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Simha S, Ahmed Y, Brummett CM, Waljee JF, Englesbe MJ, Bicket MC. Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review. Reg Anesth Pain Med 2024; 49:361-362. [PMID: 36427903 DOI: 10.1136/rapm-2022-104169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Siddartha Simha
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Yusuf Ahmed
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
- Surgery, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Michael J Englesbe
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
- Surgery, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Mark C Bicket
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
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Turcotte JJ, Brennan JC, Johnson AH, King PJ, MacDonald JH. Managing an epidemic within a pandemic: orthopedic opioid prescribing trends during COVID-19. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05329-y. [PMID: 38661999 DOI: 10.1007/s00402-024-05329-y] [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: 11/14/2023] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION In response to the opioid epidemic, a multitude of policy and clinical-guideline based interventions were launched to combat physician overprescribing. However, the sudden rise of the Covid-19 pandemic disrupted all aspects of healthcare delivery. The purpose of this study was to evaluate how opioid prescribing patterns changed during the Covid-19 pandemic within a large multispecialty orthopedic practice. MATERIALS AND METHODS A retrospective review of 1,048,559 patient encounters from January 1, 2015 to December 31, 2022 at a single orthopedic practice was performed. Primary outcomes were the percent of encounters with opioids prescribed and total morphine milligram equivalents (MMEs) per opioid prescription. Differences in outcomes were assessed by calendar year. Encounters were then divided into two groups: pre-Covid (1/1/2019-2/29/2020) and Covid (3/1/2020-12/31/2022). Univariate analyses were used to evaluate differences in diagnoses and outcomes between periods. Multivariate analysis was performed to assess changes in outcomes during Covid after controlling for differences in diagnoses. Statistical significance was assessed at p < 0.05. RESULTS The percentage of encounters with opioids prescribed decreased from a high of 4.0% in 2015 to a low of 1.6% in 2021 and 2022 (p < 0.001). MMEs per prescription decreased from 283.6 ± 213.2 in 2015 to a low of 138.6 ± 100.4 in 2019 (p < 0.001). After adjusting for diagnoses, no significant differences in either opioid prescribing rates (post-COVID OR = 0.997, p = 0.893) or MMEs (post-COVID β = 2.726, p = 0.206) were observed between the pre- and post-COVID periods. CONCLUSION During the Covid-19 pandemic opioid prescribing levels remained below historical averages. While continued efforts are needed to minimize opioid overprescribing, it appears that the significant progress made toward this goal was not lost during the pandemic era.
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Affiliation(s)
- Justin J Turcotte
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA.
| | - Jane C Brennan
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - Andrea H Johnson
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - Paul J King
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - James H MacDonald
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
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Ezell JM, Pho MT, Ajayi BP, Simek E, Shetty N, Goddard-Eckrich DA, Bluthenthal RN. Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model. Drug Alcohol Rev 2024. [PMID: 38646735 DOI: 10.1111/dar.13832] [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: 08/29/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
ISSUES To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. APPROACH Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. KEY FINDINGS Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. IMPLICATIONS There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. CONCLUSION There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, USA
| | - Babatunde P Ajayi
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Elinor Simek
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Netra Shetty
- University of California Berkeley, Berkeley, USA
| | | | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Abasilim C, Friedman LS, Karch L, Holloway-Beth A. Trends in non-fatal and fatal opioid overdoses during the first two years of the coronavirus disease-2019 pandemic. Ann Epidemiol 2024; 90:35-41. [PMID: 38501569 DOI: 10.1016/j.annepidem.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/19/2023] [Accepted: 10/26/2023] [Indexed: 03/20/2024]
Abstract
PURPOSE This study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems. METHODS We examined opioid-involved overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases. RESULTS The overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (β = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (β = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses. CONCLUSIONS We underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.
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Affiliation(s)
- Chibuzor Abasilim
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Lee S Friedman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Lydia Karch
- Epidemiology Unit, Cook County Department of Public Health, Bridgeview, IL
| | - Alfreda Holloway-Beth
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL; Epidemiology Unit, Cook County Department of Public Health, Bridgeview, IL
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5
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Garrido MM, Legler A, Strombotne KL, Frakt AB. Differences in adverse outcomes across race and ethnicity among Veterans with similar predicted risks of an overdose or suicide-related event. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:125-130. [PMID: 37738604 DOI: 10.1093/pm/pnad129] [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: 04/26/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To evaluate the degree to which differences in incidence of mortality and serious adverse events exist across patient race and ethnicity among Veterans Health Administration (VHA) patients receiving outpatient opioid prescriptions and who have similar predicted risks of adverse outcomes. Patients were assigned scores via the VHA Stratification Tool for Opioid Risk Mitigation (STORM), a model used to predict the risk of experiencing overdose- or suicide-related health care events or death. Individuals with the highest STORM risk scores are targeted for case review. DESIGN Retrospective cohort study of high-risk veterans who received an outpatient prescription opioid between 4/2018-3/2019. SETTING All VHA medical centers. PARTICIPANTS In total, 84 473 patients whose estimated risk scores were between 0.0420 and 0.0609, the risk scores associated with the top 5%-10% of risk in the STORM development sample. METHODS We examined the expected probability of mortality and serious adverse events (SAEs; overdose or suicide-related events) given a patient's risk score and race. RESULTS Given a similar risk score, Black patients were less likely than White patients to have a recorded SAE within 6 months of risk score calculation. Black, Hispanic, and Asian patients were less likely than White patients with similar risk scores to die within 6 months of risk score calculation. Some of the mortality differences were driven by age differences in the composition of racial and ethnic groups in our sample. CONCLUSIONS Our results suggest that relying on the STORM model to identify patients who may benefit from an interdisciplinary case review may identify patients with clinically meaningful differences in outcome risk across race and ethnicity.
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Affiliation(s)
- Melissa M Garrido
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA 02130, United States
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, United States
| | - Aaron Legler
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA 02130, United States
| | - Kiersten L Strombotne
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA 02130, United States
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, United States
| | - Austin B Frakt
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA 02130, United States
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, United States
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Cambridge, MA 02115, United States
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Chu R, Sarnala S, Doan T, Cheng T, Chen AW, Jamal A, Kim G, Huang R, Srinivasan M, Palaniappan L, Gross ER. COVID-19 pandemic impact on opioid overdose deaths among racial groups within the United States: an observational cross-sectional study. Br J Anaesth 2024; 132:201-204. [PMID: 37977954 DOI: 10.1016/j.bja.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/04/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Richie Chu
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA; Asian American Studies Department, University of California, Los Angeles, CA, USA; Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
| | - Sai Sarnala
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA, USA; Department of Biology, Johns Hopkins University, Baltimore, MD, USA
| | - Thanh Doan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA; Department of Biology, Johns Hopkins University, Baltimore, MD, USA
| | - Tina Cheng
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Annabel W Chen
- Stanford University Medical School, School of Medicine, Stanford University, Stanford, CA, USA
| | - Armaan Jamal
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
| | - Gloria Kim
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert Huang
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric R Gross
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
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Zang X, Walley AY, Chatterjee A, Kimmel SD, Morgan JR, Murphy SM, Linas BP, Nolen S, Reilly B, Urquhart C, Schackman BR, Marshall BDL. Changes to opioid overdose deaths and community naloxone access among Black, Hispanic and White people from 2016 to 2021 with the onset of the COVID-19 pandemic: An interrupted time-series analysis in Massachusetts, USA. Addiction 2023; 118:2413-2423. [PMID: 37640687 PMCID: PMC10986189 DOI: 10.1111/add.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIMS The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a surge in opioid overdose deaths in Massachusetts, particularly affecting racial and ethnic minority communities. We aimed to compare the impact of the pandemic on opioid overdose fatalities and naloxone distribution from community-based programs across racial and ethnic groups in Massachusetts. DESIGN Interrupted time-series. SETTING AND CASES Opioid overdose deaths (OODs) among non-Hispanic White, non-Hispanic Black, Hispanic and non-Hispanic other race people in Massachusetts, USA (January 2016 to June 2021). MEASUREMENTS Rate of OODs per 100 000 people, rate of naloxone kits distributed per 100 000 people and ratio of naloxone kits per opioid overdose death as a measure of naloxone availability. We applied five imputation strategies using complete data in different periods to account for missingness of race and ethnicity for naloxone data. FINDINGS Before COVID-19 (January 2016 to February 2020), the rate of OODs declined among non-Hispanic White people [0.2% monthly reduction (95% confidence interval = 0.0-0.4%)], yet was relatively constant among all other population groups. The rate of naloxone kits increased across all groups (0.8-1.2% monthly increase) and the ratio of naloxone kits per OOD death among non-Hispanic White was 1.1% (0.8-1.4%) and among Hispanic people was 1.0% (0.2-1.8%). After the onset of the pandemic (March 2020+), non-Hispanic Black people experienced an immediate increase in the rate of OODs [63.6% (16.4-130%)], whereas rates among other groups remained similar. Trends in naloxone rescue kit distribution did not substantively change among any groups, and the ratio of naloxone kits per OOD death for non-Hispanic Black people did not compensate for the surge in OODs deaths in this group. CONCLUSIONS With the onset of the COVID-19 pandemic, there was a surge in opioid overdose deaths among non-Hispanic Black people in Massachusetts, USA with no compensatory increase in naloxone rescue kit distribution. For non-Hispanic White and Hispanic people, opioid overdose deaths remained stable and naloxone kit distribution continued to increase.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Avik Chatterjee
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Simeon D Kimmel
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brittni Reilly
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
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Mericle AA, Patterson D, Subbaraman MS, Howell J, Sheridan D, Borkman T, Burton J, Karriker-Jaffe KJ. Mapping COVID vulnerability in relation to drug and alcohol recovery residence availability across the United States. BMC Public Health 2023; 23:2266. [PMID: 37974152 PMCID: PMC10655292 DOI: 10.1186/s12889-023-17048-x] [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: 01/17/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
Recovery housing is an important resource for those in recovery from substance use disorders. Unfortunately, we know little about its relationship to key community health risk and protective factors, potentially limiting the role it could play as a broader health resource. Leveraging county-level data on recovery residences from the National Study of Treatment and Addiction Recovery Residences (NSTARR), this study used multilevel modeling to examine Community COVID Vulnerability Index (CCVI) scores as well as availability of COVID testing and vaccination sites in relation to recovery housing. CCVI composite scores were positively associated with recovery housing availability. Analyses using CCVI thematic sub-scores found that population density and number of churches were positively associated with recovery housing availability, while epidemiological factors and healthcare system factors were negatively associated with recovery housing availability. In counties with recovery housing, there also was a positive association between CCVI and both COVID testing and vaccination availability. Recovery residences tend to be located in areas of high COVID vulnerability, reflecting effective targeting in areas with higher population density, more housing risk factors, and other high-risk environments and signaling a key point of contact to address broader health issues among those in recovery from substance use disorders.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA, 94608, USA.
| | - Deidre Patterson
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA, 94608, USA
| | | | | | - Dave Sheridan
- National Alliance for Recovery Residences, St. Paul, MN, USA
| | | | - Jayla Burton
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA, 94608, USA
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Sorensen IS, Susi A, Andreason P, Hisle-Gorman E, Jannace KC, Krishnamurthy J, Chokshi B, Dorr M, Wolfgang AS, Nylund CM. Opioid-Related Trends in Active Duty Service Members During the Coronavirus Disease 2019 Pandemic. Mil Med 2023; 188:567-574. [PMID: 37948265 DOI: 10.1093/milmed/usad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/04/2023] [Accepted: 06/26/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The USA is experiencing an opioid epidemic. Active duty service members (ADSMs) are at risk for opioid use disorder (OUD). The Coronavirus disease 2019 (COVID-19) pandemic has disrupted health care and introduced additional stressors. METHODS The Military Healthcare System Data Repository was used to evaluate changes in diagnosis of OUD, medications for OUD (MOUD), opioid overdose (OD), and opioid rescue medication. ADSMs ages 18-45 years enrolled in the Military Healthcare System between February 2019 and April 2022 were included. Joinpoint Trend Analysis Software calculated the average monthly percent change over the study period, whereas Poisson regression compared outcomes over three COVID-19 periods: Pre-lockdown (pre-COVID-19 period 0) (February 2019-February 2020), early pandemic until ADSM vaccination initiation (COVID-19 period 1 [CP1]) (March 2020-November 2020), and late pandemic post-vaccination initiation (COVID-19 period 2 [CP2]) (December 2020-April 2022). RESULTS A total of 1.86 million eligible ADSMs received care over the study period. Diagnoses of OUD decreased 1.4% monthly, MOUD decreased 0.6% monthly, diagnoses of opioid OD did not change, and opioid rescue medication increased 8.5% monthly.Diagnoses of OUD decreased in both COVID-19 time periods: CP1 and CP2: Rate ratio (RR) = 0.74 (95% CI, 0.68-0.79) and RR = 0.72 (95% CI, 0.67-0.76), respectively. MOUD decreased in both CP1 and CP2: RR = 0.77 (95% CI, 0.68-0.88) and RR = 0.86 (95% CI, 0.78-0.96), respectively. Adjusted rates for diagnoses of opioid OD did not vary in either COVID-19 time period. Opioid rescue medication prescriptions increased in CP1 and CP2: RR = 1.09 (95% CI, 1.02-1.15) and RR = 6.02 (95% CI, 5.77-6.28), respectively. CONCLUSIONS Rates of OUD and MOUD decreased, whereas rates of opioid rescue medication increased during the study period. Opioid OD rates did not significantly change in this study. Changes in the DoD policy may be affecting rates with greater effect than COVID-19 pandemic effects.
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Affiliation(s)
- Ian S Sorensen
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817, USA
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817, USA
| | | | - Elizabeth Hisle-Gorman
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Kalyn C Jannace
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817, USA
- Departments of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Center for Rehabilitation Sciences Research, Bethesda, MD 20814, USA
| | - Jayasree Krishnamurthy
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Binny Chokshi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Madeline Dorr
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817, USA
| | - Aaron S Wolfgang
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
| | - Cade M Nylund
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Felton JW, Kleinman MB, Doran K, Satinsky EN, Tralka H, Dean D, Brown CJS, Anvari MS, Bradley VD, Magidson JF. Peer Activate: A Feasibility Trial of a Peer-Delivered Intervention to Decrease Disparities in Substance Use, Depression, and Linkage to Substance Use Treatment. J Psychosoc Nurs Ment Health Serv 2023; 61:23-31. [PMID: 37256749 DOI: 10.3928/02793695-20230523-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although effective evidence-based interventions (EBIs) exist, racial/ethnic minority individuals with lower income are less likely to have access to these interventions and may experience greater stigma in the health care system, resulting in disproportionate rates of morbidity and mortality. Peer recovery specialists (PRSs) may be uniquely suited to address barriers faced by those from impoverished areas; however, peers have not traditionally been trained in implementing EBIs. The current open-label trial (N = 8) was performed to evaluate implementation and preliminary effectiveness of an adapted EBI supporting recovery, linkage to treatment, and reduced depression. Results suggest the intervention was feasible, acceptable, and appropriate for linking individuals from a community setting to substance use treatment and could be delivered with fidelity by a peer interventionist. Participants who completed the intervention demonstrated clinically reliable decreases in substance use and depressive symptoms. Findings provide initial support for PRS dissemination of EBIs to increase linkage to care and support recovery in traditionally underserved populations. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 23-31.].
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Wills BK, Ringwood KJ, Davis TT, Provost R, Bachireddy C, Wang J, Keyser-Marcus L, Moeller FG. Outcomes of Emergency Department Patients With Opioid Use Disorder Utilizing a Virtual Addiction Bridge Clinic: A Case Series. J Addict Med 2023; 17:729-731. [PMID: 37934546 DOI: 10.1097/adm.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVES Within the last decade, there has been a dramatic increase in the rate of emergency department (ED) visits and death from opioid overdose. Those who present to the ED are at high risk for subsequent morbidity and mortality. Despite effective treatment, many patients do not get rapidly connected to outpatient care. The aim of this investigation was to describe outpatient treatment engagement after ED discharge among patients with opioid use disorder (OUD) enrolled in a virtual Addiction Bridge Clinic (ABC). METHODS This was a retrospective case series describing an ED-initiated referral for rapid telehealth follow-up among patients with OUD. The primary outcome was addiction treatment engagement among those who completed the initial virtual ABC visit (engaged in ABC) vs. those who did not complete an ABC visit (Not engaged in ABC) at 1 week, 1 month, and 3 and 6 months timepoint intervals after the initial ED presentation. RESULTS Of the N = 201 patients referred to the ABC between March and December 2021, a majority were Black (71%) and male (77%). Of the 201 referrals, 85 (42%) completed an initial ABC telehealth visit. Subsequent treatment engagement was 26% at 1 week, 26% at 1 month, 22% at 3 months, and 18% at 6 months after the index ED visit. CONCLUSIONS A telehealth-enabled virtual addiction bridge clinic is one potential approach to reduce barriers to rapid treatment access. Strategies are needed to improve subsequent addiction treatment engagement after a virtual addiction bridge clinic visit.
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Affiliation(s)
- Brandon K Wills
- From the Department of Psychiatry (BKW, KJR, TTD, LK-M, FGM), Department of Emergency Medicine (BKW), School of Medicine (RP, JW), Virginia Commonwealth University; Department of Medical Assistance Services, Commonwealth of Virginia (CB), Richmond, VA
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Allen C, Arredondo C, Dunham R, Fishman M, Lev L, Mace S, Parks J, Rosa D, Shoyinka S, White D, Williams A. Guidance for Handling the Increasing Prevalence of Drugs Adulterated or Laced With Fentanyl. Psychiatr Serv 2023; 74:1059-1062. [PMID: 37042103 DOI: 10.1176/appi.ps.202100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
The use of fentanyl and its analogs is the primary driver of deaths related to the opioid overdose crisis. In fall 2021, the U.S. Drug Enforcement Administration issued its first public safety alert in 6 years to raise awareness of the escalating prevalence of fentanyl in counterfeit pills and in other opioids, such as heroin, and nonopioids, such as methamphetamine. In addition to increased public awareness, specific actions are needed to remediate the risk for fentanyl overdose. The authors endorse four principles to address the opioid overdose crisis and provide guidance for remediating its impacts: an incremental approach to behavior change or harm reduction; engagement strategies for individuals with substance use disorder; an integrated care approach to ensure better access to treatment programs and effective interventions; and vigilance among clinicians, program staff, and patients to the threat of fentanyl-adulterated drugs. The authors offer specific recommendations on how to apply these principles effectively within health care systems, communities, and law enforcement agencies across the United States.
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Affiliation(s)
- Craig Allen
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Christina Arredondo
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Rochelle Dunham
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Marc Fishman
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Leonard Lev
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Shannon Mace
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Joseph Parks
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Daniel Rosa
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Sosunmolu Shoyinka
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - DeJuan White
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
| | - Aaron Williams
- Addiction Services, Hartford HealthCare, Meriden, Connecticut (Allen); El Rio Community Health Center, Tucson (Arredondo); Metropolitan Human Services District, New Orleans (Dunham); Maryland Treatment Centers, Johns Hopkins University, Baltimore (Fishman); Beebe Healthcare, Lewes, Delaware (Lev); National Council for Mental Wellbeing, Washington, D.C. (Mace, Parks, Williams); Emergency Medicine, Acacia Network, New York City (Rosa); Department of Behavioral Health and Intellectual Disability Services, Philadelphia (Shoyinka); Psychiatric Emergency Services, Grady Health System, Emory University School of Medicine, Atlanta (White)
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Lowenstein M, Perrone J, McFadden R, Xiong RA, Meisel ZF, O'Donnell N, Abdel-Rahman D, Moon J, Mitra N, Delgado MK. Impact of Universal Screening and Automated Clinical Decision Support for the Treatment of Opioid Use Disorder in Emergency Departments: A Difference-in-Differences Analysis. Ann Emerg Med 2023; 82:131-144. [PMID: 37318434 PMCID: PMC11019868 DOI: 10.1016/j.annemergmed.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 06/16/2023]
Abstract
STUDY OBJECTIVE Emergency department (ED)-initiated buprenorphine improves outcomes in patients with opioid use disorder; however, adoption varies widely. To reduce variability, we implemented a nurse-driven triage screening question in the electronic health record to identify patients with opioid use disorder, followed by targeted electronic health record prompts to measure withdrawal and guide next steps in management, including initiation of treatment. Our objective was to assess the impact of screening implementation in 3 urban, academic EDs. METHODS We conducted a quasiexperimental study of opioid use disorder-related ED visits using electronic health record data from January 2020 to June 2022. The triage protocol was implemented in 3 EDs between March and July 2021, and 2 other EDs in the health system served as controls. We evaluated changes in treatment measures over time and used a difference-in-differences analysis to compare outcomes in the 3 intervention EDs with those in the 2 controls. RESULTS There were 2,462 visits in the intervention hospitals (1,258 in the preperiod and 1,204 in the postperiod) and 731 in the control hospitals (459 in the preperiod and 272 in the postperiod). Patient characteristics within the intervention and control EDs were similar across the time periods. Compared with the control hospitals, the triage protocol was associated with a 17% greater increase in withdrawal assessment, using the Clinical Opioid Withdrawal Scale (COWS) (95% CI 7 to 27). Buprenorphine prescriptions at discharge also increased by 5% (95% CI 0% to 10%), and naloxone prescriptions increased by 12% points (95% CI 1% to 22%) in the intervention EDs relative to controls. CONCLUSION An ED triage screening and treatment protocol led to increased assessment and treatment of opioid use disorder. Protocols designed to make screening and treatment the default practice have promise in increasing the implementation of evidence-based treatment ED opioid use disorder care.
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Affiliation(s)
- Margaret Lowenstein
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA.
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA
| | - Rachel McFadden
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA
| | - Ruiying Aria Xiong
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA
| | - Zachary F Meisel
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Nicole O'Donnell
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA
| | - Dina Abdel-Rahman
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA
| | - Jeffrey Moon
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mucio Kit Delgado
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA
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Jones AA, Shearer RD, Segel JE, Santos-Lozada A, Strong-Jones S, Vest N, Teixeira da Silva D, Khatri UG, Winkelman TNA. Opioid and stimulant attributed treatment admissions and fatal overdoses: Using national surveillance data to examine the intersection of race, sex, and polysubstance use, 1992-2020. Drug Alcohol Depend 2023; 249:109946. [PMID: 37354584 PMCID: PMC10375360 DOI: 10.1016/j.drugalcdep.2023.109946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND We use national surveillance data to evaluate race/ethnicity by sex/gender differences and trends in substance use treatment admissions and overdose deaths involving opioid and stimulant use. METHODS We used data (1992-2019) from the Treatment Episode Dataset-Admissions to identify treatment admissions and the Center for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (1999-2020) to identify overdose deaths. We assessed treatment admissions and related drug overdose deaths per 100,000 adults by sex and race/ethnicity for opioid and stimulant groups: cocaine, opioid, methamphetamines, cocaine and opioid use, cocaine and methamphetamines, and opioid and methamphetamines. RESULTS We found significant variations in treatment admissions and deaths by race/ethnicity and sex/gender. Cocaine-related treatment admissions and deaths were most prevalent among Non-Hispanic Black individuals over the study years, yet lower rates were evident among individuals from other racial/ethnic groups. Notably, Non-Hispanic Black men experienced larger increases in cocaine-only admissions than men of other racial/ethnic groups between 1992 and 2019. Men had higher opioid and stimulant treatment admissions and overdose deaths than women. We observed skyrocketing methamphetamine deaths among American Indian/Native Alaskan men and women from 1992 to 2019. DISCUSSION Steep increases in overdose deaths fueled by methamphetamines among Non-Hispanic Native Americans and cocaine among Non-Hispanic Black individuals suggest a need for more effective interventions to curb stimulant use. Variations by race/ethnicity and sex/gender also suggest interventions should be developed through an intersectionality lens.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA; Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, PA16801, USA.
| | - R D Shearer
- Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - J E Segel
- Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, PA16801, USA; Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA16801, USA; Department of Public Health Sciences, The Pennsylvania State University, University Park, PA16801, USA
| | - A Santos-Lozada
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA
| | - S Strong-Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA
| | - N Vest
- Department of Community and Health Sciences, School of Public Health, Boston University, Boston, MA02118, USA
| | - D Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
| | - U G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - T N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN 55415, USA
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Lowenstein M, Abrams MP, Crowe M, Shimamoto K, Mazzella S, Botcheos D, Bertocchi J, Westfahl S, Chertok J, Garcia KP, Truchil R, Holliday-Davis M, Aronowitz S. "Come try it out. Get your foot in the door:" Exploring patient perspectives on low-barrier treatment for opioid use disorder. Drug Alcohol Depend 2023; 248:109915. [PMID: 37207615 DOI: 10.1016/j.drugalcdep.2023.109915] [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: 02/01/2023] [Revised: 04/15/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE Low-barrier treatment is an emerging strategy for opioid use disorder (OUD) care that prioritizes access to evidence-based medication while minimizing requirements that may limit treatment access in more traditional delivery models, particularly for marginalized patients. Our objective was to explore patient perspectives about low-barrier approaches, with a focus on understanding barriers to and facilitators of engagement from the patient point of view. METHODS We conducted semi-structured interviews with patients accessing buprenorphine treatment from a multi-site, low-barrier mobile treatment program in Philadelphia, PA from July-December 2021. We analyzed interview data using thematic content analysis and identified key themes. RESULTS The 36 participants were 58% male, 64% Black, 28% White, and 31% Latinx. 89% were enrolled in Medicaid, and 47% were unstably housed. Our analysis revealed three main facilitators of treatment in the low-barrier model. These included 1) program structure that met participant needs, such as flexibility, rapid medication access and robust case management services; 2) harm reduction approach that included acceptance of patient goals other than abstinence and provision of harm reduction services on-site; and 3) strong interpersonal connections with team members, including those with lived experience. Participants contrasted these experiences with other care they had received in the past. Barriers related to lack of structure, limitations of street-based care, and limited support for co-occurring needs, particularly mental health. CONCLUSIONS This study provides key patient perspectives on low-barrier approaches for OUD treatment. Our findings can inform future program design to increase treatment access and engagement for individuals poorly served by traditional delivery models.
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Affiliation(s)
- Margaret Lowenstein
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
| | - Matthew P Abrams
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Molly Crowe
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Denise Botcheos
- Prevention Point Philadelphia, Philadelphia, PA, United States
| | | | - Shawn Westfahl
- Prevention Point Philadelphia, Philadelphia, PA, United States
| | - Judy Chertok
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Kristine Pamela Garcia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Rachael Truchil
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - M Holliday-Davis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Shoshana Aronowitz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States; University of Pennsylvania School of Nursing, Philadelphia, PA, United States
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16
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Behnoush AH, Bazmi E, Forouzesh M, Koehler SA, Monabati SJ, Behnoush B. Impact of COVID-19 on poisoning-related mortality in Iran: An interrupted time series study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104051. [PMID: 37182353 PMCID: PMC10160529 DOI: 10.1016/j.drugpo.2023.104051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic had many negative effects worldwide. These effects involved mental health status issues such as suicide, depression, and the pattern of death associated with drug/poisonings. One of the major concerns of the healthcare community during the pandemic was mortality from poisonings. This study aimed to investigate the trends of mortality from different types of poisonings before and after COVID-19. METHODS The patients who died from six different categories of drugs or poisons were identified by forensic analysis of body fluids/tissues in Tehran, Iran. The pandemic was separated into the pre-COVID-19 period (April 2018 to January 2020), and the COVID pandemic (February 2020-April 2022). Demographic characteristics were collected from each victim, and comparisons of death trends before and after the pandemic were conducted using the interrupted time series analysis. The absolute number of deaths and proportion of deaths from each type of drug/poisoning were used for the analyses. RESULTS A total of 6,316 deaths from drugs/poisoning were identified between April 2018-Mar 2022). During this period, 2,485 deaths occurred pre-COVID, and 3,831 were during the COVID-19 era. There were no statistical differences in terms of demographic characteristics before and after the pandemic, except for job status. There was a sharp increase in proportion of methanol death among all poisonings after the start of the pandemic (16.5%, p-value = 0.025), while there was a decreasing trend during the pandemic (-0.915 deaths monthly, p-value = 0.027). The trends for opioids, stimulants, and drug-related deaths changed from decreasing to increasing. No change was seen in the trends for ethanol and volatile substance deaths. This pattern was mirrored in the proportion of each type of poisoning relative to the total number. CONCLUSION Changes in poisoning-related mortality patterns showed dramatic changes after the start of the pandemic, especially deaths from methanol. Other poisonings such as opioids, stimulants, and drugs should also be addressed as there was an increasing trend during the COVID-19 period, compared to the pre-COVID data.
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Affiliation(s)
| | - Elham Bazmi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.
| | - Mehdi Forouzesh
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | | | - Behnam Behnoush
- Department of Forensic Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Stokes EK, Pickens CM, Wilt G, Liu S, David F. County-level social vulnerability and nonfatal drug overdose emergency department visits and hospitalizations, January 2018-December 2020. Drug Alcohol Depend 2023; 247:109889. [PMID: 37148633 DOI: 10.1016/j.drugalcdep.2023.109889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/13/2023] [Accepted: 04/16/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Nonfatal drug overdoses (NFODs) are often attributed to individual behaviors and risk factors; however, identifying community-level social determinants of health (SDOH) associated with increased NFOD rates may allow public health and clinical providers to develop more targeted interventions to address substance use and overdose health disparities. CDC's Social Vulnerability Index (SVI), which aggregates social vulnerability data from the American Community Survey to produce ranked county-level vulnerability scores, can help identify community factors associated with NFOD rates. This study aims to describe associations between county-level social vulnerability, urbanicity, and NFOD rates. METHODS We analyzed county-level 2018-2020 emergency department (ED) and hospitalization discharge data submitted to CDC's Drug Overdose Surveillance and Epidemiology system. Counties were ranked in vulnerability quartiles based on SVI data. We used crude and adjusted negative binomial regression models, by drug category, to calculate rate ratios and 95% confidence intervals comparing NFOD rates by vulnerability. RESULTS Generally, as social vulnerability scores increased, ED and hospitalization NFOD rates increased; however, the magnitude of the association varied across drugs, visit type, and urbanicity. SVI-related theme and individual variable analyses highlighted specific community characteristics associated with NFOD rates. CONCLUSIONS The SVI can help identify associations between social vulnerabilities and NFOD rates. Development of an overdose-specific validated index could improve translation of findings to public health action. The development and implementation of overdose prevention strategies should consider a socioecological perspective and address health inequities and structural barriers associated with increased risk of NFODs at all levels of the social ecology.
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Affiliation(s)
- Erin K Stokes
- Centers for Disease Control and Prevention, Division of Overdose Prevention, 4770 Buford Hwy MS-S106-8, Atlanta, GA30341, USA.
| | - Cassandra M Pickens
- Centers for Disease Control and Prevention, Division of Overdose Prevention, 4770 Buford Hwy MS-S106-8, Atlanta, GA30341, USA
| | - Grete Wilt
- Agency for Toxic Substances and Disease Registry, 4470 Buford Hwy NE, Atlanta, GA30341, USA
| | - Stephen Liu
- Centers for Disease Control and Prevention, Division of Overdose Prevention, 4770 Buford Hwy MS-S106-8, Atlanta, GA30341, USA
| | - Felicita David
- Centers for Disease Control and Prevention, Division of Overdose Prevention, 4770 Buford Hwy MS-S106-8, Atlanta, GA30341, USA
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18
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Forati A, Ghose R, Mohebbi F, Mantsch JR. The journey to overdose: Using spatial social network analysis as a novel framework to study geographic discordance in overdose deaths. Drug Alcohol Depend 2023; 245:109827. [PMID: 36868092 DOI: 10.1016/j.drugalcdep.2023.109827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Drug overdose deaths are often geographically discordant (the community in which the overdose death occurs is different from the community of residence). Thus, in many cases there is a journey to overdose. METHODS We applied geospatial analysis to examine characteristics that define journeys to overdoses using Milwaukee, Wisconsin, a diverse and segregated metropolitan area in which 26.72 % of overdose deaths are geographically discordant, as a case study. First, we deployed spatial social network analysis to identify hubs (census tracts that are focal points of geographically discordant overdoses) and authorities (the communities of residence from which journeys to overdose commonly begin) for overdose deaths and characterized them according to key demographics. Second, we used temporal trend analysis to identify communities that were consistent, sporadic, and emergent hotspots for overdose deaths. Third, we identified characteristics that differentiated discordant versus non-discordant overdose deaths. RESULTS Authority communities had lower housing stability and were younger, more impoverished, and less educated relative to hubs and county-wide numbers. White communities were more likely to be hubs, while Hispanic communities were more likely to be authorities. Geographically discordant deaths more commonly involved fentanyl, cocaine, and amphetamines and were more likely to be accidental. Non-discordant deaths more commonly involved opioids other than fentanyl or heroin and were more likely to be the result of suicide. CONCLUSION This study is the first to examine the journey to overdose and demonstrates that such analysis can be applied in metropolitan areas to better understand and guide community responses.
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Affiliation(s)
- Amir Forati
- Department of Geography, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Rina Ghose
- Department of Geography, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Fahimeh Mohebbi
- Department of Computer Science, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - John R Mantsch
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Johnson E, Axeen S, Vosooghi A, Lam CN, Bluthenthal R, Schneberk T. Interrupted Time Series Analysis: Patient Characteristics and Rates of Opioid-Use-Disorder-Related Emergency Department Visits in the Los Angeles County Public Hospital System during COVID-19. Healthcare (Basel) 2023; 11:healthcare11070979. [PMID: 37046906 PMCID: PMC10093818 DOI: 10.3390/healthcare11070979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
The COVID-19 pandemic led to disruptions in care for vulnerable patients, in particular patients with opioid use disorder (OUD). We aimed to examine OUD-related ED visits before and during the COVID-19 pandemic and determine if patient characteristics for OUD-related ED visits changed in the context of the pandemic. We examined all visits to the three public safety net hospital EDs in Los Angeles County from April 2019 to February 2021. We performed interrupted time series analyses examining OUD-related ED visits from Period 1, April 2019 to February 2020, compared with Period 2, April 2020 to February 2021, by race/ethnicity and payor group. We considered OUD-related ED visits as those which included any of the following: discharge diagnosis related to OUD, patients administered buprenorphine or naloxone while in the ED, and visits where a patient was prescribed buprenorphine or naloxone on discharge. There were 5919 OUD-related ED visits in the sample. OUD-related visits increased by 4.43 (2.82–6.03) per 1000 encounters from the pre-COVID period (9.47 per 1000 in February 2020) to the COVID period (13.90 per 1000 in April 2020). This represented an increase of 0.41/1000 by white patients, 0.92/1000 by black patients, and 1.83/1000 by Hispanic patients. We found increases in OUD-related ED visits among patients with Medicaid managed care of 2.23/1000 and in LA County safety net patients by 3.95/1000 ED visits. OUD-related ED visits increased during the first year of the COVID pandemic. These increases were significant among black, white, and Hispanic patients, patients with Medicaid managed care, and LA County Safety net patients. These data suggest public emergency departments served as a stopgap for patients suffering from OUD in Los Angeles County during the pandemic and can be utilized to guide preventative interventions in vulnerable populations.
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Kleinman MB, Anvari MS, Bradley VD, Felton JW, Belcher AM, Seitz-Brown CJ, Greenblatt AD, Dean D, Bennett M, Magidson JF. "Sometimes you have to take the person and show them how": adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention. Subst Abuse Treat Prev Policy 2023; 18:15. [PMID: 36879304 PMCID: PMC9990281 DOI: 10.1186/s13011-023-00524-3] [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: 07/08/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Despite efficacy of medication for opioid use disorder, low-income, ethno-racial minoritized populations often experience poor opioid use disorder treatment outcomes. Peer recovery specialists, individuals with lived experience of substance use and recovery, are well-positioned to engage hard-to-reach patients in treatment for opioid use disorder. Traditionally, peer recovery specialists have focused on bridging to care rather than delivering interventions. This study builds on research in other low-resource contexts that has explored peer delivery of evidence-based interventions, such as behavioral activation, to expand access to care. METHODS We sought feedback on the feasibility and acceptability of a peer recovery specialist-delivered behavioral activation intervention supporting retention in methadone treatment by increasing positive reinforcement. We recruited patients and staff at a community-based methadone treatment center and peer recovery specialist working across Baltimore City, Maryland, USA. Semi-structured interviews and focus groups inquired about the feasibility and acceptability of behavioral activation, recommendations for adaptation, and acceptability of working with a peer alongside methadone treatment. RESULTS Participants (N = 32) shared that peer recovery specialist-delivered behavioral activation could be feasible and acceptable with adaptations. They described common challenges associated with unstructured time, for which behavioral activation could be particularly relevant. Participants provided examples of how a peer-delivered intervention could fit well in the context of methadone treatment, emphasizing the importance of flexibility and specific peer qualities. CONCLUSIONS Improving medication for opioid use disorder outcomes is a national priority that must be met with cost-effective, sustainable strategies to support individuals in treatment. Findings will guide adaptation of a peer recovery specialist-delivered behavioral activation intervention to improve methadone treatment retention for underserved, ethno-racial minoritized individuals living with opioid use disorder.
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Affiliation(s)
- Mary B Kleinman
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA.
| | - Morgan S Anvari
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Valerie D Bradley
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Julia W Felton
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Annabelle M Belcher
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Aaron D Greenblatt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dwayne Dean
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Melanie Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
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21
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Adapting a Behavioral Activation Intervention for Opioid Use Disorder and Methadone Treatment Retention for Peer Delivery in a Low-Resource Setting: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2023. [DOI: 10.1016/j.cbpra.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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22
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Rapid induction onto extended-release injectable buprenorphine following opioid overdose: A case series. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100144. [PMID: 37033158 PMCID: PMC10073633 DOI: 10.1016/j.dadr.2023.100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023]
Abstract
Background Buprenorphine treatment has been associated with reduced non-prescribed opioid use and opioid related overdose (OD). We evaluated initial outcomes of rapid induction onto extended-release injectable buprenorphine (BUP-XR) within 7 days of emergency department presentation for unintentional OD. Methods Between February 2019-February 2021, N = 19 patients with opioid use disorder received buprenorphine/naloxone (4/1 mg), followed by BUP-XR (300 mg) at induction and continued BUP-XR outpatient for 6 months. Primary outcomes included adverse events, repeat OD, and death. Results For patients who received at least one dose of BUP-XR, there were no treatment related serious adverse events or symptoms of precipitated withdrawal. In addition, there were no repeat visits for ODs or deaths within 6 months of the initial OD. Discussion These preliminary findings support the need for larger controlled clinical trials to examine the safety and efficacy of rapid induction of BUP-XR in patients with opioid use disorder at high risk of opioid OD. Rapid induction onto long-lasting injectable buprenorphine may be a promising and protective treatment approach in the future.
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23
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Xiao Y, Junus A, Li T, Yip P. Temporal and spatial trends in suicide-related visits before and during the COVID-19 pandemic in the US, 2018-2021. J Affect Disord 2023; 324:24-35. [PMID: 36566936 PMCID: PMC9773784 DOI: 10.1016/j.jad.2022.12.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/13/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND COVID-19 disproportionately impacted mental health in disadvantaged populations and areas. However, disparities in long-term changes in suicide-related visits across the US are unclear. This retrospective study aims to characterize temporal and spatial changes in suicide-related visits in healthcare settings from 2018 to 2021 in the U.S. METHODS We use electronic health records for 21,860,370 patients from Healthjump through the COVID-19 Research Database Consortium. Healthjump harmonizes EHR data from over 55 national databases across the US. Suicide ideation and suicide attempts between January 1, 2018 and December 12, 2021 were identified by the diagnosis codes in 6 periods in 2021 compared with the same periods in 2018-2020. RESULTS There was 30,019 suicidal ideation, and 7392 suicide attempt visits from January 2018 to November 2021. 15-20-year-olds were the most represented age group at 6302 suicide ideation visits (21.0 % of suicide ideation visits) and 1326 suicide attempt visits (17.9 % of suicide attempt visits), followed by suicide-related visits among 60+ years old. Compared with pre-pandemic periods, youth aged 15-20, females, White, non-Hispanic, and English speakers had increased suicide-related visits, especially suicidal ideation (P < 0.05). Suicide attempts with non-medical substances increased to 28.0 % in the first 6 months of the pandemic in 2020, compared with the prior year (21.5 %). COVID-19 patients had increased suicidal ideation in 2020. LIMITATIONS The EHR data is not nationally representative. CONCLUSIONS This study found significant and disproportionate increases in suicide related visits over the COVID-19 stages. To prevent the next storms of suicides, future interventions shall accommodate needs among vulnerable groups during and after periods of crisis.
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Affiliation(s)
- Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine, NewYork-Presbyterian, New York, United States.
| | - Alvin Junus
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Tianzi Li
- Department of Population Health Sciences, Weill Cornell Medicine, NewYork-Presbyterian, New York, United States
| | - Paul Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong; HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
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24
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Chen S, Campbell J, Spain E, Woodruff A, Snider C. Improving the representativeness of the tribal behavioral risk factor surveillance system through data integration. BMC Public Health 2023; 23:273. [PMID: 36750936 PMCID: PMC9904248 DOI: 10.1186/s12889-023-15159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Previous literature showed significant health disparities between Native American population and other populations such as Non-Hispanic White. Most existing studies for Native American Health were based on non-probability samples which suffer with selection bias. In this paper, we are the first to evaluate the effectiveness of data integration methods, including calibration and sequential mass imputation, to improve the representativeness of the Tribal Behavioral Risk Factor Surveillance System (TBRFSS) in terms of reducing the biases of the raw estimates. METHODS We evaluated the benefits of our proposed data integration methods, including calibration and sequential mass imputation, by using the 2019 TBRFSS and the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). We combined the data from the 2018 and 2019 BRFSS by composite weighting. Demographic variables and general health variables were used as predictors for data integration. The following health-related variables were used for evaluation in terms of biases: Smoking status, Arthritis status, Cardiovascular Disease status, Chronic Obstructive Pulmonary Disease status, Asthma status, Cancer status, Stroke status, Diabetes status, and Health Coverage status. RESULTS For most health-related variables, data integration methods showed smaller biases compared with unadjusted TBRFSS estimates. After calibration, the demographic and general health variables benchmarked with those for the BRFSS. CONCLUSION Data integration procedures, including calibration and sequential mass imputation methods, hold promise for improving the representativeness of the TBRFSS.
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Affiliation(s)
- Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Janis Campbell
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Erin Spain
- Southern Plains Tribal Health Board, Oklahoma City, OK USA
| | - Alexandra Woodruff
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Cuyler Snider
- Southern Plains Tribal Health Board, Oklahoma City, OK USA
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25
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Zimmerman GM, Douglas SD, Turchan BS, Braga AA. The salience of social context, opioid antagonist use, and prior opioid exposure as determinants of fatal and non-fatal opioid overdoses. Health Place 2023; 79:102970. [PMID: 36638643 DOI: 10.1016/j.healthplace.2023.102970] [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: 09/12/2022] [Revised: 12/13/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
This study examines the salience of social context for opioid overdoses in Boston from 2014 to 2019. Longitudinal negative binomial models with random effects indicated that higher levels of concentrated disadvantage, residential instability, and illicit drug activity increased annual block group counts of opioid overdoses. Logistic hierarchical and cross-classified random effects models indicated that the use of Narcan and greater exposure to drugs through previous opioid overdose and contextual lillicit drug crime activity reduced the odds of fatal opioid overdose relative to non-fatal opioid overdose. The findings suggest that the accurate tracking of both fatal and non-fatal overdoses, and a consideration of the broader social context, can facilitate effective public health resource allocation to reduce opioid overdoses.
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Affiliation(s)
- Gregory M Zimmerman
- School of Criminology and Criminal Justice, Northeastern University, Boston, MA, USA.
| | - Stephen D Douglas
- Department of Criminology, University of Pennsylvania, Philadelphia, PA, USA
| | - Brandon S Turchan
- Department of Criminology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony A Braga
- Department of Criminology, University of Pennsylvania, Philadelphia, PA, USA
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26
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Simha S, Ahmed Y, Brummett CM, Waljee JF, Englesbe MJ, Bicket MC. Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review. Reg Anesth Pain Med 2023; 48:37-43. [DOI: 10.1136/rapm-2022-103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023]
Abstract
ImportanceThe COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future response efforts.ObjectiveTo summarize changes from the COVID-19 pandemic on outcomes regarding opioid use and misuse in the USA and Canada.Evidence reviewWe searched MEDLINE via PubMed, EMBASE, and CENTRAL for peer-reviewed articles published between March 2020 and December 2021 that examined outcomes relevant to patients with opioid use, misuse, and opioid use disorder by comparing the period before vs after COVID-19 onset in the USA and Canada. Two reviewers independently screened studies, extracted data, assessed methodological quality and bias via Newcastle-Ottawa Scale, and synthesized results.FindingsAmong 20 included studies, 13 (65%) analyzed service utilization, 6 (30%) analyzed urine drug testing results, and 2 (10%) analyzed naloxone dispensation. Opioid-related emergency medicine utilization increased in most studies (85%, 11/13) for both service calls (17% to 61%) and emergency department visits (42% to 122%). Urine drug testing positivity results increased in all studies (100%, 6/6) for fentanyl (34% to 138%), most (80%, 4/5) studies for heroin (-12% to 62%), and most (75%, 3/4) studies for oxycodone (0% to 44%). Naloxone dispensation was unchanged and decreased in one study each.InterpretationSignificant increases in surrogate measures of the opioid crisis coincided with the onset of COVID-19. These findings serve as a call to action to redouble prevention, treatment, and harm reduction efforts for the opioid crisis as the pandemic evolves.PROSPERO registration numberCRD42021236464.
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27
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Lee H, Singh GK. Estimating the impact of the COVID-19 pandemic on rising trends in drug overdose mortality in the United States, 2018-2021. Ann Epidemiol 2023; 77:85-89. [PMID: 36455852 PMCID: PMC9703855 DOI: 10.1016/j.annepidem.2022.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE During the COVID-19 pandemic, social and economic disruption such as social isolation, job and income losses, and increased psychological distress, may have contributed to the increase in drug-overdose mortality. This study aims to measure the impact of the pandemic on monthly trends in drug-overdose mortality in the United States. METHODS We used the 2018-2020 final and 2021 provisional monthly deaths from the National Vital Statistics System and monthly population estimates from the Census Bureau to compute monthly mortality rates by age, sex, and race/ethnicity. We use log-linear regression models to estimate monthly percent increases in mortality rates from January 2018 through November 2021. RESULTS The age-adjusted drug-overdose mortality rate among individuals aged older than or equal to 15 years increased by 30% between 2019 (70,459 deaths) and 2020 (91,536 deaths). During January 2018-November 2021, the monthly drug-overdose mortality rate increased by 2.05% per month for Blacks, 2.25% for American Indians/Alaska Natives, 1.96% for Hispanics, 1.33% for Asian/Pacific Islanders, and 0.96% for non-Hispanic Whites. Average monthly increases in mortality were most marked among those aged 15-24 and 35-44 years. CONCLUSIONS The COVID-19 pandemic had a substantial impact on the rising trends in drug-overdose mortality during the peak months in 2020 and 2021.
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Affiliation(s)
- Hyunjung Lee
- Department of Public Policy and Public Affairs, John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA,Corresponding author: Department of Public Policy and Public Affairs, John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA 02125
| | - Gopal K. Singh
- The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., Riverdale, MD
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28
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Wakeman SE, Lambert E, Kung S, Brisbon NM, Carroll AD, Hickman TT, Covahey C, Sequist TD, Weiner SG. Trends in buprenorphine treatment disparities during the COVID pandemic in Massachusetts. Subst Abus 2022; 43:1317-1321. [PMID: 35896001 DOI: 10.1080/08897077.2022.2095077] [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: 10/16/2022]
Abstract
Background: Racial, sex, and age disparities in buprenorphine treatment have previously been demonstrated. We evaluated trends in buprenorphine treatment disparities before and after the onset of the COVID pandemic in Massachusetts. Methods: This cross-sectional study used data from an integrated health system comparing 12-months before and after the March 2020 Massachusetts COVID state of emergency declaration, excluding March as a washout period. Among patients with a clinical encounter during the study periods with a diagnosis of opioid use disorder or opioid poisoning, we extracted outpatient buprenorphine prescription rates by age, sex, race and ethnicity, and language. Generating univariable and multivariable Poisson regression models, we calculated the probability of receiving buprenorphine. Results: Among 4,530 patients seen in the period before the COVID emergency declaration, 57.9% received buprenorphine. Among 3,653 patients seen in the second time period, 55.1% received buprenorphine. Younger patients (<24) had a lower likelihood of receiving buprenorphine in both time periods (adjusted prevalence ratio (aPR), 0.56; 95% CI, 0.42-0.75 before vs. aPR, 0.76; 95% CI, 0.60-0.96 after). Male patients had a greater likelihood of receiving buprenorphine compared to female patients in both time periods (aPR: 1.05; 95% CI, 1.00-1.11 vs. aPR: 1.09; 95% CI, 1.02-1.16). Racial disparities emerged in the time period following the COVID pandemic, with non-Hispanic Black patients having a lower likelihood of receiving buprenorphine compared to non-Hispanic white patients in the second time period (aPR, 0.85; 95% CI, 0.72-0.99). Conclusions: Following the onset of the COVID pandemic in Massachusetts, ongoing racial, age, and gender disparities were evident in buprenorphine treatment with younger, Black, and female patients less likely to be treated with buprenorphine across an integrated health system.
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Affiliation(s)
- Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Mass General Brigham, Office of the Chief Medical Officer, Boston, MA, USA
| | - Eugene Lambert
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sunny Kung
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Aleta D Carroll
- Mass General Brigham, Office of the Chief Medical Officer, Boston, MA, USA
| | - Thu-Trang Hickman
- Mass General Brigham, Office of the Chief Medical Officer, Boston, MA, USA
| | | | - Thomas D Sequist
- Harvard Medical School, Boston, MA, USA.,Mass General Brigham, Office of the Chief Medical Officer, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott G Weiner
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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29
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Linas BP, Morgan JR, Murphy SM, Walley AY, Schackman BR, Marshall BDL. Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts. Drug Alcohol Depend 2022; 241:109668. [PMID: 36309001 PMCID: PMC9833886 DOI: 10.1016/j.drugalcdep.2022.109668] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. METHODS We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and "other" (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. RESULTS From 2016-2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. CONCLUSION We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA; The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI 02906, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA.
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Barboza G, Angulski K, Hines L, Brown P. Variability in Opioid-Related Drug Overdoses, Social Distancing, and Area-Level Deprivation during the COVID-19 Pandemic: a Bayesian Spatiotemporal Analysis. J Urban Health 2022; 99:873-886. [PMID: 36068454 PMCID: PMC9447988 DOI: 10.1007/s11524-022-00675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
Monitoring the spatial and temporal course of opioid-related drug overdose mortality is a key public health determinant. Despite previous studies exploring the evolution of drug-related fatalities following the stay-at-home mandates during the COVID-19 pandemic, little is known about the spatiotemporal dynamics that mitigation efforts had on overdose deaths. The purpose of this study was to describe the spatial and temporal dynamics of overdose death relative risk using a 4-week interval over a span of 5 months following the implementation of the COVID-19 lockdown in the city of Chicago, IL. A Bayesian space-time model was used to produce posterior risk estimates and exceedance probabilities of opioid-related overdose deaths controlling for measures of area-level deprivation and stay-at-home mandates. We found that area-level temporal risk and inequalities in drug overdose mortality increased significantly in the initial months of the pandemic. We further found that a change in the area-level deprivation from the first to the fourth quintile increased the relative risk of a drug overdose risk by 44.5%. The social distancing index measuring the proportion of persons who stayed at home in each census block group was not associated with drug overdose mortality. We conclude by highlighting the importance of contextualizing the spatial and temporal risk in overdose mortality for implementing effective and safe harm reduction strategies during a global pandemic.
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Affiliation(s)
- Gia Barboza
- College of Public Health and the College of Social Work, The Ohio State University, Columbus, OH, USA.
| | - Kate Angulski
- University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Lisa Hines
- University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Philip Brown
- University of Colorado Colorado Springs, Colorado Springs, CO, USA
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31
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Magidson JF, Kleinman MB, Bradley V, Anvari MS, Abidogun TM, Belcher AM, Greenblatt AD, Dean D, Hines A, Seitz-Brown CJ, Wagner M, Bennett M, Felton JW. Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103813. [PMID: 35932644 PMCID: PMC9590100 DOI: 10.1016/j.drugpo.2022.103813] [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: 03/23/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the efficacy of methadone to treat opioid use disorder (OUD), retention is an urgent priority, particularly among low-income, minoritized populations. Peer recovery specialists are well-positioned to engage vulnerable patients, particularly when trained in an evidence-based intervention to promote retention. This hybrid effectiveness-implementation pilot trial aimed to demonstrate the proof of concept of a peer recovery specialist-delivered behavioral activation and problem solving-based approach (Peer Activate) to improve methadone retention. METHODS Implementation outcomes included feasibility, acceptability, and fidelity. Feasibility and acceptability were defined by the percentage of participants who initiated the intervention (≥75%) and completed ≥75% of core sessions, respectively. Fidelity was assessed via independent rating of a randomly selected 20% of sessions. The primary effectiveness outcome was methadone retention at three-months post-intervention vs. a comparison cohort initiating methadone during the same time period. Secondary outcomes included methadone adherence, substance use frequency, and substance use-related problems. RESULTS Benchmarks for feasibility and acceptability were surpassed: 86.5% (32/37) initiated the intervention, and 81.3% of participants who initiated attended ≥75% of core sessions. The mean independent rater fidelity score was 87.9%, indicating high peer fidelity. For effectiveness outcomes, 88.6% of participants in Peer Activate were retained in methadone treatment at three-months post-intervention-28.9% higher than individuals initiating methadone treatment alone in the same time period [χ2(1) = 10.10, p = 0.001]. Among Peer Activate participants, urine-verified methadone adherence reached 97% at post-intervention, and there was a significant reduction in substance use frequency from 48% of past two-week days used at baseline to 31.9% at post-intervention [t(25) = 1.82, p = .041]. Among participants who completed the core Peer Activate sessions (n = 26), there was a significant reduction in substance use-related problems [t(21) = 1.84, p = 0.040]. CONCLUSION Given the rapid scale-up of peer recovery specialist programs nationwide and the urgent need to promote methadone retention, these results, although preliminary, have important potential clinical significance. The next steps are to conduct a Type 1 hybrid effectiveness-implementation randomized trial with a larger sample size and longer-term follow-up to further establish the implementation and effectiveness of the Peer Activate approach.
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Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA.
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Valerie Bradley
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Morgan S Anvari
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | | | | | - Dwayne Dean
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Abigail Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Michael Wagner
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Melanie Bennett
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - Julia W Felton
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, USA
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Moran KM, Mullachery PH, Lankenau S, Bilal U. Changes in Racial/Ethnic Disparities in Opioid-Related Outcomes in Urban Areas during the COVID-19 Pandemic: A Rapid Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159283. [PMID: 35954640 PMCID: PMC9368442 DOI: 10.3390/ijerph19159283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
Opioid use disorders (OUDs) are increasingly common among minoritized populations, who have historically experienced limited access to healthcare, a situation that may have worsened during the COVID-19 pandemic. Using a structured keyword search in Pubmed, we reviewed the literature to synthesize the evidence on changes in racial/ethnic disparities in OUD-related outcomes in urban areas during the COVID-19 pandemic in the US. Nine articles were included in the final analysis. Six found increases in OUD-related outcomes during the pandemic, with four showing a widening of disparities. Results also point to the worsening of opioid outcomes among Black and Latinx individuals related to shelter-in-place or stay-at-home orders. Studies examining the use of telehealth and access to OUD treatment showed that minoritized groups have benefited from telehealth programs. The limited number of studies in a small number of jurisdictions indicate a gap in research examining the intersection between COVID-19 and OUD-related outcomes with a focus on disparities. More research is needed to understand the impact of the COVID-19 pandemic and related policies on OUD outcomes among racial/ethnic minoritized groups, including examining the impact of service disruptions on vulnerable groups with OUD.
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Affiliation(s)
- Kara M. Moran
- College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102, USA;
| | - Pricila H. Mullachery
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA;
- Correspondence:
| | - Stephen Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA;
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA;
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
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Affiliation(s)
- Rahul Gupta
- White House Office of National Drug Control Policy, Washington, DC
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Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 pandemic resulted in cataclysmic changes to the research enterprise, causing a forced shutdown or rapid pivot to virtual methods. Adapting studies to the virtual environment also impacted recruitment and retention strategies. This review elucidated challenges and offered pragmatic recommendations, drawing on published literature and our prior work, to assist researchers in re-evaluating and amending best-practice techniques to bolster inclusive recruitment and study engagement of people using substances, particularly for virtual interviews or focus groups. RECENT FINDINGS Ameliorating recruitment strategies and research protocols to better fit virtual methods of recruitment and study administration required careful consideration of ethical and logistical implications. Many procedures to increase enrollment of underrepresented populations, such as building mutually beneficial and respectful community partnerships, recruiting via social media, or providing ambulatory research centers, existed prior to this specific pandemic. However, unprecedented disruptions in resources needed to participate in virtual interviews or focus groups, privacy concerns, and possible deteriorating trust in research necessitated continued adaptation and expansion of these strategies. SUMMARY Building upon prepandemic, community-engaged strategies may continue to facilitate diverse recruitment efforts and advance science productivity in the substance use and addiction field during the pandemic and thereafter.
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Anvari MS, Kleinman MB, Massey EC, Bradley VD, Felton JW, Belcher AM, Magidson JF. "In their mind, they always felt less than": The role of peers in shifting stigma as a barrier to opioid use disorder treatment retention. J Subst Abuse Treat 2022; 138:108721. [PMID: 35067397 PMCID: PMC9167238 DOI: 10.1016/j.jsat.2022.108721] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A substantial, national need exists for culturally acceptable, accessible opioid use disorder (OUD) treatment. Medication for opioid use disorder (MOUD) is regarded as effective in treating OUD; however, retention in MOUD programs remains low nationally. One known barrier to MOUD retention is stigma, particularly within ethno-racial minority communities. Peer recovery specialists (PRSs), individuals with shared experience in substance use and recovery, may be particularly well suited to support patients in MOUD treatment, and may have capacity to play a key role in decreasing stigma-related barriers to MOUD retention. METHODS This study used qualitative methods to solicit feedback on how patients receiving methadone treatment (MT) experience stigma (i.e., toward substance use [SU] and MT). Study staff also gathered information regarding how a PRS role may reduce stigma and improve retention in care, including barriers and facilitators to the PRS role shifting stigma. Study staff conducted semi-structured qualitative interviews and focus groups (N = 32) with staff and patients receiving MT at an opioid treatment program as well as PRSs in Baltimore. RESULTS Participants identified experiences of internalized, as well as enacted and anticipated, MT and SU stigma, and described these as barriers to treatment. Participants also identified opportunities for PRSs to shift stigma-related barriers for patients receiving MT through unique aspects of the PRS role, such as their shared lived experience. CONCLUSIONS Reducing stigma surrounding SUD and MT is critical for improving MOUD outcomes, and future research may consider how the PRS role can support this effort.
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Affiliation(s)
- Morgan S Anvari
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Ebonie C Massey
- Center for Substance Abuse Research (CESAR), University of Maryland, College Park, College Park, MD, USA
| | - Valerie D Bradley
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Julia W Felton
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Annabelle M Belcher
- Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Nguyen T, Ziedan E, Simon K, Miles J, Crystal S, Samples H, Gupta S. Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2214765. [PMID: 35648400 PMCID: PMC9161014 DOI: 10.1001/jamanetworkopen.2022.14765] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
Importance COVID-19 disrupted delivery of buprenorphine and naltrexone treatment for opioid use disorder (OUD), and during the pandemic, members of racial and ethnic minority groups experienced increased COVID-19 and opioid overdose risks compared with White individuals. However, whether filled buprenorphine and naltrexone prescriptions varied across racial and ethnic groups during the COVID-19 pandemic remains unknown. Objective To investigate whether disruptions in filled buprenorphine and naltrexone prescriptions differed by race and ethnicity and insurance status or payer type. Design, Setting, and Participants This cross-sectional study used retail pharmacy claims from May 2019 to June 2021 from the Symphony Health database, which includes 92% of US retail pharmacy claims, with race and ethnicity data spanning all insurance status and payer categories. Interrupted time series were used to estimate levels and trends of dispensed buprenorphine and naltrexone prescriptions before and after pandemic onset. Included individuals were those who filled buprenorphine and extended-release naltrexone prescriptions. Data were analyzed from July 2021 through March 2022. Main Outcomes and Measures Weekly rates of dispensed buprenorphine and extended-release naltrexone prescription fills per 1000 patients and proportion of longer (ie, ≥14 days' supply) buprenorphine prescription fills were calculated. Analyses were stratified by patient race and ethnicity and further by insurance status and payer type for White and Black patients. Results A total of 1 556 860 individuals who filled buprenorphine prescriptions (4359 Asian [0.3%], 94 657 Black [6.1%], 55 369 Hispanic [3.6%], and 664 779 White [42.7%]) and 127 506 individuals who filled extended-release naltrexone prescriptions (344 Asian [0.3%], 8186 Black [6.4%], 5343 Hispanic [4.2%], and 53 068 White [41.6%]) from May 6, 2019, to June 5, 2021, were analyzed. Prepandemic increases in buprenorphine fill rate flattened for all groups after COVID-19 onset (30.5 percentage point difference in trend; P < .001) compared with prepandemic trends. Significant level decreases in buprenorphine fills (ranging from 2.5% for Black patients; P = .009 to 4.0% for Hispanic patients; P = .009) at pandemic onset were observed for members of racial and ethnic minority groups but not White patients. At pandemic onset, rate of buprenorphine fills decreased in level for Medicare and cash-paying patients but with greater decreases for Black patients (Medicare: 10.0%; P < .001; cash: 20.0%; P < .001) than White patients (Medicare: 3.5%; P = .004; cash: 15.0%; P < .001). No decreases were found among Medicaid patients. Unlike buprenorphine, extended-release naltrexone had uniform level (from 10.0% for White patients with private insurance; P < .001 to 23.3% for Black patients with Medicare; P < .001) and trend (from 15.5 percentage points for White patients with Medicaid; P = .001 to 52.0 percentage points for Black patients with private insurance; P < .001) decreases across groups. Conclusions and Relevance This study found that the COVID-19 pandemic was associated with immediate decreases in filled buprenorphine prescriptions by members of racial and ethnic minority groups but not White individuals. These findings suggest that members of racial and ethnic minority groups had larger losses in buprenorphine access during the pandemic across payer types.
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Affiliation(s)
- Thuy Nguyen
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Engy Ziedan
- Department of Economics, Tulane University, New Orleans, Louisiana
| | - Kosali Simon
- O'Neil School of Public and Environmental Affairs, Indiana University, Bloomington
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Jennifer Miles
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, School of Social Work, Rutgers University, New Brunswick, New Jersey
- School of Public Health, Rutgers University, New Brunswick, New Jersey
| | - Hillary Samples
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health Rutgers University, New Brunswick, New Jersey
| | - Sumedha Gupta
- Department of Economics, Indiana University-Purdue University Indianapolis, Indianapolis
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Harris LM, Silverstein SM, Crawford TN, Kerr JC, Ball D. Exploring the Impacts of Alcohol and Other Drug Use on HIV Care Among Older African American Adults in Kentucky: A Constructivist Grounded Theory Study. J Assoc Nurses AIDS Care 2022; 33:333-347. [PMID: 34907970 DOI: 10.1097/jnc.0000000000000319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This grounded theory study examined the use of alcohol and other drugs (AOD) on the management of HIV disease among 27 older African Americans (≥50 years). Interview transcripts were analyzed using constructivist grounded theory analytic techniques. Participants reported facing (a) environmental impacts of AOD use and (b) discrimination from the health care system. The analysis revealed six phases of AOD use, occurring at various stages of the HIV care continuum: (a) linking AOD use as the cause of HIV diagnosis, (b) having AOD use facilitate denial of HIV, (c) experiencing problematic use as a barrier to care engagement, (d) "testing the waters," (e) relying on AIDS service organizations and medical providers, and (f) changing or maintaining patterns of AOD use to maintain engagement with care. Recommendations include assessing a patient's AOD use in relationship to the care continuum to evaluate patients' experiences and barriers within systems of care.
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Affiliation(s)
- Lesley M Harris
- Lesley M. Harris, PhD, MSW, is an Associate Professor, University of Louisville, Kent School of Social Work, Louisville, Kentucky, USA. Sydney M. Silverstein, PhD, is an Assistant Professor, Wright State University, Boonshoft School of Medicine, Department of Population and Public Health Sciences, Center for Interventions, Treatment, and Addictions Research, Kettering, Ohio, USA. Timothy N. Crawford, PhD, MPH, is an Assistant Professor, Wright State University, Boonshoft School of Medicine, Department of Population and Public Health Sciences, Kettering, Ohio, USA. Jelani C. Kerr, PhD, MPH, is an Associate Professor, University of Louisville, School of Public Health and Information Sciences, Louisville, Kentucky, USA. Diana Ball, MSW, is a PhD Candidate, University of Louisville, Kent School of Social Work, Louisville, Kentucky, USA
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Kumar RG, Esterov D, Adams RS, Corrigan JD, Juengst SB, Chiaravalloti ND, Yew B, Dreer LE, Dams-O’Connor K. Changes in alcohol use and mood during the COVID-19 pandemic among individuals with traumatic brain injury: A difference-in-difference study. PLoS One 2022; 17:e0266422. [PMID: 35390043 PMCID: PMC8989351 DOI: 10.1371/journal.pone.0266422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/18/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the impact of COVID-19 pandemic exposure on changes in alcohol use and mood from years 1 to 2 after traumatic brain injury (TBI). Methods We used a difference-in-difference (DiD) study design to analyze data from 1,059 individuals with moderate-to-severe TBI enrolled in the TBI Model Systems (TBIMS) National Database. We defined COVID-19 pandemic exposure as participants who received their year 1 post-injury interviews prior to January 1, 2020, and their year 2 interview between April 1, 2020 and January 15, 2021. Pandemic-unexposed participants had both year 1 and 2 follow-up interviews before January 1, 2020. We measured current alcohol use as any past month alcohol use, average number of drinks per drinking occasion, and past month binge drinking. We measured depression symptoms using Patient Health Questionnaire-9, and anxiety symptoms using the Generalized Anxiety Disorder-7. Results We found persons with TBI exposed to the pandemic had greater increases in the average number of drinks per occasion from year 1 to 2 post-injury compared to pandemic-unexposed individuals (β = 0.36, 95% CI: 0.16, 0.57, p = 0.001), with males, adults <65 years old, and Black and Hispanic subgroups showing the greatest increases in consumption. Though average consumption was elevated, changes in rates of any alcohol use or binge drinking by pandemic exposure were not observed. Overall, there were no significant changes in depressive and anxiety symptoms over time between pandemic exposed and unexposed groups; however, pandemic-exposed Hispanics with TBI reported significant increases in anxiety symptoms from year-1 to year-2 post-injury compared to pandemic-unexposed Hispanics (β = 2.35, 95% CI: 0.25, 4.47, p = 0.028). Conclusion Among persons living with TBI, those exposed to the pandemic had significant increases in average alcohol consumption. Pandemic-exposed Hispanics with TBI had large elevations in anxiety symptoms, perhaps reflecting health inequities exacerbated by the pandemic, and suggesting a need for targeted monitoring of psychosocial distress.
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Affiliation(s)
- Raj G. Kumar
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- * E-mail:
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America
| | - Rachel Sayko Adams
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, United States of America
| | - John D. Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, United States of America
| | - Shannon B. Juengst
- TIRR Memorial Hermann, Houston TX, United States of America
- Department of Physical Medicine & Rehabilitation, UT Southwestern, Dallas, TX, United States of America
| | - Nancy D. Chiaravalloti
- Kessler Foundation, East Hanover, NJ, United States of America
- Department of Physical Medicine and Rehabilitation, Rutgers University/The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Belinda Yew
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Laura E. Dreer
- Department of Ophthalmology & Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kristen Dams-O’Connor
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Oles W, Alexander M, Kumar N, Howell B, O’Connor PG, Madden LM, Barry DT. Characterizing the social support and functioning of a low-threshold medication for opioid use disorder treatment cohort at intake. BMC Psychiatry 2022; 22:236. [PMID: 35366844 PMCID: PMC8976510 DOI: 10.1186/s12888-022-03884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite the growing morbidity and mortality rates associated with opioid use disorder, a large gap still exists between treatment need and capacity. Low-threshold clinics utilizing medication for opioid use disorder (MOUD) treatment can increase treatment access but are understudied, and little is known about how patient demographic characteristics are associated with their social support and functioning in these settings. METHODS We used multivariate regression to estimate associations between demographic characteristics and self-reported social support or functioning indicators among patients receiving MOUD in a low-threshold clinic using several validated instruments administered at intake: Behavior and Symptom Identification Scale, Brief Pain Inventory, and Life Events Checklist for DSM-5. Patients initiating MOUD treatment between April 1 and December 31, 2017, with complete surveys were included (N=582). RESULTS Patients were primarily male (62%), aged 34 or older (53%), non-Hispanic White (79%), separated or not married (86%), and unemployed (64%). Over 20% did not live in a house or apartment in the past month. Women were more likely to "get along" with people outside their family or in social situations and to identify their partner as their source of support. Women, non-White, and older patients were at higher risk of social functioning-disrupting events (physical/sexual assaults or experiencing chronic pain), while employment and housing were protective against exposure to these trauma-related events. However, employment and housing also decreased the odds of talking with others about substance use. The aforementioned results were obtained from multivariate logistic regression models and were significant to p<0.05. CONCLUSIONS Variation in support and functioning by demographic characteristics suggests that treatment facilities may benefit from adopting strategies that take baseline disparities in support and functioning into account.
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Affiliation(s)
- William Oles
- grid.47100.320000000419368710Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT USA
| | - Marcus Alexander
- Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT, USA.
| | - Navin Kumar
- grid.47100.320000000419368710Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT USA ,grid.47100.320000000419368710Department of Sociology, Yale University, New Haven, CT USA
| | - Benjamin Howell
- grid.47100.320000000419368710Section of General Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT USA ,grid.281208.10000 0004 0419 3073VA Connecticut Healthcare System, New Haven, CT USA
| | - Patrick G. O’Connor
- grid.47100.320000000419368710Section of Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT USA
| | - Lynn M. Madden
- grid.47100.320000000419368710Section of Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT USA ,grid.422797.d0000 0004 0558 5300APT Foundation, New Haven, CT USA
| | - Declan T. Barry
- grid.422797.d0000 0004 0558 5300APT Foundation, New Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Wakeman SE. Opioid Use Disorder Diagnosis and Management. NEJM EVIDENCE 2022; 1:EVIDra2200038. [PMID: 38319203 DOI: 10.1056/evidra2200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Opioid Use Disorder Diagnosis and ManagementThe last 20 years have seen a staggering increase in opioid-related morbidity and mortality. Although the consequences of untreated OUDs are significant, OUD is a treatable illness. This article reviews the epidemiology of OUD and its complications, screening, diagnosis, treatment, and harm reduction interventions.
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Affiliation(s)
- Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
- Department of Quality, Patient Experience, and Equity, Mass General Brigham, Boston
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Kumar N, Janmohamed K, Nyhan K, Martins SS, Cerda M, Hasin D, Scott J, Sarpong Frimpong A, Pates R, Ghandour LA, Wazaify M, Khoshnood K. Substance, use in relation to COVID-19: A scoping review. Addict Behav 2022; 127:107213. [PMID: 34959077 PMCID: PMC8684053 DOI: 10.1016/j.addbeh.2021.107213] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/24/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023]
Abstract
Background We conducted a scoping review focused on various forms of substance use amid the pandemic, looking at both the impact of substance use on COVID-19 infection, severity, and vaccine uptake, as well as the impact that COVID-19 has had on substance use treatment and rates. Methods A scoping review, compiling both peer-reviewed and grey literature, focusing on substance use and COVID-19 was conducted on September 15, 2020 and again in April 15, 2021 to capture any new studies. Three bibliographic databases (Web of Science Core Collection, Embase, PubMed) and several preprint servers (EuropePMC, bioRxiv, medRxiv, F1000, PeerJ Preprints, PsyArXiv, Research Square) were searched. We included English language original studies only. Results Of 1564 articles screened in the abstract and title screening phase, we included 111 research studies (peer-reviewed: 98, grey literature: 13) that met inclusion criteria. There was limited research on substance use other than those involving tobacco or alcohol. We noted that individuals engaging in substance use had increased risk for COVID-19 severity, and Black Americans with COVID-19 and who engaged in substance use had worse outcomes than white Americans. There were issues with treatment provision earlier in the pandemic, but increased use of telehealth as the pandemic progressed. COVID-19 anxiety was associated with increased substance use. Conclusions Our scoping review of studies to date during COVID-19 uncovered notable research gaps namely the need for research efforts on vaccines, COVID-19 concerns such as anxiety and worry, and low- to middle-income countries (LMICs) and under-researched topics within substance use, and to explore the use of qualitative techniques and interventions where appropriate. We also noted that clinicians can screen and treat individuals exhibiting substance use to mitigate effects of the pandemic. Funding Study was funded by the Institution for Social and Policy Studies, Yale University and The Horowitz Foundation for Social Policy. DH was funded by a NIDA grant (R01DA048860). The funding body had no role in the design, analysis, or interpretation of the data in the study.
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Lopez AM, Thomann M, Dhatt Z, Ferrera J, Al-Nassir M, Ambrose M, Sullivan S. Understanding Racial Inequities in the Implementation of Harm Reduction Initiatives. Am J Public Health 2022; 112:S173-S181. [PMID: 35349311 PMCID: PMC8965181 DOI: 10.2105/ajph.2022.306767] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To elucidate a structurally oriented theoretical framework that considers legacies of racism, trauma, and social exclusion and to interrogate the "unmet obligations" of the institutionalization of the harm reduction infrastructure to provide equitable protections to Black and Latinx people who use drugs (PWUD) in Maryland. Methods. In 2019, we conducted a rapid ethnographic assessment of and qualitative interviews with PWUD (n = 72) and stakeholders (n = 85) in 5 Maryland counties. We assessed PWUD's experiences, service gaps in as well as barriers and facilitators to accessing services, and the potential to expand harm reduction programs. Results. The unmet obligations we found included enforcement and punitive governance of syringes, naloxone, and other drug use equipment; racism and racialization, social exclusion, and legacies of trauma; and differential implications of harm reduction for populations experiencing racialized criminalization. Conclusions. The implementation of harm reduction policies are a first step, but assessment of structural dynamics are needed for diverse communities with unique histories. This research illuminates a key paradox: progressive policy is implemented, yet the overdose crisis escalates in communities where various forms of racialized exclusions are firmly entrenched. (Am J Public Health. 2022;112(S2):S173-S181. https://doi.org/10.2105/AJPH.2022.306767).
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Affiliation(s)
- Andrea M Lopez
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Matthew Thomann
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Zena Dhatt
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Julieta Ferrera
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Marwa Al-Nassir
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Margaret Ambrose
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
| | - Shane Sullivan
- Andrea M. Lopez, Matthew Thomann, Zena Dhatt, Julieta Ferrera, and Shane Sullivan are with the Department of Anthropology, University of Maryland, College Park. Marwa Al-Nassir and Margaret Ambrose are with the Center for Substance Abuse Research, University of Maryland
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Ghose R, Forati AM, Mantsch JR. Impact of the COVID-19 Pandemic on Opioid Overdose Deaths: a Spatiotemporal Analysis. J Urban Health 2022; 99:316-327. [PMID: 35181834 PMCID: PMC8856931 DOI: 10.1007/s11524-022-00610-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
Abstract
The effects of the opioid crisis have varied across diverse and socioeconomically defined urban communities, due in part to widening health disparities. The onset of the COVID-19 pandemic has coincided with a spike in drug overdose deaths in the USA. However, the extent to which the impact of the pandemic on overdose deaths has varied across different demographics in urban neighborhoods is unclear. We examine the influence of COVID-19 pandemic on opioid overdose deaths through spatiotemporal analysis techniques. Using Milwaukee County, Wisconsin as a study site, we used georeferenced opioid overdose data to examine the locational and demographic differences in overdose deaths over time (2017-2020). We find that the pandemic significantly increased the monthly overdose deaths. The worst effects were seen in the poor, urban neighborhoods, affecting Black and Hispanic communities. However, more affluent, suburban White communities also experienced a rise in overdose deaths. A better understanding of contributing factors is needed to guide interventions at the local, regional, and national scales.
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Affiliation(s)
- Rina Ghose
- Department of Geography, University Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA
| | - Amir M Forati
- Department of Geography, University Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA.
| | - John R Mantsch
- Department of Pharmacology and Therapeutics and Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, 53206, USA
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Evaluating disparities in prescribing of naloxone after emergency department treatment of opioid overdose. J Subst Abuse Treat 2022; 139:108785. [PMID: 35537918 PMCID: PMC9187615 DOI: 10.1016/j.jsat.2022.108785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/26/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patients who initially survive opioid-related overdose are at high risk for subsequent mortality. Our health system aimed to evaluate the presence of disparities in prescribing naloxone following opioid overdose. METHODS This was a retrospective cohort study of patients seen in our health system, which comprises two academic centers and eight community hospitals. Eligible patients had at least one visit to any of our hospital's emergency departments (EDs) with a diagnosis code indicating opioid-related overdose between May 1, 2018, and April 30, 2021. The primary outcome measure was prescription of nasal naloxone after at least one visit for opioid-related overdose during the study period. RESULTS The health system had 1348 unique patients who presented 1593 times to at least one of the EDs with opioid overdose. Of included patients, 580 (43.2%) received one or more prescriptions for naloxone. The majority (68.9%, n = 925) were male. For race/ethnicity, 74.5% (1000) were Non-Hispanic White, 8.0% (n = 108) were Non-Hispanic Black, and 13.0% (n = 175) were Hispanic/Latinx. Compared with the reference age group of 16-24 years, only those 65+ were less likely to receive naloxone (adjusted odds ratio [aOR] 0.41, 95% confidence interval [CI] 0.20-0.84). The study found no difference for gender (male aOR 1.23, 95% CI 0.97-1.57 compared to female). Hispanic/Latinx patients were more likely to receive a prescription when compared to Non-Hispanic White patients (aOR 1.72, 95% CI 1.22-2.44), while no difference occurred between Non-Hispanic Black compared to Non-Hispanic White patients (aOR 1.31, 95% CI 0.87-1.98). CONCLUSIONS Naloxone prescribing after overdose in our system was suboptimal, with fewer than half of patients with an overdose diagnosis code receiving this lifesaving and evidence-based intervention. Patients who were Hispanic/Latinx were more likely to receive naloxone than other race and ethnicity groups, and patients who were older were less likely to receive it. Health systems need ongoing equity-informed implementation of programs to expand access to naloxone to all patients at risk.
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Page TF, Chen W, Jacko JA, Sainfort F. Disparities in Emergency Department Visits for Opioid and Stimulant Overdoses in Florida During COVID-19. Popul Health Manag 2022; 25:480-486. [PMID: 35238629 DOI: 10.1089/pop.2021.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emergency department (ED) visits for drug overdoses increased nationally during COVID-19 despite declines in all-cause ED visits. The study purpose was to compare characteristics of ED visits for opioid and stimulant overdoses before and during COVID-19 in Florida. This study tested for disparities in ED visits for opioid and stimulant overdoses by race/ethnicity, age, and insurance status. The study identified ED visits for opioid and stimulant overdose in Florida during quarters two and three of 2019 and compared them with quarters two and three of 2020. Overall, there was an increase in the number of opioid and stimulant overdoses during COVID-19. Combined with the decline in the number of all-cause ED visits, drug overdoses represented a larger share of ED visits during COVID-19 compared with before COVID-19. The study did not find evidence of disparities by race/ethnicity, as each group experienced similar increases in the likelihood of ED visits involving drug overdoses during COVID-19. Differences emerged according to age and insurance status. ED visits involving those under age 18 were more likely to involve opioid or stimulant overdose, and ED visits among those over age 65 were less likely to involve opioid overdose during COVID-19. ED visits among those with vulnerable insurance status were more likely to involve opioid overdose during COVID-19. Patterns of behavior change during periods of restricted activity due to a pandemic. These changes in behavior change the mix of risks that people face, suggesting the need for a reallocation of population health management resources during pandemics.
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Affiliation(s)
- Timothy F Page
- Department of Management, H. Wayne Huizenga College of Business and Entrepreneurship, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Weiwei Chen
- Department of Economics, Finance and Quantitative Analysis, Michael J. Coles College of Business, Kennesaw State University, Kennesaw, Georgia, USA
| | - Julie A Jacko
- Department of Management, H. Wayne Huizenga College of Business and Entrepreneurship, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Department of Population Health Sciences, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University Fort Lauderdale, Florida, USA
| | - François Sainfort
- Department of Management, H. Wayne Huizenga College of Business and Entrepreneurship, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Department of Population Health Sciences, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University Fort Lauderdale, Florida, USA
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Jacka BP, Ziobrowski HN, Lawrence A, Baird J, Wentz AE, Marshall BDL, Wightman RS, Mello MJ, Beaudoin FL, Samuels EA. Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program. Acad Emerg Med 2022; 29:294-307. [PMID: 34738277 DOI: 10.1111/acem.14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE Emergency department (ED)-based naloxone distribution and peer-based behavioral counseling have been shown to be feasible, but little is known about utilization maintenance over time and clinician, patient, and visit level factors influencing implementation. METHODS We conducted a retrospective cohort study of an ED overdose prevention program providing take-home naloxone, behavioral counseling, and treatment linkage for patients treated for an opioid overdose at two Rhode Island EDs from 2017 to 2020: one tertiary referral center and a community hospital. Utilizing a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we evaluated program reach, adoption, implementation modifiers, and maintenance using logistic and Poisson regression. RESULTS Seven hundred forty two patients were discharged after an opioid overdose, comprising 966 visits (median: 32 visits per month; interquartile range: 29, 41). At least one intervention was provided at most (86%, 826/966) visits. Take-home naloxone was provided at 69% of visits (637/919). Over half (51%, 495/966) received behavioral counseling and treatment referral (65%, 609/932). Almost all attending physicians provided take-home naloxone (97%, 105/108), behavioral counseling (95%, 103/108), or treatment referral (95%, 103/108) at least once. Most residents and advanced practice practitioners (APPs) provided take home naloxone (78% residents; 72% APPs), behavioral counseling (76% residents; 67% APPs), and treatment referral (80% residents; 81% APPs) at least once. Most clinicians provided these services for over half of the opioid overdose patients they cared for. Patients were twice as likely to receive behavioral counseling when treated by an attending in combination with a resident and/or APP (adjusted odds ratio: 2.29; 95% confidence interval, 1.68, 3.12) compared to an attending alone. There was no depreciation in use over time. CONCLUSIONS ED naloxone distribution, behavioral counseling, and referral to treatment can be successfully integrated into usual emergency care and maintained over time with high reach and adoption. Further work is needed to identify low-cost implementation strategies to improve services use and dissemination across clinical settings.
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Affiliation(s)
- Brendan P. Jacka
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
| | - Hannah N. Ziobrowski
- Department of Health Care Policy Harvard Medical School Boston Massachusetts USA
| | - Alexis Lawrence
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Janette Baird
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Anna E. Wentz
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
| | - Brandon D. L. Marshall
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
| | - Rachel S. Wightman
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Michael J. Mello
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Francesca L. Beaudoin
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Elizabeth A. Samuels
- Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
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Vieson J, Yeh AB, Lan Q, Sprague JE. During the COVID-19 Pandemic, Opioid Overdose Deaths Revert to Previous Record Levels in Ohio. J Addict Med 2022; 16:e118-e122. [PMID: 34172625 PMCID: PMC8919935 DOI: 10.1097/adm.0000000000000874] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/26/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE During the COVID-19 pandemic, states have had to confront a drug overdose problem associated with the pandemic. The objective of this study was to identify the impact of the COVID-19 pandemic on the opioid epidemic in the state of Ohio by describing the changes in the quarterly opioid overdose deaths (OOD) over the last 10 years. METHODS This longitudinal study included OOD data from death records obtained through the Ohio Department of Health. Temporal trend analysis and visualizations were performed on the OOD death rate per 100,000 quarterly from 2010 to 2020. Age, sex, and ethnicity were also analyzed. RESULTS The OOD rate of 11.15 in Q2 of 2020 was statistically equivalent to the previous peak level of 10.87 in Q1 of 2017. There was a significant increase in the OOD rate from Q1 to Q2 of 2020 and a significant difference between the actual Q2 of 2020 OOD rate and the predicted OOD rate. The poisoning indicator fentanyl was present in 94% of OOD during Q2 of 2020. The total number of OOD remains highest in the White population. There was no significant difference between the actual and predicted OOD rates in the Black population of Q2 of 2020 based on the trend line. However, the OOD rate of 14.29 in Q2 of 2020 was significantly higher than the previous peak level of 8.34 in Q2 of 2017. The Q2 of 2020 OOD rates for 18 to 39 and 40+ age groups were significantly higher from what would be expected from the trend predictions. CONCLUSIONS Based on these findings, Ohio has entered a COVID-19 pandemic mediated fourth wave in the opioid epidemic. These findings further suggest that as efforts are made to address the worldwide COVID-19 pandemic, states need to maintain their vigilance toward combating the local opioid epidemic.
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Affiliation(s)
- Jamie Vieson
- The Ohio Attorney General's Office, Columbus, OH (JV, JES); Department of Applied Statistics and Operations Research, Bowling Green State University, Bowling Green, OH (ABY); Department of Computer Science, Bowling Green State University, Bowling Green, OH (QL); The Ohio Attorney General's Center for the Future of Forensic Science, Bowling Green State University, Bowling Green, OH (JES)
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Suen LW, Davy-Mendez T, LeSaint KT, Riley ED, Coffin PO. Emergency department visits and trends related to cocaine, psychostimulants, and opioids in the United States, 2008-2018. BMC Emerg Med 2022; 22:19. [PMID: 35120449 PMCID: PMC8814795 DOI: 10.1186/s12873-022-00573-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of ED visits related to cocaine and psychostimulant use, compared to opioid use, in the United States (US). METHODS We used 2008-2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. To make visits mutually exclusive for analysis, we excluded visits related to 2 or more of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness. RESULTS Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70-5.13; psychostimulant aOR 2.46, 95% CI 1.42-4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69, 95% CI 1.83-3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30-0.73) compared to opioid-related ED visits. CONCLUSION Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.
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Affiliation(s)
- Leslie W. Suen
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 290 Illinois Street, Suite 7227, Box 0936, San Francisco, CA 94158 USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
| | - Thibaut Davy-Mendez
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Kathy T. LeSaint
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Elise D. Riley
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Phillip O. Coffin
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA USA
- Department of Public Health, San Francisco, CA USA
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Affiliation(s)
- Joseph Friedman
- Medical Scientist Training Program, University of California, Los Angeles
| | - Leo Beletsky
- Northeastern University, School of Law and Bouvé College of Health Sciences
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Chang JE, Franz B, Cronin CE, Lindenfeld Z, Lai AY, Pagán JA. Racial/ethnic disparities in the availability of hospital based opioid use disorder treatment. J Subst Abuse Treat 2022; 138:108719. [DOI: 10.1016/j.jsat.2022.108719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 12/23/2022]
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