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Agley J, Henderson C, Seo DC, Parker M, Golzarri-Arroyo L, Dickinson S, Tidd D. The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57280. [PMID: 38551636 PMCID: PMC11015366 DOI: 10.2196/57280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND The use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdoses have been widely declaimed by medical associations and government officials and are supported by strong research evidence. Still, there are gaps in the current US national strategy because many opioid-involved overdose fatalities have no evidence of naloxone administration. Improving the likelihood that naloxone will be used to prevent fatal overdoses is predicated on facilitating an environment wherein naloxone is available near each overdose and can be accessed by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network of >1 million cardiopulmonary resuscitation (CPR) layperson responders and 4800 emergency responder agencies linked through a mobile phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and are willing to respond to possible cardiac events in public. When such an event occurs near their mobile phone's location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. OBJECTIVE This randomized controlled trial will examine the feasibility of recruiting first responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone. METHODS This will be a 3-arm parallel-group randomized controlled trial. We will randomly select 180 first responder agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by zip code designation [rural or nonrural]). We will study agency recruitment and, among the agencies we successfully recruit, responder certification of receiving overdose and naloxone education, carrying naloxone, or both. Hypothesis 1 contrasts agency recruitment success between arms 1 and 2, and hypothesis 2 contrasts the ratios of layperson certification across all 3 arms. The primary analyses will be a logistic regression comparing the recruitment rates among the arms, adjusting for rural or nonrural zip code designation. RESULTS This study was reviewed by the Indiana University Institutional Review Board (20218 and 20219). This project was funded beginning September 14, 2023, by the National Institute on Drug Abuse. CONCLUSIONS The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. TRIAL REGISTRATION OSF Registries osf.io/egn3z; https://osf.io/egn3z. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/57280.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Cris Henderson
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Dong-Chul Seo
- Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Maria Parker
- Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Stephanie Dickinson
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - David Tidd
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
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Agley J, Xiao Y, Eldridge L, Meyerson B, Golzarri-Arroyo L. Beliefs and misperceptions about naloxone and overdose among U.S. laypersons: a cross-sectional study. BMC Public Health 2022; 22:924. [PMID: 35538566 PMCID: PMC9086153 DOI: 10.1186/s12889-022-13298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overdose education and naloxone distribution (OEND) to laypersons are key approaches to reduce the incidence of opioid-involved overdoses. While some research has examined attitudes toward OEND, especially among pharmacists and first responders, our understanding of what laypersons believe about overdose and naloxone is surprisingly limited. Further, some scholars have expressed concerns about the prevalence of non-evidence-based beliefs about overdose and naloxone. We designed this study to analyze the prevalence, nature, and context of beliefs about naloxone and overdose among U.S. laypersons. METHODS We conducted a cross-sectional study (n = 702) using Prolific.co (representative of the U.S. population by age, gender, and race). Primary outcomes were the believability of six statements about overdose/naloxone on a seven-point Likert-type scale. Five statements were unsupported, and one was supported, by current scientific evidence. We used latent profile analysis to classify participants into belief groups, then used regression to study correlates of profile classification. RESULTS Believability of the statements (7: extremely believable) ranged from m = 5.57 (SD = 1.38) for a scientifically supported idea (trained bystanders can reverse overdose with naloxone), to m = 3.33 (SD = 1.83) for a statement claiming opioid users can get high on naloxone. Participants were classified into three latent belief profiles: Profile 1 (most aligned with current evidence; n = 246), Profile 2 (moderately aligned; n = 351), and Profile 3 (least aligned, n = 105). Compared to Profile 1, several covariates were associated with categorization into Profiles 2 and 3, including lower trust in science (RRR = 0.36, 95%CI = 0.24-0.54; RRR = 0.21, 95%CI = 0.12-0.36, respectively), conservative political orientation (RRR = 1.41, 95%CI = 1.23-1.63; 3:RRR = 1.62, 95%CI = 1.35-1.95, respectively), and never being trained about naloxone (Profile 3: RRR = 3.37, 95%CI = 1.16-9.77). CONCLUSIONS Preliminary evidence suggests some U.S. laypersons simultaneously believe that bystander overdose prevention with naloxone can prevent overdose and one or more scientifically unsupported claims about naloxone/overdose. Categorization into clusters displaying such belief patterns was associated with low trust in science, conservative political orientation, and not having been trained about naloxone. PREREGISTRATION This cross-sectional study was preregistered prior to any data collection using the Open Science Framework: https://osf.io/c6ufv.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47405, USA.
| | - Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Lori Eldridge
- College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Beth Meyerson
- Southwest Institute for Research On Women, College of Social & Behavioral Sciences, University of Arizona, Tucson, AZ, USA
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
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Lipira L, Leichtling G, Cook RR, Leahy JM, Orellana E, Korthuis PT, Menza TW. Predictors of having naloxone in urban and rural Oregon findings from NHBS and the OR-HOPE study. Drug Alcohol Depend 2021; 227:108912. [PMID: 34315014 PMCID: PMC8464511 DOI: 10.1016/j.drugalcdep.2021.108912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Naloxone is an opioid antagonist that can be effectively administered by bystanders to prevent overdose. We determined the proportion of people who had naloxone and identified predictors of naloxone ownership among two samples of people who inject drugs (PWID) who use opioids in Portland and rural Western Oregon. BASIC PROCEDURES We used data from participants in Portland's National HIV Behavioral Surveillance (NHBS, N = 477) and the Oregon HIV/Hepatitis and Opioid Prevention and Engagement Study (OR-HOPE, N = 133). For each sample, we determined the proportion of participants who had naloxone and estimated unadjusted and adjusted relative risk of having naloxone associated with participant characteristics. MAIN FINDINGS Sixty one percent of NHBS and 30 % of OR-HOPE participants had naloxone. In adjusted analysis, having naloxone was associated with female gender, injecting goofballs (compared to heroin alone), housing stability, and overdose training in the urban NHBS sample, and having naloxone was associated with drug of choice, frequency of injection, and race in the rural OR-HOPE sample. In both samples, having naloxone was crudely associated with SSP use, but this was attenuated after adjustment. PRINCIPAL CONCLUSIONS Naloxone ownership was insufficient and highly variable among two samples of PWID who use opioids in Oregon. People who use methamphetamine, males, and people experiencing homelessness may be at increased risk for not having naloxone and SSP may play a key role in improving access.
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Affiliation(s)
- Lauren Lipira
- Regional Research Institute, Portland State University, 1600 SW 4(th)Avenue, Suite 900, Portland, OR, 97201, USA; Public Health Division, Oregon Health Authority, 800 NE Oregon Street, Portland, OR, 97232, USA.
| | | | - Ryan R. Cook
- Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Judith M. Leahy
- Public Health Division, Oregon Health Authority, 800 NE Oregon Street, Portland, OR 97232, USA
| | - E.Roberto Orellana
- Regional Research Institute, Portland State University, 1600 SW 4th Avenue, Suite 900, Portland, OR 97201, USA
| | - P. Todd Korthuis
- Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Timothy W. Menza
- Public Health Division, Oregon Health Authority, 800 NE Oregon Street, Portland, OR 97232, USA,Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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Bohler RM, Hodgkin D, Kreiner PW, Green TC. Predictors of US states' adoption of naloxone access laws, 2001-2017. Drug Alcohol Depend 2021; 225:108772. [PMID: 34052687 PMCID: PMC8282714 DOI: 10.1016/j.drugalcdep.2021.108772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The opioid crisis has put an increasing strain on US states over the last two decades. In response, all states have passed legislation to implement a portfolio of policies to address the crisis. Although effects of some of these policies have been studied, research into factors associated with state policy adoption decisions has largely been lacking. We address this gap by focusing on factors associated with adoption of naloxone access laws (NAL), which aim to increase the accessibility and availability of naloxone in the community as a harm reduction strategy to reduce opioid-related morbidity and mortality. METHODS We used event history analysis (EHA) to identify predictors of the diffusion of naloxone access laws (NAL) from 2001, when the first NAL was passed, to 2017, when all states had adopted NAL. A variety of state characteristics were included in the model as potential predictors of adoption. RESULTS We found that state adoption of NAL increased gradually, then more rapidly starting in 2013. Consistent with this S-shaped diffusion process, the strongest predictor of adoption was prior adoption by neighboring states. Having a more conservative political ideology and having a higher percentage of residents who identified as evangelical Protestants were associated with later adoption of NAL. CONCLUSION States appear to be influenced by their neighbors in deciding whether and when to adopt NAL. Advocacy for harm reduction policies like NAL should take into account the political and religious culture of a state.
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Affiliation(s)
- Robert M Bohler
- Institute for Behavioral Health, Brandeis University, Waltham, MA, United States.
| | - Dominic Hodgkin
- Institute for Behavioral Health, Brandeis University, Waltham, MA, United States
| | - Peter W Kreiner
- Institute for Behavioral Health, Brandeis University, Waltham, MA, United States
| | - Traci C Green
- Institute for Behavioral Health, Brandeis University, Waltham, MA, United States
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Kunkel ST, Gregory JJ, Sabatino MJ, Borsinger TM, Fillingham YA, Jevsevar DS, Moschetti WE. Does Preoperative Opioid Consumption Increase the Risk of Chronic Postoperative Opioid Use After Total Joint Arthroplasty? Arthroplast Today 2021; 10:46-50. [PMID: 34307810 PMCID: PMC8283033 DOI: 10.1016/j.artd.2021.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/09/2021] [Accepted: 05/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background Risk-factor identification related to chronic opioid use after surgery may facilitate interventions mitigating postoperative opioid consumption. We evaluated the relationship between opioid use preceding total hip arthroplasty (THA) and total knee arthroplasty (TKA), and chronic use postoperatively, and the risk of chronic opioid use after total joint arthroplasty. Methods All primary THAs and TKAs performed during a 6-month period were identified. Opioid prescription and utilization data (in oxycodone equivalents) were determined via survey and electronic records. Relationship between preoperative opioid use and continued use >90 days after surgery was assessed via Chi-square, with significance set at P < .05. Results A total of 415 patients met inclusion criteria (240 THAs and 175 TKAs). Of the 240 THAs, 199 (82.9%) patients and of the 175 TKAs, 144 (82.3%) patients agreed to participate. Forty-three of 199 (21.6%) THA patients and 22 of 144 (15.3%) TKA patients used opioids within 30 days preoperatively. Nine of 199 (4.5%) THA and 10 of 144 (6.9%) TKA patients had continued use of opioids for >90 days postoperatively. Preoperative opioid consumption was significantly associated with chronic use postoperatively for THA (P = .011) and TKA (P = .024). Five of 43 (11.6%) THA and 4 of 22 (18.2%) TKA patients with preoperative opioid use had continued use for >90 days postoperatively. For opioid naïve patients, 2.6% (4/156) of THA and 4.9% (6/122) of TKA patients had chronic use postoperatively. Conclusions Preoperative opioid use was associated with nearly 5-fold and 4-fold increase in percentage of patients with chronic opioid use after THA and TKA, respectively. Surgeons should counsel patients regarding this risk and consider strategies to eliminate preoperative opioid use.
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Affiliation(s)
- Samuel T Kunkel
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James J Gregory
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Matthew J Sabatino
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Tracy M Borsinger
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wayne E Moschetti
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Antoniou T, Martins D, Campbell T, Tadrous M, Munro C, Leece P, Mamdani M, Juurlink DN, Gomes T. Impact of policy changes on the provision of naloxone by pharmacies in Ontario, Canada: a population-based time-series analysis. Addiction 2021; 116:1514-1520. [PMID: 33207025 PMCID: PMC8247272 DOI: 10.1111/add.15324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS In June 2016, the Ontario, Canada government implemented the Ontario Naloxone Program for Pharmacies (ONPP), authorizing pharmacists to provide injectable naloxone kits at no charge to all Ontario residents. In March 2018, the program was amended to include intranasal naloxone and remove the requirement to present a government health card to the dispensing pharmacist. We examined whether these changes increased naloxone dispensing through the ONPP. DESIGN Population-based time-series analysis using interventional autoregressive integrated moving average models. SETTING Ontario, Canada. PARTICIPANTS All Ontario residents between 1 July 2016 and 31 March 2020. MEASUREMENTS Monthly rates of pharmacy naloxone dispensing. FINDINGS Overall, 199 484 individuals were dispensed a naloxone kit during the study period. In the main analysis, the rate of pharmacy naloxone dispensing increased by 65.1% following program changes (55.6-91.8 kits per 100 000 population between February 2018 and May 2018; P = 0.01). In subgroup analyses, naloxone dispensing increased among individuals receiving opioid agonist therapy (OAT) (3374.9-7264.2 kits per 100 000 OAT recipients; P = 0.04) among individuals receiving other prescription opioids (192.8-381.8 kits per 100 000 population prescribed opioids; P < 0.01), among individuals with past opioid exposure (134.7-205.6 kits per 100 000 population with past opioid exposure; P < 0.01) and in urban centers (56.2-91.4 kits per 100 000 population; P < 0.01). We did not observe a clear impact on pharmacy-dispensed naloxone to individuals with no or unknown opioid exposure (34.4-39.3 kits per 100 000 population with no/unknown opioid exposure; P = 0.42) and in rural regions (50.4-97.2 kits per 100 000 population; P = 0.09). CONCLUSIONS Changes to the Ontario Naloxone Program for Pharmacies to add intranasal naloxone and remove the requirement to present a government health card appeared to increase pharmacy-based naloxone dispensing uptake in Ontario, Canada, particularly among individuals at high risk of inadvertent opioid overdose.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada,ICESTorontoOntarioCanada,Department of Family and Community Medicine, Unity HealthTorontoOntarioCanada,Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Diana Martins
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada
| | | | - Mina Tadrous
- ICESTorontoOntarioCanada,Women's College HospitalTorontoOntarioCanada,Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Charlotte Munro
- Ontario Drug Policy Research Network Lived Experience Advisory GroupTorontoOntarioCanada
| | | | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada,ICESTorontoOntarioCanada,Family and Community MedicineUniversity of TorontoTorontoOntarioCanada,Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoOntarioCanada,Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - David N. Juurlink
- ICESTorontoOntarioCanada,Department of PediatricsUniversity of TorontoTorontoOntarioCanada,Family and Community MedicineUniversity of TorontoTorontoOntarioCanada,Department of MedicineUniversity of TorontoTorontoOntarioCanada,The Sunnybrook Research InstituteTorontoCanada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada,ICESTorontoOntarioCanada,Family and Community MedicineUniversity of TorontoTorontoOntarioCanada,Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoOntarioCanada
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Lawrence MB. The Antisocial "Safety Net". Public Health Rep 2021; 136:636-639. [PMID: 33478361 DOI: 10.1177/0033354920972698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Younger DS. Cerebral vasculitis associated with drug abuse. Curr Opin Rheumatol 2021; 33:24-33. [PMID: 33186242 DOI: 10.1097/bor.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review understand the epidemiology, background, neuropharmacology, and histopathology of literature verified cases, and likely etiopathogenic mechanisms. RECENT FINDINGS There are only a handful of histologically confirmed patients in the literature with cerebral vasculitis because of drug abuse. SUMMARY There is little justification for invasive laboratory investigation given the ready availability of highly accurate vascular neuroimaging techniques to dictate management, which usually rests upon avoidance of further exposure and minimizing the secondary neurotoxic effects of the abused substances and polypharmacy use.
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Affiliation(s)
- David S Younger
- City University of New York Medical School, New York, New York, USA
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Li Y, Hyder A, Southerland LT, Hammond G, Porr A, Miller HJ. 311 service requests as indicators of neighborhood distress and opioid use disorder. Sci Rep 2020; 10:19579. [PMID: 33177583 PMCID: PMC7658248 DOI: 10.1038/s41598-020-76685-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
Opioid use disorder and overdose deaths is a public health crisis in the United States, and there is increasing recognition that its etiology is rooted in part by social determinants such as poverty, isolation and social upheaval. Limiting research and policy interventions is the low temporal and spatial resolution of publicly available administrative data such as census data. We explore the use of municipal service requests (also known as "311" requests) as high resolution spatial and temporal indicators of neighborhood social distress and opioid misuse. We analyze the spatial associations between georeferenced opioid overdose event (OOE) data from emergency medical service responders and 311 service request data from the City of Columbus, OH, USA for the time period 2008-2017. We find 10 out of 21 types of 311 requests spatially associate with OOEs and also characterize neighborhoods with lower socio-economic status in the city, both consistently over time. We also demonstrate that the 311 indicators are capable of predicting OOE hotspots at the neighborhood-level: our results show code violation, public health, and street lighting were the top three accurate predictors with predictive accuracy as 0.92, 0.89 and 0.83, respectively. Since 311 requests are publicly available with high spatial and temporal resolution, they can be effective as opioid overdose surveillance indicators for basic research and applied policy.
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Affiliation(s)
- Yuchen Li
- Department of Geography, The Ohio State University, Columbus, OH, USA
- Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, USA
| | - Ayaz Hyder
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | | | | | - Adam Porr
- Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, USA
| | - Harvey J Miller
- Department of Geography, The Ohio State University, Columbus, OH, USA.
- Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, USA.
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Recent changes in trends of opioid overdose deaths in North America. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:66. [PMID: 32867799 PMCID: PMC7457770 DOI: 10.1186/s13011-020-00308-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
Background As several regulatory and environmental changes have occurred in North America, trends in overdose deaths were examined in the United States (US), Ontario and British Columbia (BC), including changes in consumption levels of prescription opioids (PO) and overdose deaths, changes in correlations between consumption levels of PO and overdose deaths and modeled differences between observed and predicted overdose deaths if no changes had occurred. Methods Consumption levels of PO included defined daily doses for statistical purposes per million inhabitants per day for the US and Canada (2001–2015). Overdose deaths included opioid overdose deaths for the US (2001–2017) and Ontario (2003–2017) and illicit drug overdose deaths for BC (2001–2017). The analytic techniques included structural break point analyses, Pearson product-moment correlations and multivariate Gaussian state space modeling. Results Consumption levels of PO changed in the US in 2010 and in Canada in 2012. Overdose deaths changed in the US in 2014 and in Ontario and BC in 2015. Prior to the observed changes in consumption levels of PO, there were positive correlations between consumption levels of PO and overdose deaths in the US (r = 0.99, p < 0.001) and Ontario (r = 0.92, p = 0.003). After the observed changes in consumption levels of PO, there was a negative correlation between consumption levels of PO and overdose deaths in the US (r = − 0.99, p = 0.002). Observed overdose deaths exceeded predicted overdose deaths by 5.7 (95% Confidence Interval [CI]: 4.8–6.6), 3.5 (95% CI: 3.2–3.8) and 21.8 (95% CI: 18.6–24.9) deaths per 100,000 people in the US, Ontario and BC, respectively in 2017. These excess deaths corresponded to 37.7% (95% CI: 31.9–43.6), 39.2% (95% CI: 36.3–42.1) and 72.2% (95% CI: 61.8–82.6) of observed overdose deaths in the US, Ontario and BC, respectively in 2017. Conclusions The opioid crisis has evolved in North America, as a sizeable proportion of overdose deaths are now attributable to the several regulatory and environmental changes. These findings necessitate substance use policies to be conceptualized more broadly as well as the continued expansion of harm reduction services and types of pharmacotherapy interventions.
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Providers' perceptions on barriers and facilitators to prescribing naloxone for patients at risk for opioid overdose after implementation of a national academic detailing program: A qualitative assessment. Res Social Adm Pharm 2020; 16:1033-1040. [DOI: 10.1016/j.sapharm.2019.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/13/2019] [Accepted: 10/25/2019] [Indexed: 11/18/2022]
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Bagley B, Bright CF. "Those People Count": Naloxone Media Coverage in Mississippi. QUALITATIVE HEALTH RESEARCH 2020; 30:1237-1248. [PMID: 32208912 PMCID: PMC7305992 DOI: 10.1177/1049732320911952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is a movement to promote naloxone adoption by law enforcement and other stakeholders in the state of Mississippi. The purpose of this study is to understand how local media are framing the conversation about naloxone products, and to better understand how it might affect naloxone adoption among law enforcement. We searched for news articles published in Mississippi from January 2012 to July 2018 mentioning the words Narcan® and/or naloxone. Four main themes emerged from 25 articles: (a) positive and informative discussion of naloxone, (b) full articles persuading readers to use and/or advocate the use of naloxone, (c) government or organizational effort to increase the availability and use of naloxone products, and (d) negative or misleading information about naloxone. Better efforts to disseminate correct and persuasive information about the drug will have a profound and positive effect on the opioid epidemic in Mississippi and in the United States.
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Kernan WD, Basch CH, Segall LE, Garcia P. A Review of YouTube Videos About the Opioid Antagonist Medication Naloxone. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2020.1752079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- William D. Kernan
- Department of Health, William Paterson University, Wayne, New Jersey, USA
| | - Corey H. Basch
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
| | - Leslie E. Segall
- Columbia University Irving Medical Center, New York, New York, USA
| | - Philip Garcia
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
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Naloxone availability and dispensing in Indiana pharmacies 2 years after the implementation of a statewide standing order. J Am Pharm Assoc (2003) 2020; 60:470-474. [DOI: 10.1016/j.japh.2019.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 11/20/2022]
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15
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Morales M, Rafful C, Baker P, Arredondo J, Kang S, Mittal ML, Rocha-Jiménez T, Strathdee SA, Beletsky L. "Pick up anything that moves": a qualitative analysis of a police crackdown against people who use drugs in Tijuana, Mexico. HEALTH & JUSTICE 2020; 8:9. [PMID: 32350636 PMCID: PMC7191752 DOI: 10.1186/s40352-020-00111-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/24/2020] [Indexed: 06/03/2023]
Abstract
BACKGROUND Homeless people who use drugs (PWUD) are often displaced, detained, and/or forced into drug treatment during police crackdowns. Such operations follow a zero-tolerance approach to law enforcement and have a deleterious impact on the health of PWUD. In Mexico, municipal police officers (MPOs) conducted the largest crackdown documented at the Tijuana River Canal (Tijuana Mejora) to dismantle an open drug market. We analyzed active-duty MPOs' attitudes on the rationale, implementation, and outcomes of the crackdown. We also included the involvement of non-governmental allies in the disguised imprisonment as drug treatment referral and potential legal consequences of having illegally detained PWUD. METHODS Between February-June 2016, 20 semi-structured interviews were conducted with MPOs in Tijuana. Interviews were transcribed, translated and coded using a consensus-based approach. Emergent themes, trends and frameworks were analyzed through a hermeneutic grounded theory protocol. RESULTS Participants recognized the limitations of Tijuana Mejora in effectively controlling crime and addressing drug treatment solutions. MPOs perceived that the intent of the operation was to displace and detain homeless PWUD, not to assist or rehabilitate them. The police operation was largely justified as a public safety measure to reduce the risk of injury due to flooding, decrease drug consumption among PWUD and protect local tourism from PWUD. Some participants perceived the crackdown as a successful public health and safety measure while others highlighted occupational risks to MPOs and potential human rights violations of PWUD. CONCLUSIONS Tijuana Mejora illustrated why public and private actors align in enforcing zero-tolerance drug policy. Perceptions of care are often based on captivity of the diseased, not in health and well-being of PWUD. Officer perceptions shed light on the many limitations of this punitive policing tool in this context. A shift towards evidence-based municipal strategies to address drug use, wherein police are perceived as partners in harm reduction rather than antagonists, is warranted.
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Affiliation(s)
- Mario Morales
- School of Government and Public Policy, University of Arizona, Tuscon, USA
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
- Center for Global Mental Health Research, National Institute of Psychiatry, Mexico City, Mexico
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
- School of Public Health, San Diego State University, San Diego, USA.
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
| | - Sunyou Kang
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
- School of Law & Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Maria L Mittal
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
- School of Medicine, Universidad Xochicalco, Tijuana, Mexico
| | - Teresita Rocha-Jiménez
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
- School of Law & Bouvé College of Health Sciences, Northeastern University, Boston, USA
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What Happens to Unused Opioids After Total Joint Arthroplasty? An Evaluation of Unused Postoperative Opioid Disposal Practices. J Arthroplasty 2020; 35:966-970. [PMID: 31813814 DOI: 10.1016/j.arth.2019.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/22/2019] [Accepted: 11/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study evaluates the fate of unused opioids after total hip arthroplasty (THA) and total knee arthroplasty (TKA) at our facility. METHODS Medication disposal after primary elective THA and TKA was classified as appropriate (in accordance with United States Food and Drug Administration guidelines) or inappropriate for all patients undergoing these procedures during the second half of the fiscal year 2015. RESULTS In total, 199 THAs and 144 TKAs met inclusion criteria. Total pills prescribed were 55,635. Approximately 8925 (16%) of pills were unused. About 39.9% of patients disposed of unused opioids appropriately, while 60.1% of patients reported still having (18.5%), not knowing where they were (8.2%), or other (33.4%). There was no significant association with the type of opioid prescribed. CONCLUSION A large volume of unused opioids were improperly disposed of after total joint arthroplasty.
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Affiliation(s)
- Caroline Mitchell
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | | | - Kenneth M Dürsteler
- Center for Addictive Disorders, University of Basel Psychiatric Hospital, Basel, Switzerland
- University Hospital of Psychiatry Zurich, Department for Psychiatry, Psychotherapy and Psychosomatics, Centre for Addictive Disorders, Zurich, Switzerland
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18
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Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine. Drugs 2020; 79:1395-1418. [PMID: 31352603 PMCID: PMC6728289 DOI: 10.1007/s40265-019-01154-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Naloxone is a well-established essential medicine for the treatment of life-threatening heroin/opioid overdose in emergency medicine. Over two decades, the concept of 'take-home naloxone' has evolved, comprising pre-provision of an emergency supply to laypersons likely to witness an opioid overdose (e.g. peers and family members of people who use opioids as well as non-medical personnel), with the recommendation to administer the naloxone to the overdose victim as interim care while awaiting an ambulance. There is an urgent need for more widespread naloxone access considering the growing problem of opioid overdose deaths, accounting for more than 100,000 deaths worldwide annually. Rises in mortality are particularly sharp in North America, where the ongoing prescription opioid problem is now overlaid with a rapid growth in overdose deaths from heroin and illicit fentanyl. Using opioids alone is dangerous, and the mortality risk is clustered at certain times and contexts, including on prison release and discharge from hospital and residential care. The provision of take-home naloxone has required the introduction of new legislation and new naloxone products. These include pre-filled syringes and auto-injectors and, crucially, new concentrated nasal sprays (four formulations recently approved in different countries) with speed of onset comparable to intramuscular naloxone and relative bioavailability of approximately 40-50%. Choosing the right naloxone dose in the fentanyl era is a matter of ongoing debate, but the safety margin of the approved nasal sprays is superior to improvised nasal kits. New legislation in different countries permits over-the-counter sales or other prescription-free methods of provision. However, access remains uneven with take-home naloxone still not provided in many countries and communities, and with ongoing barriers contributing to implementation inertia. Take-home naloxone is an important component of the response to the global overdose problem, but greater commitment to implementation will be essential, alongside improved affordable products, if a greater impact is to be achieved.
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19
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Henche Ruiz AI. [Transmucosal fentanyl and breakthrough pain: The other side of the coin]. Rev Esp Geriatr Gerontol 2020; 55:56-57. [PMID: 31307779 DOI: 10.1016/j.regg.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/02/2019] [Accepted: 02/08/2019] [Indexed: 06/10/2023]
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Tsai AC, Kiang MV, Barnett ML, Beletsky L, Keyes KM, McGinty EE, Smith LR, Strathdee SA, Wakeman SE, Venkataramani AS. Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Med 2019; 16:e1002969. [PMID: 31770387 PMCID: PMC6957118 DOI: 10.1371/journal.pmed.1002969] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis.
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Affiliation(s)
- Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston,
Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Mbarara University of Science and Technology, Mbarara,
Uganda
| | - Mathew V. Kiang
- Center for Population Health Sciences, Stanford University School of
Medicine, Stanford, California, United States of America
| | - Michael L. Barnett
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Department of Health Policy and Management, Harvard T. H. Chan School of
Public Health, Boston, Massachusetts, United States of America
- Division of General Internal Medicine and Primary Care, Brigham and
Women’s Hospital, Boston, Massachusetts, United States of
America
| | - Leo Beletsky
- Northeastern University School of Law, Boston, Massachusetts, United
States of America
- Bouvé College of Health Sciences, Northeastern University, Boston,
Massachusetts, United States of America
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Katherine M. Keyes
- Mailman School of Public Health, Columbia University, New York City, New
York, United States of America
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg
School of Public Health, Baltimore, Maryland, United States of
America
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Sarah E. Wakeman
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Department of Medicine, Massachusetts General Hospital, Boston,
Massachusetts, United States of America
| | - Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania,
Philadelphia, Pennsylvania, United States of America
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21
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Bounthavong M, Devine EB, Christopher MLD, Harvey MA, Veenstra DL, Basu A. Implementation evaluation of academic detailing on naloxone prescribing trends at the United States Veterans Health Administration. Health Serv Res 2019; 54:1055-1064. [PMID: 31313839 DOI: 10.1111/1475-6773.13194] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Academic detailing in partnership with the Opioid Overdose Education and Naloxone Distribution (OEND) program was implemented to increase naloxone access for the prevention of opioid overdose mortality in veterans at the U.S. Department of Veterans Affairs (VA). However, implementation was not uniform leading to varying levels of intervention exposure potentially impacting naloxone prescribing. We examined the impact of implementation strength (proportion of providers exposed to academic detailing) at each station on naloxone prescribing from September 2014 to December 2017. STUDY DESIGN AND SETTING Retrospective cohort design with fixed effects models at the VA. DATA COLLECTION/EXTRACTION METHODS We used VA Corporate Data Warehouse for data on pharmacy dispensing, station-, provider- and patient-level characteristics. OEND-specific academic detailing activities came from data recorded by academic detailers using Salesforce.com. PRINCIPAL FINDINGS VA stations wherein 100 percent of providers exposed to an OEND-related academic detailing educational outreach visit experienced an increased incident rate of naloxone prescribing that was 5.52 times the incident rate of stations where no providers were exposed; alternatively, this is equivalent to an average monthly increase of 2.60 naloxone prescriptions per 1000 population at risk for opioid overdose. CONCLUSIONS Our findings highlight the importance of academic detailing's implementation strength on naloxone prescribing. Decision makers must carefully consider the implementation process to achieve the greatest effectiveness from the intervention.
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Affiliation(s)
- Mark Bounthavong
- Pharmacy Benefits Management (PBM), National Academic Detailing Service, U.S. Department of Veterans Affairs, Washington, DC.,The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, Washington.,Veterans Affairs (VA) Health Economics Resource Center (HERC), Menlo Park, California.,Veterans Affairs (VA) Center for Innovation to Implementation (Ci2i), Menlo Park, California
| | - Emily Beth Devine
- The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, Washington.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Melissa L D Christopher
- Pharmacy Benefits Management (PBM), National Academic Detailing Service, U.S. Department of Veterans Affairs, Washington, DC
| | - Michael A Harvey
- Pharmacy Benefits Management (PBM), National Academic Detailing Service, U.S. Department of Veterans Affairs, Washington, DC
| | - David L Veenstra
- The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, Washington.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
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22
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Lowder EM, Ray BR, Gruenewald JA. Criminal Justice Professionals' Attitudes Toward Mental Illness and Substance Use. Community Ment Health J 2019; 55:428-439. [PMID: 30706306 DOI: 10.1007/s10597-019-00370-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/23/2019] [Indexed: 11/29/2022]
Abstract
Despite the high prevalence of behavioral health disorders in justice settings and prior research on the importance of attitudes in successful treatment outcomes for behavioral health populations, few studies have examined criminal justice professionals' attitudes toward mental illness and substance use. We conducted a state-wide survey of 610 criminal justice professionals using items adapted from the Drug and Drug Problems Perceptions Questionnaire (Albery et al. 2003) to examine attitudes toward mental illness and substance use as a function of criminal justice position and personal contact. For attitudes toward both mental illness and substance use, defense attorneys and community corrections officers reported more positive attitudes relative to jail correctional staff and prosecutors. For attitudes toward substance use, personal contact moderated the effect of position on attitudes. Findings underscore the importance of targeted training and other contact-based interventions to improve criminal justice professionals' attitudes toward behavioral health populations.
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Affiliation(s)
- Evan M Lowder
- School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, 801 W. Michigan Street, BS 3025, Indianapolis, IN, 46202, USA.
| | - Bradley R Ray
- School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, 801 W. Michigan Street, BS 3025, Indianapolis, IN, 46202, USA
| | - Jeffrey A Gruenewald
- School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, 801 W. Michigan Street, BS 3025, Indianapolis, IN, 46202, USA
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Barré T, Vorspan F, Fortias M, Veyrier M, Cavagna P, Azuar J, Nicolas L, Naccache F, Barreteau H, Bellivier F, Bloch V. Pratique de l’ATU de cohorte de la naloxone intranasale (Nalscue®) : mise en place dans un CSAPA parisien. Therapie 2018; 73:495-500. [DOI: 10.1016/j.therap.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/08/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
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24
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Xu J, Davis CS, Cruz M, Lurie P. State naloxone access laws are associated with an increase in the number of naloxone prescriptions dispensed in retail pharmacies. Drug Alcohol Depend 2018; 189:37-41. [PMID: 29860058 DOI: 10.1016/j.drugalcdep.2018.04.020] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/20/2018] [Accepted: 04/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND In response to the ongoing opioid overdose epidemic, many states have enacted laws increasing naloxone access by lay people, such as friends and family members of people who use drugs (PWUD), as well as PWUD themselves. METHOD We utilized Symphony Health Solutions' PHAST Prescription data from 2007 to 2016 to investigate whether naloxone access laws were associated with an increase in naloxone dispensed from retail pharmacies in the United States. RESULT Using a negative binomial regression, we found that naloxone access laws were associated with an average increase of 78 prescriptions dispensed per state per quarter. This represents an average 79% increase in naloxone dispensed from U.S. retail pharmacies, compared with states where there were no such laws. CONCLUSION Our study suggests that naloxone access laws can increase the availability and accessibility of naloxone.
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Affiliation(s)
- Jing Xu
- US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
| | - Corey S Davis
- Network for Public Health Law, 3701 Wilshire Blvd. #750, Los Angeles, CA, 90010, USA.
| | - Marisa Cruz
- US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
| | - Peter Lurie
- Center for Science in the Public Interest, 1220 L St. N.W., Suite 300, Washington, DC, 20005, USA.
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25
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Chung CP, Dupont WD, Murray KT, Hall K, Stein CM, Ray WA. Comparative out-of-hospital mortality of long-acting opioids prescribed for non-cancer pain: A retrospective cohort study. Pharmacoepidemiol Drug Saf 2018; 28:48-53. [PMID: 30003613 DOI: 10.1002/pds.4619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/14/2018] [Accepted: 06/15/2018] [Indexed: 11/12/2022]
Abstract
PURPOSE Despite significant growth of opioid prescriptions, only limited data are available regarding the comparative safety of long-acting opioids for chronic non-cancer pain. Recent data suggest that transdermal fentanyl and oxycodone CR may have greater toxicity than morphine SR in patients with non-cancer pain. Thus, we compared the risk of out-of-hospital deaths in patients with non-cancer pain filling prescriptions for transdermal fentanyl or oxycodone CR with that for morphine SR. METHODS We conducted a retrospective cohort study in 50 658 patients enrolled in Tennessee Medicaid who filled prescriptions for transdermal fentanyl (n = 8717), oxycodone CR (n = 14 118), or morphine SR (n = 27 823) between 1999 and 2011. We excluded individuals with cancer or other life-threatening diagnoses and used propensity scores to adjust for multiple potential confounders. The primary outcome was out-of-hospital mortality. RESULTS During 44 385 person-years of follow-up, 689 patients died. The out-of-hospital mortality rate among all study subjects was 155/10 000 patient-years. Contrary to earlier data suggesting greater risk, mortality was not significantly different in patients filling prescriptions for transdermal fentanyl compared with morphine SR (adjusted HR = 0.96, 95% C.I.: 0.77-1.21); moreover, patients filling prescriptions for oxycodone CR had lower mortality risk compared with those filling prescriptions for morphine SR (adjusted HR = 0.79, 95% C.I. 0.66-0.95). CONCLUSION In the study population, long-acting opioids for non-cancer pain were associated with high out-of-hospital mortality rates. We found comparable out-of-hospital mortality risks associated with transdermal fentanyl and morphine SR. The risk of out-of-hospital death for oxycodone CR was lower than that for morphine SR.
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Affiliation(s)
- Cecilia P Chung
- Departments of Medicine and Pharmacology (CPC, KTM, CMS), Biostatistics (WDD), and Health Policy (KH, WAR), Vanderbilt University Medical Center, United States
| | - William D Dupont
- Departments of Medicine and Pharmacology (CPC, KTM, CMS), Biostatistics (WDD), and Health Policy (KH, WAR), Vanderbilt University Medical Center, United States
| | - Katherine T Murray
- Departments of Medicine and Pharmacology (CPC, KTM, CMS), Biostatistics (WDD), and Health Policy (KH, WAR), Vanderbilt University Medical Center, United States
| | - Kathi Hall
- Departments of Medicine and Pharmacology (CPC, KTM, CMS), Biostatistics (WDD), and Health Policy (KH, WAR), Vanderbilt University Medical Center, United States
| | - C Michael Stein
- Departments of Medicine and Pharmacology (CPC, KTM, CMS), Biostatistics (WDD), and Health Policy (KH, WAR), Vanderbilt University Medical Center, United States
| | - Wayne A Ray
- Departments of Medicine and Pharmacology (CPC, KTM, CMS), Biostatistics (WDD), and Health Policy (KH, WAR), Vanderbilt University Medical Center, United States
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26
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Beletsky L. 21 st Century Cures for the Opioid Crisis: Promise, Impact, and Missed Opportunities. AMERICAN JOURNAL OF LAW & MEDICINE 2018; 44:359-385. [PMID: 30106650 DOI: 10.1177/0098858818789417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Signed into law in 2016, the landmark 21stCentury Cures Act is as complex as it is divisive. For some stakeholders, including patient groups and representatives of regulated industries, the Act represented a major leap forward in pharmaceutical innovation, human subjects protections, and numerous other provisions. For other observers, this legislation was characterized as a major rollback in important regulations, which would leave patients worse off and the payers holding the bag. The one element of the Act that was relatively uncontroversial covered a number of provisions related to addressing the opioid crisis.This was by design. Provisions related to this issue were not part of the original legislation and were added to win over additional members of Congress who needed to be brought along to support the legislation. Many of the statute's provisions were intertwined with the Comprehensive Addiction Recovery Act (“CARA”) passed previously, but that legislation was stripped of much of its funding for opioid crisis response.
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Affiliation(s)
- Leo Beletsky
- Associate Professor of Law and Health Sciences, Northeastern University; Adjunct Professor, UCSD School of Medicine; J.D., Temple University Beasley School of Law, 2008; M.P.H., Brown University, 2004; A.B., Vassar College, 2000. The author thanks the participants of the American Journal of Law & Medicine's 2018 Symposium and participants of the Second Annual Regional Health Law Works-in-Progress Retreat at Seton Hall Law School for their feedback. Sarah Seymour and Zachary Siegel provided valuable research assistance
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27
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Zoorob MJ. Polydrug epidemiology: Benzodiazepine prescribing and the drug overdose epidemic in the United States. Pharmacoepidemiol Drug Saf 2018. [DOI: 10.1002/pds.4417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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28
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Whittington R, Whittington K, Whittington J, Porter J, Zimmermann K, Case H, Berg S. One-on-one care management and procurement of Naloxone for ambulatory use. J Public Health (Oxf) 2018; 40:858-862. [DOI: 10.1093/pubmed/fdy029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Joel Porter
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Holly Case
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Stacey Berg
- Intermountain Healthcare, Salt Lake City, Utah, USA
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29
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Lai JT, Chapman BP, Boyle KL, Boyer EW, Chai PR. Low-energy Bluetooth for detecting real-world penetrance of bystander naloxone kits: a pilot study. PROCEEDINGS OF THE ... ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES. ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES 2018; 2018:3253-3258. [PMID: 29416443 PMCID: PMC5798450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Opioid overdose is a growing public health emergency in the United States. The antidote naloxone must be administered rapidly after opioid overdose to prevent death. Bystander or "take-home" naloxone programs distribute naloxone to opioid users and other community members to increase naloxone availability at the time of overdose. However, data describing the natural history of take-home naloxone in the hands of at-risk individuals is lacking. To understand patterns of naloxone uptake in at-risk users, we developed a smart naloxone kit that uses low-energy Bluetooth (BLE) to unobtrusively detect the transit of naloxone through a hospital campus. In this paper, we describe development of the smart naloxone kit and results from the first 10 participants in our pilot study.
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Zedler BK, Saunders WB, Joyce AR, Vick CC, Murrelle EL. Validation of a Screening Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in a US Commercial Health Plan Claims Database. PAIN MEDICINE (MALDEN, MASS.) 2018; 19:68-78. [PMID: 28340046 PMCID: PMC5939826 DOI: 10.1093/pm/pnx009] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To validate a risk index that estimates the likelihood of overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids. Subjects and Methods A case-control analysis of 18,365,497 patients with an opioid prescription from 2009 to 2013 in the IMS PharMetrics Plus commercially insured health plan claims database (CIP). An OIRD event occurred in 7,234 cases. Four controls were selected per case. Validity of the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD), developed previously using Veterans Health Administration (VHA) patient data, was assessed. Multivariable logistic regression was used within the CIP study population to develop a slightly refined RIOSORD. The composition and performance of the CIP-based RIOSORD was evaluated and compared with VHA-based RIOSORD. Results VHA-RIOSORD performed well in discriminating OIRD events in CIP (C-statistic = 0.85). Additionally, re-estimation of logistic model coefficients in CIP yielded a 0.90 C-statistic. The resulting comorbidity and pharmacotherapy variables most highly associated with OIRD and retained in the CIP-RIOSORD were largely concordant with VHA-RIOSORD. These variables included neuropsychiatric and cardiopulmonary disorders, impaired drug excretion, opioid characteristics, and concurrent psychoactive medications. The average predicted probability of OIRD ranged from 2% to 83%, with excellent agreement between predicted and observed incidence across risk classes. Conclusions RIOSORD had excellent predictive accuracy in a large population of US medical users of prescription opioids, similar to its performance in VHA. This practical risk index is designed to support clinical decision-making for safer opioid prescribing, and its clinical utility should be evaluated prospectively.
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Affiliation(s)
| | - William B Saunders
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Holt CT, McCall KL, Cattabriga G, Tu C, Smalley EK, Nichols SD. Using Controlled Substance Receipt Patterns to Predict Prescription Overdose Death. Pharmacology 2017; 101:140-147. [PMID: 29248915 DOI: 10.1159/000484667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study evaluates complete state data from controlled substance prescribing trends in the prescription monitoring program (PMP) database and their association with the risk of prescription drug overdose death. SUMMARY Maine PMP records of individuals who died of prescription overdose deaths between 2006 and 2010 were selected (n = 690). For each subject, an age, gender, and residence matched cohort of PMP users in a 50: 1 ratio was identified (n = 34,500). Key Messages: Prescription opioids contributed to 480 of 690 prescription deaths, many co-ingestions were noted, and OR for overdose death increased with milligram of morphine equivalent (MME)/day >100. The majority who were prescribed MME >100 per day received a prescription within 90 days of overdose matching the toxicology cause of death. CONCLUSIONS Medication profiles available through state PMP can identify dosing of prescriptions associated with drug overdose death.
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Affiliation(s)
- Christina T Holt
- Department of Family Medicine, Maine Medical Center, Portland, Maine, USA
| | - Kenneth L McCall
- University of New England College of Pharmacy, Portland, Maine, USA
| | - Gary Cattabriga
- University of New England College of Pharmacy, Portland, Maine, USA
| | - Chunhao Tu
- University of New England College of Pharmacy, Portland, Maine, USA
| | - Elenna K Smalley
- University of New England College of Pharmacy, Portland, Maine, USA
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Today’s fentanyl crisis: Prohibition’s Iron Law, revisited. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:156-159. [DOI: 10.1016/j.drugpo.2017.05.050] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/28/2017] [Indexed: 01/27/2023]
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Abstract
Background Pain complaints are common, but clinicians are increasingly concerned about overuse of opioid pain medications. This may lead patients with actual pain to be stigmatized as “drug-seeking,” or attempting to obtain medications they do not require medically. We assessed whether patient requests for specific opioid pain medication would lead physicians to classify them as drug-seeking and change management decisions. Methods and findings Mixed-methods analysis of interviews with 192 office-based primary care physicians after viewing video vignettes depicting patients presenting with back pain. For each presentation physicians were randomly assigned to see either an active request for a specific medication or a more general request for help with pain. The main outcome was assignment by the physician of “drug-seeking” as a potential diagnosis among patients presenting with back pain. Additional outcomes included other actions the physician would take and whether the physician would prescribe the medication requested. A potential diagnosis of drug-seeking behavior was included by 21% of physicians seeing a specific request for oxycodone vs. 3% for a general request for help with back pain(p<0.001). In multivariable models an active request was most strongly associated with a physician-assigned diagnosis of drug-seeking behavior(OR 8.10; 95% CI 2.11–31.15;p = 0.002); other major patient and physician characteristics, including gender and race, did not have strong associations with drug-seeking diagnosis. Physicians described short courses of opioid medications as a strategy for managing patients with pain while avoiding opioid overuse. Conclusions When patients make a specific request for opioid pain medication, physicians are far more likely to suspect that they are drug-seeking. Physician suspicion of drug-seeking behavior did not vary by patient characteristics, including gender and race. The strategies used to assess patients further varied widely. These findings indicate a need for the development of better clinical tools to support the evaluation and management of patients presenting with pain.
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Pricolo A, Nielsen S. Naloxone rescheduling in Australia: Processes, implementation and challenges with supply of naloxone as a ‘pharmacist only’ over-the-counter medicine. Drug Alcohol Rev 2017; 37:450-453. [DOI: 10.1111/dar.12547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Suzanne Nielsen
- National Drug and Alcohol Centre; University of New South Wales; Sydney Australia
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney Australia
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Hurstak EE, Kushel M, Chang J, Ceasar R, Zamora K, Miaskowski C, Knight K. The risks of opioid treatment: Perspectives of primary care practitioners and patients from safety-net clinics. Subst Abus 2017; 38:213-221. [PMID: 28394752 DOI: 10.1080/08897077.2017.1296524] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with a history of substance use are more likely than those without substance use to experience chronic noncancer pain (CNCP), to be prescribed opioids, and to experience opioid misuse or overdose. Primary care practitioners (PCPs) in safety-net settings care for low-income patients with CNCP and substance use, usually without specialist consultation. To inform communication related to opioid risk, we explored PCPs' and patients' perceptions of the risks of chronic opioid therapy. METHODS We conducted semistructured interviews with 23 PCPs and 46 of their patients, who had a history of CNCP and substance use. We recruited from 6 safety-net health care settings in the San Francisco Bay Area. We transcribed interviews verbatim and analyzed transcripts using grounded theory methodology. RESULTS (1) PCPs feared harming patients and the community by opioid prescribing. PCPs emphasized fear of opioid overdose. (2) Patients did not highlight concerns about the adverse health consequences of opioids, except for addiction. (3) Both patients and PCPs were concerned about PCPs' medicolegal risks related to opioid prescribing. (4) Patients reported feeling stigmatized by policies aimed at reducing opioid misuse. CONCLUSION We identified differences in how clinicians and patients perceive opioid risk. To improve the informed consent process for opioid therapy, patients and PCPs need to have a shared understanding of the risks of opioids and engage in discussions that promote patient autonomy and safety. As clinics implement opioid prescribing policies, clinicians must develop effective communication strategies in order to educate patients about opioid risks and decrease patients' experiences of stigma and discrimination.
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Affiliation(s)
- Emily E Hurstak
- a Department of Medicine , University of California San Francisco , San Francisco , California , USA.,b Division of General Internal Medicine , University of California San Francisco/Zuckerberg San Francisco General Hospital , San Francisco , California , USA
| | - Margot Kushel
- a Department of Medicine , University of California San Francisco , San Francisco , California , USA.,b Division of General Internal Medicine , University of California San Francisco/Zuckerberg San Francisco General Hospital , San Francisco , California , USA
| | - Jamie Chang
- c Department of Psychiatry , University of California San Francisco , San Francisco , California , USA
| | - Rachel Ceasar
- d School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Kara Zamora
- e United States Department of Veterans Affairs , San Francisco , California , USA
| | - Christine Miaskowski
- f School of Nursing , University of California San Francisco , San Francisco , California , USA
| | - Kelly Knight
- g Department of Anthropology, History, and Social Medicine, and Global Health Sciences , University of California San Francisco , San Francisco , California , USA
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Abstract
PURPOSE Opioid overdose deaths have become an escalating epidemic in the United States. To combat this complex issue, naloxone distribution to the public has been initiated in many states as a harm reduction strategy. While supportive legislation develops and community programs expand, research- and policy-focused literature surrounding this timely topic require exploration, compilation, and analysis. The purpose of this systematic review is to identify trends in the current literature, gaps in the findings, nursing implications, and opportunities for further exploration. METHODS Following a systematic approach, the keywords "naloxone" and "opioid overdose" were used to retrieve articles through the search engines Academic Search Premier, CINAHL Complete, MEDLINE Complete, PubMed, and Psychology and Behavior Sciences Collection. FINDINGS In the 38 articles selected for the final review, six categories were discussed: global trends, U.S. overdose education programs with naloxone distribution, barriers to public access of naloxone, political opposition and support, financial impact, and recommendations. After reviewing the findings, gaps in the literature were examined, and nursing implications were acknowledged. ORIGINALITY AND VALUE Although many authors have researched and discussed public naloxone distribution, a comprehensive review of the current evidence is useful and necessary to enhance future research, practice, and policy efforts. By discovering significant gaps in the literature and by recognizing opportunities for nursing practice, this literature review provides valuable input for healthcare professionals, public health officials, policymakers, and laypersons to better understand an ethically, politically, and socially complicated public health initiative.
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Burrell A, Ethun L, Fawcett JA, Rickard-Aasen S, Williams K, Kearney SM, Pringle JL. The pharmacist's role in overdose: Using mapping technologies to analyze naloxone and pharmacy distribution. J Am Pharm Assoc (2003) 2017; 57:S73-S77.e1. [DOI: 10.1016/j.japh.2016.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/16/2022]
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Alford DP, Zisblatt L, Ng P, Hayes SM, Peloquin S, Hardesty I, White JL. SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program. PAIN MEDICINE 2016; 17:52-63. [PMID: 26304703 PMCID: PMC4718419 DOI: 10.1111/pme.12878] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. METHOD Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. SUBJECTS The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. RESULTS Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. CONCLUSIONS The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain.
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Affiliation(s)
- Daniel P. Alford
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Lara Zisblatt
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Pamela Ng
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Sean M. Hayes
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Sophie Peloquin
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Ilana Hardesty
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Julie L. White
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
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Affiliation(s)
- Ravi Gupta
- From Yale University School of Medicine (R.G., J.S.R.), the Department of Health Policy and Management, Yale University School of Public Health (J.S.R.), and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (J.S.R.) - all in New Haven, CT; and the Division of Health Care Policy and Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (N.D.S.)
| | - Nilay D Shah
- From Yale University School of Medicine (R.G., J.S.R.), the Department of Health Policy and Management, Yale University School of Public Health (J.S.R.), and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (J.S.R.) - all in New Haven, CT; and the Division of Health Care Policy and Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (N.D.S.)
| | - Joseph S Ross
- From Yale University School of Medicine (R.G., J.S.R.), the Department of Health Policy and Management, Yale University School of Public Health (J.S.R.), and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (J.S.R.) - all in New Haven, CT; and the Division of Health Care Policy and Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (N.D.S.)
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Nielsen S, Menon N, Larney S, Farrell M, Degenhardt L. Community pharmacist knowledge, attitudes and confidence regarding naloxone for overdose reversal. Addiction 2016; 111:2177-2186. [PMID: 27367125 DOI: 10.1111/add.13517] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/09/2016] [Accepted: 06/28/2016] [Indexed: 11/25/2022]
Abstract
AIM Given the potential to expand naloxone supply through community pharmacy, the aim of this study was to estimate Australian pharmacists': (1) level of support for overdose prevention, (2) barriers and facilitators for naloxone supply and (3) knowledge about naloxone administration. DESIGN Online survey from nationally representative sample of community pharmacies. SETTING Australia, September-November 2015. PARTICIPANTS A total of 1317 community pharmacists were invited to participate with 595 responses (45.1%). MEASUREMENTS We assessed attitudes towards harm reduction, support for overdose prevention, attitudes and knowledge about naloxone. We tested the association between attitudes towards harm reduction and different aspects of naloxone supply. FINDINGS Pharmacists were willing to receive training about naloxone (n = 479, 80.5%) and provide naloxone with a prescription (n = 537, 90.3%). Fewer (n = 234, 40.8%) were willing to supply naloxone over-the-counter. Positive attitudes towards harm reduction were associated with greater willingness to supply naloxone with a prescription [odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.11-1.19] and over-the-counter (OR = 1.13, 95% CI = 1.09-1.17). Few pharmacists were confident they could identify appropriate patients (n = 203, 34.1%) and educate them on overdose and naloxone use (n = 190, 31.9%). Mean naloxone knowledge scores were 1.8 (standard deviation 1.7) out of 5. More than half the sample identified lack of time, training, knowledge and reimbursement as potential barriers for naloxone provision. CONCLUSION Community pharmacists in Australia appear to be willing to supply naloxone. Low levels of knowledge about naloxone pharmacology and administration highlight the importance of training pharmacists about overdose prevention.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills, NSW, Australia
| | - Nadia Menon
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Coffin P, Rich J, Dailey M, Stancliff S, Beletsky L. While we dither, people continue to die from overdose: Comments on 'Clinical provision of improvised nasal naloxone without experimental testing and without regulatory approval: imaginative shortcut or dangerous bypass of essential safety procedures?'. Addiction 2016; 111:1880-1. [PMID: 27412566 PMCID: PMC5510754 DOI: 10.1111/add.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Phillip Coffin
- San Francisco Department of Public Health, Substance Use Research, San Francisco, CA, USA. .,University of California, San Francisco, Division of HIV, ID, & Global Health, San Francisco, CA, USA.
| | - Josiah Rich
- Brown University, The Miriam Hospital, Providence, RI, USA
| | | | | | - Leo Beletsky
- Northeastern University School of Law and Bouvé College of
Health Sciences and University of California, San Diego School of Medicine, CA,
USA
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Arias F, Arnsten JH, Cunningham CO, Coulehan K, Batchelder A, Brisbane M, Segal K, Rivera-Mindt M. Neurocognitive, psychiatric, and substance use characteristics in opioid dependent adults. Addict Behav 2016; 60:137-43. [PMID: 27131800 PMCID: PMC6508857 DOI: 10.1016/j.addbeh.2016.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/26/2016] [Accepted: 03/29/2016] [Indexed: 11/30/2022]
Abstract
AIMS To describe neurocognitive function among opioid-dependent adults seeking buprenorphine treatment and to explore the impact of lifetime psychiatric conditions on neurocognitive function. To explore the additive interaction of patient-based characteristics that may help to inform treatment. DESIGN Cross-sectional assessment of neurocognitive function, substance use, and psychiatric characteristics of adults seeking buprenorphine treatment within substance use treatment centers in New York City. PARTICIPANTS Thirty-eight opioid-dependent adults seeking buprenorphine treatment. MEASUREMENTS A comprehensive battery, which included measures of executive functioning, learning, memory, verbal fluency, attention, processing speed, and motor functioning were administered. The Wide Range Achievement Test-Third Edition, the Composite International Diagnostic Interview, and an audio computer assisted structured interview were also completed. Correlations and independent sample t-tests were used to ascertain group differences. FINDINGS Thirty-nine percent of participants were impaired in global neurocognitive function (n=15). Over one third were impaired in either: learning (n=28), memory (n=26), executive functioning (n=17), motor functioning (n=17), attention/working memory (n=14) or verbal fluency (n=12). Lifetime history of alcohol dependence was associated with impairment in global neurocognitive, executive functioning, and motor functioning. Lifetime history of cocaine dependence was associated with impairment in executive functioning and motor functioning (all p's<0.05). Major depressive disorder history was not associated with neurocognitive impairment. CONCLUSIONS Among this sample of opioid-dependent adults, there were high rates of global and domain-specific neurocognitive impairment, with severe impairment in learning and memory. Lifetime alcohol and cocaine dependence were associated with greater neurocognitive impairment, particularly in executive functioning. Because executive functioning is critical for decision-making and learning/memory dysfunction may interfere with information encoding, these findings suggest that opioid-dependent adults may require enhanced support for medical decision-making.
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Affiliation(s)
| | - Julia H Arnsten
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, and Montefiore Medical Center, United States
| | - Chinazo O Cunningham
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, and Montefiore Medical Center, United States
| | - Kelly Coulehan
- Psychology Department, Fordham University, United States
| | - Abigail Batchelder
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, and Montefiore Medical Center, United States
| | - Mia Brisbane
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, and Montefiore Medical Center, United States
| | - Katie Segal
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, and Montefiore Medical Center, United States
| | - Monica Rivera-Mindt
- Psychology Department, Fordham University, United States; Mount Sinai School of Medicine, Departments of Neurology and Psychiatry, United States
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Cochran G, Hruschak V, DeFosse B, Hohmeier KC. Prescription opioid abuse: pharmacists' perspective and response. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2016; 5:65-73. [PMID: 29354541 PMCID: PMC5741039 DOI: 10.2147/iprp.s99539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Opioid medication abuse and overdose are major concerns for public health, and a number of responses to address these issues have taken place across the US. Pharmacists and the pharmacy profession have made important contributions as a part of the response to this national crisis. This article provides a brief review of the antecedents, driving forces, and health status of patients involved in the opioid medication and overdose epidemic. This review further discusses pharmacy-based actions that have been undertaken to address this issue, including prescription drug monitoring, take-back, and naloxone training/distribution programs. This review likewise examines current efforts underway in the field to educate practitioners and needed future steps that must be taken by pharmacists in order to continue the profession's pivotal role in working toward resolving this national public health problem. In particular, evidence and arguments are presented for proactively identifying and intervening with patients who abuse and/or are at risk for overdose. Continued and active engagement by pharmacists in these efforts has the potential to result in important reductions in opioid medication abuse and overdose and improvements for patient's health.
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Affiliation(s)
- Gerald Cochran
- Department of Psychiatry, School of Medicine
- School of Social Work, University of Pittsburgh, Pittsburgh, PA
| | | | - Brooke DeFosse
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee, Memphis, TN, USA
| | - Kenneth C Hohmeier
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee, Memphis, TN, USA
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Frank JW, Levy C, Calcaterra SL, Hoppe JA, Binswanger IA. Naloxone Administration in US Emergency Departments, 2000-2011. J Med Toxicol 2016; 12:148-56. [PMID: 26621354 PMCID: PMC4880605 DOI: 10.1007/s13181-015-0525-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Rates of opioid overdose and opioid-related emergency department (ED) visits have increased dramatically. Naloxone is an effective antidote to potentially fatal opioid overdose, but little is known about naloxone administration in ED settings. We examined trends and correlates of naloxone administration in ED visits nationally from 2000 to 2011. Using data from the National Hospital Ambulatory Medical Care Survey, we examined ED visits involving (1) the administration of naloxone or (2) a diagnosis of opioid overdose, abuse, or dependence. We assessed patient characteristics in these visits, including concomitant administration of prescription opioid medications. We used logistic regression to identify correlates of naloxone administration. From 2000 to 2011, naloxone was administered in an estimated 1.7 million adult ED visits nationally; 19 % of these visits recorded a diagnosis of opioid overdose, abuse, or dependence. An estimated 2.9 million adult ED visits were related to opioid overdose, abuse, or dependence; 11 % of these visits involved naloxone administration. In multivariable logistic regression models, patient age, race, and insurance and non-rural facility location were independently associated with naloxone administration. An opioid medication was provided in 14 % of visits involving naloxone administration. Naloxone was administered in a minority of ED visits related to opioid overdose, abuse, or dependence. Among all ED visits involving naloxone administration, prescription opioids were also provided in one in seven visits. Further work should explore the provider decision-making in the management of opioid overdose in ED settings and examine patient outcomes following these visits.
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Affiliation(s)
- Joseph W Frank
- Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
- VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO, 80207, USA.
| | - Cari Levy
- VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO, 80207, USA
- Division of Health Care Policy and Research, University of Colorado, Mailstop F-480, 13199 E. Montview Blvd., Suite 400, Aurora, CO, 80045, USA
| | - Susan L Calcaterra
- Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA
- Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA
| | - Jason A Hoppe
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA
- Rocky Mountain Poison and Drug Center, 777 Bannock Street, Denver, CO, 80204, USA
| | - Ingrid A Binswanger
- Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA
- Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, Suite 300, Denver, CO, 80231, USA
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What is known about community pharmacy supply of naloxone? A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:24-33. [DOI: 10.1016/j.drugpo.2016.02.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/03/2016] [Accepted: 02/06/2016] [Indexed: 11/21/2022]
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Strang J, McDonald R, Alqurshi A, Royall P, Taylor D, Forbes B. Naloxone without the needle - systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal. Drug Alcohol Depend 2016; 163:16-23. [PMID: 26996745 DOI: 10.1016/j.drugalcdep.2016.02.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Deaths from opioid overdose can be prevented through administration of the antagonist naloxone, which has been licensed for injection since the 1970s. To support wider availability of naloxone in community settings, novel non-injectable naloxone formulations are being developed, suitable for emergency use by non-medical personnel. OBJECTIVES 1) Identify candidate routes of injection-free naloxone administration potentially suitable for emergency overdose reversal; 2) consider pathways for developing and evaluating novel naloxone formulations. METHODS A three-stage analysis of candidate routes of administration was conducted: 1) assessment of all 112 routes of administration identified by FDA against exclusion criteria. 2) Scrutiny of empirical data for identified candidate routes, searching PubMed and WHO International Clinical Trials Registry Platform using search terms "naloxone AND [route of administration]". 3) Examination of routes for feasibility and against the inclusion criteria. RESULTS Only three routes of administration met inclusion criteria: nasal, sublingual and buccal. Products are currently in development and being studied. Pharmacokinetic data exist only for nasal naloxone, for which product development is more advanced, and one concentrated nasal spray was granted licence in the US in 2015. However, buccal naloxone may also be viable and may have different characteristics. CONCLUSION After 40 years of injection-based naloxone treatment, non-injectable routes are finally being developed. Nasal naloxone has recently been approved and will soon be field-tested, buccal naloxone holds promise, and it is unclear what sublingual naloxone will contribute. Development and approval of reliable non-injectable formulations will facilitate wider naloxone provision across the community internationally.
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Affiliation(s)
- John Strang
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK.
| | - Rebecca McDonald
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK.
| | - Abdulmalik Alqurshi
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK.
| | - Paul Royall
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK.
| | - David Taylor
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK; Pharmacy Department, South London and Maudsley NHS Foundation Trust (SLaM), Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK.
| | - Ben Forbes
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK.
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Rebbert-Franklin K, Haas E, Singal P, Cherico-Hsii S, Baier M, Collins K, Webner K, Sharfstein J. Development of Maryland Local Overdose Fatality Review Teams: A Localized, Interdisciplinary Approach to Combat the Growing Problem of Drug Overdose Deaths. Health Promot Pract 2016; 17:596-600. [PMID: 27091609 DOI: 10.1177/1524839916632549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Maryland Local Overdose Fatality Review Teams (LOFRTs) are multiagency, multidisciplinary teams that critically analyze individual cases of drug overdose in their jurisdictions to identify preventable risk factors and missed opportunities for intervention, and to make policy and programmatic recommendations to prevent future overdose deaths. Three Maryland LOFRTs were first piloted in early 2014, and became established in law in May of the same year. LOFRTs provide unique opportunities for enhanced interagency collaboration and locally driven prevention efforts. This study describes the process of establishing LOFRTs in Maryland. The experiences and information regarding LOFRTs may help counties in other states combat the growing problem of deaths by drug overdose.
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Affiliation(s)
| | - Erin Haas
- Maryland Department of Mental Health and Hygiene, Baltimore, MD, USA
| | - Pooja Singal
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sara Cherico-Hsii
- Maryland Department of Mental Health and Hygiene, Baltimore, MD, USA
| | - Michael Baier
- Maryland Department of Mental Health and Hygiene, Baltimore, MD, USA
| | | | - Karl Webner
- Cecil County Health Department, Elkton, MD, USA
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48
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Sivilotti MLA. Flumazenil, naloxone and the 'coma cocktail'. Br J Clin Pharmacol 2016; 81:428-36. [PMID: 26469689 PMCID: PMC4767210 DOI: 10.1111/bcp.12731] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 01/14/2023] Open
Abstract
Flumazenil and naloxone are considered to be pharmacologically ideal antidotes. By competitive binding at the molecular target receptors, they are highly specific antagonists of two important drug classes, the benzodiazepines and opioids, respectively. Both antidotes enjoy rapid onset and short duration after parenteral administration, are easily titrated and are essentially devoid of agonist effects. Yet only naloxone is widely used as a component of the 'coma cocktail', a sequence of empirical treatments to correct altered mental status, while experts discourage the use of flumazenil for such patients. This review contrasts the history, indications, published evidence and novel applications for each antidote in order to explain this disparity in the clinical use of these 'ideal' antidotes.
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Affiliation(s)
- Marco L A Sivilotti
- Emergency Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario
- Ontario Poison Centre, Hospital for Sick Children, Toronto, Ontario, Canada
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49
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EVZIO: A New Delivery System for Naloxone. J Addict Nurs 2015; 26:217-8. [PMID: 26669230 DOI: 10.1097/jan.0000000000000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Ashrafioun L, Gamble S, Herrmann M, Baciewicz G. Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods. Subst Abus 2015; 37:76-81. [DOI: 10.1080/08897077.2015.1110550] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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