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Karaye IM, Gonzalez J, Owens S, Jalal S, Sosa S, Alexander K, Thomas M, Granger GG, Markowitz WL, Kyriacou CM. Contemporary burden and trends of opioid-overdose mortality in New York State. Prev Med 2024; 185:108010. [PMID: 38801836 DOI: 10.1016/j.ypmed.2024.108010] [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: 07/05/2023] [Revised: 05/08/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Limited research exists on contemporary opioid overdose mortality burden and trends in New York State, with most studies focusing on New York City. This study aimed to assess opioid overdose burden and death trends in New York State by age, sex, race/ethnicity, geographic area, opioid type, and overdose intent from 1999 to 2020. METHODS Mortality data were obtained from the Centers for Disease Control and Prevention's WONDER database. Opioid overdose decedents were identified using relevant International Classification of Diseases, 10th Revision codes. Joinpoint regression analyzed trends, estimating annual and average annual percentage changes in age-adjusted mortality rates (AAMR). 95% confidence intervals were derived using the Parametric Method. RESULTS From 1999 to 2020, New York State recorded 34,109 opioid overdose deaths (AAMR = 7.9 per 100,000 persons; 95% CI: 7.8-7.9). The overall trend increased by 12.6% per year (95% CI: 10.8, 14.4) from 2004 to 2020. Subgroups exhibited varying trends, with an 11.1% yearly increase among Non-Hispanic White persons from 2007 to 2020 (95% CI: 9.0, 13.2), a 24.6% annual rise among Non-Hispanic Black persons from 2012 to 2020 (95% CI: 17.7, 31.8), and an 18.3% increase yearly among Hispanic individuals from 2011 to 2020 (95% CI: 14.0, 22.9). Recent trends have worsened in both males and females, across all age groups, in both New York City (NYC) and areas outside NYC, and for heroin, natural and semisynthetic opioids, and synthetic opioids. CONCLUSIONS Opioid overdose mortality in New York State has worsened significantly in the last two decades. Further research is essential to identify driving factors for targeted public health interventions.
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Affiliation(s)
- Ibraheem M Karaye
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States of America; Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.
| | - Jirel Gonzalez
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Serenity Owens
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Shubha Jalal
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America.
| | - Sofia Sosa
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America.
| | - Kaden Alexander
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Michelle Thomas
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States of America.
| | - Gina G Granger
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, NY 11549, United States of America.
| | - Walter L Markowitz
- Department of Population Health, Hofstra University, United States of America.
| | - Corinne M Kyriacou
- School of Health Professions and Human Services, Hofstra University, Hempstead, NY 11549, United States of America.
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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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Nolen S, Trinidad AJ, Jordan AE, Green TC, Jalali A, Murphy SM, Zang X, Marshall BDL, Schackman BR. Racial/ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City. Harm Reduct J 2023; 20:152. [PMID: 37853481 PMCID: PMC10585909 DOI: 10.1186/s12954-023-00891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC). METHODS We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White, and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group. RESULTS Non-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate, and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents. CONCLUSIONS This study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA
| | - Andrew J Trinidad
- Department of Health & Mental Hygiene, Bureau of Alcohol & Drug Use Prevention, Care, & Treatment, 42-09 28Th St, Queens, New York, NY, 11101, USA
| | - Ashly E Jordan
- Department of Health & Mental Hygiene, Bureau of Alcohol & Drug Use Prevention, Care, & Treatment, 42-09 28Th St, Queens, New York, NY, 11101, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
- Center of Biomedical Research Excellence On Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI, 02906, USA
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
| | - Xiao Zang
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA.
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
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Zammit Dimech D, Ranjan R. A protocol of a systematic review on deep brain stimulation surgery and its efficacy in addressing substance abuse addiction. Health Sci Rep 2023; 6:e1409. [PMID: 37431486 PMCID: PMC10329741 DOI: 10.1002/hsr2.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/17/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
Background Pharmacotherapy and psychotherapeutic approaches are still the mainstay first line of treatment for substance use disorder. However, the path to rehabilitation and cessation of dependence often proves uncertain and laborious, with risks of relapse being considerable despite exposure to current therapeutic modalities. For cases of treatment-refractory addiction, deep brain stimulation (DBS) interventions can prove a more effective long term therapeutic solution for the patient. Objectives The aim of the study will be to systematically assess whether attempts at correcting substance use disorder via DBS neurosurgical interventions have been successful in inducing remission or ameliorating relapse rates. Methods The current study will analyze available literature from database inception up to 15th April 2023, reviewing all publications documenting results achieved with human patients undergoing DBS for substance use disorder in PubMed, Ovid, Cochrane, and Web of Science. The electronic database search will exclude animal studies in the field and focus solely on the application of DBS for the purposes of addressing addiction disorders. Results The expectation is for a reduced number of trial results to have been reported, namely due to the relatively recent application of DBS to address severe addiction. Nonetheless, numbers should be in sufficient amount to inform about the efficacy of the intervention. Conclusion This study will attempt to demonstrate the viability of DBS as a solution for tackling treatment-refractory substance use disorder, proposing it as a valid therapeutic option that can deliver robust results and help combat an expanding societal plague that is drug dependence.
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Affiliation(s)
- David Zammit Dimech
- Department of Surgical SciencesSurgical Sciences Programme, University of EdinburghEdinburghUK
| | - Redoy Ranjan
- Department of Surgical SciencesSurgical Sciences Programme, University of EdinburghEdinburghUK
- Department of SurgeryFaculty of Surgery, Bangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
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Nolen S, Trinidad AJ, Jordan AE, Green TC, Jalali A, Murphy SM, Zang X, Marshall BDL, Schackman BR. Racial/Ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City. RESEARCH SQUARE 2023:rs.3.rs-2934002. [PMID: 37292718 PMCID: PMC10246282 DOI: 10.21203/rs.3.rs-2934002/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC). Methods We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group. Results Non-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents. Conclusions This study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.
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Affiliation(s)
| | | | | | - Traci C Green
- Warren Alpert School of Medicine of Brown University
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Paul LA, Li Y, Leece P, Gomes T, Bayoumi AM, Herring J, Murray R, Brown P. Identifying the changing age distribution of opioid-related mortality with high-frequency data. PLoS One 2022; 17:e0265509. [PMID: 35442953 PMCID: PMC9020746 DOI: 10.1371/journal.pone.0265509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Opioid-related mortality continues to rise across North America, and mortality rates have been further exacerbated by the COVID-19 pandemic. This study sought to provide an updated picture of trends of opioid-related mortality for Ontario, Canada between January 2003 and December 2020, in relation to age and sex. Methods Using mortality data from the Office of the Chief Coroner for Ontario, we applied Bayesian Poisson regression to model age/sex mortality per 100,000 person-years, including random walks to flexibly capture age and time effects. Models were also used to explore how trends might continue into 2022, considering both pre- and post-COVID-19 courses. Results From 2003 to 2020, there were 11,633 opioid-related deaths in Ontario. A shift in the age distribution of mortality was observed, with the greatest mortality rates now among younger individuals. In 2003, mortality rates reached maximums at 5.5 deaths per 100,000 person-years (95% credible interval: 4.0–7.6) for males around age 44 and 2.2 deaths per 100,000 person-years (95% CI: 1.5–3.2) for females around age 51. As of 2020, rates have reached maximums at 67.2 deaths per 100,000 person-years (95% CI: 55.3–81.5) for males around age 35 and 16.8 deaths per 100,000 person-years (95% CI: 12.8–22.0) for females around age 37. Our models estimate that opioid-related mortality among the younger population will continue to grow, and that current conditions could lead to male mortality rates that are more than quadruple those of pre-pandemic estimations. Conclusions This analysis may inform a refocusing of public health strategy for reducing rising rates of opioid-related mortality, including effectively reaching both older and younger males, as well as young females, with health and social supports such as treatment and harm reduction measures.
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Affiliation(s)
- Lauren A. Paul
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
| | - Ye Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
- * E-mail:
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Substance Use Service, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Herring
- Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
| | - Regan Murray
- Office of the Chief Coroner for Ontario, Toronto, Ontario, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Patrick Brown
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
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The release of abuse-deterrent OxyContin and adolescent heroin use. Drug Alcohol Depend 2021; 229:109114. [PMID: 34638038 DOI: 10.1016/j.drugalcdep.2021.109114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the association between the abuse-deterrent reformulation of OxyContin and adolescent lifetime heroin use in the United States. METHODS The quasi-experimental study uses individual survey data from the 1999-2019 Youth Risk Behavior Surveillance System to examine whether the reformulation of OxyContin in August 2010 affected adolescent lifetime heroin use, exploiting heterogeneity in state-level rates of OxyContin misuse before the reformulation. Multiple regression analysis adjusted for state and year fixed effects, adolescent demographics, and time-varying state characteristics and policies. RESULTS The release of the abuse-deterrent reformulation of OxyContin was associated with a reduction in adolescents reporting ever using heroin. An adolescent in a state with a one percentage point higher state-level rate of pre-reformulation OxyContin misuse was 1.7% points less likely to report ever using heroin after the reformulation (95% confidence interval, [(CI) = -0.007, -0.027]). These effects are strongest for adolescent males (estimate: -0.028, [(CI) = -0.016, 0.040]) and non-whites (estimate: -0.021, [(CI) = -0.005, -0.037]). CONCLUSIONS These results suggest the release of abuse-deterrent OxyContin is associated with a decrease in the likelihood of adolescent lifetime heroin use in states with higher pre-reformulation rates of OxyContin misuse. Pharmaceutical innovations and policies that reduce the likelihood of prescription opioid misuse may be effective in reducing adolescent lifetime heroin use.
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Ezell JM, Ompad DC, Walters S. How urban and rural built environments influence the health attitudes and behaviors of people who use drugs. Health Place 2021; 69:102578. [PMID: 33964805 DOI: 10.1016/j.healthplace.2021.102578] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Research suggests that the built environment is associated with drug use. However, there is limited scholarship focusing on specific features of the built environment that influence drug use behaviors, experiences, and patterns and how risk factors for drug use are placed in distinctive urban and rural settings. Applying Neely and Samura's conceptual theory that describes space as contested, fluid and historical, interactional and relational, and defined by inequality and difference, we assessed data from semi-structured qualitative interviews conducted between 2019 and 2020 with consumers at syringe exchange programs (SEPs) in an urban location (New York City) and a rural location (southern Illinois). We aimed to contextualize how drug use manifests in each space. In total, 65 individuals, including 59 people who use drugs (PWUD) and six professionals who worked with PWUD, were interviewed. Findings illustrate that, in both the urban and rural setting, the built environment regulates the drug use milieu by mediating social reproduction, namely the degree of agency PWUD exert to acquire and use drugs where they desire. Processes of "stigma zoning," defined as socio-spatial policing of boundaries of behavior deemed undesirable or deviant, impacted PWUD's socio-geographic mobility, social conditions, and resource access, and modulated PWUD's broader capacity and self-efficacy. Similar patterns of drug use, according to social and economic inequities chiefly related to housing instability, were further observed in both settings.
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Affiliation(s)
- Jerel M Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, USA; Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA; Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA.
| | - Danielle C Ompad
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY, USA; Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Suzan Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Powell D, Pacula RL. THE EVOLVING CONSEQUENCES OF OXYCONTIN REFORMULATION ON DRUG OVERDOSES. AMERICAN JOURNAL OF HEALTH ECONOMICS 2020; 7:41-67. [PMID: 34568515 PMCID: PMC8460090 DOI: 10.1086/711723] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Recent evidence suggests that the short-term transition of the opioid crisis from prescription opioids to heroin can be attributed to the reformulation of OxyContin, which substantially reduced access to abusable prescription opioids. In this paper, we find that over a longer time horizon, reformulation stimulated illicit drug markets to grow and evolve. We compare overdose trajectories in areas more exposed to reformulation, defined as states with higher rates of nonmedical OxyContin use before reformulation, to less exposed areas. More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and nonopioid substances like cocaine, suggesting that these new epidemics are related to the same factors driving the rise in heroin deaths. Instead of just short-term substitution from prescription opioid to heroin overdoses, the transition to illicit markets spurred by reformulation led to growth in the overall overdose rate to unprecedented levels.
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Affiliation(s)
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, and NBER
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