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Wheeler PB, Miller-Roenigk B, Jester J, Stevens-Watkins D. Knowledge, experiences, and perceptions of medications for opioid use disorder among Black Kentuckians. Ann Med 2024; 56:2322051. [PMID: 38442301 PMCID: PMC10916927 DOI: 10.1080/07853890.2024.2322051] [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] [Received: 10/20/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake. METHODS Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis. RESULTS Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%). DISCUSSION Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.
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Affiliation(s)
- Paris B. Wheeler
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Brittany Miller-Roenigk
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
| | - Jasmine Jester
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
| | - Danelle Stevens-Watkins
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
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Marks SJ, Pham H, McCray N, Palazzolo J, Harrell A, Lowe J, Bachireddy C, Guerra L, Cunningham PJ, Barnes AJ. Patient experiences with outpatient opioid use disorder treatment before and during COVID-19: results from a survey of Medicaid members. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-14. [PMID: 38759212 DOI: 10.1080/00952990.2024.2328543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/05/2024] [Indexed: 05/19/2024]
Abstract
Background: Payers are increasingly interested in quality improvement for opioid use disorder (OUD) treatment, including incorporating patient experiences. Medicaid is the largest payer for OUD treatment, yet we know little about the treatment benefits Medicaid members report, how these vary across members, or changed with the COVID-19 pandemic.Objective: To examine Medicaid members' report of outpatient treatment benefits, employment, and housing outcomes before and during the pandemic.Methods: A representative sample of 1,032 Virginia Medicaid members (52% women) receiving OUD treatment completed a survey of treatment benefits, health status and social needs. A reported treatment benefit index was created based on seven self-reported items. Multivariable linear regression models, pooled and stratified by time (pre-COVID-19/COVID-19), assessed member characteristics associated with reported treatment benefit, employment and housing outcomes.Results: Members reported strong treatment benefit (mean: 21.8 [SD: 5.9] out of 28 points) and improvements in employment (2.4 [1.3] out of 5) and housing (2.8 [1.2] out of 5). After adjustment, mental distress (regression coefficient: -3.00 [95% CI:-3.97;-2.03]), polysubstance use (-1.25 [-1.99;-0.51]), and food insecurity (-1.00 [-1.71;-0.29]), were associated with decreased benefits from treatment. During COVID-19, justice-involved individuals reported decreased benefits (-2.17 [-3.54; -0.80]) compared to before the pandemic (-0.09 [-1.4-;1.24] p < .05).Conclusions: Medicaid members receiving outpatient OUD treatment reported positive treatment benefits, and housing and employment outcomes. However, those with comorbid health and social conditions often benefited the least. As payers move toward quality improvement and value-based purchasing initiatives, collecting and integrating patient reported outcomes into quality metrics is critical.
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Affiliation(s)
- Sarah J Marks
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
- Medical Scientist Training Program, Virginia Commonwealth University, Richmond, VA, USA
| | - Huyen Pham
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Neil McCray
- Virginia Department of Medical Assistance Services, Richmond, VA, USA
| | | | - Ashley Harrell
- Virginia Department of Medical Assistance Services, Richmond, VA, USA
| | - Jason Lowe
- Virginia Department of Medical Assistance Services, Richmond, VA, USA
| | | | - Lauren Guerra
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Peter J Cunningham
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Andrew J Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
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Barbosa C, Dowd WN, Buell N, Allaire B, Bobashev G. Simulated impact of medicaid expansion on the economic burden of opioid use disorder in North Carolina. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104449. [PMID: 38733650 DOI: 10.1016/j.drugpo.2024.104449] [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: 12/09/2023] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) imposes significant costs on state and local governments. Medicaid expansion may lead to a reduction in the cost burden of OUD to the state. METHODS We estimated the health care, criminal justice and child welfare costs, and tax revenue losses, attributable to OUD and borne by the state of North Carolina in 2022, and then estimated changes in the same domains following Medicaid expansion in North Carolina (adopted in December 2023). Analyses used existing literature on the national and state-level costs attributable to OUD to estimate individual-level health care, criminal justice, and child welfare system costs, and lost tax revenues. We combined Individual-level costs and prevalence estimates to estimate costs borne by the state before Medicaid expansion. Changes in costs after expansion were computed based on a) medication for opioid use disorder (MOUD) access for new enrollees and b) shifting of responsibility for some health care costs from the state to the federal government. Monte Carlo simulation accounted for the impact of parameter uncertainty. Dollar estimates are from the 2022 price year, and costs following the first year were discounted at 3 %. RESULTS In 2022, North Carolina incurred costs of $749 million (95 % credible interval [CI]: $305 M-$1,526 M) associated with OUD (53 % in health care, 36 % in criminal justice, 7 % in lost tax revenue, and 4 % in child welfare costs). Expanding Medicaid lowered the cost burden of OUD incurred by the state. The state was predicted to save an estimated $72 million per year (95 % CI: $6 M-$241 M) for the first two years and $30 million per year (95 % CI: -$28 M-$176 M) in subsequent years. Over five years, savings totaled $224 million (95 % CI: -$47 M-$949 M). CONCLUSION Medicaid expansion has the potential to decrease the burden of OUD in North Carolina, and policymakers should expedite its implementation.
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Affiliation(s)
- Carolina Barbosa
- Health Economics Program, RTI International, Research Triangle Park, NC, USA.
| | - William N Dowd
- Health Economics Program, RTI International, Research Triangle Park, NC, USA
| | - Naomi Buell
- Health Economics Program, RTI International, Research Triangle Park, NC, USA
| | - Benjamin Allaire
- Advanced Methods Development, RTI International, Research Triangle Park, NC, USA
| | - Georgiy Bobashev
- Center for Data Science, RTI International, Research Triangle Park, NC, USA
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Wurcel AG, Suzuki J, Schranz AJ, Eaton EF, Cortes-Penfield N, Baddour LM. Strategies to Improve Patient-Centered Care for Drug Use-Associated Infective Endocarditis: JACC Focus Seminar 2/4. J Am Coll Cardiol 2024; 83:1338-1347. [PMID: 38569764 DOI: 10.1016/j.jacc.2024.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 04/05/2024]
Abstract
Drug use-associated infective endocarditis (DUA-IE) is a major cause of illness and death for people with substance use disorder (SUD). Investigations to date have largely focused on advancing the care of patients with DUA-IE and included drug use disorder treatment, decisions about surgery, and choice of antibiotics during the period of hospitalization. Transitions from hospital to outpatient care are relatively unstudied and frequently a key factor of uncontrolled infection, continued substance use, and death. In this paper, we review the evidence supporting cross-disciplinary care for people with DUA-IE and highlight domains that need further clinician, institutional, and research investment in clinicians and institutions. We highlight best practices for treating people with DUA-IE, with a focus on addressing health disparities, meeting health-related social needs, and policy changes that can support care for people with DUA-IE in the hospital and when transitioning to the community.
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Affiliation(s)
- Alysse G Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Asher J Schranz
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen F Eaton
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | | | - Larry M Baddour
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Handanagic S, Broz D, Finlayson T, Kanny D, Wejnert C. Unmet need for medication for opioid use disorder among persons who inject drugs in 23 U.S. cities. Drug Alcohol Depend 2024; 257:111251. [PMID: 38457965 PMCID: PMC11031279 DOI: 10.1016/j.drugalcdep.2024.111251] [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] [Received: 08/25/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Persons who inject drugs (PWID) are at increased risk of HIV and hepatitis C virus (HCV) infections and premature mortality due to drug overdose. Medication for opioid use disorder (MOUD), such as methadone or buprenorphine, reduces injecting behaviors, HIV and HCV transmission, and mortality from opioid overdose. Using data from National HIV Behavioral Surveillance, we evaluated the unmet need for MOUD among PWID in 23 U.S. cities. METHODS PWID were recruited by respondent-driven sampling, interviewed, and tested for HIV. This analysis includes PWID who were ≥18 years old and reported injecting drugs and opioid use in the past 12 months. We used Poisson regression to examine factors associated with self-reported unmet need for MOUD and reported adjusted prevalence ratios (aPR) with 95% confidence intervals. RESULTS Of 10,879 PWID reporting using opioids, 68.8% were male, 48.2% were ≥45 years of age, 38.8% were non-Hispanic White, 49.6% experienced homelessness, and 28.0% reported an unmet need for MOUD in the past 12 months. PWID who were more likely to report unmet need for MOUD experienced homelessness (aPR 1.26; 95% CI: 1.19-1.34), were incarcerated in the past 12 months (aPR 1.15; 95% CI: 1.08-1.23), injected ≥once a day (aPR 1.42; 95% CI: 1.31-1.55), reported overdose (aPR 1.33; 95% CI: 1.24-1.42), and sharing of syringes (aPR 1.14; 95% CI: 1.06-1.23). CONCLUSIONS The expansion of MOUD provision for PWID is critical. Integrating syringe service programs and MOUD provision and linking PWID who experience overdose, incarceration or homelessness to treatment with MOUD could improve its utilization among PWID.
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Affiliation(s)
- Senad Handanagic
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, USA.
| | - Dita Broz
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, USA
| | - Teresa Finlayson
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, USA
| | - Dafna Kanny
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, USA
| | - Cyprian Wejnert
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, USA
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Collins ME, Hall M, Chung PJ, Bettenhausen JL, Keys JR, Bard D, Puls HT. Spending on public benefit programs and exposure to adverse childhood experiences. CHILD ABUSE & NEGLECT 2024:106717. [PMID: 38433038 DOI: 10.1016/j.chiabu.2024.106717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Adverse childhood experiences are associated with poverty, and public benefit programs are increasingly used as primary prevention for negative child outcomes. OBJECTIVE To estimate the association between spending on benefit programs and cumulative exposure to ACEs among children. PARTICIPANTS AND SETTING Children aged 0-17 years in the United States during 2016-17 as reported in National Survey of Children's Health. METHODS We examined the sum of state and federal spending on 5 categories of public benefit programs at the state-level. The primary exposure was mean annual spending per person living below the Federal poverty limit across 2010-2017 Federal fiscal years. The primary outcome was children <18 years old having ever been exposed to ≥ 4 ACEs. RESULTS Nationally, 5.7 % (95 % confidence interval [CI] 5.3 % - 6.0 %) of children had exposure to ≥ 4 ACEs. After adjustment for children's race and ethnicity, total spending on benefit programs was associated with lower exposure to ≥ 4 ACEs (odds 0.96 [95 % CI: 0.95, 0.97]; p < 0.001). Increased spending in each individual benefit category was also associated with decreased cumulative ACEs exposure (all p < 0.05). Inverse associations were largely consistent when children were stratified by race and ethnicity and income strata. CONCLUSIONS Investments in public benefit programs may not only decrease poverty but also have broad positive effects on near- and long-term child well-being beyond the programs' stated objectives. Findings support federal and state efforts to prioritize families' economic stability as part of a public health model to prevent ACEs.
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Affiliation(s)
- Megan E Collins
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States.
| | - Matthew Hall
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; Children's Hospital Association, 16011 College Boulevard #250, Lenexa, Kansas 66219, United States.
| | - Paul J Chung
- Department of Health Systems Science, Kaiser Permanente School of Medicine, 98 South Los Robles Avenue, Pasadena, California 91101, United States; Departments of Pediatrics and Health Policy & Management, UCLA, 10833 Le Conte Avenue, Los Angeles, California 90095, United States.
| | - Jessica L Bettenhausen
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States.
| | - Jordan R Keys
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States.
| | - David Bard
- Department of Pediatrics, College of Medicine, The University of Oklahoma, 940 Stanton L Young Boulevard #357, Norman, OK 73104, United States.
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States.
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Naumann RB, Frank M, Shanahan ME, Reyes HLM, Ammerman AS, Corbie G, Austin AE. State Supplemental Nutrition Assistance Program Policies and Substance Use Rates. Am J Prev Med 2024; 66:526-533. [PMID: 37918458 DOI: 10.1016/j.amepre.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Food insecurity is associated with the development of substance misuse and use disorders (SUD). This study sought to estimate associations between state Supplemental Nutrition Assistance Program (SNAP) eligibility policies and substance-related outcomes. METHODS 2014-2017 SNAP Policy Database and 2015-2019 National Survey on Drug Use and Health state-level estimates were used to estimate associations between state SNAP eligibility policies and alcohol use disorder (AUD), opioid misuse, illicit drug use disorder (IDUD), SUD, and needing but not receiving SUD treatment. State SNAP policies included those that (1) do not disqualify individuals with a felony drug conviction from SNAP and/or (2) expand SNAP eligibility by increasing the income limit or removing the asset test. Analyses were conducted January-May 2023. RESULTS States that adopted both SNAP eligibility policies had reduced rates of AUD (adjusted rate ratio (aRR): 0.92; 95% CI 0.86, 0.99), opioid misuse (aRR: 0.94; 95% CI 0.89, 0.98), IDUD (aRR: 0.91; 95% CI 0.85, 0.98), SUD (aRR: 0.91; 95% CI 0.85, 0.97), and needing but not receiving SUD treatment (aRR: 0.92; 95% CI 0.87, 0.98) compared to states with neither policy. Among states that did not adopt increases to the income limit or removal of the asset test, those that removed the felony drug disqualification had lower rates of IDUD, SUD, and needing but not receiving SUD treatment, compared to those that maintained a disqualification. CONCLUSIONS Expanded SNAP eligibility could help reduce rates of substance misuse and SUD. Opting out of the federal disqualification on SNAP participation for those with felony drug convictions may be particularly beneficial.
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Affiliation(s)
- Rebecca B Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Madeline Frank
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Meghan E Shanahan
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - H Luz McNaughton Reyes
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Giselle Corbie
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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de Saxe Zerden L, Ware OD, Lombardi BN, Lombardi BM. Harm reduction workforce, behavioral health, and service delivery in the USA: a cross-sectional study. Harm Reduct J 2024; 21:36. [PMID: 38336662 PMCID: PMC10858514 DOI: 10.1186/s12954-024-00952-9] [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] [Received: 06/20/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Despite recent financial and policy support for harm reduction in the USA, information on the types of workers within organizations who design, implement, and actualize harm reduction services remains nascent. Little is known about how variability in the harm reduction workforce impacts referrals and linkages to other community supports. This exploratory mixed-methods study asked: (1) Who constitutes the harm reduction workforce? (2) Who provides behavioral health services within harm reduction organizations? (3) Are referral services offered and by whom? (4) Do referrals differ by type of harm reduction worker? METHODS Purposive sampling techniques were used to distribute an electronic survey to U.S.-based harm reduction organizations. Descriptive statistics were conducted. Multivariate binary logistic regression models examined the associations (a) between the odds of the referral processes at harm reduction organizations and (b) between the provision of behavioral health services and distinct types of organizational staff. Qualitative data were analyzed using a hybrid approach of inductive and thematic analysis. RESULTS Data from 41 states and Washington, D.C. were collected (N = 168; 48% response rate). Four primary types of workers were identified: community health/peer specialists (87%); medical/nursing staff (55%); behavioral health (49%); and others (34%). About 43% of organizations had a formal referral process; among these, only 32% had follow-up protocols. Qualitative findings highlighted the broad spectrum of behavioral health services offered and a broad behavioral health workforce heavily reliant on peers. Unadjusted results from multivariate models found that harm reduction organizations were more than 5 times more likely (95% CI [1.91, 13.38]) to have a formal referral process and 6 times more likely (95% CI [1.74, 21.52]) to have follow-up processes when behavioral health services were offered. Organizations were more than two times more likely (95% CI [1.09, 4.46]) to have a formal referral process and 2.36 (95% CI [1.11, 5.0]) times more likely to have follow-up processes for referrals when behavioral health providers were included. CONCLUSIONS The composition of the harm reduction workforce is occupationally diverse. Understanding the types of services offered, as well as the workforce who provides those services, offers valuable insights into staffing and service delivery needs of frontline organizations working to reduce morbidity and mortality among those who use substances. Workforce considerations within U.S.-based harm reduction organizations are increasingly important as harm reduction services continue to expand.
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Affiliation(s)
- Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA
| | - Brooke N Lombardi
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Brianna M Lombardi
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Hogue A, Satcher MF, Drazdowski TK, Hagaman A, Hibbard PF, Sheidow AJ, Coetzer-Liversage A, Mitchell SG, Watson DP, Wilson KJ, Muench F, Fishman M, Wenzel K, de Martell SC, Stein LAR. Linkage facilitation services for opioid use disorder: Taxonomy of facilitation practitioners, goals, and activities. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209217. [PMID: 37981242 PMCID: PMC10922806 DOI: 10.1016/j.josat.2023.209217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/14/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION This article proposes a taxonomy of linkage facilitation services used to help persons with opioid use disorder access treatment and recovery resources. Linkage facilitation may be especially valuable for persons receiving medication for opioid use disorder (MOUD) given the considerable barriers to treatment access and initiation that have been identified. The science of linkage facilitation currently lacks both consistent communication about linkage facilitation practices and a conceptual framework for guiding research. METHODS To address this gap, this article presents a taxonomy derived from expert consensus that organizes the array of practitioners, goals, and activities associated with linkage services for OUD and related needs. Expert panelists first independently reviewed research reports and policy guidelines summarizing the science and practice of linkage facilitation for substance use disorders generally and OUD specifically, then met several times to vet the conceptual scheme and content of the taxonomy until they reached a final consensus. RESULTS The derived taxonomy contains eight domains: facilitator identity, facilitator lived experience, linkage client, facilitator-client relationship, linkage activity, linkage method, linkage connectivity, and linkage goal. For each domain, the article defines basic domain categories, highlights research and practice themes in substance use and OUD care, and introduces innovations in linkage facilitation being tested in one of two NIDA-funded research networks: Justice Community Opioid Innovation Network (JCOIN) or Consortium on Addiction Recovery Science (CoARS). CONCLUSIONS To accelerate consistent application of this taxonomy to diverse research and practice settings, the article concludes by naming several considerations for linkage facilitation workforce training and implementation.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, United States of America.
| | - Milan F Satcher
- Dartmouth Health and Geisel School of Medicine at Dartmouth College, United States of America
| | | | - Angela Hagaman
- East Tennessee State University, United States of America
| | | | | | | | | | | | | | - Frederick Muench
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, United States of America
| | - Marc Fishman
- Maryland Treatment Centers, United States of America
| | - Kevin Wenzel
- Maryland Treatment Centers, United States of America
| | | | - L A R Stein
- Department of Psychology, University of Rhode Island, United States of America; Department of Behavioral & Social Sciences, Brown University, United States of America; Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, RI, United States of America
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10
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Onohuean H, Oosthuizen F. Multinational appraisal of the epidemiological distribution of opioid fatalities: a systematic review and meta-analysis. Front Psychiatry 2024; 14:1290461. [PMID: 38250280 PMCID: PMC10796457 DOI: 10.3389/fpsyt.2023.1290461] [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: 09/08/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024] Open
Abstract
Background The global or multinational scientific evidence on the distribution of opioid fatality is unknown. Hence, the current study collects epidemiological characteristics to shed light on the ongoing global or multinational opioid crisis and to promote the development of public health prevention/management strategies. Method All documents on PRISMA standards were retrieved via electronic databases. Results Among the 47 articles relevant to our studies, which depict a total population size of 10,191 individuals, the prevalence of opioid fatal overdose was 15,022 (14.74%). Among the 47 articles, 14 of them reported the gender of the participants, with 22,125 (15.79%) male individuals and 7,235 (5.17%) female individuals, and the age distribution of the participants that was most affected by the overdose was as follows: 29,272 (31.13%) belonged to the 18-34-year-old age group and 25,316 (26.92%) belonged to the less than 18-year-old age group. Eighteen studies qualified for the meta-analysis of the multinational prevalence of fatal opioid overdose, depicting an overall pooled prevalence estimate of 19.66%, with 95% CIs (0.13-0.29), I2 = 99.76% determined using the random-effects model, and Q statistic of 7198.77 (p < 0.0001). The Egger test models of publication bias revealed an insubstantial level of bias (p = 0.015). The subgroup analysis of the study design (cohort or other) revealed that others have the highest prevalence estimate of 34.37, 95% CIs (0.1600-0.5901), I2 = 97.04%, and a sample size of less than 1,000 shows the highest prevalence of 34.66, 95% CIs (0.2039-0.5234), I2 = 97.82%, compared to that of more than 1,000 with a prevalence of 12.28, 95% CIs (0.0675-0.2131), I2 = 99.85%. The meta-regression analysis revealed that sample size (less-than or greater-than 1,000), (p = 0.0098; R2 = 3.83%) is significantly associated with the observed heterogeneity. Conclusion Research-based findings of fatal opioid overdose are grossly lacking in middle- and low-income nations. We established that there is a need for opioid fatality surveillance systems in developing nations.
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Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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11
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Hughes PM, Ostrach B, Tak CR. Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209171. [PMID: 37739125 DOI: 10.1016/j.josat.2023.209171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION North Carolina's 2017 STOP Act implemented several measures to address the increasing opioid overdose death rate. However, due to racial differences prescription opioid use and treatment service access, the STOP Act may exhibit differential impacts by race. This study examined the impact of the STOP Act on opioid overdose deaths by race. METHODS State-level secondary data were compiled for all 50 states. Race-stratified opioid overdose rates were obtained from the Centers for Disease Control and Prevention's WONDER database from 2010 to 2019. The study obtained state-level population characteristics from the Current Population Surveys from 2010 to 2016, the CDC's 2017 Drug Surveillance Report, the National Survey of Substance Abuse Treatment Services from 2011 to 2016, and the National Survey on Drug Use and Health from 2010 to 2016. We obtained outcomes from 2010 to 2019 and state characteristics were obtained for the pre-STOP Act period (2010-2016) as available. Using the synthetic control method, we created two synthetic North Carolinas, one Black/African American and one White, from a weighted average of other states similar to North Carolina in terms of pre-STOP Act race-stratified opioid overdose rates and population characteristics. Change was assessed as the difference in the race-stratified opioid overdose death rate for North Carolina the corresponding synthetic control. RESULTS The opioid overdose death rate among the White population decreased by 7.17 and 8.96 deaths/100 k in 2018 and 2019 following the STOP Act (overall decrease p = .0217); however, the study found no significant change in the opioid overdose death rate among the Black/African American population (overall decrease p = .1053), with decreases 1.68 and 3.2 deaths/100 k in 2018 and 2019, respectively. CONCLUSIONS Our findings suggest that the STOP Act reduced the opioid overdose death rate in North Carolina among the White, but not Black/African American, population. This heterogeneous effect has implications for health equity and can inform the development of future substance use policies.
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Affiliation(s)
- Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States of America; Division of Research, UNC Health Sciences at MAHEC, Asheville, NC, United States of America.
| | - Bayla Ostrach
- Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Casey R Tak
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, United States of America
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Conway A, Krawczyk N, McGaffey F, Doyle S, Baaklini V, Marshall AD, Treloar C, Davis CS, Colledge-Frisby S, Grebely J, Cerdá M. Typology of laws restricting access to methadone treatment in the United States: A latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104141. [PMID: 37540917 DOI: 10.1016/j.drugpo.2023.104141] [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] [Received: 02/10/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND In the United States, methadone treatment for opioid use disorder is only available at opioid treatment programs (OTPs). In addition to federal regulations, states can enact laws which shape access to OTPs. We aimed to define classes of states according to restrictiveness of state OTP laws and examine population characteristics associated with class membership. METHODS A set of laws was extracted from a database of statutes and regulations governing OTPs in 49 states and the District of Columbia as of June 2021. Latent class analysis of laws was used to estimate the probability of class membership for each state. Class-weighted multinomial logistic regression analysis assessed state-level correlates of class membership and adjusted Relative Risk Ratio (aRRR) and 95% confidence intervals (95%CI) were generated. RESULTS States (n = 50) were assigned to three classes; Class 1) High restrictiveness on patient experience, low restrictiveness on access to service (n = 13); Class 2) Medium restrictiveness on patient experience, high restrictiveness on access to service (n = 14); Class 3) Low restrictiveness on patient experience, low restrictiveness on access to service (n = 23). States with a higher probability of membership in Classes with higher restrictiveness had higher rates of unemployment (Class 1 vs Class 3, aRRR:1.24; 95%CI:1.06-1.45), and Black residents (Class 2 vs Class 3, aRRR:1.10; 95%CI:1.04-1.15), and lower likelihood of Medicaid coverage of methadone (Class 1 vs Class 3, aRRR:0.25; 95%CI:0.07-0.88). States with a higher probability of membership in Classes with higher restrictiveness also had higher rates of potential indicators for opioid use disorder treatment need, including rates of opioid dispensing (Class 1 vs Class 3, aRRR:1.06; 95%CI:1.02-1.10, Class 2 vs Class 3, aRRR:1.07; 95%CI:1.03-1.11) and HIV diagnoses attributed to injection (Class 1 vs Class 3, aRRR:3.92; 95%CI:1.25-12.22). CONCLUSIONS States with indicators of greater potential need for opioid use disorder treatment have the most restrictions, raising concerns about unmet treatment need.
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Affiliation(s)
- Anna Conway
- The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia.
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Sheri Doyle
- The Pew Charitable Trusts, Philadelphia, United States
| | | | - Alison D Marshall
- The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Corey S Davis
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Network for Public Health Law, Los Angeles, United States
| | - Samantha Colledge-Frisby
- National Drug Research Institute, Curtin University, Melbourne, Australia; National Drug and Alcohol Research Centre, Burnet Institute, Melbourne, Australia
| | | | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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Castillo-Carniglia A, Rivera-Aguirre A, Santaella-Tenorio J, Fink DS, Crystal S, Ponicki W, Gruenewald P, Martins SS, Keyes KM, Cerdá M. Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020. Epidemiology 2023; 34:467-475. [PMID: 36943813 DOI: 10.1097/ede.0000000000001609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US from 2002 to 2020. METHODS Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin. RESULTS Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR] = 1.14; 95% credible interval [CrI] = 1.11, 1.18), benzodiazepines (RR = 1.19; 95% CrI = 1.12, 1.26), and opioids+benzodiazepines (RR = 1.22; 95% CrI = 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR = 0.88; 95% CrI = 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR = 0.81; 95% CrI = 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid- (RR = 0.83; 95% CrI = 0.76, 0.91), benzodiazepine- (RR = 0.79; 95% CrI = 0.68, 0.92), and opioid+benzodiazepine-related poisonings (RR = 0.83; 95% CrI = 0.70, 0.98). CONCLUSIONS Implementation of medical cannabis laws was associated with higher rates of opioid- and benzodiazepine-related deaths, whereas laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. The estimated effects of the expanded availability of cannabis seem dependent on the type of law implemented and its provisions.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- From the Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Millennium Nucleus on Sociomedicine (Sociomed), Chile
- Department of Population Health, New York University Grossman School of Medicine, NY
| | - Ariadne Rivera-Aguirre
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Department of Population Health, New York University Grossman School of Medicine, NY
| | | | | | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, New Brunswick, NJ
| | - William Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | | | | | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, NY
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Assini-Meytin LC, Nair R, McGinty EB, Stuart EA, Letourneau EJ. Is the Affordable Care Act Medicaid Expansion Associated With Reported Incidents of Child Sexual Abuse? CHILD MALTREATMENT 2023; 28:203-208. [PMID: 35213252 DOI: 10.1177/10775595221079605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There is substantial evidence that adequate access to healthcare among low-income adults through the Affordable Care Act Medicaid expansion mitigates risk factors associated with childhood maltreatment, including parental financial insecurity, substance use, and poor mental health. Indeed, studies identified reduced reports of child neglect in states that expanded Medicaid, relative to those that did not. However, it is unknown whether Medicaid expansion is associated with reported child sexual abuse (CSA). We present findings from a study evaluating the association of Medicaid expansion with incidents of CSA reported to child protective services. Using a difference-in-differences approach, we analyzed data from the National Child Abuse and Neglect Data System to examine the effects of state-level adoption of the Medicaid expansion on CSA reports per 100,000 children across 2008-2018. Results indicated no statistically significant association between Medicaid expansion and CSA incidents. We discuss potential reasons for differential association of macro-level policies on types of child maltreatment.
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Affiliation(s)
- Luciana C Assini-Meytin
- Department of Mental Health, 1466Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Reshmi Nair
- Department of Mental Health, 1466Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma B McGinty
- Department of Health Policy and Management, 1466Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, 1466Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth J Letourneau
- Department of Mental Health, 1466Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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CERDÁ MAGDALENA, KRAWCZYK NOA, KEYES KATHERINE. The Future of the United States Overdose Crisis: Challenges and Opportunities. Milbank Q 2023; 101:478-506. [PMID: 36811204 PMCID: PMC10126987 DOI: 10.1111/1468-0009.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Policy Points People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm-reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm-reduction services. Priorities for action include investing in evidence-based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.
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Affiliation(s)
- MAGDALENA CERDÁ
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | - NOA KRAWCZYK
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
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Mehta A, Patel BM. Long-acting opioids and cardiovascular diseases: Help or hindrance! Vascul Pharmacol 2023; 149:107144. [PMID: 36740214 DOI: 10.1016/j.vph.2023.107144] [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: 12/02/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Opioids are widely being used for chronic pain management, cough and diarrhea suppressants, anesthetic agents, and opioid de-addiction therapy. Opioid receptors, present in the central nervous system and peripheral tissues, are documented to regulate several cardiac functions through different signaling pathways. Long-acting opioids (LAO) have been successfully evaluated for their beneficial effects in various cardiovascular diseases viz. myocardial infarction, ischemic reperfusion injuries, atherosclerosis etc. However, on the other hand, several research studies pointed towards the harmful effects of LAOs which are mainly associated with QTc prolongation, torsade de pointes, ventricular arrhythmias, and cardiac arrest. This review shall familiarize readers with the benefits as well as the harmful effects of long-acting opioids in cardiovascular diseases. We have also provided an overview of cardiac opioid receptors, endogenous cardiac opioid peptides, and regulation of cardiovascular functions by central and cardiac opioid receptors.
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Affiliation(s)
- Ankita Mehta
- Labcorp Central Laboratory Services Limited Partnership, Bangalore, India
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MONTEZ JENNIFERKARAS, GRUMBACH JACOBM. US State Policy Contexts and Population Health. Milbank Q 2023; 101:196-223. [PMID: 37096608 PMCID: PMC10126966 DOI: 10.1111/1468-0009.12617] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points This Perspective connects the dots between the polarization in US states' policy contexts and the divergence in population health across states. Key interlocking forces that fueled this polarization are the political investments of wealthy individuals and organizations and the nationalization of US political parties. Key policy priorities for the next decade include ensuring all Americans have opportunities for economic security, deterring behaviors that kill or injure hundreds of thousands of Americans each year, and protecting voting rights and democratic functioning.
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Walters SM, Liu W, Lamuda P, Huh J, Brewer R, Johnson O, Bluthenthal RN, Taylor B, Schneider JA. A National Portrait of Public Attitudes toward Opioid Use in the US: A Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4455. [PMID: 36901465 PMCID: PMC10001548 DOI: 10.3390/ijerph20054455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Opioid overdose rates have steadily been increasing in the United States (US) creating what is considered an overdose death crisis. The US has a mixture of public health and punitive policies aimed to address opioid use and the overdose crisis, yet little is known about public opinion relating to opioid use and policy support. Understanding the intersection of public opinion about opioid use disorder (OUD) and policy can be useful for developing interventions to address policy responses to overdose deaths. METHODS A national sample of cross-sectional data from the AmeriSpeak survey conducted from 27 February 2020 through 2 March 2020 was analyzed. Measures included attitudes toward OUD and policy beliefs. Latent class analysis, a person-centered approach, was used to identify groups of individuals endorsing similar stigma and policy beliefs. We then examined the relationship between the identified groups (i.e., classes) and key behavioral and demographic factors. RESULTS We identified three distinct groups: (1) "High Stigma/High Punitive Policy", (2) "High Stigma/Mixed Public Health and Punitive Policy", and (3) "Low Stigma/High Public Health Policy". People with higher levels of education had reduced odds of being in the "High Stigma/High Punitive Policy" group. CONCLUSION Public health policies are most effective in addressing OUD. We suggest targeting interventions toward the "High Stigma/Mixed Public Health and Punitive Policy" group since this group already displays some support for public health policies. Broader interventions, such as eliminating stigmatizing messaging in the media and redacting punitive policies, could reduce OUD stigma among all groups.
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Affiliation(s)
- Suzan M. Walters
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
| | - Weiwei Liu
- Public Health Department, NORC at the University of Chicago, Chicago, IL 60603, USA
| | - Phoebe Lamuda
- Public Health Department, NORC at the University of Chicago, Chicago, IL 60603, USA
| | - Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - O’Dell Johnson
- Southern Public Health and Criminal Justice Research Center, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Ricky N. Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Bruce Taylor
- Public Health Department, NORC at the University of Chicago, Chicago, IL 60603, USA
| | - John A. Schneider
- Public Health Department, NORC at the University of Chicago, Chicago, IL 60603, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
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Vuong NX, Woods NK. On the Relationship Between Stakeholder Affiliation and Attitudes Toward Behavioral Health Reform in Kansas. Kans J Med 2023; 16:28-34. [PMID: 36845265 PMCID: PMC9957591 DOI: 10.17161/kjm.vol16.18542] [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: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The lack of access to behavioral health care, trends in behavioral health issues, and the impact of social determinants of health underlie the need for behavioral health reform in Kansas. However, stakeholders may affect progress toward behavioral health reform. This study examined stakeholders' attitudes toward behavioral health reform. Methods The authors analyzed data from a survey administered to elected officials, members of health advocacy groups, state employees, and payers in Kansas. Main outcome measures included attitudes toward the perceived benefit of certain behavioral health and social determinants of health policies and the perceived performance of the primary care and behavioral health care systems in Kansas. Results Payers perceived legislation to improve insurance coverage for behavioral health issues as less beneficial than state employees and members of health advocacy groups. Elected officials perceived legislation to address various social determinants of health as less beneficial than health advocates. Members of health advocacy groups rated the behavioral health care system more poorly than elected officials did. Conclusions Preliminary findings reflected both the barriers and facilitators to behavioral health reform in Kansas. However, several limitations undermined the generalizability of these findings. Future studies should consider more representative sample sizes, additional variables in behavioral health and social determinants of health policies, and more comprehensive, validated measures.
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Affiliation(s)
- Ngoc X. Vuong
- Dorothy and Bill Cohen Honors College, Wichita State University, Wichita, KS
| | - Nikki K. Woods
- Department of Public Health Sciences, Wichita, KS,Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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Cano M, Oh S, Osborn P, Olowolaju SA, Sanchez A, Kim Y, Moreno AC. County-level predictors of US drug overdose mortality: A systematic review. Drug Alcohol Depend 2023; 242:109714. [PMID: 36463764 DOI: 10.1016/j.drugalcdep.2022.109714] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This systematic review summarized published literature on county-level predictors of drug overdose mortality in the United States (US). METHODS Peer-reviewed studies and doctoral dissertations published in English between 1990 and July 19, 2022 were identified from PubMed, Web of Science, ProQuest Dissertations & Theses, PsycINFO, CINAHL, and EconLit. Eligible studies examined at least one county-level predictor of drug overdose mortality in US counties. Two reviewers independently completed screening, quality assessment (with an adapted National Institutes of Health Quality Assessment Tool), and data extraction. Results were qualitatively summarized and grouped by predictor categories. RESULTS Of 56 studies included, 42.9% were subnational, and 53.6% were limited to opioid overdose. In multiple studies, measures related to opioid prescribing, illness/disability, economic distress, mining employment, incarceration, family distress, and single-parent families were positively associated with drug overdose mortality outcomes, while measures related to cannabis dispensaries, substance use treatment, social capital, and family households were negatively associated with drug overdose mortality outcomes. Both positive and negative associations were documented for smoking, uninsurance, healthcare professional shortage status, physicians per capita, unemployment, income, poverty, educational attainment, racial composition, and rurality. Findings within studies also differed by subpopulation (by race/ethnicity, gender, age, or rurality) and the type of drugs involved in overdose. CONCLUSIONS The findings of this review provide relatively mixed evidence regarding many county-level predictors of overdose mortality, several of which also vary between subpopulations, supporting the importance of additional research to elucidate pathways through which the county context may shape risk of fatal overdose.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, USA.
| | - Sehun Oh
- College of Social Work, The Ohio State University, USA
| | | | | | - Armando Sanchez
- Department of Social Work, University of Texas at San Antonio, USA
| | - Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, USA; School of Social Work, University of Texas at Arlington, USA
| | - Alberto Cano Moreno
- Department of Public Policy, Universidad Autónoma del Estado de Hidalgo, México
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Bradford D, Parman M, Levy S, Turner WH, Li L, Leisch L, Eaton E, Crockett KB. HIV and Addiction Services for People Who Inject Drugs: Healthcare Provider Perceptions on Integrated Care in the U.S. South. J Prim Care Community Health 2023; 14:21501319231161208. [PMID: 36941754 PMCID: PMC10031597 DOI: 10.1177/21501319231161208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
This qualitative study evaluates physician training and experience with treatment and prevention services for people who inject drugs (PWID) including medications for opioid use disorder (MOUD) and HIV pre-exposure prophylaxis (PrEP). The Behavioral Model of Healthcare Utilization for Vulnerable Populations was applied as a framework for data analysis and interpretation. Two focus groups were conducted, one with early career physicians (n = 6) and one with mid- to late career physicians (n = 3). Focus group transcripts were coded and analyzed using thematic analysis to identify factors affecting implementation of treatment and prevention services for PWID. Respondents identified that increasing the availability of providers prescribing MOUD was a critical enabling factor for PWID seeking and receiving care. Integrated, interdisciplinary services were identified as an additional resource although these remain fragmented in the current healthcare system. Barriers to care included provider awareness, stigma associated with substance use, and access limitations. Providers identified the interwoven risk factors associated with injection drug use that must be addressed, including the risk of HIV acquisition, notably more at the forefront in the minds of early career physicians. Additional research is needed addressing the medical education curriculum, health system, and healthcare policy to address the addiction and HIV crises in the U.S. South.
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Affiliation(s)
- Davis Bradford
- Department of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mariel Parman
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sera Levy
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wesli H Turner
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leah Leisch
- Department of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ellen Eaton
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kaylee B Crockett
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Leonhardt MM, Spartz JR, Shankar A, Murphy SA. Fatal drug use in the COVID-19 pandemic response: Changing trends in drug-involved deaths before and after stay-at-home orders in Louisiana. Front Public Health 2023; 11:1117841. [PMID: 37113181 PMCID: PMC10126274 DOI: 10.3389/fpubh.2023.1117841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
The effect of disaster events on increasing drug-involved deaths has been clearly shown in previous literature. As the COVID-19 pandemic led to stay-at-home orders throughout the United States, there was a simultaneous spike in drug-involved deaths around the country. The landscape of a preexisting epidemic of drug-involved deaths in the United States is one which is not geographically homogenous. Given this unequal distribution of mortality, state-specific analysis of changing trends in drug use and drug-involved deaths is vital to inform both care for people who use drugs and local policy. An analysis of public health surveillance data from the state of Louisiana, both before and after the initial stay-at-home order of the COVID-19 pandemic, was used to determine the effect the pandemic may have had on the drug-involved deaths within this state. Using the linear regression analysis of total drug-involved deaths, as well as drug-specific subgroups, trends were measured based on quarterly (Qly) deaths. With the initial stay-at-home order as the change point, trends measured through quarter 1 (Q1) of 2020 were compared to trends measured from quarter 2 (Q2) of 2020 through quarter 3 (Q3) of 2021. The significantly increased rate of change in Qly drug-involved deaths, synthetic opioid-involved deaths, stimulant-involved deaths, and psychostimulant-involved deaths indicates a long-term change following the initial response to the COVID-19 pandemic. Changes in the delivery of mental health services, harm reduction services, medication for opioid use disorder (MOUD), treatment services, withdrawal management services, addiction counseling, shelters, housing, and food supplies further limited drug-involved prevention support, all of which were exacerbated by the new stress of living in a pandemic and economic uncertainty.
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Affiliation(s)
- Maxwell M. Leonhardt
- Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
- *Correspondence: Maxwell M. Leonhardt
| | - John R. Spartz
- Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Arti Shankar
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Stephen A. Murphy
- Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
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23
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Muacevic A, Adler JR, Ozaki A, Hori A, Tsuchiya T. Eleven-Year Trend of Drug and Chemical Substance Overdose at a Local Emergency Hospital in Japan. Cureus 2022; 14:e32475. [PMID: 36644086 PMCID: PMC9835393 DOI: 10.7759/cureus.32475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate long-term trends of overdose in the emergency department of a regional core hospital in Sendai, Miyagi Prefecture, Japan, and to identify patient characteristics as well as drugs and chemicals associated with overdose. METHODS Patients who visited the emergency department from January 1, 2010, to December 31, 2020, and were diagnosed with a drug or chemical overdose were included in the study. We conducted a descriptive analysis based on the data collected. RESULTS In total, 577 patients (mean 38.4 years old, female 75.0%) were considered, and 16.8% had a history of repeated overdose. The number of patients during the study period showed a downward trend, with slight increases in 2012 and 2020. In addition, the top four drugs suspected of causing overdose were over the counter (OTC) antipyretic analgesics and cold medicines (N=97), followed by flunitrazepam (N=80), etizolam (N=72), and brotizolam (N=70). CONCLUSION There was a decreasing trend in overdose, and OTC medicines, sedatives, and anxiolytics were the primary medications causing overdose. OTC antipyretic analgesics and cold medicines were the most common suspected overdose drugs, with an increasing trend in the later years.
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Shiue KY, Naumann RB, Proescholdbell S, Cox ME, Aurelius M, Austin AE. Differences in overdose deaths by intent: Unintentional & suicide drug poisonings in North Carolina, 2015-2019. Prev Med 2022; 163:107217. [PMID: 35998765 DOI: 10.1016/j.ypmed.2022.107217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
Comprehensive fatal overdose prevention requires an understanding of the fundamental causes and context surrounding drug overdose. Using a social determinants of health (SDOH) framework, this descriptive study examined unintentional and self-inflicted (i.e., suicide) overdose deaths in North Carolina (NC), focusing on specific drug involvement and contextual factors. Unintentional and suicide overdose deaths were identified using 2015-2019 NC death certificate data. Specific drug involvement was assessed by searching literal text fields for drug mentions. County-level contextual factors were obtained from NC Institute of Medicine and County Health Rankings, encompassing five SDOH domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment). Descriptive statistics were calculated by intent for drug involvement and a variety of contextual factors. During 2015-2019, 9% of NC drug overdose deaths were self-inflicted and 89% were unintentional (2% other/undetermined). Unintentional overdoses largely involved illicit drugs [fentanyl (47%), cocaine (33%), heroin (29%)]. Suicide overdoses frequently involved prescription opioids [oxycodone (18%), hydrocodone (10%)] and antidepressants (32%). Overall, overdose deaths tended to occur in under-resourced counties across all SDOH domains, though unintentional overdoses occurred more often among residents of under-resourced counties than suicide overdoses, with differences most pronounced for economic stability-related factors. There are notable distinctions between unintentional and suicide overdose deaths in demographics and drug involvement, though the assessment of SDOH demonstrated that overdose mortality is broadly associated with marginalization across all domains. These findings highlight the value of allocating resources to prevention and intervention approaches that target upstream causes of overdose (e.g., housing first, violence prevention programs).
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Affiliation(s)
- Kristin Y Shiue
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States.
| | - Rebecca B Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC 27699-1915, United States
| | - Mary E Cox
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC 27699-1915, United States
| | - Michelle Aurelius
- Office of the Chief Medical Examiner, Division of Public Health, North Carolina Department of Health and Human Services, 4312 District Drive, Raleigh, NC 27607, United States
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, United States
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25
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Hamilton LK, Wheeler-Martin K, Davis CS, Martins SS, Samples H, Cerdá M. A modified Delphi process to identify experts' perceptions of the most beneficial and harmful laws to reduce opioid-related harm. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103809. [PMID: 35908313 DOI: 10.1016/j.drugpo.2022.103809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND States have enacted multiple types of laws, with a variety of constituent provisions, in response to the opioid epidemic, often simultaneously. This temporal proximity and variation in state-to-state operationalization has resulted in significant challenges for empirical research on their effects. Thus, expert consensus can be helpful to classify laws and their provisions by their degree of helpfulness and impact. METHODS We conducted a four-stage modified policy Delphi process to identify the top 10 most helpful and 5 most harmful provisions from eight opioid-related laws. This iterative consultation with six types of opioid experts included a preliminary focus group (n=12), two consecutive surveys (n=56 and n=40, respectively), and a final focus group feedback session (n=5). RESULTS On a scale of very harmful (0) to very helpful (4), overdose Good Samaritan laws received the highest average helpfulness rating (3.62, 95% CI: 3.48-3.75), followed by naloxone access laws (3.37, 95% CI: 3.22-3.51), and pain management clinic laws (3.08, 95% CI: 2.89-3.26). Drug-induced homicide (DIH) laws were rated the most harmful (0.88, 95% CI: 0.66-1.11). Impact ratings aligned similarly, although Medicaid laws received the second highest overall impact rating (3.71, 95% CI: 3.45, 3.97). The two most helpful provisions were naloxone standing orders (3.94, 95% CI: 3.86-4.02) and Medicaid coverage of medications for opioid use disorder (MOUD) (3.89, 95% CI: 3.82). Mandatory minimum DIH laws were the most harmful provision (0.73, 95% CI 0.53-0.93); followed by requiring prior authorization for Medicaid coverage of MOUD (1.00 95% CI: 0.72-1.27). CONCLUSION Overall, experts rated laws and provisions that facilitated harm reduction efforts and access to MOUD as most helpful. Laws and provisions rated as most harmful criminalized substance use and placed restrictions on access to MOUD. These ratings provide a foundation for evaluating the overall overdose policy environment for each state.
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Affiliation(s)
- Leah K Hamilton
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, United States; New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States.
| | - Katherine Wheeler-Martin
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States
| | - Corey S Davis
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States; Network for Public Health Law, 7101 York Avenue South, #270, Edina, MN 55435, United States
| | - Silvia S Martins
- Columbia University, Mailman School of Public Health, Department of Epidemiology, Epidemiology, 722 West 168th St. New York, NY 10032, United States
| | - Hillary Samples
- Rutgers Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, United States; Rutgers School of Public Health, Department of Health Behavior, 683 Hoes Lane West, Piscataway, NJ 08854, United States
| | - Magdalena Cerdá
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States
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26
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Letourneau EJ, Assini-Meytin LC, Nair R, Stuart EA, Decker MR, McGinty EB. Health insurance expansion and family violence prevention: A conceptual framework. CHILD ABUSE & NEGLECT 2022; 129:105664. [PMID: 35580400 DOI: 10.1016/j.chiabu.2022.105664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
Family violence, including child maltreatment (CM) and intimate partner violence (IPV), plagues far too many American families, particularly those in low-income communities. CM and IPV are intertwined and impose a significant emotional, health and financial burden on children and families and an economic burden on our country. Although these and other forms of violence are influenced by shared risk factors across the socioecological spectrum, prevention efforts typically intervene on a single type of violence at a microsystem level via individual or family intervention. Research is needed to identify policies operating at macrosystem levels that reduce, at scale, multiple forms of violence affecting children. In this paper, we propose a three-step theory of change through which health insurance expansions might reduce rates of CM and IPV, using Medicaid expansion as an exemplar. The proposed framework can inform research examining the link between health insurance and the primary prevention of CM and IPV.
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Affiliation(s)
- Elizabeth J Letourneau
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Luciana C Assini-Meytin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Reshmi Nair
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma Beth McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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27
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Samuels EA, Martin AF. Beyond the Waiver: Multilevel Interventions Needed to Expand Buprenorphine Treatment. JAMA Netw Open 2022; 5:e2212425. [PMID: 35552731 DOI: 10.1001/jamanetworkopen.2022.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alister F Martin
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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28
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Abstract
This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 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, Flushing, NY, 11367, United States.
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29
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Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: A difference in differences analysis. Drug Alcohol Depend 2022; 233:109381. [PMID: 35259679 PMCID: PMC8971012 DOI: 10.1016/j.drugalcdep.2022.109381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Opioid-related overdoses are a major cause of mortality in the US. Medicaid Expansion is posited to reduce opioid overdose-related mortality (OORM), and may have a particularly strong effect among people of lower socioeconomic status. This study assessed the association between state Medicaid Expansion and county-level OORM rates among individuals with low educational attainment. METHODS This quasi-experimental study used lagged multilevel difference-in-difference models to test the relationship of state Medicaid Expansion to county-level OORM rates among people with a high-school diploma or less. Longitudinal (2008-2018) OORM data on 2978 counties nested in 48 states and the District of Columbia (DC) were drawn from the National Center for Health Statistics. The state-level exposure was a time-varying binary-coded variable capturing pre- and post-Medicaid Expansion under the Affordable Care Act (an "on switch"-type variable). The main outcome was annual county-level OORM rates among low-education adults adjusted for potential underreporting of OORM. FINDINGS The adjusted county-level OORM rates per 100,000 among the study population rose on average from 10.26 (SD = 13.56) in 2008-14.51 (SD = 18.20) in 2018. In the 1-year lagged multivariable model that controlled for policy and sociodemographic covariates, the association between state Medicaid Expansion and county-level OORM rates was statistically insignificant. CONCLUSIONS We found no evidence that expanding Medicaid eligibility reduced OORM rates among adults with lower educational attainment. Future work should seek to corroborate our findings and also identify - and repair - breakdowns in mechanisms that should link Medicaid Expansion to reduced overdoses.
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30
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Auty SG, Griffith KN. Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2022; 232:109340. [PMID: 35131533 PMCID: PMC8809643 DOI: 10.1016/j.drugalcdep.2022.109340] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused disruptions in the delivery of health services, which may have adversely affected access to substance use disorder (SUD) treatment services. Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. Thus, the pandemic may have differentially impacted overdose mortality depending on expansion status. This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. METHODS State-level data on overdose mortality were obtained from the Centers for Disease Control and Prevention's WONDER database for 2013-2020 (N = 408 state-years). The primary outcomes were drug and opioid overdose deaths per 100,000 residents. The primary exposure was Medicaid expansion status as of January 1st, 2020. Difference-in-difference (DID) models were used to compare changes in outcomes between expansion and non-expansion states after the onset of the COVID-19 pandemic. RESULTS The U.S. experienced 91,799 drug overdose deaths in 2020, a 29.9% relative increase from 2019. Expansion states experienced an adjusted increase of 7.0 drug overdose deaths per 100,000 residents (95% CI 3.3, 10.7) and non-expansion states experienced an increase of 4.3 deaths (95% CI 1.5, 8.2) from 2019 to 2020. Similar trends were observed in opioid overdose deaths. In DID models, Medicaid expansion was not associated with changes in drug (0.9 deaths, 95% CI -2.0, 3.7) or opioid overdose deaths (0.8 deaths, 95% CI -1.8, 3.5). CONCLUSIONS The increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
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Affiliation(s)
- Samantha G. Auty
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118, USA,Correspondence to: 715 Albany Street, Talbot Building, Boston, Massachusetts 02118, USA
| | - Kevin N. Griffith
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Nashville, Tennessee 37203, USA,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130, USA
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31
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Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuéllar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022; 399:555-604. [PMID: 35122753 PMCID: PMC9261968 DOI: 10.1016/s0140-6736(21)02252-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amy S B Bohnert
- Department of Psychiatry and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA USA
| | | | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA; Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yasmin L Hurd
- Addiction Institute, Icahn School of Medicine, New York, NY, USA
| | - David N Juurlink
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Erin E Krebs
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery and Outcomes Research, Veterans Affairs Minneapolis Health Care System, Minneapolis, MN, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Timko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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32
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Cho SK, Jun H, Varisco TJ, Lam J, Romley JA, Li J, Thornton JD. Association of cash payment with intensity of opioid prescriptions. J Am Pharm Assoc (2003) 2022; 62:1224-1231.e5. [DOI: 10.1016/j.japh.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
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Samuels EA, Doran KM. Moving Upstream: A Social Emergency Medicine Approach to Opioid Use Disorder. Ann Emerg Med 2022; 79:168-171. [PMID: 34756453 DOI: 10.1016/j.annemergmed.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
| | - Kelly M Doran
- Ronald O. Perelman Department of Emergency Medicine and the Department of Population Health, NYU School of Medicine, New York, NY
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34
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Simes JT, Jahn JL. The consequences of Medicaid expansion under the Affordable Care Act for police arrests. PLoS One 2022; 17:e0261512. [PMID: 35020737 PMCID: PMC8754343 DOI: 10.1371/journal.pone.0261512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND & METHODS National protests in the summer of 2020 drew attention to the significant presence of police in marginalized communities. Recent social movements have called for substantial police reforms, including "defunding the police," a phrase originating from a larger, historical abolition movement advocating that public investments be redirected away from the criminal justice system and into social services and health care. Although research has demonstrated the expansive role of police to respond a broad range of social problems and health emergencies, existing research has yet to fully explore the capacity for health insurance policy to influence rates of arrest in the population. To fill this gap, we examine the potential effect of Medicaid expansion under the Affordable Care Act (ACA) on arrests in 3,035 U.S. counties. We compare county-level arrests using FBI Uniform Crime Reporting (UCR) Program Data before and after Medicaid expansion in 2014-2016, relative to counties in non-expansion states. We use difference-in-differences (DID) models to estimate the change in arrests following Medicaid expansion for overall arrests, and violent, drug, and low-level arrests. RESULTS Police arrests significantly declined following the expansion of Medicaid under the ACA. Medicaid expansion produced a 20-32% negative difference in overall arrests rates in the first three years. We observe the largest negative differences for drug arrests: we find a 25-41% negative difference in drug arrests in the three years following Medicaid expansion, compared to non-expansion counties. We observe a 19-29% negative difference in arrests for violence in the three years after Medicaid expansion, and a decrease in low-level arrests between 24-28% in expansion counties compared to non-expansion counties. Our main results for drug arrests are robust to multiple sensitivity analyses, including a state-level model. CONCLUSIONS Evidence in this paper suggests that expanded Medicaid insurance reduced police arrests, particularly drug-related arrests. Combined with research showing the harmful health consequences of chronic policing in disadvantaged communities, greater insurance coverage creates new avenues for individuals to seek care, receive treatment, and avoid criminalization. As police reform is high on the agenda at the local, state, and federal level, our paper supports the perspective that broad health policy reforms can meaningfully reduce contact with the criminal justice system under historic conditions of mass criminalization.
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Affiliation(s)
- Jessica T. Simes
- Department of Sociology, Boston University, Boston, MA, United States of America
| | - Jaquelyn L. Jahn
- Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
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35
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Cano M, Agan A, Bandoian L, Larochelle L. Individual and County-Level Disparities in Drug and Opioid Overdose Mortality for Hispanic Men in Massachusetts and the Northeast United States. Subst Use Misuse 2022; 57:1131-1143. [PMID: 35459423 DOI: 10.1080/10826084.2022.2064507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to identify individual- and county-level inequalities that may underlie disparities in drug overdose mortality for Hispanic men in Massachusetts and the broader Northeast region. METHODS The study first used data from the State Unintentional Drug Overdose Reporting System to compare the 635 Hispanic and 3593 Non-Hispanic (NH) White men who died of unintentional/undetermined opioid-related overdoses in Massachusetts in 2016-2018. Next, the study used 2015-2019 data from the Multiple Cause of Death online platform to: a) compare rates of drug overdose mortality in Hispanic versus NH White men in 54 counties in the Northeast United States; and b) examine associations with inequalities in poverty, educational attainment, unemployment, and uninsurance (from 2015-2019 American Community Survey data). RESULTS At the individual level, in Massachusetts, Hispanic and NH White men who died of opioid-related overdose differed in terms of educational attainment, birthplace, urbanicity, substance use disorder treatment history, and specific drugs involved in death. At the county level, in the Northeast region, each one-standard deviation increase in the ratio of the Hispanic to NH White poverty rate was associated with a 27% increase in the ratio of Hispanic to NH White male overdose mortality; each one-standard deviation increase in the ratio of the Hispanic to NH White unemployment rate was associated with a 43% increase in the ratio of Hispanic to NH White male overdose mortality. CONCLUSIONS Findings underscore the importance of equitable interventions and efforts to address inequalities in social determinants of health for Hispanic populations in the Northeast.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Anna Agan
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lisa Bandoian
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lauren Larochelle
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
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Social Determinants of Mortality of COVID-19 and Opioid Overdose in American Rural and Urban Counties. J Addict Med 2022; 16:e52-e55. [PMID: 35120068 PMCID: PMC8815643 DOI: 10.1097/adm.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Both COVID-19 deaths and opioid overdose deaths continue to increase in the United States. Little is known about the characteristics of counties with high rates of mortality for both.
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Lee BP, Dodge JL, Terrault NA. Medicaid expansion and variability in mortality in the USA: a national, observational cohort study. THE LANCET PUBLIC HEALTH 2022; 7:e48-e55. [PMID: 34863364 PMCID: PMC10122976 DOI: 10.1016/s2468-2667(21)00252-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The expansion of the Medicaid public health insurance programme has varied by state in the USA. Longer-term mortality and factors associated with variability in outcomes after Medicaid expansion are under-studied. We aimed to investigate the association of state Medicaid expansion with all-cause mortality. METHODS This was a population-based, national, observational cohort study capturing all reported deaths among adults aged 25-64 years via death certificate data in the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database in the USA from Jan 1, 2010, to Dec 31, 2018. We obtained national demographic and mortality data for adults aged 25-64 years, and state-level demographics and 2010-18 mortality estimates for the overall population by linking federally maintained registries (CDC WONDER, Behavioral Risk Factor Surveillance System, Health Resources and Services Administration, US Census Bureau, and Bureau of Labor Statistics). States were categorised as Medicaid expansion or non-expansion states as classified by the Kaiser Family Foundation. Multivariable difference-in-differences analysis assessed the absolute difference in the annual, state-level, all-cause mortality per 100 000 adults after Medicaid expansion. FINDINGS Among 32 expansion states and 17 non-expansion states, Medicaid expansion was associated with reductions in all-cause mortality (-11·8 deaths per 100 000 adults [95% CI -21·3 to -2·2]). There was variability in changes in all-cause mortality associated with Medicaid expansion by state (ranging from -63·8 deaths per 100 000 adults [95% CI -134·1 to -42·9] in Delaware to 30·4 deaths per 100 000 adults [-39·8 to 51·4] in New Mexico). State-level proportions of women (-17·8 deaths per 100 000 adults [95% CI -26·7 to -8·8] for each percentage point increase in women residents) and non-Hispanic Black residents (-1·4 deaths per 100 000 adults [-2·4 to -0·3] for each percentage point increase in non-Hispanic Black residents) were associated with greater adjusted reductions in all-cause mortality among expansion states. INTERPRETATION After 4 years of implementation, Medicaid expansion remains associated with significant reductions in all-cause mortality, but reductions are variable by state characteristics. These results could inform policy makers to provide broad-based equitable improvements in health outcomes. FUNDING University of Southern California Research Center for Liver Diseases.
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Utilization of Medications for Opioid Use Disorder Across US States: Relationship to Treatment Availability and Overdose Mortality. J Addict Med 2022; 16:114-117. [PMID: 35120067 DOI: 10.1097/adm.0000000000000820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Availability of medications for opioid use disorder (MOUD) remains sparse. To date, there has been no national, state-by-state comparison of patient MOUD utilization relative to treatment availability and burden of overdose deaths. We aimed to quantify, for each state, the number of MOUD patients relative to (1) office-based buprenorphine providers and opioid treatment programs (OTPs) and (2) overdose deaths. METHODS We conducted a spatial analysis of patients receiving MOUD from OTPs or buprenorphine providers in March 2017 across all 50 states and Washington, DC. For each state, we calculated the number of patients receiving MOUD from OTPs and buprenorphine prescriptions, relative to available OTPs and buprenorphine providers; as well as ratios of number of patients receiving MOUD relative to overdose deaths. RESULTS In March 2017, 942,368 patients attended an OTP (410,288) or received a buprenorphine prescription (486,318). Patient to OTP ratio was highest in West Virginia, Delaware, Washington, DC, New Jersey, New Hampshire, Connecticut and Ohio, ranging from 91 to 193 patients per OTP in the first quintile to 430 to 648 in the fifth. Patient to buprenorphine provider ratio was highest in Kentucky and West Virginia, ranging from 3 to 7 patients per provider in the first quintile to 19 to 28 in the fifth. Median MOUD patients per overdose death was 21 (IQR:14.9-28.2). Of high overdose states, Washington, DC, New Jersey, and Ohio had the smallest number of patients on MOUD relative to deaths. CONCLUSIONS High patient volume relative to treatment availability in overdose-burdened areas may indicate strain on MOUD providers and OTPs. Promoting greater utilization while expanding MOUD providers and programs is critical.
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Potter JS, Finley EP, King VL, Lanham HJ, Schmidt S, Schneegans S, Rosen KD. Adapting and scaling a single site DEA X-waiver training program to a statewide initiative: Implementing GetWaiveredTX. J Subst Abuse Treat 2021; 137:108688. [DOI: 10.1016/j.jsat.2021.108688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 11/05/2021] [Accepted: 12/02/2021] [Indexed: 01/10/2023]
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Describing the changing relationship between opioid prescribing rates and overdose mortality: A novel county-level metric. Drug Alcohol Depend 2021; 225:108761. [PMID: 34051545 DOI: 10.1016/j.drugalcdep.2021.108761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS In the United States, the rate of drug overdose death has more than tripled over the past two decades, a trend that is often attributed to changes in opioid prescribing practices. We developed a novel, longitudinal metric to summarize the relationship between prescription opioid prescribing practices and drug overdose mortality and to assess if longitudinal changes in that relationship differ by characteristics of place. METHODS We constructed a single county-level measure of overdose deaths per 100,000 opioid prescriptions annually from 2006 to 2018. We used latent profile analysis to classify all U.S. counties into classes based on demographic and socioeconomic characteristics and fit a mixed Poisson log-linear model to quantify temporal changes in our measure by county-type classes. RESULTS Latent profile analysis resulted in 7 classes with high separation between classes (overall entropy = 0.916). Across all groups, the average number of overdose deaths per opioid prescription remained steady from 2006 to 2011 and increased from 2012-2018. The largest increases were in the high GDP (average annual change: 18.1 %, 95 %CI: 17.5, 18.6) and high education classes (16.6 %, 95 %CI: 16.0, 17.1). CONCLUSIONS This novel summary metric enhances our understanding of the shift in overdose mortality and the role of geography and place characteristics.
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Pro G, Giano Z, Camplain R, Haberstroh S, Camplain C, Wheeler D, Hubach RD, Baldwin JA. The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum. Community Ment Health J 2021; 57:1017-1022. [PMID: 33033972 DOI: 10.1007/s10597-020-00719-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/01/2020] [Indexed: 02/03/2023]
Abstract
Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states ([Formula: see text]=-0.038, SE = 0.005, p < 0.0001) than in expansion states ([Formula: see text]=-0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population.
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Affiliation(s)
- George Pro
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Zach Giano
- Center for Rural Health, Oklahoma State University, Tulsa, OK, USA
| | - Ricky Camplain
- Southwest Health Equity Research Collaborative, Northern Arizona University, Flagstaff, AZ, USA
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Shane Haberstroh
- Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ, USA
| | - Carly Camplain
- Center for Health Equity Research, Northern Arizona University, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA
| | - Denna Wheeler
- Center for Rural Health, Oklahoma State University, Tulsa, OK, USA
| | | | - Julie A Baldwin
- Southwest Health Equity Research Collaborative, Northern Arizona University, Flagstaff, AZ, USA
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
- Center for Health Equity Research, Northern Arizona University, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA
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Doby BL, Hanner K, Johnson S, Purnell TS, Shah MB, Lynch RJ. Results of a data-driven performance improvement initiative in organ donation. Am J Transplant 2021; 21:2555-2562. [PMID: 33314706 DOI: 10.1111/ajt.16442] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
New metrics for organ procurement organization (OPO) performance utilize National Center for Health Statistics data to measure cause, age, and location consistent (CALC) deaths. We used this denominator to identify opportunities for improved donor conversion at one OPO, Indiana Donor Network (INOP). We sought to determine whether such analyses are immediately actionable for quality improvement (QI) initiatives directed at increased donor conversion. CALC-based assessment of INOP's performance revealed an opportunity to improve conversion of older donors. Following the QI initiative, INOP donor yield rose by 44%, while organs transplanted rose by 29%. These changes tolerated temporary disruption around the COVID-19 pandemic. Improved donor yield was primarily seen in older groups identified by CALC-based methods. Process changes in resource allocation and monitoring were associated with a 57% increase in the number of potential donors approached in the QI period and a subsequent rise in the number of potential donor referrals, suggesting positive feedback at area hospitals. Post-intervention, INOP's projected donation performance rose from 51st to 18th among all OPOs. OPOs can use CALC death data to accurately assess donor conversion by categories including age and race/ethnicity. These data can be used in real time to inform OPO-level processes to maximize donor recovery.
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Affiliation(s)
- Brianna L Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Tanjala S Purnell
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Malay B Shah
- Department of Surgery, Division of Abdominal Transplant Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Raymond J Lynch
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
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Davis CS, Lieberman AJ. Laws limiting prescribing and dispensing of opioids in the United States, 1989-2019. Addiction 2021; 116:1817-1827. [PMID: 33245795 DOI: 10.1111/add.15359] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/23/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Opioid overdose is a public health emergency in the United States. In an attempt to reduce potentially inappropriate opioid prescribing, many US states have adopted legal restrictions on the ability of medical professionals to prescribe or dispense opioids for pain. This review describes the major elements of relevant US state laws and the ways in which they have changed over time. METHODS Systematic legal review in which two trained legal researchers collected and reviewed all US state laws that limit the amount or duration of opioids that medical professionals may prescribe or dispense for pain. These laws were then coded on a set of pre-selected measures, including when the law was enacted, dosage and duration limits imposed, circumstances in which the restrictions do not apply and whether additional requirements or restrictions apply to prescriptions issued to minors. RESULTS The number of US states with opioid limitation laws increased from 10 in 2016 to 39 by the end of 2019. The provisions of these laws vary between states and have shifted within states over time. At the end of 2019 the modal duration limit was 7 days, with a range of 3 to 31. Fourteen states imposed limits on the dosage of opioids that can be prescribed, ranging from 30 morphine milligram equivalents (MME) to a 120 MME daily maximum. In 16 states, different limits apply to prescriptions issued to minors. CONCLUSIONS The number of US states with opioid limitation laws nearly quadrupled between 2016 and 2019, with a great amount of heterogeneity between state restrictions and changes over time.
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Abstract
OBJECTIVE The authors examined changes in buprenorphine treatment following Medicaid expansion, including the contribution of Medicaid-financed prescriptions. METHODS Buprenorphine pharmacy claims for patients were identified in the 2012-2018 IQVIA Longitudinal Prescription Data (LRx) data set, including 79.8% of U.S. retail prescriptions in 2012, increasing to 92.0% in 2018. A cohort analysis was used to assess the mean number of patients in a yearly quarter filling one or more buprenorphine prescriptions during preexpansion (2012-2013) and postexpansion (2014-2018) periods in expansion and nonexpansion states. Interrupted time-series analysis estimated associations of Medicaid expansion period with change in Medicaid-financed treatment. Separate analyses evaluated changes in duration and dose of new treatment episodes focused on mean quarterly number of patients treated with buprenorphine and proportions of new treatment episodes ≥180 days long and with ≥16 mg/day. RESULTS Between preexpansion and postexpansion, the mean quarterly number of patients taking buprenorphine increased by 93,300 in expansion states and by 84,960 in nonexpansion states. Corresponding changes for Medicaid-financed patients were 28,760 and 4,050, respectively. The fastest growth in Medicaid-financed treatment occurred among patients ages 25-44. Among new Medicaid-financed treatment episodes, little change was found in the proportion reaching the 180-day threshold, and declines were observed in the proportion receiving ≥16 mg/day. CONCLUSIONS The findings are consistent with previous research indicating that Medicaid expansion has increased Medicaid-financed buprenorphine treatment. However, because of offsetting changes in other payment groups, the overall increase in expansion states was similar to the increase in nonexpansion states.
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Affiliation(s)
- Mark Olfson
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai)
| | - Victoria Shu Zhang
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai)
| | - Marissa King
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai)
| | - Ramin Mojtabai
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai)
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Austin AE, Naumann RB, Short NA. Association of Medicaid Expansion with Suicide Deaths among Nonelderly U.S. Adults. Am J Epidemiol 2021; 190:1760-1769. [PMID: 34467410 DOI: 10.1093/aje/kwab130] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/14/2022] Open
Abstract
In 2014, the Affordable Care Act gave states the option to expand Medicaid coverage to nonelderly adults (18-64 years) with incomes up to 138% of the federal poverty level. The association of Medicaid expansion with suicide, a leading cause of death in the U.S., has not been examined. We used 2005-2017 National Violent Death Reporting System data for eight Medicaid expansion and seven non-expansion states. We examined the association of Medicaid expansion with rates of suicide death among nonelderly adults per 100,000 population using a difference-in-differences approach. Adjusting for state-level confounders, Medicaid expansion states had 1.2 (95% CI -2.5, 0.1) fewer suicide deaths per 100,000 population per year in the post-expansion period than would have been expected if they had followed the same trend in suicide rates as non-expansion states. Medicaid expansion was associated with reductions in suicide rates among women, men, those 30-44 years, white, non-Hispanic individuals, and those without a college degree. Medicaid expansion was not associated with a change in suicide rates among those 18-29 or 45-64 years, and non-white or Hispanic individuals. Overall, Medicaid expansion was associated with reductions in rates of suicide death among nonelderly adults. Further research on inequities in expansion benefits is needed.
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Thakarar K, Nenninger K, Agmas W. Harm Reduction Services to Prevent and Treat Infectious Diseases in People Who Use Drugs. Infect Dis Clin North Am 2021; 34:605-620. [PMID: 32782104 DOI: 10.1016/j.idc.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article reviews the principles of harm reduction, evidence-based harm reduction strategies such as syringe service programs and supervised injection facilities, and provides approaches to integrating a harm reduction approach into clinical practice. As providers strive to increase capacity to treat underlying substance use disorder, we must also recognize that some people may continue to use drugs. In this setting, providers can still deliver nonjudgmental, individualized care, and advocate for the health and safety of people who inject drugs.
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Affiliation(s)
- Kinna Thakarar
- Infectious Disease and Addiction Medicine, Maine Medical Center/Tufts University School of Medicine, 50 Foden Road, South Portland, ME 04106, USA.
| | - Katherine Nenninger
- Preventive Medicine, Maine Medical Center/Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA
| | - Wollelaw Agmas
- Infectious Disease, Maine Medical Center/Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA
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Macmadu A, Paull K, Youssef R, Batthala S, Wilson KH, Samuels EA, Yedinak JL, Marshall BDL. Predictors of enrollment in opioid agonist therapy after opioid overdose or diagnosis with opioid use disorder: A cohort study. Drug Alcohol Depend 2021; 219:108435. [PMID: 33310383 PMCID: PMC7855664 DOI: 10.1016/j.drugalcdep.2020.108435] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Medicaid recipients have a high burden of opioid overdose and opioid use disorder (OUD). Opioid agonist therapies are an effective treatment for OUD, but there is a wide and persisting gap between those who are indicated and those who receive treatment. The objective of this study was to identify the predictors of enrollment in opioid agonist therapy within 6 months of an opioid overdose or OUD diagnosis in a cohort of Medicaid recipients. METHODS Using multiple linked, state-level databases, we conducted a retrospective cohort study of 17,449 Medicaid recipients in Rhode Island who had an opioid overdose or an OUD diagnosis between July 2013 and June 2018. RESULTS The majority (58 %) of Medicaid recipients did not enroll in opioid agonist therapy within 6 months. In adjusted models, having one or more prior overdose (adjusted risk ratio [ARR] = 0.33, 95 % CI: 0.28, 0.38), alcohol use disorder (ARR = 0.56, 95 % CI: 0.52, 0.60), or back problems (ARR = 0.58, 95 % CI: 0.55, 0.61) were strong predictors of non-enrollment. Conversely, emergency department (ARR = 1.31, 95 % CI: 1.28-1.34) and primary care provider (ARR = 1.03, 95 % CI: 1.01-1.34) visit frequency above the 75th percentile were associated with timely enrollment in opioid agonist therapy. CONCLUSIONS Our findings underscore the need to enhance pathways to treatment for OUD through varied nodes of engagement with healthcare systems. Interventions to improve screening for OUD and referrals to opioid agonist therapies should include high-impact settings, such as treatment programs for alcohol and substance use disorders, pain clinics, and outpatient behavioral care settings.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI, USA
| | - Kimberly Paull
- Executive Office of Health and Human Services, State of Rhode Island, Cranston, RI, USA
| | - Rouba Youssef
- Executive Office of Health and Human Services, State of Rhode Island, Cranston, RI, USA
| | - Sivakumar Batthala
- Executive Office of Health and Human Services, State of Rhode Island, Cranston, RI, USA
| | | | - Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA.
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Yan LD, Ali MK, Strombotne KL. Impact of Expanded Medicaid Eligibility on the Diabetes Continuum of Care Among Low-Income Adults: A Difference-in-Differences Analysis. Am J Prev Med 2021; 60:189-197. [PMID: 33191065 PMCID: PMC10420391 DOI: 10.1016/j.amepre.2020.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The impact of Medicaid expansion on linkage to care, self-maintenance, and treatment among low-income adults with diabetes was examined. METHODS A difference-in-differences design was used on data from the Behavioral Risk Factor Surveillance System, 2008-2018. Analysis was restricted to states with diabetes outcomes and nonpregnant adults aged 18-64 years who were Medicaid eligible on the basis of income. Separate analyses were performed for early postexpansion (1, 2, 3) and late postexpansion years (4, 5). Analyses were performed from September 2019 to March 2020. RESULTS In comparing expansion with control states, low-income residents with diabetes had similar ages (48.9 vs 49.1 years) and similar proportions who were female (54.4% vs 55.0%) but were less likely to be Black, non-Hispanic (20.8% vs 29.2%, standardized difference= -16.3%). In expansion states, health insurance increased by 7.2 percentage points (95% CI=3.9, 10.4), and the ability to afford a physician increased by 5.5 percentage points (95% CI=1.9, 9.1) in the early years, but no difference was found in late years. Medicaid expansion led to a 5.3-percentage point increase in provider foot examinations in the early period (95% CI=0.14, 10.4) and a 7.2-percentage point increase in self-foot examinations in the late period (95% CI=1.1, 13.3). No statistically significant changes were detected in self-reported linkage to care, self-maintenance, or treatment. CONCLUSIONS Although health insurance, ability to afford a physician visit, and foot examinations increased for Medicaid-eligible people with diabetes, there was no statistically significant difference found for other care continuum measures.
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Affiliation(s)
- Lily D Yan
- Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts; Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kiersten L Strombotne
- Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
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Jackson D, Singh S, Zhang-James Y, Faraone S, Johnson B. The Effects of Low Dose Naltrexone on Opioid Induced Hyperalgesia and Fibromyalgia. Front Psychiatry 2021; 12:593842. [PMID: 33664680 PMCID: PMC7921161 DOI: 10.3389/fpsyt.2021.593842] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: While opioids temporarily alleviate pain, the overshoot of balancing pain drivers may increase pain, leading to opioid induced hyperalgesia (OIH). Our goal was to find out what chronic opioid treatment does to pain tolerance as measured by the cold pressor test (CPT), an objective measure of pain tolerance, and to find an alternative effective treatment for chronic pain and FM. Materials and Methods: The setting was an academic addiction medicine service that has an embedded pain service. Patients had routine clinical care starting with an evaluation that included assessment of medical and psychiatric conditions. Participants were 55 patients with OIH and 21 patients with fibromyalgia; all had at least two CPTs. Treatment included a single dose of buprenorphine for detoxification. In this open-label case series, patients were treated with low dose naltrexone (LDN), a pure opioid receptor antagonist that, we hypothesize, treats OIH and FM by restoring endogenous opioid tone. Results: Comparing initial and last CPT times, those with OIH more than quadrupled their pain tolerance, and those with FM doubled theirs. This improved pain tolerance for OIH and FM was statistically significant (p < 0.0001 and p = 0.003, respectively) and had a large effect size (r = 0.82 and r = 0.63, respectively). Discussion: Results suggest that patients on chronic opioid therapy should have pain tolerance measured by CPT with detoxification and LDN provided to correct opioid induced hyperalgesia if found. FM may also be treated with LDN. The main limitation of the findings was lack of a randomized control group treated with placebo.
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Affiliation(s)
- Daniel Jackson
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Sunita Singh
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Yanli Zhang-James
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Stephen Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Brian Johnson
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States
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Snell-Rood C, Willging C, Showalter D, Peters H, Pollini RA. System-level factors shaping the implementation of “hub and spoke” systems to expand MOUD in rural areas. Subst Abus 2020; 42:716-725. [DOI: 10.1080/08897077.2020.1846149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Claire Snell-Rood
- University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - David Showalter
- Department of Sociology, University of California Berkeley, Berkeley, California, USA
| | - Hannah Peters
- University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Robin A. Pollini
- West Virginia University School of Public Health, Morgantown, West Virginia, USA
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