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Gezer F, Howard KA, Litwin AH, Martin NK, Rennert L. Identification of factors associated with opioid-related and hepatitis C virus-related hospitalisations at the ZIP code area level in the USA: an ecological and modelling study. Lancet Public Health 2024; 9:e354-e364. [PMID: 38821682 PMCID: PMC11163979 DOI: 10.1016/s2468-2667(24)00076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Opioid overdose and related diseases remain a growing public health crisis in the USA. Identifying sociostructural and other contextual factors associated with adverse health outcomes is needed to improve prediction models to inform policy and interventions. We aimed to identify high-risk communities for targeted delivery of screening and prevention interventions for opioid use disorder and hepatitis C virus (HCV). METHODS In this ecological and modelling study, we fit mixed-effects negative binomial regression models to identify factors associated with, and predict, opioid-related and HCV-related hospitalisations for ZIP code tabulation areas (ZCTAs) in South Carolina, USA. All individuals aged 18 years or older living in South Carolina from Jan 1, 2016, to Dec 31, 2021, were included. Data on opioid-related and HCV-related hospitalisations, as well as data on additional individual-level variables, were collected from medical claims records, which were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic and socioeconomic variables were obtained from the United States Census Bureau (American Community Survey, 2021) with additional structural health-care barrier data obtained from South Carolina's Center for Rural and Primary Health Care, and the American Hospital Directory. FINDINGS Between Jan 1, 2016, and Dec 31, 2021, 41 691 individuals were hospitalised for opioid misuse and 26 860 were hospitalised for HCV. There were a median of 80 (IQR 24-213) opioid-related hospitalisations and 61 (21-196) HCV-related hospitalisations per ZCTA. A standard deviation increase in ZCTA-level uninsured rate (relative risk 1·24 [95% CI 1·17-1·31]), poverty rate (1·24 [1·17-1·31]), mortality (1·18 [1·12-1·25]), and social vulnerability index (1·17 [1·10-1·24]) was significantly associated with increased combined opioid-related and HCV-related hospitalisation rates. A standard deviation increase in ZCTA-level income (0·79 [0·75-0·84]) and unemployment rate (0·87 [0·82-0·93]) was significantly associated with decreased combined opioid-related and HCV-related hospitalisations. Using 2016-20 hospitalisations as training data, our models predicted ZCTA-level opioid-related hospitalisations in 2021 with a median of 80·4% (IQR 66·8-91·1) accuracy and HCV-related hospitalisations in 2021 with a median of 75·2% (61·2-87·7) accuracy. Several underserved high-risk ZCTAs were identified for delivery of targeted interventions. INTERPRETATION Our results suggest that individuals from economically disadvantaged and medically under-resourced communities are more likely to have an opioid-related or HCV-related hospitalisation. In conjunction with hospitalisation forecasts, our results could be used to identify and prioritise high-risk, underserved communities for delivery of field-level interventions. FUNDING South Carolina Center for Rural and Primary Healthcare, National Institute on Drug Abuse, and National Library of Medicine.
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Affiliation(s)
- Fatih Gezer
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA; Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | - Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA; Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | - Alain H Litwin
- Clemson University School of Health Research, Clemson University, Clemson, SC, USA; Prisma Health-Upstate, Greenville, SC, USA; University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Natasha K Martin
- Division of Infectious Disease and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA; Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA.
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Sankaran D, Rawat S, Kachelmeyer JL, Li ES, Reynolds AM, Rawat M, Chandrasekharan P. Severe Neonatal Opioid Withdrawal Requiring Pharmacotherapy: Impact of Region of Residence. Am J Perinatol 2024; 41:e654-e663. [PMID: 35973797 DOI: 10.1055/a-1925-1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Our objective was to evaluate the trend and to assess the impact of maternal region of residence in Western New York (WNY), on severe neonatal opioid withdrawal syndrome (NOWS). STUDY DESIGN Term infants' born at gestational age greater than or equal to 37 weeks with severe NOWS, defined as withdrawal resulting in the receipt of pharmacologic therapy from WNY admitted to our neonatal intensive care unit (NICU) from January 1, 2008 to December 31, 2016, were included. Severe NOWS admissions to our NICU from the following five regions were controlled with birth and insurance data: (1) Urban North, (2) Erie Coastal, (3) Niagara Frontier, (4) Southern Tier, and (5) Urban South. RESULTS "Urban South" residence was associated with an increased risk of severe NOWS (adjusted odds ratio = 1.8, 97.5% confidence interval: 1.1-2.9). The trend in admission for severe NOWS doubled between 2008 to 2010 and 2014 to 2016 (p = 0.01). More infants born to maternal nonprescribed opioid users were placed in foster care at discharge (36.5 vs. 1.9%, p < 0.001). CONCLUSION In WNY, neonates born to mothers from the "Urban South" were twice at risk of being admitted for severe NOWS. One-third of infants with severe NOWS after nonprescribed opioid use were placed in foster care. Implementing targeted strategies at the community level may help improve outcomes in NOWS. KEY POINTS · Maternal region of residence is a risk factor for severe neonatal opioid withdrawal.. · Admissions for severe neonatal opioid withdrawal trended up from 2008 to 2010 to 2014 to 2016.. · One-third of the infants born to mothers on nonprescribed opioids were discharged to foster care..
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Affiliation(s)
- Deepika Sankaran
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
- Division of Neonatology, Department of Pediatrics, University of California at Davis, Sacramento, California
| | - Shikha Rawat
- Department of Economics, Stony Brook University, Stony Brook, New York
- Research Analyst, American Express, New York, New York
| | - Jennifer L Kachelmeyer
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Emily S Li
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Anne M Reynolds
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Munmun Rawat
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
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Pustz J, Srinivasan S, Shrestha S, Larochelle MR, Walley AY, Samet JH, Babakhanlou-Chase H, Carpenter JF, Stopka TJ. Applied risk mapping and spatial analysis of address-level decedent data to inform opioid overdose interventions: The Massachusetts HEALing Communities Study. Drug Alcohol Depend 2023; 251:110947. [PMID: 37666091 PMCID: PMC10587829 DOI: 10.1016/j.drugalcdep.2023.110947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/27/2023] [Accepted: 08/05/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Death certificate data provide powerful and sobering records of the opioid overdose crisis. In Massachusetts, where address-level decedent data are publicly available upon request, mapping and spatial analysis of fatal overdoses can provide valuable insights to inform prevention interventions. We describe how we used this approach to support a community-level intervention to reduce opioid-involved overdose mortality. METHODS We developed a method to clean and geocode decedent data that substituted injury locations (the likely location of fatal overdoses) for deaths recorded in hospitals. After geomasking for greater privacy protection, we created maps to visualize the spatial distribution of decedent residence addresses, alone and juxtaposed with drive and walk-time distances to opioid treatment programs (OTPs), and place of death by overdose address. We used spatial statistical analyses to identify locations with significant clusters of overdoses. RESULTS In the 8 intervention communities, 785 individuals died from opioid-involved overdoses between 2017 and 2020. We found that 19.7% of fatal overdoses were recorded in hospitals, 50.2% occurred at the decedent's residence, and 30.1% at another location. We identified overdose hotspots in study communities. By juxtaposing decedent residence data with drive- and walk-time analyses, we highlighted actionable spatial gaps in access to OTP treatment. CONCLUSION To better understand local fatal opioid overdose risk environments and inform the development of community-level prevention interventions, we used publicly available address-level decedent data to conduct nuanced spatial analyses. Our approach can be replicated in other jurisdictions to inform overdose prevention responses.
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Affiliation(s)
- Jennifer Pustz
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Sumeeta Srinivasan
- Department of Urban and Environmental Policy and Planning, Tufts University, Medford, MA, USA
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Marc R Larochelle
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; Massachusetts Department of Public Health, Boston, MA, USA
| | - Jeffrey H Samet
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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Unudurthi SD, Wright KD, Klimpel JM, Sud A, Tan A, Warren BJ. Sudarshan Kriya Meditation Reduces Substance Abuse Cravings and Improves Physical and Emotional Well-Being of Individuals With Opioid Use Disorder: A Pilot Study. J Psychosoc Nurs Ment Health Serv 2023; 61:51-59. [PMID: 36989479 DOI: 10.3928/02793695-20230321-01] [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: 03/31/2023]
Abstract
Opioid use disorder (OUD) is widely prevalent in the United States and there are high levels of comorbidity between OUD and mental illnesses, such as depression, anxiety, and posttraumatic stress disorder. Psychotherapy, in addition to medication-assisted therapy, are considered important components of long-term OUD treatment. Sudarshan Kriya Yoga (SKY) is a breathing-based mind-body intervention that has been demonstrated to have multiple physiological and psychological benefits. In the current study, participants (N = 8) recruited from a rural community were offered SKY in addition to treatment-as-usual. Physical and psychological well-being were measured using the Behavior and Symptom Identification Scale-24, Short Form-36, Perceived Stress Scale, and participant logs and journals. Of eight participants, seven (87.5%) successfully completed the SKY intervention. Compared to baseline, there was a significant decrease in substance use cravings (p = 0.04) and depression (p = 0.01). In addition, physical functioning and emotional well-being significantly increased after SKY. SKY demonstrated efficacy in improving physical and social functioning along with enhancing mental and emotional well-being. Larger-scale trials should be performed to validate these findings. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 51-59.].
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Leibowitz GS, Turner W, Bruckenthal P, Mezzatesta M, Ramsey KS, Dyer ME. Lessening the Impact of Opioid Misuse at a Federally Qualified Health Center in New York: Outcomes of an Integrated Workforce Training Program. Public Health Rep 2023; 138:42S-47S. [PMID: 37226953 PMCID: PMC10226063 DOI: 10.1177/00333549231170216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The COVID-19 pandemic has placed an unprecedented burden on patients, health care providers, and communities and has been particularly challenging for medically underserved populations impacted by the social determinants of health, as well as people with co-occurring mental health and substance use risks. This case study examines outcomes and lessons learned from a multisite low-threshold medication-assisted treatment (MAT) program at a federally qualified health center in partnership with a large suburban public university in New York to integrate and train Health Resources & Services Administration Behavioral Health Workforce Education and Training-funded graduate student trainees in social work and nursing in screening, brief intervention, and referral to treatment and patient care coordination, including social determinants of health and medical and behavioral comorbidities. The MAT program for the treatment of opioid use disorder has a low threshold for entry that is accessible and affordable, reduces barriers to care, and uses a harm reduction approach. Outcome data showed an average 70% retention rate in the MAT program and reductions in substance use. And, while more than 73% of patients reported being somewhat or definitely impacted by the pandemic, most patients endorsed the effectiveness of telemedicine and telebehavioral health, such that 86% indicated the pandemic did not affect the quality of their health care. The main implementation lessons learned were the importance of increasing the capacity of primary care and health care centers to deliver integrated care, using cross-disciplinary practicum experiences to enhance trainee competencies, and addressing the social determinants of health among populations with social vulnerabilities and chronic medical conditions.
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Affiliation(s)
- George S Leibowitz
- Schools of Social Welfare and Nursing, Stony Brook University, Stony Brook, NY, USA
| | - Win Turner
- Schools of Social Welfare and Nursing, Stony Brook University, Stony Brook, NY, USA
| | - Patricia Bruckenthal
- Schools of Social Welfare and Nursing, Stony Brook University, Stony Brook, NY, USA
| | | | - Kelly S Ramsey
- Office of Addiction Services and Supports, Albany, NY, USA
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Cuadros DF, Branscum AJ, Moreno CM, MacKinnon NJ. Narrative minireview of the spatial epidemiology of substance use disorder in the United States: Who is at risk and where? World J Clin Cases 2023; 11:2374-2385. [PMID: 37123313 PMCID: PMC10131000 DOI: 10.12998/wjcc.v11.i11.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/31/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
Drug overdose is the leading cause of death by injury in the United States. The incidence of substance use disorder (SUD) in the United States has increased steadily over the past two decades, becoming a major public health problem for the country. The drivers of the SUD epidemic in the United States have changed over time, characterized by an initial heroin outbreak between 1970 and 1999, followed by a painkiller outbreak, and finally by an ongoing synthetic opioid outbreak. The nature and sources of these abused substances reveal striking differences in the socioeconomic and behavioral factors that shape the drug epidemic. Moreover, the geospatial distribution of the SUD epidemic is not homogeneous. The United States has specific locations where vulnerable communities at high risk of SUD are concentrated, reaffirming the multifactorial socioeconomic nature of this epidemic. A better understanding of the SUD epidemic under a spatial epidemiology framework is necessary to determine the factors that have shaped its spread and how these patterns can be used to predict new outbreaks and create effective mitigation policies. This narrative minireview summarizes the current records of the spatial distribution of the SUD epidemic in the United States across different periods, revealing some spatiotemporal patterns that have preceded the occurrence of outbreaks. By analyzing the epidemic of SUD-related deaths, we also describe the epidemic behavior in areas with high incidence of cases. Finally, we describe public health interventions that can be effective for demographic groups, and we discuss future challenges in the study and control of the SUD epidemic in the country.
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Affiliation(s)
- Diego F Cuadros
- Digital Futures, University of Cincinnati, Cincinnati, OH 45206, United States
| | - Adam J Branscum
- Department of Biostatistics, Oregon State University, Corvallis, OR 97331, United States
| | - Claudia M Moreno
- Department of Physiology and Biophysics, University of Washington, Seattle, WA 98195, United States
| | - Neil J MacKinnon
- Department of Population Health Sciences, Augusta University, Augusta, GA 30912, United States
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Fischer KR, Traynor T, Stryckman B, Richardson J, Buchanan L, Dezman ZDW. Illicit Fentanyl Exposure Among Victims of Violence Treated at a Trauma Center. J Surg Res 2023; 283:937-944. [PMID: 36915022 DOI: 10.1016/j.jss.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/13/2022] [Accepted: 10/16/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Opioid overdoses and violent injury are leading causes of death in the United States, yet testing for novel opioids like fentanyl remains uncommon. The purpose of this investigation is to characterize a population of victims of violence who test positive for illicit fentanyl. METHODS Retrospective cohort study of patients treated at a level-one trauma center between January 31, 2019 and February 21, 2020. Data were extracted from the electronic medical record. Subjects were included if they had an encounter diagnosis for a violent or intentional injury, using the International Classification of Diseases, v10 (X92-Y09). We excluded patients who received licit fentanyl as a part of their care before testing. Those who tested positive for fentanyl exposure on our standard hospital urine drug screen were considered to have been exposed to illicit fentanyl. Those testing negative for fentanyl were considered controls. RESULTS Of the 1132 patients treated for intentional injuries during the study period, 366 were included in the study (32.3%). Of these, 133 (36.3%) subjects were exposed to illicit fentanyl prehospital. There were no demographic differences between cases and controls. Cases had a lower GCS voice score on arrival (median = 4, interquartile range [IQR] = 4-5 versus median = 5, IQR = 4-5, P = 0.02), higher rates of ventilator usage (32.3% versus 21.5%, P = 0.02), and more intensive care unit admissions (27.1% versus 12.0%, P = 0.005). More than half of cases tested negative for opiates (78/133, 58.6%). Cases had more trauma center encounters (26.3% had ≥2 visits versus 15.5%). CONCLUSIONS Exposure to illicit fentanyl was common among victims of violence in this single-center study. These patients are at increased risk of being admitted to intensive care units and repeated trauma center visits, suggesting fentanyl testing may help identify those who could benefit from violence prevention and substance abuse treatment.
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Affiliation(s)
- Kyle R Fischer
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Timothy Traynor
- University of Maryland School of Medicine, University of Maryland, Baltimore, Baltimore, Maryland
| | - Benoit Stryckman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joseph Richardson
- Department of African-American Studies and Anthropology, University of Maryland College Park, Maryland
| | | | - Zachary D W Dezman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
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King B, Holmes LM, Rishworth A, Patel R. Geographic variations in opioid overdose patterns in Pennsylvania during the COVID-19 pandemic. Health Place 2023; 79:102938. [PMID: 36549235 PMCID: PMC9765327 DOI: 10.1016/j.healthplace.2022.102938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
The convergence of the opioid epidemic and the COVID-19 pandemic has created new health challenges throughout the United States. Since the onset of the pandemic, media attention and scholarly research have drawn attention to the intersections of addiction and COVID-19. However, there remain few empirical studies that examine the direct impacts of the COVID-19 pandemic for opioid overdose patterns. Even fewer have integrated quantitative and qualitative methods to detail the place-specific dynamics shaping opioid overdose and addiction treatment during the COVID-19 pandemic. This article measures and maps change in the age-adjusted rate of opioid-related overdose incidents at the county level from 2018 to 2020. These analyses are combined with interviews conducted since December 2020 with public health providers in the state of Pennsylvania to identify the key factors influencing opioid misuse and transformations in addiction treatment practices.
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Affiliation(s)
- Brian King
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States.
| | - Louisa M. Holmes
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States
| | | | - Ruchi Patel
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States.
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James WL, Brindley C, Purser C, Topping M. Conceptualizing rurality: The impact of definitions on the rural mortality penalty. Front Public Health 2022; 10:1029196. [PMID: 36408010 PMCID: PMC9669957 DOI: 10.3389/fpubh.2022.1029196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background In the U.S., inequality is widespread and still growing at nearly every level conceivable. This is vividly illustrated in the long-standing, well-documented inequalities in outcomes between rural and urban places in the U.S.; namely, the rural mortality penalty of disproportionately higher mortality rates in these areas. But what does the concept of "rural" capture and conjure? How we explain these geographic differences has spanned modes of place measurement and definitions. We employ three county-level rural-urban definitions to (1) analyze how spatially specific and robust rural disparities in mortality are and (2) identify whether mortality outcomes are dependent on different definitions. Methods We compare place-based all-cause mortality rates using three typologies of "rural" from the literature to assess robustness of mortality rates across these rural and urban distinctions. Results show longitudinal all-cause mortality rate trends from 1968 to 2020 for various categories of urban and rural areas. We then apply this data to rural and urban geography to analyze the similarity in the distribution of spatial clusters and outliers in mortality using spatial autocorrelation methodologies. Results The rural disadvantage in mortality is remarkably consistent regardless of which rural-urban classification scheme is utilized, suggesting the overall pattern of rural disadvantage is robust to any definition. Further, the spatial association between rurality and high rates of mortality is statistically significant. Conclusion Different definitions yielding strongly similar results suggests robustness of rurality and consequential insights for actionable policy development and implementation.
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Affiliation(s)
- Wesley L. James
- Department of Sociology, Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States,*Correspondence: Wesley L. James
| | - Claire Brindley
- Department of Sociology, Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States
| | - Christopher Purser
- Department of Politics, Justice, Law, and Philosophy, University of North Alabama, Florence, AL, United States
| | - Michael Topping
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, United States
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Ruhter L, Juhascik M, Watson J, Sweeney K, Daniulaityte R. Tramadol in seized drugs containing non-pharmaceutical fentanyl: Crime lab data from Ohio, USA. EMERGING TRENDS IN DRUGS, ADDICTIONS, AND HEALTH 2022; 2:100042. [PMID: 36743966 PMCID: PMC9897305 DOI: 10.1016/j.etdah.2022.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Introduction Non-pharmaceutical fentanyl and related drugs (NPF) have contributed to increases in drug-related overdose mortality in the U.S. More data are needed to track the shifting composition of fentanyl-containing drug mixtures. The key aims of the study are to characterize the crime lab data from Montgomery County, Ohio on the increased cases of seized drugs containing mixtures of NPF and tramadol. Methods Crime lab data on seized drugs in Montgomery County, Ohio (2015 - 2020) were analyzed to extract information on cases that tested positive for NPF and tramadol. Descriptive statistics are provided to characterize NPF/tramadol mixtures in terms of the quantity, weight, form of the drug seized (powder, tablet, capsule, residue), and the types of fentanyl analogs and other drugs identified. Results In December 2017, the first case of NPF/tramadol mixture was identified in the amount of 0.2 g. Sub-sequently, cases containing NPF/tramadol increased significantly to 149 cases in 2018, 102 in 2019, and 134 in 2020. The total yearly amounts of seized NPF/tramadol mixtures increased to 373.27 g in 2018, 2,601.82 g in 2019, and 13,487.62 g in 2020. The majority (72.6%) of the cases were in powder form. There were 15 other drugs identified along with fentanyl with tramadol mixtures, including heroin (38.8%), 5.7% cocaine (5.7%), and methamphetamine (4.9%). Conclusions The addition of tramadol to NPF may be viewed as a harm mitigation strategy but contributes to the overall unpredictability of the illicit drug supply. According to Ohio legal statutes, identification of schedule IV drugs such as tramadol with fentanyl (schedule II) may provide a reduction in drug-related charges from a felony to a misdemeanor. More research is needed to characterize potential sources of tramadol in NPF-containing drugs.
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Affiliation(s)
- Lance Ruhter
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Matthew Juhascik
- Montgomery County Coroner’s Office and Miami Valley Regional Crime Lab, Dayton, Ohio
| | - Jennifer Watson
- Montgomery County Coroner’s Office and Miami Valley Regional Crime Lab, Dayton, Ohio
| | - Kaylin Sweeney
- College of Health Solutions, Arizona State University, Phoenix, Arizona
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Antoniou T, Men S, Tadrous M, Leece P, Munro C, Gomes T. Impact of a publicly funded pharmacy-dispensed naloxone program on fatal opioid overdose rates: A population-based study. Drug Alcohol Depend 2022; 236:109473. [PMID: 35523113 DOI: 10.1016/j.drugalcdep.2022.109473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Studies examining the impact of pharmacy-dispensed naloxone programs on fatal opioid overdose rates are lacking. We examined the impact of the publicly funded Ontario Naloxone Program for Pharmacies (ONPP), implemented in June 2016, on provincial rates of opioid overdose deaths. METHODS We conducted a population-based interrupted time-series study between July 1, 2012 and December 31, 2018. We considered a parsimonious model with terms for time, ONPP implementation, and time following the ONPP implementation. Models were adjusted for population characteristics, number of pharmacies and rate of naloxone distributed through non-pharmacy sites within provincial public health units. RESULTS In the parsimonious model, the ONPP was associated with a non-significant 9% reduction in the level of fatal opioid overdoses (rate ratio [RR] 0.91; 95% confidence interval [CI] 0.79-1.06), a finding that was most pronounced in regions in the lowest tertile of implementation (RR 0.75; 95% CI 0.62-0.91). Following multivariable adjustment, there was an increase in the level (RR 1.06; 95% CI 0.94-1.19) and slope change (RR 1.06; 95% CI 1.02-1.10) of fatal overdose rates. CONCLUSION The ONPP is insufficient as a single intervention to meaningfully reduce rates of fatal opioid overdoses during a period in which the cause of these deaths shifted from prescription opioids to highly potent fentanyl analogs. Access to additional harm reduction, treatment, and other interventions is necessary to prevent deaths and optimize the health of people who use drugs.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | | | - Mina Tadrous
- ICES, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | - Pamela Leece
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Kiang MV, Acosta RJ, Chen YH, Matthay EC, Tsai AC, Basu S, Glymour MM, Bibbins-Domingo K, Humphreys K, Arthur KN. Sociodemographic and geographic disparities in excess fatal drug overdoses during the COVID-19 pandemic in California: A population-based study. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100237. [PMID: 35342895 PMCID: PMC8934030 DOI: 10.1016/j.lana.2022.100237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic is co-occurring with a drug addiction and overdose crisis. Methods We fit overdispersed Poisson models, accounting for seasonality and secular trends, to estimate the excess fatal drug overdoses (i.e., deaths greater than expected), using data on all deaths in California from 2016 to 2020. Findings Between January 5, 2020 and December 26, 2020, there were 8605 fatal drug overdoses—a 44% increase over the same period one year prior. We estimated 2084 (95% CI: 1925 to 2243) fatal drug overdoses were excess deaths, representing 5·28 (4·88 to 5·68) excess fatal drug overdoses per 100,000 population. Excess fatal drug overdoses were driven by opioids (4·48 [95% CI: 4·18 to 4·77] per 100,000), especially synthetic opioids (2·85 [95% CI: 2·56 to 3·13] per 100,000). The non-Hispanic Black and Other non-Hispanic populations were disproportionately affected with 10·1 (95% CI: 7·6 to 12·5) and 13·26 (95% CI: 11·0 to 15·5) excess fatal drug overdoses per 100,000 population, respectively, compared to 5·99 (95% CI: 5.2 to 6.8) per 100,000 population in the non-Hispanic white population. There was a steep, nonlinear educational gradient with the highest rate among those with only a high school degree. There was a strong spatial patterning with the highest levels of excess mortality in the southernmost region and consistently lower levels at progressively more northern latitudes (7·73 vs 1·96 per 100,000). Interpretation Fatal drug overdoses disproportionately increased in 2020 among structurally marginalized populations and showed a strong geographic gradient. Local, tailored public health interventions are urgently needed to reduce growing inequities in overdose deaths. Funding US National Institutes of Health and Department of Veterans Affairs.
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Affiliation(s)
- Mathew V Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, Stanford, CA 94304, USA
| | - Rolando J Acosta
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Ellicott C Matthay
- Center for Health and Community, University of California, San Francisco, CA, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sanjay Basu
- Research and Development, Station Health, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Keith Humphreys
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristen N Arthur
- Substance and Addiction Prevention Branch, California Department of Public Health, Sacramento, CA, USA
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Choi JI, Lee J, Yeh AB, Lan Q, Kang H. Spatial clustering of heroin-related overdose incidents: a case study in Cincinnati, Ohio. BMC Public Health 2022; 22:1253. [PMID: 35752791 PMCID: PMC9233379 DOI: 10.1186/s12889-022-13557-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background Drug overdose is one of the top leading causes of accidental death in the U.S., largely due to the opioid epidemic. Although the opioid epidemic is a nationwide issue, it has not affected the nation uniformly. Methods We combined multiple data sources, including emergency medical service response, American Community Survey data, and health facilities datasets to analyze distributions of heroin-related overdose incidents in Cincinnati, Ohio at the census block group level. The Ripley’s K function and the local Moran’s I statistics were performed to examine geographic variation patterns in heroin-related overdose incidents within the study area. Then, conditional cluster maps were plotted to examine a relationship between heroin-related incident rates and sociodemographic characteristics of areas as well as the resources for opioid use disorder treatment. Results The global spatial analysis indicated that there was a clustered pattern of heroin-related overdose incident rates at every distance across the study area. The univariate local spatial analysis identified 7 hot spot clusters, 27 cold spot clusters, and 1 outlier cluster. Conditional cluster maps showed characteristics of neighborhoods with high heroin overdose rates, such as a higher crime rate, a high percentage of the male, a high poverty level, a lower education level, and a lower income level. The hot spots in the Southwest areas of Cincinnati had longer distances to opioid treatment programs and buprenorphine prescribing physicians than the median, while the hot spots in the South-Central areas of the city had shorter distances to those health resources. Conclusions Our study showed that the opioid epidemic disproportionately affected Cincinnati. Multi-phased spatial clustering models based on various data sources can be useful to identify areas that require more policy attention and targeted interventions to alleviate high heroin-related overdose rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13557-3.
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Affiliation(s)
- Jung Im Choi
- Data Science, Bowling Green State University, 221 Hayes Hall, Bowling Green, OH, 43403, USA
| | - Jinha Lee
- Faculty of Public and Allied Health, Bowling Green State University, 111 Health and Human Services Building, Bowling Green, OH, 43403, USA.
| | - Arthur B Yeh
- Faculty of Applied Statistics and Operations Research, Bowling Green State University, 1001 E Wooster Street, Maurer Center 241J, Bowling Green, OH, 43403, USA
| | - Qizhen Lan
- Data Science, Bowling Green State University, 221 Hayes Hall, Bowling Green, OH, 43403, USA
| | - Hyojung Kang
- Faculty of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 1206 Fourth Street, IL, 61820, Champaign, USA.
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14
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Abell-Hart K, Rashidian S, Teng D, Rosenthal RN, Wang F. Where Opioid Overdose Patients Live Far From Treatment: Geospatial Analysis of Underserved Populations in New York State. JMIR Public Health Surveill 2022; 8:e32133. [PMID: 35412467 PMCID: PMC9044159 DOI: 10.2196/32133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/08/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Opioid addiction and overdose have a large burden of disease and mortality in New York State (NYS). The medication naloxone can reverse an overdose, and buprenorphine can treat opioid use disorder. Efforts to increase the accessibility of both medications include a naloxone standing order and a waiver program for prescribing buprenorphine outside a licensed drug treatment program. However, only a slim majority of NYS pharmacies are listed as participating in the naloxone standing order, and less than 7% of prescribers in NYS have a buprenorphine waiver. Therefore, there is a significant opportunity to increase access. OBJECTIVE Identifying the geographic regions of NYS that are farthest from resources can help target interventions to improve access to naloxone and buprenorphine. To maximize the efficiency of such efforts, we also sought to determine where these underserved regions overlap with the largest numbers of actual patients who have experienced opioid overdose. METHODS We used address data to assess the spatial distribution of naloxone pharmacies and buprenorphine prescribers. Using the home addresses of patients who had an opioid overdose, we identified geographic locations of resource deficits. We report findings at the high spatial granularity of census tracts, with some neighboring census tracts merged to preserve privacy. RESULTS We identified several hot spots, where many patients live far from the nearest resource of each type. The highest density of patients in areas far from naloxone pharmacies was found in eastern Broome county. For areas far from buprenorphine prescribers, we identified subregions of Oswego county and Wayne county as having a high number of potentially underserved patients. CONCLUSIONS Although NYS is home to thousands of naloxone pharmacies and potential buprenorphine prescribers, access is not uniform. Spatial analysis revealed census tract areas that are far from resources, yet contain the residences of many patients who have experienced opioid overdose. Our findings have implications for public health decision support in NYS. Our methods for privacy can also be applied to other spatial supply-demand problems involving sensitive data.
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Affiliation(s)
- Kayley Abell-Hart
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
| | - Sina Rashidian
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Dejun Teng
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Richard N Rosenthal
- Department of Psychiatry, Stony Brook Medicine, Stony Brook, NY, United States
| | - Fusheng Wang
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
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15
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Abstract
Over the past two decades, opioid overdose deaths contributed to the dramatic rise in all-cause mortality among non-Hispanic Whites. To date, efforts among scholars to understand the role of local area labor market conditions on opioid overdose mortality have led to mixed results. We argue the reason for these disparate findings is scholars have not considered the moderating effects of income support policies such as unemployment insurance. The present study leverages two sources of variation-county mass layoffs and changes in the generosity of state unemployment insurance benefits-to investigate if unemployment benefits moderate the relationship between job loss and county opioid overdose death rates. Our difference-in-differences estimation strategy reveals that the harmful effects of job loss on opioid overdose mortality decline with increasing state unemployment insurance benefit levels. These findings suggest that social policy in the form of income transfers played a crucial role in disrupting the link between job loss and opioid overdose mortality.
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Affiliation(s)
- Pinghui Wu
- The Federal Reserve Bank of Boston, Boston, MA, USA
| | - Michael Evangelist
- Department of Sociology, School of Social Work, and Poverty Solutions, University of Michigan, Ann Arbor, MI, USA
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16
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Ory MG, Lee S, Smith ML, Alonzo JP, Clark HR, Burdine JN. Differences in the attitudes towards the opioid crisis between metropolitan and rural counties in Central Texas: Secondary data analysis using cross-sectional data. Prev Med Rep 2022; 26:101757. [PMID: 35310324 PMCID: PMC8931431 DOI: 10.1016/j.pmedr.2022.101757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022] Open
Abstract
Poorer access to opioid use disorder care reported in rural than in urban areas. Less supports for syringe exchange programs in rural than in urban areas. Important to tailor efforts to address opioid use disorder in rural and urban areas.
This study examined metropolitan and rural differences regarding concerns about opioid misuse and support for different strategies to reduce opioid use disorder risk in areas not designated as high-risk. This study used cross-sectional data from a regional community health assessment, which was collected in 2019 using a combination of stratified random sampling and clinic-based purposive sampling in Central Texas. The secondary data included 430 and 270 respondents from metropolitan and rural (not metropolitan) counties, respectively. The primary outcomes were perceived concern about the opioid crisis, perceived likelihood of getting addiction treatment, and support for strategies to reduce opioid use disorder risks. Multiple multivariable regression models were used to examine metropolitan and rural differences in the outcome variables after adjusting for age, sex, ethnicity, race, marital status, education, and household income. Respondents were about 58 years old on average. A majority were female (60%), non-Hispanic (88%), and White (83%). About 60% of rural and metropolitan respondents were concerned about opioid use and misuse in their community. After adjusting for respondents’ demographic characteristics, rural respondents were significantly less likely to perceive that individuals are getting the needed opioid use disorder treatment (aOR = 0.69, P = 0.031). Rural respondents were also significantly less supportive for legalizing syringe service programs in their communities (aOR = 0.71, P = 0.044) than metropolitan respondents. Differing attitudes by respondents from metropolitan and rural areas indicate the importance of tailoring prevention and mitigation efforts to address opioid use disorder in advance of an impending public health crisis.
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Affiliation(s)
- Marcia G Ory
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Shinduk Lee
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA.,College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Joy P Alonzo
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, College Station, TX, USA
| | - Heather R Clark
- Office of Public Health Practice, School of Public Health, Texas A&M University, College Station, TX, USA.,Center for Community Health Development, School of Public Health, Texas A&M University, College Station, TX, USA
| | - James N Burdine
- Center for Community Health Development, School of Public Health, Texas A&M University, College Station, TX, USA.,Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
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17
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Harper S, Riddell CA, King NB. Declining Life Expectancy in the United States: Missing the Trees for the Forest. Annu Rev Public Health 2021; 42:381-403. [PMID: 33326297 DOI: 10.1146/annurev-publhealth-082619-104231] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In recent years, life expectancy in the United States has stagnated, followed by three consecutive years of decline. The decline is small in absolute terms but is unprecedented and has generated considerable research interest and theorizing about potential causes. Recent trends show that the decline has affected nearly all race/ethnic and gender groups, and the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer's disease. A slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from improving further. Although a popular explanation for the decline is the cumulative decline in living standards across generations, recent trends suggest that distinct mechanisms for specific causes of death are more plausible explanations. Interventions to stem the increase in overdose deaths, reduce access to mechanisms that contribute to violent deaths, and decrease cardiovascular risk over the life course are urgently needed to improve mortality in the United States.
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Affiliation(s)
- Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec H3A 1A2, Canada; , .,Institute for Health and Social Policy, McGill University, Montreal, Quebec H3A 1A2, Canada.,Department of Public Health, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Corinne A Riddell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California 94720, USA;
| | - Nicholas B King
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec H3A 1A2, Canada; , .,Institute for Health and Social Policy, McGill University, Montreal, Quebec H3A 1A2, Canada.,Biomedical Ethics Unit, McGill University, Montreal, Quebec H3A 1X1, Canada
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18
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Alsabbagh MW, Chang F, Cooke M, Elliott SJ, Chen M. National trends in population rates of opioid-related mortality, hospitalization and emergency department visits in Canada between 2000 and 2017. A population-based study. Addiction 2021; 116:3482-3493. [PMID: 34170044 DOI: 10.1111/add.15571] [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: 10/27/2020] [Revised: 01/26/2021] [Accepted: 05/05/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Existing assessments of the time-trends of opioid-related mortality, hospitalization and emergency department visits in Canada have relied mainly on provincial databases, while national assessments generally do not provide information before 2016. We aimed to estimate Canadian national time trends in opioid-related mortality from 2000 to 2017 and opioid-related hospitalization and emergency department visits between 2000 and 2012. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Residents of all Canadian provinces and territories for which comparable data were available from 2000 to 2017. MEASUREMENTS We identified opioid-related mortality, hospitalization and emergency department visits using validated algorithms using ICD codes from administrative databases. We calculated crude rates and sex- and age-adjusted rates per million. For hospitalizations, we calculated case-fatality, 90-day and 365-day all-cause mortality and opioid-related re-hospitalization rates. We used Poisson regression to examine the significance of the time trend. FINDINGS From 2000 to 2017, the adjusted opioid mortality rate in Canada (outside Quebec) increased significantly by 592.9% (from 20.0 opioid deaths per million in 2000 to 118.3 in 2017). The highest year-to-year increases were from 2015 to 2016 (31.8%) and from 2016 to 2017 (52.2%). The adjusted hospitalizations doubled significantly during the study period (an increase of 103.7%, from 159.7 opioid hospitalizations per million Canadians in 2000 to 325.3 in 2012). The adjusted rate of emergency department visits increased significantly by 188.7% (from 280.6 per million in 2000 to 810.1 in 2012). Case-fatality was 2.3% overall and was mainly constant during the study period. Both 90- and 365-day all-cause mortality increased significantly between 2000 and 2011 (from 1.7 to 3.1% and 3.9 to 7.4%, respectively), while re-hospitalization for opioid-related diagnoses was reduced (from 7.8 to 6.4% and 14.2 to 12.9%, respectively). CONCLUSIONS Opioid-related mortality, hospitalization and emergency department visits in Canada have been increasing gradually since 2000.
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Affiliation(s)
- Mhd Wasem Alsabbagh
- Faculty of Science, School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Feng Chang
- Faculty of Science, School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Martin Cooke
- Faculty of Applied Health Sciences, School of Public Health, University of Waterloo, Waterloo, ON, Canada.,Faculty of Science, School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Susan J Elliott
- Faculty of Science, Geography and Environmental Studies, University of Waterloo, Waterloo, ON, Canada
| | - Meixi Chen
- Faculty of Mathematics, Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
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19
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Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan. Healthcare (Basel) 2021; 9:healthcare9111402. [PMID: 34828449 PMCID: PMC8625753 DOI: 10.3390/healthcare9111402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022] Open
Abstract
(1) Background: The prevalence of opioid use in Taiwan increased by 41% between 2002 and 2014. However, little is known regarding the risk of mortality among long-term opioid analgesics users who do not have cancer. This study investigated this mortality risk with an emphasis on the calendar year and patients’ age and sex. (2) Methods: This retrospective cohort study included 12,990 adult individuals without cancer who were long-term users of opioid analgesics and were randomly selected from the data set of Taiwan’s National Health Insurance program from 2000 to 2012. They were then followed up through 2013. Information on the underlying causes of death was retrieved from the Taiwan Death Registry. Age, sex, and calendar year-standardized mortality ratios (SMRs) of all-cause and cause-specific mortality were calculated with reference to those of the general population. (3) Results: With up to 14 years of follow-up, 558 individuals had all-cause mortality in 48,020 person-years (cumulative mortality: 4.3%, mortality rate: 11.62 per 1000 person-years). Compared with the general population, the all-cause SMR of 4.30 (95% confidence interval (95% CI): 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural (5.04, 95% CI: 3.88–6.45) causes. (4) Conclusions: Long-term opioid analgesics use among individuals without cancer in Taiwan was associated with a significantly increased risk of mortality. The notably increased mortality in younger adults warrants attention. Strategies to reduce long-term opioid analgesics use, especially their overuse or misuse, are in an urgent need.
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20
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Singh B, Rao R. PerspectivesIs there an opioid epidemic in India? J Public Health (Oxf) 2021; 43:ii43-ii50. [PMID: 34622293 DOI: 10.1093/pubmed/fdab322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bhrigupati Singh
- Department of Anthropology and Sociology, Ashoka University, Rajiv Gandhi Education City, Sonipat, Haryana 131029, India.,Psychiatry, Carney Institute for Brain Sciences, Brown University, 164 Angell Street, 4th Floor, Providence, RI 02906, USA
| | - Ravindra Rao
- Additional Professor, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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21
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Lay knowledge and practices of methamphetamine use to manage opioid-related overdose risks. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103463. [PMID: 34619443 DOI: 10.1016/j.drugpo.2021.103463] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 12/21/2022]
Abstract
AIM Methamphetamine use has increased among individuals with opioid use disorder. The key aims of this study are to detail and contextualise lay knowledge, attitudes, and behaviours related to methamphetamine use in relation to opioid overdose risks in an area dominated by non-pharmaceutical fentanyl-type drugs (NPF). METHODS The study recruited 41 individuals in Dayton, Ohio, who reported past 30-day use of methamphetamine and heroin/fentanyl. Interviews included structured and qualitative questions. Urine toxicology analysis was conducted to identify NPFs and other drugs. Open-ended interview sections were audio-recorded, transcribed, and analysed qualitatively using NVivo. RESULTS The mean age was 38.3 years, 51% were female, and 100% non-Hispanic white. Participants described an exceedingly unpredictable local opioid market that became saturated with NPFs. The sample tested positive for 10 NPFs, including fentanyl (100%), acetyl fentanyl (61%), tetrahydrofuran fentanyl (29%), and carfentanil (12%). Most participants believed that methamphetamine could help prevent and/or reverse an opioid-related overdose. Nearly half had personally used it to help manage overdose risks related to NPF. These beliefs were embedded in a lay understanding of how methamphetamine works to stimulate the cardiovascular system. They were acted upon in the context of last resort situations that were determined by a lack of immediate access to naloxone, ambiguities surrounding overdose symptomatology, and easy access to plentiful and inexpensive methamphetamine. CONCLUSION Lay efforts to rely on methamphetamine to manage NPF-related overdose risks highlight the need for a continuing expansion of take-home-naloxone programs and implementation of other novel harm reduction approaches in communities affected by NPFs.
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Marks C, Abramovitz D, Donnelly CA, Carrasco-Escobar G, Carrasco-Hernández R, Ciccarone D, González-Izquierdo A, Martin NK, Strathdee SA, Smith DM, Bórquez A. Identifying counties at risk of high overdose mortality burden during the emerging fentanyl epidemic in the USA: a predictive statistical modelling study. Lancet Public Health 2021; 6:e720-e728. [PMID: 34118194 PMCID: PMC8565591 DOI: 10.1016/s2468-2667(21)00080-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The emergence of fentanyl around 2013 represented a new, deadly stage of the opioid epidemic in the USA. We aimed to develop a statistical regression approach to identify counties at the highest risk of high overdose mortality in the subsequent years by predicting annual county-level overdose death rates across the contiguous USA and to validate our approach against observed overdose mortality data collected between 2013 and 2018. METHODS We fit mixed-effects negative binomial regression models to predict overdose death rates in the subsequent year for 2013-18 for all contiguous state counties in the USA (ie, excluding Alaska and Hawaii). We used publicly available county-level data related to health-care access, drug markets, socio-demographics, and the geographical spread of opioid overdose as model predictors. The crude number of county-level overdose deaths was extracted from restricted US Centers for Disease Control and Prevention mortality records. To predict county-level overdose rates for the year 201X: (1) a model was trained on county-level predictor data for the years 2010-201(X-2) paired with county-level overdose deaths for the year 2011-201(X-1); (2) county-level predictor data for the year 201(X-1) was fed into the model to predict the 201X county-level crude number of overdose deaths; and (3) the latter were converted to a population-adjusted rate. For comparison, we generated a benchmark set of predictions by applying the observed slope of change in overdose death rates in the previous year to 201(X-1) rates. To assess the predictive performance of the model, we compared predicted values (of both the model and benchmark) to observed values by (1) calculating the mean average error, root mean squared error, and Spearman's correlation coefficient and (2) assessing the proportion of counties in the top decile (10%) of overdose death rates that were correctly predicted as such. Finally, in a post-hoc analysis, we sought to identify variables with greatest predictive utility. FINDINGS Between 2013 and 2018, among the 3106 US counties included, our modelling approach outperformed the benchmark strategy across all metrics. The observed average county-level overdose death rate rose from 11·8 per 100 000 people in 2013 to 15·4 in 2017 before falling to 14·6 in 2018. Our negative binomal modelling approach similarly identified an increasing trend, predicting an average 11·8 deaths per 100 000 in 2013, up to 15·1 in 2017, and increasing further to 16·4 in 2018. The benchmark model over-predicted average death rates each year, ranging from 13·0 per 100 000 in 2013 to 18·3 in 2018. Our modelling approach successfully ranked counties by overdose death rate identifying between 42% and 57% of counties in the top decile of overdose mortality (compared with 29% and 43% using the benchmark) each year and identified 194 of the 808 counties with emergent overdose outbreaks (ie, newly entered the top decile) across the study period, versus 31 using the benchmark. In the post-hoc analysis, we identified geospatial proximity of overdose in nearby counties, opioid prescription rate, presence of an urgent care facility, and several economic indicators as the variables with the greatest predictive utility. INTERPRETATION Our model shows that a regression approach can effectively predict county-level overdose death rates and serve as a risk assessment tool to identify future high mortality counties throughout an emerging drug use epidemic. FUNDING National Institute on Drug Abuse.
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Affiliation(s)
- Charles Marks
- Interdisciplinary Research on Substance Use Joint Doctoral Program, San Diego State University and University of California, San Diego, CA, USA.
| | | | - Christl A Donnelly
- Department of Statistics, University of Oxford, Oxford, UK; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Gabriel Carrasco-Escobar
- Department of Medicine, University of California, San Diego, CA, USA; Health Innovation Lab, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Daniel Ciccarone
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | | | - Natasha K Martin
- Department of Medicine, University of California, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Davey M Smith
- Department of Medicine, University of California, San Diego, CA, USA
| | - Annick Bórquez
- Department of Medicine, University of California, San Diego, CA, USA
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Kiang MV, Tsai AC, Alexander MJ, Rehkopf DH, Basu S. Racial/Ethnic Disparities in Opioid-Related Mortality in the USA, 1999-2019: the Extreme Case of Washington DC. J Urban Health 2021; 98:589-595. [PMID: 34664185 PMCID: PMC8566633 DOI: 10.1007/s11524-021-00573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
In 2019, there were nearly 50,000 opioid-related deaths in the US, with substantial variation across sociodemographic groups and geography. To systematically investigate patterns of racial/ethnic inequities in opioid-related mortality, we used joinpoint regression models to estimate the trajectory of the opioid epidemic among non-Hispanic Black versus non-Hispanic white residents in Washington DC, 45 states, and 81 sub-state areas. We highlight the unique inequities observed in Washington DC. In 2019, the observed opioid-related mortality rate among Black DC residents was 11.3 times higher than white DC residents, resulting in 56.0 more deaths per 100,000 (61.5 vs. 5.5 per 100,000). This inequity was substantially higher than any other jurisdiction on both the relative and absolute scales. Most opioid-related deaths in DC involved synthetic opioids, which was present in 92% (N=198) of deaths among Black DC residents and 69% (N=11) of deaths among white DC residents. Localized, equitable, culturally-appropriate, targeted interventions are necessary to reduce the uniquely disproportionate burden of opioid-related mortality among Black DC residents.
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Affiliation(s)
- Mathew V Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
- Harvard FXB Center for Health and Human Rights, Boston, MA, USA.
- Center for Population Health Sciences, Stanford University, 1701 Page Mill Road, CA, 94304, Palo Alto, USA.
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Monica J Alexander
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Sociology, University of Toronto, Toronto, ON, Canada
| | - David H Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanjay Basu
- Institute of Health Policy, Management, and Evaluation, University of Toronto, ON, Toronto, Canada
- School of Public Health, Imperial College, London, UK
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
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24
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Abstract
This paper is the forty-second consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2019 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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25
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Bresnahan BW, Jarvik JG, Meier EN, James KT, Gold LS, Rundell SD, Turner JA, Suri P, Luetmer PH, Friedly JL, Sherman KJ, Heagerty PJ, Kallmes DF, Avins AL, Griffith BD, Kessler LG. Expected Organizational Costs for Inserting Prevalence Information Into Lumbar Spine Imaging Reports. J Am Coll Radiol 2021; 18:1415-1422. [PMID: 34216559 DOI: 10.1016/j.jacr.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Modifying physician behavior to more closely align with guideline-based care can be challenging. Few effective strategies resulting in appropriate spine-related health care have been reported. The Lumbar Imaging With Reporting of Epidemiology (LIRE) intervention did not result in reductions in spine care but did in opioid prescriptions written. OBJECTIVES To estimate organizational resource needs and costs associated with implementing a pragmatic, decision support-type intervention that inserted age- and modality-matched prevalence information for common lumbar spine imaging findings, using site-based resource use data from the LIRE trial. RESEARCH DESIGN Time and cost estimation associated with implementing the LIRE intervention in a health organization. SUBJECTS Providers and patients assessed in the LIRE trial. MEASURES Expected personnel costs required to implement the LIRE intervention. RESULTS Annual salaries were converted to daily average per person costs, ranging from $400 to $2,200 per day (base case) for personnel (range: $300-$2,600). Estimated total average cost for implementing LIRE was $5,009 (range: $2,651-$12,020), including conducting pilot testing with providers. Costs associated with a small amount of time for a radiologist (6-12 hours) and imaging-ordering providers (1-8 hours each) account for approximately 75% of the estimated total cost. CONCLUSIONS The process of implementing an intervention for lumbar spine imaging reports containing age- and modality-appropriate epidemiological benchmarks for common imaging findings required radiologists, imaging-ordering providers, information technology specialists, and limited testing and monitoring. The LIRE intervention seems to be a relatively low-cost, evidence-based, complementary tool that can be easily integrated into the reporting of spine imaging.
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Affiliation(s)
- Brian W Bresnahan
- Department of Radiology, University of Washington, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington.
| | - Jeffrey G Jarvik
- Department of Radiology, University of Washington, Seattle, Washington; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Eric N Meier
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kathryn T James
- Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Laura S Gold
- Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Sean D Rundell
- Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Judith A Turner
- Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Pradeep Suri
- Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | | | - Janna L Friedly
- Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | | | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | - Andrew L Avins
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Brent D Griffith
- Diagnostic Radiology, Henry Ford Hospital, Henry Ford Health System, Detroit, Michigan
| | - Larry G Kessler
- Department of Health Services, University of Washington, Seattle, Washington
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26
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Furst JA, Mynarski NJ, McCall KL, Piper BJ. Pronounced Regional Disparities in United States Methadone Distribution. Ann Pharmacother 2021; 56:271-279. [PMID: 34184584 DOI: 10.1177/10600280211028262] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Methadone is an evidence-based treatment for opioid use disorder (OUD) and pain management. Methadone for OUD may be difficult for some patients to access, particularly those in rural areas. OBJECTIVE The purpose of this study was to characterize methadone distribution patterns between 2017 and 2019 across the United States. METHODS The US Drug Enforcement Administration's Automated Reports and Consolidated Ordering System was used to acquire the number of opioid treatment programs (OTPs) per state and methadone distribution weight in grams. Methadone distributions by weight, corrected for state population and number of OTPs, were compared from 2017 to 2019 between states, within regions, and nationally. RESULTS The national distribution of methadone increased +12.3% for OTPs but decreased -34.6% for pain. Whereas all states saw a decrease in pain distribution, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for OTPs, and most states demonstrated a relatively stable or increasing number of OTPs, with an +11.5% increase nationally. The number of OTPs per 100K state population ranged from 2.1 in Rhode Island to 0.0 in Wyoming. CONCLUSION AND RELEVANCE Although methadone distribution for OUD was increasing in the United States, the pronounced regional disparities identified warrant further consideration to improve patient access to this evidence-based pharmacotherapy, particularly in the Midwest and West regions. Greater implementation of telehealth and involvement of primary care into opioid treatment practice offer possible solutions to eliminating geographical treatment barriers.
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Affiliation(s)
- John A Furst
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | | | - Brian J Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA.,Center for Pharmacy Innovation and Outcomes, Forty Fort, PA, USA
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27
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Hernández A, Lan M, MacKinnon NJ, Branscum AJ, Cuadros DF. "Know your epidemic, know your response": Epidemiological assessment of the substance use disorder crisis in the United States. PLoS One 2021; 16:e0251502. [PMID: 34038441 PMCID: PMC8153501 DOI: 10.1371/journal.pone.0251502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/27/2021] [Indexed: 02/02/2023] Open
Abstract
The United States (U.S.) is currently experiencing a substance use disorders (SUD) crisis with an unprecedented magnitude. The objective of this study was to recognize and characterize the most vulnerable populations at high risk of SUD mortality in the U.S., and to identify the locations where these vulnerable population are located. We obtained the most recent available mortality data for the U.S. population aged 15-84 (2005-2017) from the Centers for Diseases and Prevention (CDC). Our analysis focused on the unintentional substance poisoning to estimate SUD mortality. We computed health-related comorbidities and socioeconomic association with the SUD distribution. We identified the most affected populations and conducted a geographical clustering analysis to identify places with increased concentration of SUD related deaths. From 2005-2017, 463,717 SUD-related deaths occurred in the United States. White population was identified with the highest SUD death proportions. However, there was a surge of the SUD epidemic in the Black male population, with a sharp increase in the SUD-related death rate since 2014. We also found that an additional average day of mental distress might increase the relative risk of SUD-related mortality by 39%. The geographical distribution of the epidemic showed clustering in the West and Mid-west regions of the U.S. In conclusion, we found that the SUD epidemic in the U.S. is characterized by the emergence of several micro-epidemics of different intensities across demographic groups and locations within the country. The comprehensive description of the epidemic presented in this study could assist in the design and implementation of targeted policy interventions for addiction mitigation campaigns.
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Affiliation(s)
- Andrés Hernández
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, Ohio, United States of America
- Department of Geography and GIS, University of Cincinnati, Cincinnati, Ohio, United States of America
- Department of Geo-information Processing, Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, The Netherlands
| | - Minxuan Lan
- Department of Geography and GIS, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Neil J. MacKinnon
- Department of Population Health Sciences, Medical College of Georgia, Augusta, Georgia, United States of America
- Geospatial Health Advising Group, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Adam J. Branscum
- Department of Biostatistics, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, United States of America
| | - Diego F. Cuadros
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, Ohio, United States of America
- Department of Geography and GIS, University of Cincinnati, Cincinnati, Ohio, United States of America
- Geospatial Health Advising Group, University of Cincinnati, Cincinnati, Ohio, United States of America
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28
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Darlington F, Acha BM, Roshan T, Ikeanyionwu C, Kutse S, Abajue U, Osazuwa B, Gomez I, Spooner KK, Salemi JL, Dongarwar D, Olaleye OA, Salihu HM, Ndefo UA. Opioid-Related Disorders Among Pregnant Women with Sickle Cell Disease and Adverse Pregnancy Outcomes. PAIN MEDICINE 2021; 21:3087-3093. [PMID: 32710119 DOI: 10.1093/pm/pnaa188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Opioid use during pregnancy has increased in recent years, parallel with the opioid epidemic in the general population. Opioids are commonly used as an analgesic for pain crisis, a hallmark symptom of sickle cell disease (SCD). With the amplified frequency and severity of SCD pain crisis during pregnancy, the use of opioids may increase concurrently. The aim of this study was to examine trends in opioid-related disorders (ORDs) among pregnant women with and without SCD, as well as assess the risk for preterm labor, maternal sepsis, and poor fetal growth among patients with SCD and ORD. METHODS We conducted a retrospective analysis of inpatient pregnancy- and childbirth-related hospital discharge data from the 2002-2014 National (Nationwide) Inpatient Sample database. The primary outcome was the risk of ORD in pregnant women with SCD and its impact on threatened preterm labor, fetal growth, and maternal sepsis. RESULTS Among the >57 million pregnancy-related hospitalizations examined, 9.6 per 10,000 had SCD. ORD in mothers with SCD was four times as prevalent as in those without SCD (2% vs 0.5%). A significant rise in ORD occurred throughout the study period and was associated with an increased risk of maternal sepsis, threatened preterm labor, and poor fetal growth. CONCLUSIONS Pregnant women with SCD have a fourfold increased risk of ORD compared with their non-SCD counterparts. The current opioid epidemic continues to worsen in both groups, warranting a tailored and effective public health response to reduce the resulting adverse pregnancy outcomes.
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Affiliation(s)
- Francis Darlington
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Benjamina Mbah Acha
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Tasha Roshan
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Charles Ikeanyionwu
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Seun Kutse
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Uzoamaka Abajue
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Billy Osazuwa
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Ian Gomez
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Kiara K Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas, USA
| | - Omonike A Olaleye
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.,Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas, USA
| | - Uche Anadu Ndefo
- Department of Pharmaceutical and Environmental Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
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29
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Romman AN, Hsu CM, Chou LN, Kuo YF, Przkora R, Gupta RK, Lozada MJ. Opioid Prescribing to Medicare Part D Enrollees, 2013-2017: Shifting Responsibility to Pain Management Providers. PAIN MEDICINE 2021; 21:1400-1407. [PMID: 31904839 DOI: 10.1093/pm/pnz344] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine opioid prescribing frequency and trends to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type. METHODS We conducted a retrospective, cross-sectional, specialty- and provider-level analysis of Medicare Part D prescriber data for opioid claims from 2013 to 2017. We analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims. RESULTS From 2013 to 2017, pain management providers increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017; physical medicine and rehabilitation providers increased opioid claims 16.9% to 511 mean claims per provider in 2017. Every other medical specialty decreased opioid claims over this period, with emergency medicine (-19.9%) and orthopedic surgery (-16.0%) dropping opioid claims more than any specialty. Physicians overall decreased opioid claims per provider by -5.2%. Meanwhile, opioid claims among both dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period. CONCLUSIONS From 2013 to 2017, pain management and PMR increased opioid claims to Medicare Part D enrollees, whereas physicians in every other specialty decreased opioid prescribing. Dentists and nonphysician providers also increased opioid prescribing. Overall, opioid claims to Medicare Part D enrollees decreased and continue to drop at faster rates.
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Affiliation(s)
- Adam N Romman
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Connie M Hsu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lin-Na Chou
- Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Rene Przkora
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Rajnish K Gupta
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - M James Lozada
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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30
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Cerdá M, Krawczyk N, Hamilton L, Rudolph KE, Friedman SR, Keyes KM. A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic. Annu Rev Public Health 2021; 42:95-114. [PMID: 33256535 PMCID: PMC8675278 DOI: 10.1146/annurev-publhealth-090419-102727] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
More than 750,000 people in the United States died from an overdose between 1999 and 2018; two-thirds of those deaths involved an opioid. In this review, we present trends in opioid overdose rates during this period and discuss how the proliferation of opioid prescribing to treat chronic pain, changes in the heroin and illegally manufactured opioid synthetics markets, and social factors, including deindustrialization and concentrated poverty, contributed to the rise of the overdose epidemic. We also examine how current policies implemented to address the overdose epidemic may have contributed to reducing prescription opioid overdoses but increased overdoses involving illegal opioids. Finally, we identify new directions for research to understand the causes and solutions to this critical public health problem, including research on heterogeneous policy effects across social groups, effective approaches to reduce overdoses of illegal opioids, and the role of social contexts in shaping policy implementation and impact.
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Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA; , , ,
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA; , , ,
| | - Leah Hamilton
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA; , , ,
| | - Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10027, USA; ,
| | - Samuel R Friedman
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA; , , ,
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10027, USA; ,
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31
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Thrul J, Reboussin BA, Rabinowitz JA, Maher BS, Ialongo NS. Alcohol trajectories and subsequent risk for opioid misuse in a cohort of urban adolescents. Subst Abus 2021; 42:873-879. [PMID: 33759726 PMCID: PMC8460686 DOI: 10.1080/08897077.2021.1890675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: The opioid epidemic is a public health emergency in the US. Alcohol is the most widely used addictive substance among all age groups; however, the contribution of different alcohol use trajectories throughout adolescence and young adulthood to the development of opioid misuse in young adulthood among urban minority youth has not been investigated. Methods: Data are from a study of 580 youth (85% African American, 67% low SES) residing in Baltimore City followed from ages 6-26. Alcohol trajectories were identified between ages 14 and 26 using group-based trajectory modeling. Opioid misuse was defined as using opioid painkillers without a prescription or using heroin between ages 19 and 26. Opioid misuse outcomes were also investigated separately. Logistic regression examined associations of alcohol trajectories with opioid misuse in young adulthood adjusting for socio-demographics, early use of tobacco and cannabis, neighborhood, and peer factors. Results: Six alcohol use trajectories were identified: Young adult increasing (21.4%), adult increasing (19.1%), abstaining (19.1%), experimenting (15.3%), adolescent increasing (14.8%), and adolescent limited (10.2%). In models fully adjusted for covariates, relative to the abstaining trajectory, the adolescent increasing trajectory was associated with an elevated risk of opioid misuse (aOR = 3.3, 95%CI = 1.4, 7.8) and prescription opioid misuse (aOR = 3.9, 95%CI = 1.4, 10.8) in young adulthood. Conclusions: Escalating alcohol use in adolescence and young adulthood is associated with an elevated risk of opioid misuse in young adulthood in a cohort of predominantly African American and socio-economically disadvantaged young people. Tailored interventions should target high levels of alcohol use during these developmental periods to reduce risk for opioid misuse among disadvantaged youth.
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Affiliation(s)
- Johannes Thrul
- department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Balitmore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, NC, USA
| | - Jill A. Rabinowitz
- department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brion S. Maher
- department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S. Ialongo
- department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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32
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Social vulnerability in persons with chronic hepatitis C virus infection is associated with a higher risk of prescription opioid use. Sci Rep 2021; 11:5883. [PMID: 33723313 PMCID: PMC7961056 DOI: 10.1038/s41598-021-85283-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/15/2021] [Indexed: 01/20/2023] Open
Abstract
Prescription opioid use (POU) is often a precursor to opioid use disorder (OUD) and subsequent consequences. Persons with chronic hepatitis C virus infection (CHC) may be at a higher risk of POU due to a higher comorbidity burden and social vulnerability factors. We sought to determine the burden of POU and associated risk factors among persons with CHC in the context of social vulnerability. We identified CHC persons and propensity-score matched HCV− controls in the electronically retrieved Cohort of HCV-Infected Veterans and determined the frequency of acute, episodic long-term and chronic long-term POU and the prevalence of social vulnerability factors among persons with POU. We used logistic regression analysis to determine factors associated with POU. Among 160,856 CHC and 160,856 propensity-score matched HCV-controls, acute POU was recorded in 38.4% and 38.0% (P = 0.01) respectively. Episodic long-term POU was recorded in 3.9% in each group (P = 0.5), while chronic long-term POU was recorded in 28.4% and 19.2% (P < 0.0001). CHC was associated with a higher risk of chronic long-term POU (OR 1.66, 95%CI 1.63, 1.69), but not with acute or episodic long-term POU. Black race, female sex and homelessness were associated with a higher risk of chronic long-term POU. Presence of ≥ 1 factor was associated with a higher risk of all POU patterns. Persons with CHC have more social vulnerability factors and a higher risk of chronic long-term POU. Presence of ≥ 1 social vulnerability factor is associated with a higher risk of POU. Downstream consequences of POU need further study.
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33
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Singh B. Can a Neighborhood Fall Sick? Opioid Addiction, Collective Violence and Currents of Death in Contemporary India. Med Anthropol Q 2021; 35:159-189. [PMID: 33715229 DOI: 10.1111/maq.12629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
Opioid abuse is an increasingly global phenomenon. Rather than assuming it to be a uniformly global or neoliberal pathology, how might we better understand comparative and locally specific dimensions of opioid addiction? Working with neighborhoods as a unit of analysis, this article analyzes the striking differences between patterns of addiction and violence in two proximate and seemingly similar urban poor neighborhoods in Delhi, India. Rather than global or national etiologies, I suggest that an attention to sharp ecological variation within epidemics challenges social scientists to offer more fine-grained diagnostics. Using a combination of quantitative and ethnographic methods, I show how heroin addiction and collective violence might be understood as expressions of what Durkheim called "suicido-genetic currents." I suggest the idea of varying currents as an alternative to the sociology of neighborhood "effects" in understanding significant differences in patterns of self-harm and injury across demographically similar localities.
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Affiliation(s)
- Bhrigupati Singh
- Department of Anthropology & Sociology Ashoka University (India).,Carney Institute Department of Psychiatry, Brown University
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34
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Chen X, Hou W, Rashidian S, Wang Y, Zhao X, Leibowitz GS, Rosenthal RN, Saltz M, Saltz JH, Schoenfeld ER, Wang F. A large-scale retrospective study of opioid poisoning in New York State with implications for targeted interventions. Sci Rep 2021; 11:5152. [PMID: 33664282 PMCID: PMC7933431 DOI: 10.1038/s41598-021-84148-2] [Citation(s) in RCA: 3] [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: 09/17/2020] [Accepted: 02/12/2021] [Indexed: 01/11/2023] Open
Abstract
Opioid overdose related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP). To discover trends and patterns of opioid poisoning and the demographic and regional disparities, we analyzed large scale patient visits data in New York State (NYS). Demographic, spatial, temporal and correlation analyses were performed for all OP patients extracted from the claims data in the New York Statewide Planning and Research Cooperative System (SPARCS) from 2010 to 2016, along with Decennial US Census and American Community Survey zip code level data. 58,481 patients with at least one OP diagnosis and a valid NYS zip code address were included. Main outcome and measures include OP patient counts and rates per 100,000 population, patient level factors (gender, age, race and ethnicity, residential zip code), and zip code level social demographic factors. The results showed that the OP rate increased by 364.6%, and by 741.5% for the age group > 65 years. There were wide disparities among groups by race and ethnicity on rates and age distributions of OP. Heroin and non-heroin based OP rates demonstrated distinct temporal trends as well as major geospatial variation. The findings highlighted strong demographic disparity of OP patients, evolving patterns and substantial geospatial variation.
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Affiliation(s)
- Xin Chen
- Department of Biomedical Informatics, Stony Brook University, 2313D Computer Science, Stony Brook, NY, 11794-8330, USA
| | - Wei Hou
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Sina Rashidian
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - Yu Wang
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - Xia Zhao
- School of Health Technology and Management, Stony Brook University, Stony Brook, NY, USA
| | | | - Richard N Rosenthal
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mary Saltz
- Department of Biomedical Informatics, Stony Brook University, 2313D Computer Science, Stony Brook, NY, 11794-8330, USA
- Department of Radiology, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Joel H Saltz
- Department of Biomedical Informatics, Stony Brook University, 2313D Computer Science, Stony Brook, NY, 11794-8330, USA
| | - Elinor Randi Schoenfeld
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Fusheng Wang
- Department of Biomedical Informatics, Stony Brook University, 2313D Computer Science, Stony Brook, NY, 11794-8330, USA.
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA.
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Thrul J, Rabinowitz JA, Reboussin BA, Maher BS, Ialongo NS. Adolescent cannabis and tobacco use are associated with opioid use in young adulthood-12-year longitudinal study in an urban cohort. Addiction 2021; 116:643-650. [PMID: 32692425 PMCID: PMC7855765 DOI: 10.1111/add.15183] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/08/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Cannabis, tobacco and alcohol use are prevalent among youth in the United States and may be risk factors for opioid use. The current study aimed at investigating associations between developmental trajectories of cannabis, tobacco and alcohol use in adolescence and opioid use in young adulthood in an urban cohort over the span of 12 years. DESIGN Cohort study of adolescents originally recruited for a randomized prevention trial with yearly assessments into young adulthood. SETTING Nine urban elementary schools in Baltimore, MD in the United States. PARTICIPANTS Participants (n = 583, 86.8% African American, 54.7% male) were originally recruited as first grade students. MEASUREMENTS Cannabis, tobacco and alcohol use were assessed annually from ages 14-18 years and opioid use from ages 19-26. Socio-demographics were assessed at age 6. Intervention status was also randomly assigned at age 6. Gender, race, free/reduced-priced lunch and intervention status were included as covariates in individual and sequential growth models. FINDINGS There were significant positive associations between the cannabis use intercept at age 14 and the opioid use intercept at age 19 (beta = 1.43; P = 0.028), the tobacco use intercept at age 14 and the opioid use intercept at age 19 (beta = 0.82; P = 0.042). Specifically, more frequent use of cannabis or tobacco at age 14 was associated with more frequent use of opioids at age 19. CONCLUSIONS Cannabis and tobacco use in early adolescence may be risk factors for opioid use in young adulthood among African Americans living in urban areas.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Heath, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill A. Rabinowitz
- Department of Mental Heath, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC,, USA
| | - Brion S. Maher
- Department of Mental Heath, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S. Ialongo
- Department of Mental Heath, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Neonatal Opioid Withdrawal Syndrome (NOWS): A Transgenerational Echo of the Opioid Crisis. Cold Spring Harb Perspect Med 2021; 11:cshperspect.a039669. [PMID: 32229609 DOI: 10.1101/cshperspect.a039669] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The incidence of neonatal opioid withdrawal syndrome (NOWS) has increased substantially in the setting of the opioid epidemic, a major public health problem in the United States. At present, NOWS has commonly used assessment and treatment protocols, but new protocols have questioned old practices. However, because of limited access to opioid use disorder (OUD) treatment and socioeconomic factors, many pregnant (and postpartum) women with OUD do not receive treatment. The pathophysiology of NOWS is not completely understood, although limited research studies have been conducted in humans and animals to better understand its etiology. Moreover, there is evidence that epigenetic and genetic factors play a role in the development of NOWS, but further study is needed. Animal models have suggested that there are deleterious effects of in utero opioid exposure later in life. Clinical research has revealed the harmful long-term sequelae of NOWS, with respect to cognitive function and childhood development. Many psychiatric disorders begin during adolescence, so as infants born with NOWS approach adolescence, additional clinical and molecular studies are warranted to identify biologic and psychosocial risk factors and long-term effects of NOWS. Additionally, access to specialized OUD treatment for pregnant women must be more readily available in the United States, especially in rural areas.
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Perceptions of Signs of Addiction Among Opioid Naive Patients Prescribed Opioids in the Emergency Department. J Addict Med 2021; 15:491-497. [PMID: 33560692 DOI: 10.1097/adm.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient knowledge deficits related to opioid risks, including lack of knowledge regarding addiction, are well documented. Our objective was to characterize patients' perceptions of signs of addiction. METHODS This study utilized data obtained as part of a larger interventional trial. Consecutively discharged English-speaking patients, age >17 years, at an urban academic emergency department, with a new opioid prescription were enrolled from July 2015 to August 2017. During a follow-up phone interview 7 to 14 days after discharge, participants were asked a single question, "What are the signs of addiction to pain medicine?" Verbatim transcribed answers were analyzed using a directed content analysis approach and double coding. These codes were then grouped into themes. RESULTS There were 325 respondents, 57% female, mean age 43.8 years, 70.1% privately insured. Ten de novo codes were added to the 11 DSM-V criteria codes. Six themes were identified: (1) effort spent acquiring opioids, (2) emotional and physical changes related to opioid use, (3) opioid use that is "not needed, (4) increasing opioid use, (5) an emotional relationship with opioids, and (6) the inability to stop opioid use. CONCLUSIONS Signs of addiction identified by opioid naive patients were similar to concepts identified in medical definitions. However, participants' understanding also included misconceptions, omissions, and conflated misuse behaviors with signs of addiction. Identifying these differences will help inform patient-provider risk communication, providing an opportunity for counseling and prevention.
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Rockett IR, Caine ED, Banerjee A, Ali B, Miller T, Connery HS, Lulla VO, Nolte KB, Larkin GL, Stack S, Hendricks B, McHugh RK, White FM, Greenfield SF, Bohnert AS, Cossman JS, D'Onofrio G, Nelson LS, Nestadt PS, Berry JH, Jia H. Fatal self-injury in the United States, 1999-2018: Unmasking a national mental health crisis. EClinicalMedicine 2021; 32:100741. [PMID: 33681743 PMCID: PMC7910714 DOI: 10.1016/j.eclinm.2021.100741] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Suicides by any method, plus 'nonsuicide' fatalities from drug self-intoxication (estimated from selected forensically undetermined and 'accidental' deaths), together represent self-injury mortality (SIM)-fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999-2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. METHODS For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the 'nonsuicide' SIM component. FINDINGS The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI: 1.6%, 2.0%; p<0.001) for the suicide rate. By 2017/2018, all states except Nebraska (19.9) posted a SIM rate of at least 21.0 deaths per 100,000 population-the floor of the rate range for the top 5 ranking states in 1999/2000. The rank-order correlation coefficient for SIM and suicide rates was 0.82 (p<0.001) in 1999/2000 versus 0.34 (p = 0.02) by 2017/2018. Seven states in the West posted a ≥ 5.0% reduction in their standardised mortality ratios of 'nonsuicide' drug fatalities, relative to the national ratio, and 6 states from the other 3 major regions a >6.0% increase (p<0.05). INTERPRETATION Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice. FUNDING This study was partially funded by the National Centre for Injury Prevention and Control, US Centers for Disease Control and Prevention (R49CE002093) and the US National Institute on Drug Abuse (1UM1DA049412-01; 1R21DA046521-01A1).
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Affiliation(s)
- Ian R.H. Rockett
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States
| | - Eric D. Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States
| | - Aniruddha Banerjee
- Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States
| | - Bina Ali
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States
| | - Ted Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Hilary S. Connery
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Vijay O. Lulla
- Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States
| | - Kurt B. Nolte
- Department of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
| | - G. Luke Larkin
- Northeast Ohio Medical University, Rootstown, Ohio, United States
| | - Steven Stack
- Department of Criminal Justice, Wayne State University, Detroit, Michigan, United States
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, United States
| | - Brian Hendricks
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States
| | - R. Kathryn McHugh
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Franklin M.M. White
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly F. Greenfield
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Amy S.B. Bohnert
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, United States
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, United States
| | - Jeralynn S. Cossman
- College for Health, Community and Policy, University of Texas-San Antonio, San Antonio, Texas, United States
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Lewis S. Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
- School of Nursing, Columbia University, New York, New York, United States
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Abstract
This cross-sectional study examines trends in heroin treatment admission rates in the United States by race, sex, and age from 2000 to 2017.
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Affiliation(s)
- Elodie C. Warren
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care and Treatment, Long Island City, New York
- Mailman School of Public Health, Columbia University, New York, New York
| | - Andrew Kolodny
- Mailman School of Public Health, Columbia University, New York, New York
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Silverstein SM, Daniulaityte R, Getz K, Zule W. "It's Crazy What Meth Can Help You Do": Lay Beliefs, Practices, and Experiences of Using Methamphetamine to Self-Treat Symptoms of Opioid Withdrawal. Subst Use Misuse 2021; 56:1687-1696. [PMID: 34279180 DOI: 10.1080/10826084.2021.1949612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Across the U.S., methamphetamine use is expanding among people who use illicit opioids (PWUIO). Motives for methamphetamine use must be contextualized within the experiences of PWUIO, who may use methamphetamine not only to achieve euphoria, but also as a tactic of self-management. The overall aim of this study is to contextualize lay beliefs, practices, and experiences of methamphetamine use as a form of self-treatment of symptoms related to chronic opioid use among PWUIO in the Dayton Metro Area of Southwest Ohio, an epicenter of the ongoing opioid crisis. METHODS This paper draws on two phases of interviews conducted with 38 individuals who use both heroin/fentanyl and methamphetamine. This paper primarily analyzes qualitative data but includes supplementary information from the structured interview component. Qualitative interview sections were transcribed in their entirety and thematically analyzed. RESULTS Participants described learning about methamphetamine as a tactic to treat opioid withdrawal symptoms through social networks and through personal experimentation. Many participants suggested that methamphetamine was helpful in relieving exhaustion, alleviating some acute physical symptoms of opioid withdrawal, and providing a psychological distraction, although some admitted that methamphetamine use could incur additional health risks. To effectively use methamphetamine as a tactic of self-treatment, participants emphasized the importance of timing and dosing. DISCUSSION Among PWUIO in the Dayton area, methamphetamine use as a tactic to self-manage opioid withdrawal must be studied in relation to historical and evolving patterns of illicit opioid use and associated risks. More research is needed to understand the long-term health impacts of this emergent practice of polydrug use.
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Affiliation(s)
- Sydney M Silverstein
- Center for Interventions, Treatment, and Addictions Research/Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | | | - Kylie Getz
- Wright State University, Dayton, Ohio, USA
| | - William Zule
- Center for Global Health, RTI International, Durham, North Carolina, USA
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Chen W, Page TF, Sun W. Racial/Ethnic Disparities in Opioid Use Disorder and Poisoning Emergency Department Visits in Florida. J Racial Ethn Health Disparities 2020; 8:1395-1405. [PMID: 33140289 DOI: 10.1007/s40615-020-00901-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To examine the role of individual race/ethnicity and community racial/ethnic mix on the type of opioid-related emergency department (ED) visits in Florida. METHODS The study identifies opioid-related ED visits that involved heroin, non-heroin poisoning, and opioid use disorder (OUD) from the first quarter of 2010 to the second quarter of 2018 in Florida. The trend is depicted by patients' race/ethnicity and racial/ethnic mix of residential communities. Combined with zip code tabulation area data, the study builds a multilevel model and examines how individual-level and community-level covariates relate to the type of opioid-related ED visits. RESULTS While opioid-related ED visit rate was highest among white patients, majority-black communities caught up with the majority-white communities in the visit rate. The multilevel model results suggest that the likelihood of an opioid-related ED visit involving heroin, non-heroin poisoning, or OUD differed by patient race/ethnicity as well as community racial/ethnic mix. Opioid-related ED visits among minority patients were more likely to involve non-heroin poisoning than non-Hispanic white patients, whereas patients from minority-dominant communities were more likely to involve heroin poisoning than from majority-white communities. However, community racial/ethnic mix was not significantly or less significantly associated with the likelihood of involving OUD ED visits. CONCLUSIONS The study highlights the heterogeneity of the opioid overdose problem across racial/ethnic patients and communities with different racial/ethnic mixes. Future policies may consider the effect of living in different racial/ethnic mixed communities in addition to individual race/ethnicity.
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Affiliation(s)
- Weiwei Chen
- Department of Economics, Finance and Quantitative Analysis, Michael J. Coles College of Business, Kennesaw State University, 560 Parliament Garden Way, Kennesaw, GA, 30144, USA.
| | - Timothy F Page
- Department of Management, H. Wayne Huizenga College of Business and Entrepreneurship, Nova Southeastern University, 3301 College Ave, Davie, FL, 33314, USA
| | - Wenjie Sun
- Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
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Academia EC, Gabriel CJ, Mueller A, Schwarz KA, Bartels K, Valuck RJ, Reynolds PM. Opioid Prescribing After Discharge in a Previously Mechanically Ventilated, Opioid-Naïve Cohort. Ann Pharmacother 2020; 54:1065-1072. [PMID: 32349532 DOI: 10.1177/1060028020919122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Opioids are utilized for pain management during and after mechanical ventilation in the intensive care unit (ICU). OBJECTIVE The purpose of this study was to determine the percentage of potentially unnecessary opioid prescriptions on discharge in previously opioid-naïve patients. METHODS This retrospective cohort study included mechanically ventilated, opioid-naïve ICU patients who received opioids. The primary outcome of this study was the discrepancy between the amounts of opioids prescribed at discharge versus those likely required based on actual 24-hour prehospital discharge opioid requirements. RESULTS A total of 71 patients were included. Of these, 63.3% (n = 45) of discharge prescriptions were in alignment with 24-hour predischarge requirements, and 36.7% (n = 26) of discharge prescriptions were in excess of calculated predischarge requirements. At discharge, 57.7% (n = 41) of patients received a nonopioid analgesic. Multivariable linear regression revealed that cardiothoracic ICU admission was associated with an increased risk of inappropriate discharge opioid prescribing, whereas a shorter duration of inpatient oral opioid therapy decreased risk of inappropriate discharge prescribing. CONCLUSION AND RELEVANCE Opioid prescribing for previously mechanically ventilated patients warrants improvement as a part of the discharge planning process. Application of these data may aid in the reduction of opioid overprescribing at discharge after an ICU stay.
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Affiliation(s)
- Emmeline C Academia
- University of Colorado Hospital, Aurora, CO, USA
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | - Amanda Mueller
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Kerry A Schwarz
- University of Colorado Hospital, Aurora, CO, USA
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | - Robert J Valuck
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Paul M Reynolds
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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Evans EA, Delorme E, Cyr K, Goldstein DM. A qualitative study of big data and the opioid epidemic: recommendations for data governance. BMC Med Ethics 2020; 21:101. [PMID: 33087123 PMCID: PMC7576981 DOI: 10.1186/s12910-020-00544-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The opioid epidemic has enabled rapid and unsurpassed use of big data on people with opioid use disorder to design initiatives to battle the public health crisis, generally without adequate input from impacted communities. Efforts informed by big data are saving lives, yielding significant benefits. Uses of big data may also undermine public trust in government and cause other unintended harms. OBJECTIVES We aimed to identify concerns and recommendations regarding how to use big data on opioid use in ethical ways. METHODS We conducted focus groups and interviews in 2019 with 39 big data stakeholders (gatekeepers, researchers, patient advocates) who had interest in or knowledge of the Public Health Data Warehouse maintained by the Massachusetts Department of Public Health. RESULTS Concerns regarding big data on opioid use are rooted in potential privacy infringements due to linkage of previously distinct data systems, increased profiling and surveillance capabilities, limitless lifespan, and lack of explicit informed consent. Also problematic is the inability of affected groups to control how big data are used, the potential of big data to increase stigmatization and discrimination of those affected despite data anonymization, and uses that ignore or perpetuate biases. Participants support big data processes that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions. Recommendations for ethical big data governance offer ways to narrow the big data divide (e.g., prioritize health equity, set off-limits topics/methods, recognize blind spots), enact shared data governance (e.g., establish community advisory boards), cultivate public trust and earn social license for big data uses (e.g., institute safeguards and other stewardship responsibilities, engage the public, communicate the greater good), and refocus ethical approaches. CONCLUSIONS Using big data to address the opioid epidemic poses ethical concerns which, if unaddressed, may undermine its benefits. Findings can inform guidelines on how to conduct ethical big data governance and in ways that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA.
| | - Elizabeth Delorme
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Karl Cyr
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Daniel M Goldstein
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
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Gutin I, Hummer RA. Occupation, employment status, and "despair"-associated mortality risk among working-aged U.S. adults, 1997-2015. Prev Med 2020; 137:106129. [PMID: 32439488 PMCID: PMC7311220 DOI: 10.1016/j.ypmed.2020.106129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/08/2020] [Accepted: 05/10/2020] [Indexed: 11/20/2022]
Abstract
The recent rise in U.S. midlife mortality has been conceptualized as a "working-class" crisis, defined by increasing mortality among blue-collar and/or unemployed workers and the decline of manual labor; yet research on the topic overwhelmingly focuses on educational attainment as the key socioeconomic determinant of midlife mortality, especially among "despair"-related deaths. The present study addresses this gap by using data on 360,146 adults ages 25-64 from restricted-use National Health Interview Survey-Linked Mortality Files (1997-2015; average follow-up 9.87 years) to estimate associations between individuals' occupation and employment status and alcoholic liver disease, suicide, or accidental poisoning mortality risk, net of confounders. Adults in service, manual labor, and transport occupations exhibited two-to-three times the risk of mortality from accidental poisonings compared to those in managerial/administrative positions. Notably, health professionals exhibited the highest accidental poisoning mortality risks. Relative to managerial/administrative professionals, adults not in the labor force had double the suicide risk and nearly seven times the accidental poisoning risk, net of confounders. Unemployed adults and those having never worked also had elevated risks from accidental poisoning mortality. Critically, the fact that individuals' occupations and employment status are independently associated with midlife mortality due to deaths of despair - especially accidental poisoning - highlights the need for measures of socioeconomic status beyond educational attainment and income in understanding rising midlife mortality. Moreover, policies addressing working-aged mortality must target particular workplace contexts and the consequences of unemployment, both of which affect a large and growing segment of the working-aged U.S. population.
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Affiliation(s)
- Iliya Gutin
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, United States of America.
| | - Robert A Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, United States of America
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Addressing the Opioid Crisis through an Interdisciplinary Task Force in Cincinnati, Ohio, USA. PHARMACY 2020; 8:pharmacy8030116. [PMID: 32660044 PMCID: PMC7559994 DOI: 10.3390/pharmacy8030116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/05/2023] Open
Abstract
Opioid use has been a topic of concern in recent years in the United States, causing thousands of deaths each year. Ohio is one of the states hit hardest by the epidemic, and its state and local governments have responded with comprehensive health policies. Cincinnati, located in the southwest region of Ohio, is one of the epicenters of the state’s opioid crisis. Responding to the needs of their community, the University of Cincinnati (UC) and its affiliate health system, UC Health, have brought together leaders in research, clinical practice, and education to form the UC/UC Health Opioid Task Force. By encouraging interdisciplinary partnerships, the Task Force is pioneering new ways to understand, prevent, and treat opioid use disorder, while preparing the next generation of healthcare professionals. Additionally, collaboration across departments in UC Health has improved access to treatment and recovery resources for hundreds of patients. Leading educational events, supporting local agencies, and participating in government initiatives have further solidified UC and UC Health’s role as a stakeholder in this crisis, showcasing how academic health centers are critical to promoting public health.
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Cao Y, Stewart K, Factor J, Billing A, Massey E, Artigiani E, Wagner M, Dezman Z, Wish E. Using socially-sensed data to infer ZIP level characteristics for the spatiotemporal analysis of drug-related health problems in Maryland. Health Place 2020; 63:102345. [PMID: 32543431 DOI: 10.1016/j.healthplace.2020.102345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/02/2020] [Accepted: 04/14/2020] [Indexed: 01/07/2023]
Abstract
This research investigated how socially sensed data can be used to detect ZIP level characteristics that are associated with spatial and temporal patterns of Emergency Department patients with a chief complaint and/or diagnosis of overdose or drug-related health problems for four hospitals in Baltimore and Anne Arundel County, MD during 2016-2018. Dynamic characteristics were identified using socially-sensed data (i.e., geo-tagged Twitter data) at ZIP code level over varying temporal resolutions. Data about three place-based variables including comments and concerns about crime, drug use, and negative or depressed sentiments, were extracted from tweets, along with data from four socio-environmental variables from the American Community Survey were collected to explore socio-environmental characteristics during the same period. Our study showed a statistically significant increase in adjusted rates of Emergency Department (ED) visits occurred between June and November 2017 for patients residing in ZIP codes in western Baltimore and northeastern Anne Arundel County. During this period, the three topics extracted from Twitter data were highly correlated with the ZIP codes where the patients were residing. Exploring the dynamic spatial associations between socio-environmental variables and ED visits for acute overdose assists local health officials in optimizing interventions for vulnerable locations.
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Affiliation(s)
- Yanjia Cao
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Kathleen Stewart
- Center for Geospatial Information Science, Department of Geographical Sciences, University of Maryland, College Park, MD, USA
| | - Julie Factor
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Amy Billing
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Ebonie Massey
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Eleanor Artigiani
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Michael Wagner
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
| | - Zachary Dezman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric Wish
- Center for Substance Abuse Research, University of Maryland, College Park, MD, USA
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Azar P, Wong JS, Jassemi S, Moore E, Vo DX, Nikoo M, Young S. A Case Report: Rapid Micro‐Induction of Buprenorphine/Naloxone to Administer Buprenorphine Extended‐Release in an Adolescent With Severe Opioid Use Disorder. Am J Addict 2020; 29:531-535. [DOI: 10.1111/ajad.13050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Pouya Azar
- Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada
| | - James S.H. Wong
- Addictions and Concurrent Disorders Research Group, Department of Psychiatry Institute of Mental Health University of British Columbia Vancouver British Columbia Canada
| | - Sara Jassemi
- Department of Pediatrics, Division of Adolescent Health and Medicine B.C. Children’s Hospital University of British Columbia Vancouver British Columbia Canada
| | - Eva Moore
- Department of Pediatrics, Division of Adolescent Health and Medicine B.C. Children’s Hospital University of British Columbia Vancouver British Columbia Canada
| | - Dzung X. Vo
- Department of Pediatrics, Division of Adolescent Health and Medicine B.C. Children’s Hospital University of British Columbia Vancouver British Columbia Canada
| | - Mohammadali Nikoo
- Addictions and Concurrent Disorders Research Group, Department of Psychiatry Institute of Mental Health University of British Columbia Vancouver British Columbia Canada
| | - Samantha Young
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence, St. Paul’s Hospital Vancouver British Columbia Canada
- Department of Medicine, Interdepartmental Division of Addiction Medicine St. Paul’s Hospital Vancouver British Columbia Canada
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Puac-Polanco V, Chihuri S, Fink DS, Cerdá M, Keyes KM, Li G. Prescription Drug Monitoring Programs and Prescription Opioid-Related Outcomes in the United States. Epidemiol Rev 2020; 42:134-153. [PMID: 32242239 DOI: 10.1093/epirev/mxaa002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/14/2022] Open
Abstract
Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.
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Affiliation(s)
- Victor Puac-Polanco
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Stanford Chihuri
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - David S Fink
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Guohua Li
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Hernandez A, Branscum AJ, Li J, MacKinnon NJ, Hincapie AL, Cuadros DF. Epidemiological and geospatial profile of the prescription opioid crisis in Ohio, United States. Sci Rep 2020; 10:4341. [PMID: 32152360 PMCID: PMC7063043 DOI: 10.1038/s41598-020-61281-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022] Open
Abstract
The underlying reasons behind the unprecedented increase of the mortality rates due to the opioid epidemics in the United States are still not fully uncovered. Most efforts have been focused on targeting opioids, but there is little information about vulnerable populations at high risk of opioid abuse and death. In this study, we used data from the Ohio Department of Health for deaths caused by prescription opioids from 2010-2017 to analyze the spatiotemporal dynamics of the opioid overdose epidemic. Our results showed a rapid increase in prescription opioid death rates among the white male population aged 30-39 but also a considerable increase among the black male population with an exponential growth trend. Our geospatial analysis suggests that the increasing rates of the opioid overdose epidemic in Ohio were driven by the epidemic hotspot areas. Our findings highlight the relevance of prioritizing public health measures targeting specific locations and vulnerable populations to mitigate the current opioids crisis.
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Affiliation(s)
- Andres Hernandez
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, USA
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
| | - Adam J Branscum
- Department of Biostatistics, College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
| | - Jingjing Li
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Neil J MacKinnon
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ana L Hincapie
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Diego F Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, USA.
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA.
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50
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Venkataramani AS, Bair EF, O'Brien RL, Tsai AC. Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States: A Difference-in-Differences Analysis. JAMA Intern Med 2020; 180:254-262. [PMID: 31886844 PMCID: PMC6990761 DOI: 10.1001/jamainternmed.2019.5686] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Fading economic opportunity has been hypothesized to be an important factor associated with the US opioid overdose crisis. Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities. OBJECTIVE To estimate the extent to which automotive assembly plant closures were associated with increasing opioid overdose mortality rates among working-age adults. DESIGN, SETTING, AND PARTICIPANTS A county-level difference-in-differences study was conducted among adults aged 18 to 65 years in 112 manufacturing counties located in 30 commuting zones (primarily in the US South and Midwest) with at least 1 operational automotive assembly plant as of 1999. The study analyzed county-level changes from January 1, 1999, to December 31, 2016, in age-adjusted, county-level opioid overdose mortality rates before vs after automotive assembly plant closures in manufacturing counties affected by plant closures compared with changes in manufacturing counties unaffected by plant closures. Data analyses were performed between April 1, 2018, and July 20, 2019. EXPOSURE Closure of automotive assembly plants in the commuting zone of residence. MAIN OUTCOMES AND MEASURES The primary outcome was the county-level age-adjusted opioid overdose mortality rate. Secondary outcomes included the overall drug overdose mortality rate and prescription vs illicit drug overdose mortality rates. RESULTS During the study period, 29 manufacturing counties in 10 commuting zones were exposed to an automotive assembly plant closure, while 83 manufacturing counties in 20 commuting zones remained unexposed. Mean (SD) baseline opioid overdose rates per 100 000 were similar in exposed (0.9 [1.4]) and unexposed (1.0 [2.1]) counties. Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100 000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% higher increase relative to the mortality rate that would have been expected had exposed counties followed the same outcome trends as unexposed counties. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in nonmanufacturing counties were not statistically significant. CONCLUSIONS AND RELEVANCE From 1999 to 2016, automotive assembly plant closures were associated with increases in opioid overdose mortality. These findings highlight the potential importance of eroding economic opportunity as a factor in the US opioid overdose crisis.
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Affiliation(s)
- Atheendar S Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Elizabeth F Bair
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rourke L O'Brien
- Department of Sociology, Yale University, New Haven, Connecticut
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
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