differences were observed for PT. Conclusions and Relevance In this retrospective cohort study of Medicare beneficiaries with comorbid CLBP and OUD, receipt of PT and chiropractic care was low overall and lower across most racial and ethnic minority groups compared with non-Hispanic White persons. The findings underscore the need to address inequities in guideline-concordant pain management, particularly among Black or African American and Hispanic persons with OUD.
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Affiliation(s)
- Fiona Bhondoekhan
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Theresa I. Shireman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Amal N. Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Jessica S. Merlin
- CHAllenges in Managing and Preventing Pain Clinical Research Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
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Tracy M, Gordis E, Strully K, Marshall BDL, Cerdá M. Applications of agent-based modeling in trauma research. Psychol Trauma 2023; 15:939-950. [PMID: 36136775 PMCID: PMC10030380 DOI: 10.1037/tra0001375] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Trauma, violence, and their consequences for population health are shaped by complex, intersecting forces across the life span. We aimed to illustrate the strengths of agent-based modeling (ABM), a computational approach in which population-level patterns emerge from the behaviors and interactions of simulated individuals, for advancing trauma research; Method: We provide an overview of agent-based modeling for trauma research, including a discussion of the model development process, ABM as a complement to other causal inference and complex systems approaches in trauma research, and past ABM applications in the trauma literature; Results: We use existing ABM applications to illustrate the strengths of ABM for trauma research, including incorporating interactions between individuals, simulating processes across multiple scales, examining life-course effects, testing alternate theories, comparing intervention strategies in a virtual laboratory, and guiding decision making. We also discuss the challenges of applying ABM to trauma research and offer specific suggestions for incorporating ABM into future studies of trauma and violence; Conclusion: Agent-based modeling is a useful complement to other methodological advances in trauma research. We recommend a more widespread adoption of ABM, particularly for research into patterns and consequences of individual traumatic experiences across the life course and understanding the effects of interventions that may be influenced by social norms and social network structures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, 1 University Place, Rensselaer, NY 12144, United States
| | - Elana Gordis
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Kate Strully
- Department of Sociology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI, 02912, United States
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10016, United States
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Choudry E, Rofé KL, Konnyu K, Marshall BDL, Shireman TI, Merlin JS, Trivedi AN, Schmidt C, Bhondoekhan F, Moyo P. Treatment Patterns and Population Characteristics of Nonpharmacological Management of Chronic Pain in the United States' Medicare Population: A Scoping Review. Innov Aging 2023; 7:igad085. [PMID: 38094932 PMCID: PMC10714895 DOI: 10.1093/geroni/igad085] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Clinical practice guidelines recommend noninvasive nonpharmacological pain therapies; however, reviews that assess the literature pertaining to nonpharmacological pain management among older adults and people with long-term disabilities who are disproportionately affected by pain are lacking. This scoping review aimed to systematically map and characterize the existing studies about the receipt of noninvasive, nonpharmacological pain therapies by Medicare beneficiaries. Research Design and Methods We conducted a literature search in MEDLINE (PubMed), CINAHL (EBSCO), SocINDEX (EBSCO), Cochrane Library, Web of Science citation indices, and various sources of gray literature. The initial search was conducted on November 2, 2021, and updated on March 9, 2022. Two independent reviewers screened titles, abstracts, and full texts for inclusion and extracted the characteristics of the studies, studied populations, and nonpharmacological pain therapies. Data were summarized using tabular and narrative formats. Results The final review included 33 studies. Of these, 24 were quantitative, 7 were qualitative, and 2 were mixed-methods studies. Of 32 studies that focused on Medicare beneficiaries, 10 did not specify the Medicare type, and all but one of the remaining studies were restricted to fee-for-service enrollees. Back and neck pain and arthritis were the most commonly studied pain types. Chiropractic care (n = 19) and physical therapy (n = 17) appeared frequently among included studies. The frequency and/or duration of nonpharmacological treatment were mentioned in 13 studies. Trends in the utilization of nonpharmacological pain therapies were assessed in 6 studies but none of these studies went beyond 2008. Discussion and Implications This scoping review found that manipulative therapies, mainly chiropractic, have been the most widely studied approaches for nonpharmacological pain management in the Medicare population. The review also identified the need for future research that updates trend data and addresses contemporary issues such as rising Medicare Advantage enrollment and promulgation of practice guidelines for pain management.
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Affiliation(s)
- Erum Choudry
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Kara L Rofé
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Kristin Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Theresa I Shireman
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Division of Infectious Disease, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amal N Trivedi
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Catherine Schmidt
- Department of Physical Therapy, Massachusetts General Hospital Institute of Health Professions, School of Health and Rehabilitation Sciences, Boston, Massachusetts, USA
| | - Fiona Bhondoekhan
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Patience Moyo
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
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Ti L, Grant CJ, Tobias S, Hore DK, Laing R, Marshall BDL. Development of a neural network model to predict the presence of fentanyl in community drug samples. PLoS One 2023; 18:e0288656. [PMID: 37440523 DOI: 10.1371/journal.pone.0288656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Increasingly, Fourier-transform infrared (FTIR) spectroscopy is being used as a harm reduction tool to provide people who use drugs real-time information about the contents of their substances. However, FTIR spectroscopy has been shown to have a high detection limit for fentanyl and interpretation of results by a technician can be subjective. This poses concern, given that some synthetic opioids can produce serious toxicity at sub-detectable levels. The objective of this study was to develop a neural network model to identify fentanyl and related analogues more accurately in drug samples compared to traditional analysis by technicians. METHODS Data were drawn from samples analyzed point-of-care using combination FTIR spectroscopy and fentanyl immunoassay strips in British Columbia between August 2018 and January 2021. We developed neural network models to predict the presence of fentanyl based on FTIR data. The final model was validated against the results from immunoassay strips. Prediction performance was assessed using F1 score, accuracy, and area under the receiver-operating characteristic curve (AUROC), and was compared to results obtained from analysis by technicians. RESULTS A total of 12,684 samples were included. The neural network model outperformed results from those analyzed by technicians, with an F1 score of 96.4% and an accuracy of 96.4%, compared to 78.4% and 82.4% with a technician, respectively. The AUROC of the model was 99.0%. Fentanyl positive samples correctly detected by the model but not by the technician were typically those with low fentanyl concentrations (median: 2.3% quantity by weight; quartile 1-3: 0.0%-4.6%). DISCUSSION Neural network models can accurately predict the presence of fentanyl and related analogues using FTIR data, including samples with low fentanyl concentrations. Integrating this tool within drug checking services utilizing FTIR spectroscopy has the potential to improve decision making to reduce the risk of overdose and other negative health outcomes.
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Affiliation(s)
- Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron J Grant
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Samuel Tobias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dennis K Hore
- Department of Chemistry, University of Victoria, Victoria, British Columbia, Canada
- Department of Computer Science, University of Victoria, Victoria, British Columbia, Canada
| | - Richard Laing
- Strategic Research and Science Development, Health Canada Drug Analysis Service, Burnaby, British Columbia, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States of America
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Tracy M, Chong LS, Strully K, Gordis E, Cerdá M, Marshall BDL. A Systematic Review of Systems Science Approaches to Understand and Address Domestic and Gender-Based Violence. J Fam Violence 2023; 38:1-17. [PMID: 37358982 PMCID: PMC10213598 DOI: 10.1007/s10896-023-00578-8] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
Purpose We aimed to synthesize insights from systems science approaches applied to domestic and gender-based violence. Methods We conducted a systematic review of systems science studies (systems thinking, group model-building, agent-based modeling [ABM], system dynamics [SD] modeling, social network analysis [SNA], and network analysis [NA]) applied to domestic or gender-based violence, including victimization, perpetration, prevention, and community responses. We used blinded review to identify papers meeting our inclusion criteria (i.e., peer-reviewed journal article or published book chapter that described a systems science approach to domestic or gender-based violence, broadly defined) and assessed the quality and transparency of each study. Results Our search yielded 1,841 studies, and 74 studies met our inclusion criteria (45 SNA, 12 NA, 8 ABM, and 3 SD). Although research aims varied across study types, the included studies highlighted social network influences on risks for domestic violence, clustering of risk factors and violence experiences, and potential targets for intervention. We assessed the quality of the included studies as moderate, though only a minority adhered to best practices in model development and dissemination, including stakeholder engagement and sharing of model code. Conclusions Systems science approaches for the study of domestic and gender-based violence have shed light on the complex processes that characterize domestic violence and its broader context. Future research in this area should include greater dialogue between different types of systems science approaches, consideration of peer and family influences in the same models, and expanded use of best practices, including continued engagement of community stakeholders. Supplementary Information The online version contains supplementary material available at 10.1007/s10896-023-00578-8.
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, GEC 133, Rensselaer, NY 12144 USA
| | - Li Shen Chong
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222 USA
| | - Kate Strully
- Department of Sociology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222 USA
| | - Elana Gordis
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222 USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10016 USA
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI 02912 USA
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20
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Moyo P, Vaillant J, Girard A, Gairola R, Shireman TI, Trivedi AN, Merlin JS, Marshall BDL. Prevalence of opioid and nonopioid pain management therapies among Medicare beneficiaries with musculoskeletal pain conditions from 2016 to 2019. Drug Alcohol Depend 2023; 248:109930. [PMID: 37269776 DOI: 10.1016/j.drugalcdep.2023.109930] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Pain treatment guidelines prioritize nonopioid therapies over opioid medications to prevent opioid-related harms. We examined trends in receipt and intensity of nonpharmacologic, nonopioid medication, and opioid therapies among Medicare beneficiaries. METHODS Using a 20% national random sample of Medicare data from 2016 to 2019, we identified fee-for-service beneficiaries with ≥2 diagnoses of back, neck, fibromyalgia, or osteoarthritis/joint pain annually. We excluded beneficiaries with cancer. We calculated annual proportions of beneficiaries who received physical therapy (PT), chiropractic care, gabapentin, and opioids, overall and in demographic, geographic, and clinical subgroups. We estimated the intensity of therapies using the annual number of visitsor prescription fills, prescription days' supply, and opioid dose. RESULTS During 2016-2019, PT receipt increased (22.8% to 25.5%) and the mean number of visits among recipients of PT went from 12 to 13. Chiropractic receipt (~18%) and mean annual visits (~10) remained unchanged. The prevalence of gabapentin receipt was stable at ~22% and the mean annual number of fills was unchanged though gabapentin days increased slightly. Opioid prescribing decreased (56.7% to 46.5%) and reductions in opioid dose and duration were observed. Opioid receipt was high among beneficiaries who were under 65 years, American Indian/Alaska Native, Black/African American, or had opioid use disorder (OUD), in whom nonpharmacologic therapies were also received the least. CONCLUSION Utilization of nonopioid therapies lagged opioids among Medicare beneficiaries with musculoskeletal pain, with limited changes from 2016 to 2019. As opioid prescribing declines and alternative pain therapy receipt remains low, there are potential increasing risks of pain going untreated or undertreated and individuals seeking illicit opioids to alleviate their pain.
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Affiliation(s)
- Patience Moyo
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA.
| | | | - Anthony Girard
- Brown University School of Public Health, Department of Biostatistics, Providence, RI, USA
| | - Richa Gairola
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA
| | - Theresa I Shireman
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Amal N Trivedi
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Jessica S Merlin
- CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Brandon D L Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA
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21
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Nolen S, Trinidad AJ, Jordan AE, Green TC, Jalali A, Murphy SM, Zang X, Marshall BDL, Schackman BR. Racial/Ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City. Res Sq 2023:rs.3.rs-2934002. [PMID: 37292718 PMCID: PMC10246282 DOI: 10.21203/rs.3.rs-2934002/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC). Methods We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group. Results Non-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents. Conclusions This study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.
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Affiliation(s)
| | | | | | - Traci C Green
- Warren Alpert School of Medicine of Brown University
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22
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Cartus AR, Marshall BDL. Invited Commentary: On the Mathematization of Epidemiology as a Socially Engaged Quantitative Science. Am J Epidemiol 2023; 192:757-759. [PMID: 36632844 PMCID: PMC10423628 DOI: 10.1093/aje/kwad010] [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: 10/07/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Ensuring that patients with opioid use disorder (OUD) have access to optimal medication therapies is a critical challenge in substance use epidemiology. Rudolph et al. (Am J Epidemiol. 2023;XXX(X):XXXX-XXXX) demonstrated that sophisticated data-adaptive statistical techniques can be used to learn optimal, individualized treatment rules that can aid providers in choosing a medication treatment modality for a particular patient with OUD. This important work also highlights the effects of the mathematization of epidemiologic research. Here, we define mathematization and demonstrate how it operates in the context of effectiveness research on medications for OUD using the paper by Rudolph et al. as a springboard. In particular, we address the normative dimension of mathematization and how it tends to resolve a fundamental tension in epidemiologic practice between technical sophistication and public health considerations in favor of more technical solutions. The process of mathematization is a fundamental part of epidemiology; we argue not for eliminating it but for balancing mathematization and technical demands equally with practical and community-centric public health needs.
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Affiliation(s)
| | - Brandon D L Marshall
- Correspondence to Dr. Brandon Marshall, 121 S. Main Street, Providence, RI 02903 (e-mail: )
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23
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Cartus AR, Goedel WC, Jent VA, Macmadu A, Pratty C, Hallowell BD, Allen B, Li Y, Cerdá M, Marshall BDL. Neighborhood-level association between release from incarceration and fatal overdose, Rhode Island, 2016-2020. Drug Alcohol Depend 2023; 247:109867. [PMID: 37084507 DOI: 10.1016/j.drugalcdep.2023.109867] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 04/02/2023] [Indexed: 04/23/2023]
Abstract
The association between recent release from incarceration and dramatically increased risk of fatal overdose is well-established at the individual level. Fatal overdose and. arrest/release are spatially clustered, suggesting that this association may persist at the neighborhood level. We analyzed multicomponent data from Rhode Island, 2016-2020, and observed a modest association at the census tract level between rates of release per 1000 population and fatal overdose per 100,000 person-years, adjusting for spatial autocorrelation in both the exposure and outcome. Our results suggest that for each additional person released to a given census tract per 1000 population, there is a corresponding increase in the rate of fatal overdose by 2 per 100,000 person years. This association is more pronounced in suburban tracts, where each additional release awaiting trial is associated with an increase in the rate of fatal overdose of 4 per 100,000 person-years and 6 per 100,000 person-years for each additional release following sentence expiration. This association is not modified by the presence or absence of a licensed medication for opioid use disorder (MOUD) treatment provider in the same or surrounding tracts. Our results suggest that neighborhood-level release rates are moderately informative as to tract-level rates of fatal overdose and underscore the importance of expanding pre-release MOUD access in correctional settings. Future research should explore risk and resource environments particularly in suburban and rural areas and their impacts on overdose risk among individuals returning to the community.
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Affiliation(s)
- Abigail R Cartus
- Department of Epidemiology, Brown University School of Public Health, United States
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Victoria A Jent
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Claire Pratty
- Department of Epidemiology, Brown University School of Public Health, United States
| | | | - Bennett Allen
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, United States.
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24
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Tolou-Shams M, Folk JB, Holloway ED, Ordorica CM, Dauria EF, Kemp K, Marshall BDL. Psychiatric and Substance-Related Problems Predict Recidivism for First-Time Justice-Involved Youth. J Am Acad Psychiatry Law 2023; 51:35-46. [PMID: 36646452 PMCID: PMC10019581 DOI: 10.29158/jaapl.220028-21] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Justice-involved youth with clinically significant co-occurring psychiatric and substance-related problems are at increased risk for recidivism. Less is known about how psychiatric symptoms (i.e., internalizing and externalizing) and substance-related problems (i.e., alcohol and cannabis) interact to predict recidivism, especially at first court contact. Among 361 first-time justice-involved youth aged 12 to 18, we used nested multivariate negative binomial regression models to examine the association between psychiatric symptoms, substance-related problems and 24-month recidivism while accounting for demographic and legal covariates. Clinically significant externalizing symptoms and alcohol-related problems predicted recidivism. Moderation analyses revealed that alcohol-related problems drove recidivism for youth without clinically significant psychiatric symptoms and externalizing symptoms predicted recidivism, regardless of alcohol-related problems. After accounting for other predictors, Latinx, Black non-Latinx, and multiracial non-Latinx youth were more likely to recidivate at follow-up than White non-Latinx youth. Systematic screening, referral, and linkage to treatment for psychiatric and substance-related problems are needed to reduce recidivism risk among first-time justice-involved youth. Differences in recidivism rates by race/ethnicity not attributable to behavioral health needs suggest it is imperative to concurrently deploy large-scale structural interventions designed to combat systemic racial bias and overrepresentation of ethnoracial minoritized youth within the juvenile justice system.
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Affiliation(s)
- Marina Tolou-Shams
- Dr. Tolou-Shams is Professor, Dr. Folk is Assistant Professor, Dr. Holloway is Postdoctoral Fellow, and Ms. Ordorica is Clinical Research Coordinator, University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA. Dr. Dauria is Assistant Professor at University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA. Dr. Kemp is Assistant Professor at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI. Dr. Marshall is Associate Professor at Brown University School of Public Health, Department of Epidemiology, Providence, RI.
| | - Johanna B Folk
- Dr. Tolou-Shams is Professor, Dr. Folk is Assistant Professor, Dr. Holloway is Postdoctoral Fellow, and Ms. Ordorica is Clinical Research Coordinator, University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA. Dr. Dauria is Assistant Professor at University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA. Dr. Kemp is Assistant Professor at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI. Dr. Marshall is Associate Professor at Brown University School of Public Health, Department of Epidemiology, Providence, RI
| | - Evan D Holloway
- Dr. Tolou-Shams is Professor, Dr. Folk is Assistant Professor, Dr. Holloway is Postdoctoral Fellow, and Ms. Ordorica is Clinical Research Coordinator, University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA. Dr. Dauria is Assistant Professor at University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA. Dr. Kemp is Assistant Professor at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI. Dr. Marshall is Associate Professor at Brown University School of Public Health, Department of Epidemiology, Providence, RI
| | - Catalina M Ordorica
- Dr. Tolou-Shams is Professor, Dr. Folk is Assistant Professor, Dr. Holloway is Postdoctoral Fellow, and Ms. Ordorica is Clinical Research Coordinator, University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA. Dr. Dauria is Assistant Professor at University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA. Dr. Kemp is Assistant Professor at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI. Dr. Marshall is Associate Professor at Brown University School of Public Health, Department of Epidemiology, Providence, RI
| | - Emily F Dauria
- Dr. Tolou-Shams is Professor, Dr. Folk is Assistant Professor, Dr. Holloway is Postdoctoral Fellow, and Ms. Ordorica is Clinical Research Coordinator, University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA. Dr. Dauria is Assistant Professor at University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA. Dr. Kemp is Assistant Professor at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI. Dr. Marshall is Associate Professor at Brown University School of Public Health, Department of Epidemiology, Providence, RI
| | - Kathleen Kemp
- Dr. Tolou-Shams is Professor, Dr. Folk is Assistant Professor, Dr. Holloway is Postdoctoral Fellow, and Ms. Ordorica is Clinical Research Coordinator, University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA. Dr. Dauria is Assistant Professor at University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA. Dr. Kemp is Assistant Professor at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI. Dr. Marshall is Associate Professor at Brown University School of Public Health, Department of Epidemiology, Providence, RI
| | - Brandon D L Marshall
- Dr. Tolou-Shams is Professor, Dr. Folk is Assistant Professor, Dr. Holloway is Postdoctoral Fellow, and Ms. Ordorica is Clinical Research Coordinator, University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA. Dr. Dauria is Assistant Professor at University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA. Dr. Kemp is Assistant Professor at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI. Dr. Marshall is Associate Professor at Brown University School of Public Health, Department of Epidemiology, Providence, RI
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25
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Frueh L, Collins AB, Newman R, Barnett NP, Rich JD, Clark MA, Marshall BDL, Macmadu A. Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation. Harm Reduct J 2023; 20:14. [PMID: 36739417 PMCID: PMC9898862 DOI: 10.1186/s12954-023-00741-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here, we use qualitative methods to examine the impact of the COVID-19 pandemic and pandemic-related response measures on drug use behaviors in a sample of PWUD in Rhode Island. Using a social-ecological framework, we highlight the nested, interactive levels of the pandemic's influence on increased overdose risk behaviors. METHODS From July to October 2021, semi-structured interviews were conducted with 18 PWUD who self-reported any increase in behaviors associated with overdose risk (e.g., increased use, change in drug type and/or more solitary drug use) relative to before the pandemic. Thematic analysis was conducted using a codebook with salient themes identified from interview guides and those that emerged through close reading of transcribed interviews. Guided by a social-ecological framework, themes were grouped into individual, network, institutional, and policy-level influences of the pandemic on drug use behaviors. RESULTS Individual-level influences on increased overdose risk behaviors included self-reported anxiety and depression, isolation and loneliness, and boredom. Network-level influences included changes in local drug supply and changes in social network composition specific to housing. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels. CONCLUSIONS Participants identified multi-level influences of the COVID-19 pandemic and pandemic-related response measures on their drug use behavior patterns and overdose risk. These findings suggest that effective harm reduction during large-scale crises, such as the COVID-19 pandemic, must address several levels of influence concurrently.
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Affiliation(s)
- Lisa Frueh
- grid.166341.70000 0001 2181 3113Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA 19104 USA
| | - Alexandra B. Collins
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Roxxanne Newman
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Nancy P. Barnett
- grid.40263.330000 0004 1936 9094Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI USA
| | - Josiah D. Rich
- grid.240267.50000 0004 0443 5079The Center for Health + Justice Transformation, The Miriam Hospital, 1125 North Main Street, Providence, RI USA
| | - Melissa A. Clark
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI USA
| | - Brandon D. L. Marshall
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Cartus AR, Samuels EA, Cerdá M, Marshall BDL. Outcome class imbalance and rare events: An underappreciated complication for overdose risk prediction modeling. Addiction 2023; 118:1167-1176. [PMID: 36683137 PMCID: PMC10175167 DOI: 10.1111/add.16133] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS Low outcome prevalence, often observed with opioid-related outcomes, poses an underappreciated challenge to accurate predictive modeling. Outcome class imbalance, where non-events (i.e. negative class observations) outnumber events (i.e. positive class observations) by a moderate to extreme degree, can distort measures of predictive accuracy in misleading ways, and make the overall predictive accuracy and the discriminatory ability of a predictive model appear spuriously high. We conducted a simulation study to measure the impact of outcome class imbalance on predictive performance of a simple SuperLearner ensemble model and suggest strategies for reducing that impact. DESIGN, SETTING, PARTICIPANTS Using a Monte Carlo design with 250 repetitions, we trained and evaluated these models on four simulated data sets with 100 000 observations each: one with perfect balance between events and non-events, and three where non-events outnumbered events by an approximate factor of 10:1, 100:1, and 1000:1, respectively. MEASUREMENTS We evaluated the performance of these models using a comprehensive suite of measures, including measures that are more appropriate for imbalanced data. FINDINGS Increasing imbalance tended to spuriously improve overall accuracy (using a high threshold to classify events vs non-events, overall accuracy improved from 0.45 with perfect balance to 0.99 with the most severe outcome class imbalance), but diminished predictive performance was evident using other metrics (corresponding positive predictive value decreased from 0.99 to 0.14). CONCLUSION Increasing reliance on algorithmic risk scores in consequential decision-making processes raises critical fairness and ethical concerns. This paper provides broad guidance for analytic strategies that clinical investigators can use to remedy the impacts of outcome class imbalance on risk prediction tools.
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Affiliation(s)
- Abigail R Cartus
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Elizabeth A Samuels
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Magdalena Cerdá
- Division of Epidemiology, Department of Population Health, Center for Opioid Epidemiology and Policy, School of Medicine, New York University, New York, New York, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
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Scheidell JD, Townsend T, Ban KF, Caniglia EC, Charles D, Edelman EJ, Marshall BDL, Gordon AJ, Justice AC, Braithwaite RS, Khan MR. Cessation of self-reported opioid use and impacts on co-occurring health conditions. Drug Alcohol Depend 2023; 242:109712. [PMID: 36469994 PMCID: PMC10108375 DOI: 10.1016/j.drugalcdep.2022.109712] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Among veterans in care reporting opioid use, we investigated the association between ceasing opioid use on subsequent reduction in report of other substance use and improvements in pain, anxiety, and depression. METHODS Using Veterans Aging Cohort Study survey data collected between 2003 and 2012, we emulated a hypothetical randomized trial (target trial) of ceasing self-reported use of prescription opioids and/or heroin, and outcomes including unhealthy alcohol use, smoking, cannabis use, cocaine use, pain, and anxiety and depressive symptoms. Among those with baseline opioid use, we compared participants who stopped reporting opioid use at the first follow-up (approximately 1 year after baseline) with those who did not. We fit logistic regression models to estimate associations with change in each outcome at the second follow-up (approximately 2 years after baseline) among participants with that condition at baseline. We examined two sets of adjusted models that varied temporality assumptions. RESULTS Among 2473 participants reporting opioid use, 872 did not report use, 606 reported use, and 995 were missing data on use at the first follow-up. Ceasing opioid use was associated with no longer reporting cannabis (adjusted odds ratio [AOR]=1.82, 95% confidence interval [CI] 1.10, 3.03) and cocaine use (AOR=1.93, 95% CI 1.16, 3.20), and improvements in pain (AOR=1.53, 95% CI 1.05, 2.24) and anxiety (AOR=1.56, 95% CI 1.01, 2.41) symptoms. CONCLUSION Cessation of opioid misuse may be associated with subsequent cessation of other substances and reduction in pain and anxiety symptoms, which supports efforts to screen and provide evidence-based intervention where appropriate.
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Affiliation(s)
- Joy D Scheidell
- NYU Grossman School of Medicine, Department of Population Health, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA.
| | - Tarlise Townsend
- NYU Grossman School of Medicine, Department of Population Health, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA
| | - Kaoon Francois Ban
- NYU Grossman School of Medicine, Department of Population Health, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA
| | - Ellen C Caniglia
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics, Philadelphia, PA, USA
| | - Dyanna Charles
- NYU Grossman School of Medicine, Department of Population Health, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - R Scott Braithwaite
- NYU Grossman School of Medicine, Department of Population Health, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA
| | - Maria R Khan
- NYU Grossman School of Medicine, Department of Population Health, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Linas BP, Morgan JR, Murphy SM, Walley AY, Schackman BR, Marshall BDL. Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts. Drug Alcohol Depend 2022; 241:109668. [PMID: 36309001 PMCID: PMC9833886 DOI: 10.1016/j.drugalcdep.2022.109668] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 08/29/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. METHODS We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and "other" (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. RESULTS From 2016-2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. CONCLUSION We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA; The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI 02906, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA.
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Zang X, Bessey SE, Krieger MS, Hallowell BD, Koziol JA, Nolen S, Behrends CN, Murphy SM, Walley AY, Linas BP, Schackman BR, Marshall BDL. Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island. JAMA Netw Open 2022; 5:e2241174. [PMID: 36350649 PMCID: PMC9647481 DOI: 10.1001/jamanetworkopen.2022.41174] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
IMPORTANCE In 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations. OBJECTIVE To compare various strategies to increase naloxone distribution through community-based programs in Rhode Island to identify one most effective and efficient strategy in preventing opioid overdose deaths (OODs). DESIGN, SETTING, AND PARTICIPANTS In this decision analytical model study conducted from January 2016 to December 2022, a spatial microsimulation model with an integrated decision tree was developed and calibrated to compare the outcomes of alternative strategies for distributing 10 000 additional naloxone kits annually among all individuals at risk for opioid overdose in Rhode Island. INTERVENTIONS Distribution of 10 000 additional naloxone kits annually, focusing on people who inject drugs, people who use illicit opioids and stimulants, individuals at various levels of risk for opioid overdose, or people who misuse prescription opioids vs no additional kits (status quo). Two expanded distribution implementation approaches were considered: one consistent with the current spatial distribution patterns for each distribution program type (supply-based approach) and one consistent with the current spatial distribution of individuals in each of the risk groups, assuming that programs could direct the additional kits to new geographic areas if required (demand-based approach). MAIN OUTCOMES AND MEASURES Witnessed OODs, cost per OOD averted (efficiency), geospatial health inequality measured by the Theil index, and between-group variance for OOD rates. RESULTS A total of 63 131 simulated individuals were estimated to be at risk for opioid overdose in Rhode Island based on current population data. With the supply-based approach, prioritizing additional naloxone kits to people who use illicit drugs averted more witnessed OODs by an estimated mean of 18.9% (95% simulation interval [SI], 13.1%-30.7%) annually. Expanded naloxone distribution using the demand-based approach and focusing on people who inject drugs had the best outcomes across all scenarios, averting an estimated mean of 25.3% (95% SI, 13.1%-37.6%) of witnessed OODs annually, at the lowest mean incremental cost of $27 312 per OOD averted. Other strategies were associated with fewer OODs averted at higher costs but showed similar patterns of improved outcomes and lower unit costs if kits could be reallocated to areas with greater need. The demand-based approach reduced geospatial inequality in OOD rates in all scenarios compared with the supply-based approach and status quo. CONCLUSIONS AND RELEVANCE In this decision analytical model study, variations in the effectiveness, efficiency, and health inequality of the different naloxone distribution expansion strategies and approaches were identified. Future efforts should be prioritized for people at highest risk for overdose (those who inject drugs or use illicit drugs) and redirected toward areas with the greatest need. These findings may inform future naloxone distribution priority settings.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Sam E. Bessey
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Maxwell S. Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | | | | | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Czarina N. Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Alexander Y. Walley
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Brandon D. L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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30
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Kennedy MC, Karamouzian M, Marshall BDL. The North American opioid crisis: how effective are supervised consumption sites? Lancet 2022; 400:1403-1404. [PMID: 36273477 DOI: 10.1016/s0140-6736(22)01593-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/12/2022] [Indexed: 03/23/2023]
Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; School of Social Work, University of British Columbia-Okanagan Campus, Kelowna, BC, Canada
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; Centre On Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA.
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Macmadu A, Yolken A, Frueh L, Toussaint JR, Newman R, Jacka BP, Collins AB, Marshall BDL. Characteristics of events in which police responded to overdoses: an examination of incident reports in Rhode Island. Harm Reduct J 2022; 19:116. [PMID: 36258209 PMCID: PMC9578237 DOI: 10.1186/s12954-022-00698-2] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Narrow or non-existent Good Samaritan Law protections and harsh drug selling statutes in the USA have been shown to deter bystanders from seeking medical assistance for overdoses. Additionally, little is known about the actions that police take when responding to overdose events. The objectives of this study were to assess the prevalence and correlates of naloxone administration by police, as well as to examine overdose events where arrests were made and those in which the person who overdosed was described as combative. Methods We analyzed incident reports of police responding to an overdose between September 1, 2019, and August 31, 2020 (i.e., 6 months prior to and during the COVID-19 pandemic), from a city in Rhode Island. We examined characteristics of incidents, as well as individual characteristics of the person who overdosed. Correlates of police naloxone administration were assessed using Wilcoxon rank sum tests and Fisher’s exact tests, and we examined incidents where arrests occurred and incidents in which the person who overdosed was described as combative descriptively. Results Among the 211 incidents in which police responded to an overdose during the study period, we found that police administered naloxone in approximately 10% of incidents. In most incidents, police were the last group of first responders to arrive on scene (59%), and most often, naloxone was administered by others (65%). Police were significantly more likely to administer naloxone when they were the first professionals to arrive, when naloxone had not been administered by others, and when the overdose occurred in public or in a vehicle. Arrests at overdose events were rarely reported (1%), and people who overdosed were rarely (1%) documented in incident reports as being ‘combative.’ Conclusions Considering these findings, ideally, all jurisdictions should have sufficient first responder staffing and resources to ensure a rapid response to overdose events, with police rarely or never dispatched to respond to overdoses. However, until this ideal can be achieved, any available responders should be dispatched concurrently, with police instructed to resume patrol once other professional responders arrive on scene; additionally, warrant searches of persons on scene should be prohibited. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00698-2.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | | | - Lisa Frueh
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Jai'el R Toussaint
- Department of Africana Studies, Brown University Churchill House, 155 Angell Street, Providence, RI, USA
| | - Roxxanne Newman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Brendan P Jacka
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Chambers LC, Hallowell BD, Zang X, Rind DM, Guzauskas GF, Hansen RN, Fuchs N, Scagos RP, Marshall BDL. The estimated costs and benefits of a hypothetical supervised consumption site in Providence, Rhode Island. Int J Drug Policy 2022; 108:103820. [PMID: 35973341 PMCID: PMC10131249 DOI: 10.1016/j.drugpo.2022.103820] [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: 02/24/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Overdose deaths have increased dramatically in the United States, including in Rhode Island. In July 2021, the Rhode Island government passed legislation supporting a two-year pilot program authorizing supervised consumption sites (SCSs) in response to this crisis. We estimated the costs and benefits of a hypothetical SCS in Providence, Rhode Island. METHODS We utilized a decision analytic mathematical model to compare costs and outcomes for people who inject drugs under two scenarios: (1) a SCS that includes syringe services provision, and (2) a syringe service program only (i.e., status quo). We assumed 0.95% of injections result in overdose, the SCS would serve 400 clients monthly and have a net cost of $783,899 annually, 46% of overdoses occurring outside of the SCS result in an ambulance run and 43% result in an emergency department (ED) visit, 0.79% of overdoses occurring within the SCS result in an ambulance run and ED visit, and the SCS would lead to a 25.7% reduction in fatal overdoses near the site. The model was developed from a modified societal perspective with a one-year time horizon. RESULTS A hypothetical SCS in Providence would prevent approximately 2 overdose deaths, 261 ambulance runs, 244 ED visits, and 117 inpatient hospitalizations for emergency overdose care annually compared to a scenario that includes a syringe service program only. The SCS would save $1,104,454 annually compared to the syringe service program only, accounting only for facility costs and short-term costs of emergency overdose care and ignoring savings associated with averted deaths. Influential parameters included the percentage of injections resulting in overdose, the total annual injections at the SCS, and the percentage of overdoses outside of the SCS that result in an ED visit. CONCLUSION A SCS in would result in substantial cost savings due to prevention of costly emergency overdose care.
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Affiliation(s)
- Laura C Chambers
- Drug Overdose Surveillance Program, Rhode Island Department of Health, Providence, Rhode Island, USA; Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA.
| | - Benjamin D Hallowell
- Drug Overdose Surveillance Program, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David M Rind
- Institute for Clinical and Economic Review, Boston, Massachusetts, USA
| | - Greg F Guzauskas
- Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, Washington, USA
| | - Ryan N Hansen
- Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, Washington, USA
| | - Nathaniel Fuchs
- Drug Overdose Surveillance Program, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Rachel P Scagos
- Drug Overdose Surveillance Program, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
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Macmadu A, Reddon H, Marshall BDL, Fairbairn N, Nolan S, Socías ME, Milloy MJ. Crack cocaine use frequency is associated with HIV disease severity independent of antiretroviral therapy exposure: a prospective cohort study. AIDS Behav 2022; 26:3356-3364. [PMID: 35429306 PMCID: PMC10719826 DOI: 10.1007/s10461-022-03648-y] [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] [Accepted: 03/05/2022] [Indexed: 11/01/2022]
Abstract
We sought to evaluate the effect of crack cocaine use frequency on HIV disease severity among HIV-positive people who use unregulated drugs (PWUD). We analyzed data from the ACCESS study, an open prospective cohort of HIV-positive PWUD including comprehensive HIV clinical monitoring in a setting with no-cost healthcare. Multivariable generalized linear mixed-effects models were used to estimate the independent effect of time-updated crack cocaine use frequency on HIV disease severity, adjusting for ART exposure and relevant confounders. In multivariable adjusted models, daily or greater frequency of crack cocaine use was significantly associated with higher VACS Index scores (β = 0.8, 95% confidence interval: 0.1, 1.5) as compared to none. Our finding suggests that daily or greater frequency of crack cocaine use exacerbates HIV disease severity independent of ART exposure. The observed effect may reflect an underlying biological mechanism or other factors linked with crack cocaine use; further investigation is warranted.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Hudson Reddon
- British Columbia Centre on Substance Use, 1045 Howe Street, V6Z 2A9, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard St, V6Z 1Y6, Vancouver, BC, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 1045 Howe Street, V6Z 2A9, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard St, V6Z 1Y6, Vancouver, BC, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, 1045 Howe Street, V6Z 2A9, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard St, V6Z 1Y6, Vancouver, BC, Canada
| | - M Eugenia Socías
- British Columbia Centre on Substance Use, 1045 Howe Street, V6Z 2A9, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard St, V6Z 1Y6, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe Street, V6Z 2A9, Vancouver, BC, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard St, V6Z 1Y6, Vancouver, BC, Canada.
- Department of Medicine Research Scientist, BC Centre on Substance Use, University of British Columbia, 1045 Howe Street, Vancouver, BC, Canada.
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Macmadu A, Frueh L, Collins AB, Newman R, Barnett NP, Rich JD, Clark MA, Marshall BDL. Drug use behaviors, trauma, and emotional affect following the overdose of a social network member: A qualitative investigation. Int J Drug Policy 2022; 107:103792. [PMID: 35816791 PMCID: PMC9462427 DOI: 10.1016/j.drugpo.2022.103792] [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: 04/27/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Scant research has examined the influence of overdoses occurring in social networks (i.e., knowing someone who has overdosed) on individual overdose risk. We sought to characterize drug use behaviors of individuals following the overdose of someone in their social network. METHODS We conducted semi-structured interviews with 25 people who use drugs and knew someone who overdosed in the prior 90 days. All interviews were conducted in person in Rhode Island from July to October 2021. Data were stratified by drug use behaviors following the overdose of a network member (i.e., risk behaviors, protective behaviors, no change; selected a priori) and analyzed using a thematic analysis variation to identify salient themes. RESULTS We identified variation in the effect of knowing someone who overdosed on subsequent drug use behaviors and emotional affect. Several participants described increasing their drug use or using more types of drugs than usual to manage feelings of bereavement and trauma, and a subset of these participants described increased drug use with suicidal intention and increased suicidal ideations following the overdose event. Other participants described reducing their drug use and engaging in protective behaviors in response to heightened perceived overdose risk, protection motivation (i.e., increased motivation to protect oneself), and concern for others. Additionally, some participants reported no change in drug use behaviors, and these participants described already engaging in harm reduction practices, feeling desensitized due to frequent or repeated exposure to overdose, and ambivalence about living. CONCLUSIONS Findings suggest a need for enhanced investment in network-based overdose prevention interventions, as well as more robust integration of bereavement support and mental health services in settings that serve people who use drugs. The findings also suggest a need for future research to identify mediators of the effect of overdose occurring in social networks on individual overdose risk.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Lisa Frueh
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Roxxanne Newman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Josiah D Rich
- The Center for Health + Justice Transformation, The Miriam Hospital, 1125 North Main Street, Providence, RI, USA
| | - Melissa A Clark
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA.
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Beaudoin FL, Jacka BP, Li Y, Samuels EA, Hallowell BD, Peachey AM, Newman RA, Daly MM, Langdon KJ, Marshall BDL. Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2225582. [PMID: 35943744 PMCID: PMC9364125 DOI: 10.1001/jamanetworkopen.2022.25582] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Fatal and nonfatal opioid overdoses are at record levels, and emergency department (ED) visits may be an opportune time to intervene. Peer-led models of care are increasingly common; however, little is known about their effectiveness. OBJECTIVE To evaluate the effect of a peer-led behavioral intervention compared with the standard behavioral intervention delivered in the ED on engagement in substance use disorder (SUD) treatment within 30 days after the ED encounter. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial recruited 648 patients from 2 EDs from November 15, 2018, to May 31, 2021. Patients were eligible to participate if they were in the ED for an opioid overdose, receiving treatment related to an opioid use disorder, or identified as having had a recent opioid overdose. INTERVENTIONS Participants were randomly assigned to receive a behavioral intervention from a certified peer recovery specialist (n = 323) or a standard intervention delivered by a hospital-employed licensed clinical social worker (n = 325). A certified peer recovery specialist was someone with at least 2 years of recovery who completed a 45-hour training program and had 500 hours of supervised work experience. After the ED intervention, the certified peer recovery specialists offered continued contact with participants for up to 90 days. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of SUD treatment within 30 days of enrollment, assessed with deterministic linkage of statewide administrative databases. Treatment engagement was defined as admission to a formal, publicly licensed SUD treatment program or receipt of office-based medication for opioid use disorder within 30 days of the initial ED visit. RESULTS Among the 648 participants, the mean (SD) age was 36.9 (10.8) years, and most were male (442 [68.2%]) and White (444 [68.5%]). Receipt of SUD treatment occurred for 103 of 323 participants (32%) in the intervention group vs 98 of 325 participants (30%) in the usual care group within 30 days of the ED visit. Among all participants, the most accessed treatments were outpatient medication for opioid use disorder (buprenorphine, 119 [18.4%]; methadone, 44 [6.8%]) and residential treatment (44 [6.8%]). CONCLUSIONS AND RELEVANCE Overall, this study found that a substantial proportion of participants in both groups engaged in SUD treatment within 30 days of the ED visit. An ED-based behavioral intervention is likely effective in promoting treatment engagement, but who delivers the intervention may be less influential on short-term outcomes. Further study is required to determine the effects on longer-term engagement in SUD care and other health outcomes (eg, recurrent overdose). TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03684681.
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Affiliation(s)
| | - Brendan P. Jacka
- Brown University School of Public Health, Providence, Rhode Island
| | - Yu Li
- Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | | | - Mackenzie M. Daly
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Providence
| | - Kirsten J. Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
- Brown-Lifespan Center for Digital Health, Brown University, Providence, Rhode Island
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Cartus AR, Goedel WC, Hallowell BD, Allen B, Pratty C, Planey AM, Ahern J, Cerdá M, Marshall BDL. Divergence Between Individual- and Neighborhood-Level Fatal Overdose Burden: A Population-Based Statewide Study. R I Med J (2013) 2022; 105:46-51. [PMID: 35882001] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To compare the characteristics of individual overdose decedents in Rhode Island, 2016-2020 to the neighborhoods where fatal overdoses occurred over the same time period. METHODS We conducted a retrospective analysis of fatal overdoses occurring between January 1, 2016 and June 30, 2020. Using individual- and neighborhood-level data, we conducted descriptive analyses to explore the characteristics of individuals and neighborhoods most affected by overdose. RESULTS Most overdose decedents during the study period were non-Hispanic White. Across increasingly more White and non-Hispanic neighborhoods, rates of fatal overdose per 100,000 person-years decreased. An opposite pattern was observed across quintiles of average neighborhood poverty. CONCLUSIONS Rates of fatal overdose were higher in less White, more Hispanic, and poorer neighborhoods, suggesting modest divergence between the characteristics of individuals and the neighborhoods most severely affected. These impacts may not be uniform across space and may accrue differentially to more disadvantaged and racially/ethnically diverse neighborhoods.
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Affiliation(s)
- Abigail R Cartus
- Department of Epidemiology, Brown University School of Public Health
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health
| | | | - Bennett Allen
- Department of Population Health, Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine
| | | | - Arrianna M Planey
- Department of Health Policy and Management, Gillings School of Global Public Health; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | - Jennifer Ahern
- Division of Epidemiology, University of California, Berkeley School of Public Health
| | - Magdalena Cerdá
- Department of Population Health, Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine
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Labs J, Nunn AS, Chan PA, Bessey S, Park CJ, Marshall BDL, Patel RR, Mena LA, Goedel WC. Projected Effects of Disruptions to Human Immunodeficiency Virus (HIV) Prevention Services During the Coronavirus Disease 2019 Pandemic Among Black/African American Men Who Have Sex With Men in an Ending the HIV Epidemic Priority Jurisdiction. Open Forum Infect Dis 2022; 9:ofac274. [PMID: 35855962 PMCID: PMC9214131 DOI: 10.1093/ofid/ofac274] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Disruptions in access to in-person human immunodeficiency virus (HIV) preventive care during the coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on our progress towards the Ending the HIV Epidemic goals in the United States. Methods We used an agent-based model to simulate HIV transmission among Black/African American men who have sex with men in Mississippi over 5 years to estimate how different reductions in access affected the number of undiagnosed HIV cases, new pre-exposure prophylaxis (PrEP) starts, and HIV incidence. Results We found that each additional 25% decrease in HIV testing and PrEP initiation was associated with decrease of 20% in the number of cases diagnosed and 23% in the number of new PrEP starts, leading to a 15% increase in HIV incidence from 2020 to 2022. Conclusions Unmet need for HIV testing and PrEP prescriptions during the COVID-19 pandemic may temporarily increase HIV incidence in the years immediately after the disruption period.
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Affiliation(s)
- Jennifer Labs
- Department of Applied Mathematics, Brown University, Providence, Rhode Island, USA
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Philip A Chan
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - S Bessey
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Carolyn J Park
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Rupa R Patel
- John T. Milliken Department of Internal Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Leandro A Mena
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Reddon H, Socias ME, Justice A, Cui Z, Nosova E, Barrios R, Fairbairn N, Marshall BDL, Milloy MJ. Periods of Homelessness Linked to Higher VACS Index Among HIV-Positive People Who Use Drugs. AIDS Behav 2022; 26:1739-1749. [PMID: 35064852 PMCID: PMC9150923 DOI: 10.1007/s10461-021-03524-1] [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] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
We sought to evaluate the impact of homelessness on HIV disease progression among people who use unregulated drugs (PWUD) living with HIV and test if this association was mediated by adherence to antiretroviral therapy (ART). We applied general linear mixed-effects modeling to estimate the longitudinal relationship between homelessness and the Veterans Aging Cohort Study (VACS) Index, a validated measure of HIV disease progression that predicts all-cause mortality, among a prospective cohort of PWUD. In a longitudinal model adjusted for ART adherence, homelessness was significantly associated with increased VACS Index scores and 16% of the association was mediated by ART adherence. These findings indicate that homelessness was a significant risk factor for HIV disease progression and this association was marginally mediated by ART adherence. Future studies are needed to quantify the other mechanisms (e.g., food insecurity, mental health) by which homelessness increases mortality risk among PWUD living with HIV.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Amy Justice
- Department of Medicine, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Zishan Cui
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Division of Social Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
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Gordon KS, Becker WC, Bryant KJ, Crystal S, Maisto SA, Marshall BDL, McInnes DK, Satre DD, Williams EC, Edelman EJ, Justice AC. Patient-Reported Bothersome Symptoms Attributed to Alcohol Use Among People With and Without HIV. AIDS Behav 2022; 26:3589-3596. [PMID: 35553287 PMCID: PMC10084471 DOI: 10.1007/s10461-022-03628-2] [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] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
Helping people with HIV (PWH) and without HIV (PWoH) understand the relationship between physical symptoms and alcohol use might help motivate them to decrease use. In surveys collected in the Veterans Aging Cohort Study from 2002 to 2018, PWH and PWoH were asked about 20 common symptoms and whether they thought any were caused by alcohol use. Analyses were restricted to current alcohol users (AUDIT-C > 0). We applied generalized estimating equations. The outcome was having any Symptoms Attributed to Alcohol use (SxAA). Primary independent variables were each of the 20 symptoms and HIV status. Compared to PWoH, PWH had increased odds of SxAA (OR 1.54; 95% CI 1.27, 1.88). Increased AUDIT-C score was also associated with SxAA (OR 1.32; 95% CI 1.28, 1.36), as were trouble remembering, anxiety, and weight loss/wasting. Evidence that specific symptoms are attributed to alcohol use may help motive people with and without HIV decrease their alcohol use.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - William C Becker
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Stephen Crystal
- Rutgers University School of Social Work, New Brunswick, NJ, USA
| | - Stephen A Maisto
- Syracuse University College of Arts and Sciences, Syracuse, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - D Keith McInnes
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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Bahji A, Li Y, Vickers-Smith R, Crystal S, Kerns RD, Gordon KS, Macmadu A, Skanderson M, So-Armah K, Sung ML, Bhondoekhan F, Marshall BDL, Edelman EJ. Self-Reported Cannabis Use and HIV Viral Control among Patients with HIV Engaged in Care: Results from a National Cohort Study. Int J Environ Res Public Health 2022; 19:5649. [PMID: 35565045 PMCID: PMC9101884 DOI: 10.3390/ijerph19095649] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023]
Abstract
Background: The association between cannabis use and HIV-1 RNA (viral load) among people with HIV (PWH) engaged in care is unclear. Methods: We used data collected from 2002 to 2018 on PWH receiving antiretroviral therapy (ART) enrolled in the Veterans Aging Cohort Study. Generalized estimating equations were used to estimate associations between self-reported past-year cannabis use and detectable viral load (≥500 copies/mL), with and without adjustment for demographics, other substance use, and adherence. Results: Among 2515 participants, 97% were male, 66% were Black, the mean age was 50 years, and 33% had detectable HIV viral load at the first study visit. In unadjusted analyses, PWH with any past-year cannabis use had 21% higher odds of a detectable viral load than those with no past-year use (OR = 1.21; 95% CI, 1.07-1.37). However, there was no significant association between cannabis use and viral load after adjustment. Conclusions: Among PWH engaged in care and receiving ART, cannabis use is associated with decreased adherence in unadjusted analyses but does not appear to directly impact viral control. Future studies are needed to understand other potential risks and benefits of cannabis use among PWH.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada
- Research in Addiction Medicine Scholars Program, Boston University Medical Center, Boston, MA 02118, USA
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; (Y.L.); (A.M.); (F.B.); (B.D.L.M.)
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY 40536, USA;
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, Rutgers, NJ 08901, USA;
| | - Robert D. Kerns
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA;
- VA Connecticut Healthcare System, West Haven, CT 06516, USA; (K.S.G.); (M.S.); (M.L.S.)
| | - Kirsha S. Gordon
- VA Connecticut Healthcare System, West Haven, CT 06516, USA; (K.S.G.); (M.S.); (M.L.S.)
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; (Y.L.); (A.M.); (F.B.); (B.D.L.M.)
| | - Melissa Skanderson
- VA Connecticut Healthcare System, West Haven, CT 06516, USA; (K.S.G.); (M.S.); (M.L.S.)
| | - Kaku So-Armah
- Clinical Addiction Research & Education (CARE) Unit, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Minhee L. Sung
- VA Connecticut Healthcare System, West Haven, CT 06516, USA; (K.S.G.); (M.S.); (M.L.S.)
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Fiona Bhondoekhan
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; (Y.L.); (A.M.); (F.B.); (B.D.L.M.)
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; (Y.L.); (A.M.); (F.B.); (B.D.L.M.)
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06511, USA
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Kemp K, Poindexter B, Ng MY, Correia V, Marshall BDL, Koinis-Mitchell D, Tolou-Shams M. EARLY IDENTIFICATION OF SUICIDE RISK FACTORS AMONG JUSTICE-INVOLVED YOUTH. Crim Justice Behav 2022; 49:730-744. [PMID: 35754948 PMCID: PMC9221642 DOI: 10.1177/00938548211059504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Suicidal thoughts and behaviors among juvenile justice populations are elevated. However, the characteristics of justice-involved youth who consider and attempt suicide are not well understood. This study examined suicidal ideation and attempt with first-time, preadjudicated diverted youth, and the relationship with commonly associated risk factors. The sample included 135 youth (50% male, M age = 14.48) that provided complete responses to self-reported lifetime suicidal ideation and attempt items. Analyses examined relationships between suicidal ideation/attempt and mental health, child welfare involvement, delinquency, self-cutting, and substance use. First time, preadjudicated diverted youth reported high rates of lifetime suicidal ideation (27%) and attempt (17%). Suicidal ideation and attempt were associated with sexually minoritized status and self-cutting, while child welfare involvement was only associated with suicidal ideation. This high-risk population would benefit from refined suicide screening and prevention services not always available to justice-involved youth living in the community.
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Zang X, Goedel WC, Bessey SE, Lurie MN, Galea S, Galvani AP, Friedman SR, Nosyk B, Marshall BDL. The impact of syringe services program closure on the risk of rebound HIV outbreaks among people who inject drugs: a modeling study. AIDS 2022; 36:881-888. [PMID: 35212666 PMCID: PMC9081164 DOI: 10.1097/qad.0000000000003199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite their effectiveness in preventing the transmission of HIV among people who inject drugs (PWID), syringe services programs (SSPs) in many settings are hampered by social and political opposition. We aimed to estimate the impact of closure and temporary interruption of SSP on the HIV epidemic in a rural United States setting. METHODS Using an agent-based model (ABM) calibrated to observed surveillance data, we simulated HIV risk behaviors and transmission in adult populations who inject and do not inject drugs in Scott County, Indiana. We projected HIV incidence and prevalence between 2020 and 2025 for scenarios with permanent closure, delayed closure (one additional renewal for 24 months before closure), and temporary closure (lasting 12 months) of an SSP in comparison to persistent SSP operation. RESULTS With sustained SSP operation, we projected an incidence rate of 0.15 per 100 person-years among the overall population (95% simulation interval: 0.06-0.28). Permanently closing the SSP would cause an average of 58.4% increase in the overall incidence rate during 2021-2025, resulting in a higher prevalence of 60.8% (50.9-70.6%) (18.7% increase) among PWID by 2025. A delayed closure would increase the incidence rate by 38.9%. A temporary closure would cause 12 (35.3%) more infections during 2020-2021. CONCLUSION Our analysis suggests that temporary interruption and permanent closure of existing SSPs operating in rural United States may lead to 'rebound' HIV outbreaks among PWID. To reach and sustain HIV epidemic control, it will be necessary to maintain existing and implement new SSPs in combination with other prevention interventions.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Williams C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Sam E Bessey
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Mark N Lurie
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Sandro Galea
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Alison P Galvani
- Department of Ecology and Evolutionary Biology
- Program in Computational Biology and Bioinformatics
- School of Public Health, Yale University, New Haven, Connecticut
| | - Samuel R Friedman
- Department of Population Health, Grossman School of Medicine, New York University, New York City, New York, USA
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Kumar A, Linas BP, Morgan JR, Murphy SM, Walley AY, Yan S, Schackman BR, Marshall BDL. Community-based naloxone coverage equity for the prevention of opioid overdose fatalities in racial/ethnic minority communities in Massachusetts and Rhode Island. Addiction 2022; 117:1372-1381. [PMID: 34825427 PMCID: PMC8983544 DOI: 10.1111/add.15759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Opioid-related overdose death rates continue to rise in the United States, especially in racial/ethnic minority communities. Our objective was to determine if US municipalities with high percentages of non-white residents have equitable access to the overdose antidote naloxone distributed by community-based organizations. METHODS We used community-based naloxone data from the Massachusetts Department of Public Health and the Rhode Island non-pharmacy naloxone distribution program for 2016-18. We obtained publicly available opioid-related overdose death data from Massachusetts and the Office of the State Medical Examiners in Rhode Island. We defined the naloxone coverage ratio as the number of community-based naloxone kits received by a resident in a municipality divided by the number of opioid-related overdose deaths among residents, updated annually. We used a Poisson regression with generalized estimating equations to analyze the relationship between the municipal racial/ethnic composition and naloxone coverage ratio. To account for the potential non-linear relationship between naloxone coverage ratio and race/ethnicity we created B-splines for the percentage of non-white residents; and for a secondary analysis examining the percentage of African American/black and Hispanic residents. The models were adjusted for the percentage of residents in poverty, urbanicity, state and population size. RESULTS Between 2016 and 2018, the annual naloxone coverage ratios range was 0-135. There was no difference in naloxone coverage ratios among municipalities with varying percentages of non-white residents in our multivariable analysis. In the secondary analysis, municipalities with higher percentages of African American/black residents had higher naloxone coverage ratios, independent of other factors. Naloxone coverage did not differ by percentage of Hispanic residents. CONCLUSIONS There appear to be no municipal-level racial/ethnic inequities in naloxone distribution in Rhode Island and Massachusetts, USA.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, Providence, RI, USA.,The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.,Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Aranshi Kumar
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Shapei Yan
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Collins AB, Edwards S, McNeil R, Goldman J, Hallowell BD, Scagos RP, Marshall BDL. A rapid ethnographic study of risk negotiation during the COVID-19 pandemic among unstably housed people who use drugs in Rhode Island. Int J Drug Policy 2022; 103:103626. [PMID: 35228056 PMCID: PMC8849851 DOI: 10.1016/j.drugpo.2022.103626] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic has greatly exacerbated the United States' overdose crisis. However, the overlapping impacts of COVID-19 and the overdose crisis have not been experienced equally, with unstably housed people who use drugs (PWUD) disproportionately impacted. Amid these changes, there is a need to understand how risk is experienced and managed among unstably housed PWUD to address health and social needs more effectively. METHODS This project draws on ethnographic research conducted from June 2020 to April 2021 in Rhode Island. Data include 39 in-depth interviews with unstably housed PWUD and approximately 50 h of ethnographic fieldwork conducted alongside street-based outreach workers. RESULTS COVID-19 risks were primarily contextualized in relation to participants' prior experiences of overdose events and adverse health outcomes. However, participants had varying levels of risk tolerance that were managed in ways that allowed them to reassert control and agency within the uncertainty of overlapping public health crises. Given participants' level of structural vulnerabilities, COVID-19 risk was managed alongside meeting their basic needs to survive. CONCLUSIONS Findings demonstrate how COVID-related public health measures (e.g., stay-at-home orders, service closures) reinforced participants' structural vulnerabilities in ways that increased their risk of health and social harms. Implementing and scaling up programs that meet the basic needs of individuals, including permanent housing, social supports, and overdose prevention interventions (e.g., supervised consumption sites) is critically needed to address intersecting risks faced by unstably housed PWUD.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States.
| | - Sarah Edwards
- Parent Support Network of Rhode Island, Warwick, Rhode Island, United States
| | - Ryan McNeil
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States; Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Jacqueline Goldman
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | | | - Rachel P Scagos
- Rhode Island Department of Health, Providence, Rhode Island, United States
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
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Werb D, Scheim AI, Soipe A, Aeby S, Rammohan I, Fischer B, Hadland SE, Marshall BDL. Health harms of non-medical prescription opioid use: A systematic review. Drug Alcohol Rev 2022; 41:941-952. [PMID: 35437841 PMCID: PMC9064965 DOI: 10.1111/dar.13441] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
ISSUES Non-medical prescription opioid use (NMPOU) contributes substantially to the global burden of morbidity. However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken. APPROACH We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD-10 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence-Based Medicine 'Levels of Evidence' scale to assess study quality. KEY FINDINGS Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self-harm and 1 study assessing its association with assault (<1%). IMPLICATIONS A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non-fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self-harm, suicidal ideation and assault. DISCUSSION AND CONCLUSIONS Findings may inform the prevention of harms associated with NMPOU, although higher-quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.
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Affiliation(s)
- Dan Werb
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Ayden I Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ayorinde Soipe
- Department of Epidemiology, Brown University School of Public Health, Providence, USA.,Division of Nephrology, Department of Medicine, State University of New York, New York, USA
| | - Samantha Aeby
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada.,Department of Psychiatry, Federal University of Sao Paulo, São Paulo, Brazil
| | - Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, USA.,Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
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46
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Oldfield BJ, Li Y, Vickers-Smith R, Barry DT, Crystal S, Gordon KS, Kerns RD, Williams EC, Marshall BDL, Edelman EJ. Longitudinal analysis of the prevalence and correlates of heavy episodic drinking and self-reported opioid use among a national cohort of patients with HIV. Alcohol Clin Exp Res 2022; 46:600-613. [PMID: 35257397 PMCID: PMC9018502 DOI: 10.1111/acer.14801] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/20/2022] [Accepted: 02/25/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use. METHODS We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use. We used multinomial logistic regression to estimate odds of reporting concomitant HED and self-reported opioid use. RESULTS Among 3702 PWH, 1458 (39.4%) reported HED during the study period and 350 (9.5%) reported opioid use. In the multinomial model, compared to reporting neither HED nor opioid use, lifetime housing instability (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.01 to 2.35), Veterans Aging Cohort Study Index 2.0 (a measure of disease severity; aOR 1.14, 95% CI 1.02 to 1.28), depressive symptoms (aOR 2.27, 95% CI 1.42 to 3.62), past-year cigarette smoking (aOR 3.06, 95% CI 1.53 to 6.14), cannabis use (aOR 1.69, 95% CI 1.09 to 2.62), and cocaine/stimulant use (aOR 11.54, 95% CI 7.40 to 17.99) were independently associated with greater odds of concomitant HED and self-reported opioid use. Compared to having attended no college, having some college or more (aOR 0.39, 95% CI 0.26 to 0.59) was associated with lower odds of concomitant HED and self-reported opioid use. CONCLUSIONS Among PWH, concomitant HED and self-reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater illness severity. Efforts to minimize opioid-related risk should address high-risk drinking as a modifiable risk factor for harm among these groups.
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Affiliation(s)
- Benjamin J Oldfield
- Fair Haven Community Health Care, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Yu Li
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | | | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, Rutgers, New Jersey, USA
| | - Kirsha S Gordon
- Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Robert D Kerns
- Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA.,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development, VA Puget Sound, Seattle, Washington, USA
| | | | - E Jennifer Edelman
- Yale School of Medicine, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
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Marshall BDL, Alexander-Scott N, Yedinak JL, Hallowell BD, Goedel WC, Allen B, Schell RC, Li Y, Krieger MS, Pratty C, Ahern J, Neill DB, Cerdá M. Preventing Overdose Using Information and Data from the Environment (PROVIDENT): protocol for a randomized, population-based, community intervention trial. Addiction 2022; 117:1152-1162. [PMID: 34729851 PMCID: PMC8904285 DOI: 10.1111/add.15731] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS In light of the accelerating drug overdose epidemic in North America, new strategies are needed to identify communities most at risk to prioritize geographically the existing public health resources (e.g. street outreach, naloxone distribution efforts). We aimed to develop PROVIDENT (Preventing Overdose using Information and Data from the Environment), a machine learning-based forecasting tool to predict future overdose deaths at the census block group (i.e. neighbourhood) level. DESIGN Randomized, population-based, community intervention trial. SETTING Rhode Island, USA. PARTICIPANTS All people who reside in Rhode Island during the study period may contribute data to either the model or the trial outcomes. INTERVENTION Each of the state's 39 municipalities will be randomized to the intervention (PROVIDENT) or comparator condition. An interactive, web-based tool will be developed to visualize the PROVIDENT model predictions. Municipalities assigned to the treatment arm will receive neighbourhood risk predictions from the PROVIDENT model, and state agencies and community-based organizations will direct resources to neighbourhoods identified as high risk. Municipalities assigned to the control arm will continue to receive surveillance information and overdose prevention resources, but they will not receive neighbourhood risk predictions. MEASUREMENTS The primary outcome is the municipal-level rate of fatal and non-fatal drug overdoses. Fatal overdoses will be defined as unintentional drug-related death; non-fatal overdoses will be defined as an emergency department visit for a suspected overdose reported through the state's syndromic surveillance system. Intervention efficacy will be assessed using Poisson or negative binomial regression to estimate incidence rate ratios comparing fatal and non-fatal overdose rates in treatment vs. control municipalities. COMMENTS The findings will inform the utility of predictive modelling as a tool to improve public health decision-making and inform resource allocation to communities that should be prioritized for prevention, treatment, recovery and overdose rescue services.
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Affiliation(s)
- Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - Jesse L. Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - William C. Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Bennett Allen
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Robert C. Schell
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Maxwell S. Krieger
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Claire Pratty
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Daniel B. Neill
- Center for Urban Science and Progress, New York University, New York, NY, USA,Courant Institute of Mathematical Sciences, Department of Computer Science, New York University, New York, NY, USA,Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
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Townsend T, Kline D, Rivera-Aguirre A, Bunting AM, Mauro PM, Marshall BDL, Martins SS, Cerdá M. Racial/Ethnic and Geographic Trends in Combined Stimulant/Opioid Overdoses, 2007-2019. Am J Epidemiol 2022; 191:599-612. [PMID: 35142341 PMCID: PMC9077116 DOI: 10.1093/aje/kwab290] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/02/2021] [Accepted: 12/21/2021] [Indexed: 01/26/2023] Open
Abstract
In the United States, combined stimulant/opioid overdose mortality has risen dramatically over the last decade. These increases may particularly affect non-Hispanic Black and Hispanic populations. We used death certificate data from the US National Center for Health Statistics (2007-2019) to compare state-level trends in overdose mortality due to opioids in combination with 1) cocaine and 2) methamphetamine and other stimulants (MOS) across racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian American/Pacific Islander). To avoid unstable estimates from small samples, we employed principles of small area estimation and a Bayesian hierarchical model, enabling information-sharing across groups. Black Americans experienced severe and worsening mortality due to opioids in combination with both cocaine and MOS, particularly in eastern states. Cocaine/opioid mortality increased 575% among Black people versus 184% in White people (Black, 0.60 to 4.05 per 100,000; White, 0.49 to 1.39 per 100,000). MOS/opioid mortality rose 16,200% in Black people versus 3,200% in White people (Black, 0.01 to 1.63 per 100,000; White, 0.09 to 2.97 per 100,000). Cocaine/opioid overdose mortality rose sharply among Hispanic and Asian Americans. State-group heterogeneity highlighted the importance of data disaggregation and methods to address small sample sizes. Research to understand the drivers of these trends and expanded efforts to address them are needed, particularly in minoritized groups.
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Affiliation(s)
- Tarlise Townsend
- Correspondence to Dr. Tarlise Townsend, Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016 (e-mail: )
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Irvine MA, Oller D, Boggis J, Bishop B, Coombs D, Wheeler E, Doe-Simkins M, Walley AY, Marshall BDL, Bratberg J, Green TC. Estimating naloxone need in the USA across fentanyl, heroin, and prescription opioid epidemics: a modelling study. Lancet Public Health 2022; 7:e210-e218. [PMID: 35151372 PMCID: PMC10937095 DOI: 10.1016/s2468-2667(21)00304-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The US overdose crisis is driven by fentanyl, heroin, and prescription opioids. One evidence-based policy response has been to broaden naloxone distribution, but how much naloxone a community would need to reduce the incidence of fatal overdose is unclear. We aimed to estimate state-level US naloxone need in 2017 across three main naloxone access points (community-based programmes, provider prescription, and pharmacy-initiated distribution) and by dominant opioid epidemic type (fentanyl, heroin, and prescription opioid). METHODS In this modelling study, we developed, parameterised, and applied a mechanistic model of risk of opioid overdose and used it to estimate the expected reduction in opioid overdose mortality after deployment of a given number of two-dose naloxone kits. We performed a literature review and used a modified-Delphi panel to inform parameter definitions. We refined an established model of the population at risk of overdose by incorporating changes in the toxicity of the illicit drug supply and in the naloxone access point, then calibrated the model to 2017 using data obtained from proprietary data sources, state health departments, and national surveys for 12 US states that were representative of each epidemic type. We used counterfactual modelling to project the effect of increased naloxone distribution on the estimated number of opioid overdose deaths averted with naloxone and the number of naloxone kits needed to be available for at least 80% of witnessed opioid overdoses, by US state and access point. FINDINGS Need for naloxone differed by epidemic type, with fentanyl epidemics having the consistently highest probability of naloxone use during witnessed overdose events (range 58-76% across the three modelled states in this category) and prescription opioid-dominated epidemics having the lowest (range 0-20%). Overall, in 2017, community-based and pharmacy-initiated naloxone access points had higher probability of naloxone use in witnessed overdose and higher numbers of deaths averted per 100 000 people in state-specific results with these two access points than with provider-prescribed access only. To achieve a target of naloxone use in 80% of witnessed overdoses, need varied from no additional kits (estimated as sufficient) to 1270 kits needed per 100 000 population across the 12 modelled states annually. In 2017, only Arizona had sufficient kits to meet this target. INTERPRETATION Opioid epidemic type and how naloxone is accessed have large effects on the number of naloxone kits that need to be distributed, the probability of naloxone use, and the number of deaths due to overdose averted. The extent of naloxone distribution, especially through community-based programmes and pharmacy-initiated access points, warrants substantial expansion in nearly every US state. FUNDING National Institute of Health, National Institute on Drug Abuse.
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Affiliation(s)
- Michael A Irvine
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Jesse Boggis
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Brian Bishop
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Daniel Coombs
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Traci C Green
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; Brown University School of Public Health, Providence, RI, USA.
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50
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Jacka BP, Ziobrowski HN, Lawrence A, Baird J, Wentz AE, Marshall BDL, Wightman RS, Mello MJ, Beaudoin FL, Samuels EA. Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program. Acad Emerg Med 2022; 29:294-307. [PMID: 34738277 DOI: 10.1111/acem.14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE Emergency department (ED)-based naloxone distribution and peer-based behavioral counseling have been shown to be feasible, but little is known about utilization maintenance over time and clinician, patient, and visit level factors influencing implementation. METHODS We conducted a retrospective cohort study of an ED overdose prevention program providing take-home naloxone, behavioral counseling, and treatment linkage for patients treated for an opioid overdose at two Rhode Island EDs from 2017 to 2020: one tertiary referral center and a community hospital. Utilizing a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we evaluated program reach, adoption, implementation modifiers, and maintenance using logistic and Poisson regression. RESULTS Seven hundred forty two patients were discharged after an opioid overdose, comprising 966 visits (median: 32 visits per month; interquartile range: 29, 41). At least one intervention was provided at most (86%, 826/966) visits. Take-home naloxone was provided at 69% of visits (637/919). Over half (51%, 495/966) received behavioral counseling and treatment referral (65%, 609/932). Almost all attending physicians provided take-home naloxone (97%, 105/108), behavioral counseling (95%, 103/108), or treatment referral (95%, 103/108) at least once. Most residents and advanced practice practitioners (APPs) provided take home naloxone (78% residents; 72% APPs), behavioral counseling (76% residents; 67% APPs), and treatment referral (80% residents; 81% APPs) at least once. Most clinicians provided these services for over half of the opioid overdose patients they cared for. Patients were twice as likely to receive behavioral counseling when treated by an attending in combination with a resident and/or APP (adjusted odds ratio: 2.29; 95% confidence interval, 1.68, 3.12) compared to an attending alone. There was no depreciation in use over time. CONCLUSIONS ED naloxone distribution, behavioral counseling, and referral to treatment can be successfully integrated into usual emergency care and maintained over time with high reach and adoption. Further work is needed to identify low-cost implementation strategies to improve services use and dissemination across clinical settings.
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Affiliation(s)
- Brendan P. Jacka
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
| | - Hannah N. Ziobrowski
- Department of Health Care Policy Harvard Medical School Boston Massachusetts USA
| | - Alexis Lawrence
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Janette Baird
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Anna E. Wentz
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
| | - Brandon D. L. Marshall
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
| | - Rachel S. Wightman
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Michael J. Mello
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Francesca L. Beaudoin
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Elizabeth A. Samuels
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
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