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Wolf DA, Monnat SM, Wiemers EE, Sun Y, Zhang X, Grossman ER, Montez JK. State COVID-19 Policies and Drug Overdose Mortality Among Working-Age Adults in the United States, 2020. Am J Public Health 2024; 114:714-722. [PMID: 38696735 DOI: 10.2105/ajph.2024.307621] [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] [Indexed: 05/04/2024]
Abstract
Objectives. To identify relationships between US states' COVID-19 in-person activity limitation and economic support policies and drug overdose deaths among working-age adults in 2020. Methods. We used county-level data on 140 435 drug overdoses among adults aged 25 to 64 years during January 2019 to December 2020 from the National Vital Statistics System and data on states' COVID-19 policies from the Oxford COVID-19 Government Response Tracker to assess US trends in overdose deaths by sex in 3138 counties. Results. Policies limiting in-person activities significantly increased, whereas economic support policies significantly decreased, overdose rates. A 1-unit increase in policies restricting activities predicted a 15% average monthly increase in overdose rates for men (incident rate ratio [IRR] = 1.15; 95% confidence interval [CI] = 1.09, 1.20) and a 14% increase for women (IRR = 1.14; 95% CI = 1.09, 1.20). A 1-unit increase in economic support policies predicted a 3% average monthly decrease for men (IRR = 0.97; 95% CI = 0.95, 1.00) and a 4% decrease for women (IRR = 0.96; 95% CI = 0.93, 0.99). All states' policy combinations are predicted to have increased drug-poisoning mortality. Conclusions. The economic supports that states enacted were insufficient to fully mitigate the adverse relationship between activity limitations and drug overdoses. (Am J Public Health. 2024;114(7):714-722. https://doi.org/10.2105/AJPH.2024.307621).
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Affiliation(s)
- Douglas A Wolf
- Douglas A. Wolf, Emily E. Wiemers, Yue Sun, and Jennifer Karas Montez are with the Aging Studies Institute, Syracuse University, Syracuse, NY. Shannon M. Monnat and Xue Zhang are with the Lerner Center for Public Health Promotion and Population Health, Syracuse University. Elyse R. Grossman is with the Epidemiology Research Branch, US National Institute on Drug Abuse, Gaithersburg, MD
| | - Shannon M Monnat
- Douglas A. Wolf, Emily E. Wiemers, Yue Sun, and Jennifer Karas Montez are with the Aging Studies Institute, Syracuse University, Syracuse, NY. Shannon M. Monnat and Xue Zhang are with the Lerner Center for Public Health Promotion and Population Health, Syracuse University. Elyse R. Grossman is with the Epidemiology Research Branch, US National Institute on Drug Abuse, Gaithersburg, MD
| | - Emily E Wiemers
- Douglas A. Wolf, Emily E. Wiemers, Yue Sun, and Jennifer Karas Montez are with the Aging Studies Institute, Syracuse University, Syracuse, NY. Shannon M. Monnat and Xue Zhang are with the Lerner Center for Public Health Promotion and Population Health, Syracuse University. Elyse R. Grossman is with the Epidemiology Research Branch, US National Institute on Drug Abuse, Gaithersburg, MD
| | - Yue Sun
- Douglas A. Wolf, Emily E. Wiemers, Yue Sun, and Jennifer Karas Montez are with the Aging Studies Institute, Syracuse University, Syracuse, NY. Shannon M. Monnat and Xue Zhang are with the Lerner Center for Public Health Promotion and Population Health, Syracuse University. Elyse R. Grossman is with the Epidemiology Research Branch, US National Institute on Drug Abuse, Gaithersburg, MD
| | - Xue Zhang
- Douglas A. Wolf, Emily E. Wiemers, Yue Sun, and Jennifer Karas Montez are with the Aging Studies Institute, Syracuse University, Syracuse, NY. Shannon M. Monnat and Xue Zhang are with the Lerner Center for Public Health Promotion and Population Health, Syracuse University. Elyse R. Grossman is with the Epidemiology Research Branch, US National Institute on Drug Abuse, Gaithersburg, MD
| | - Elyse R Grossman
- Douglas A. Wolf, Emily E. Wiemers, Yue Sun, and Jennifer Karas Montez are with the Aging Studies Institute, Syracuse University, Syracuse, NY. Shannon M. Monnat and Xue Zhang are with the Lerner Center for Public Health Promotion and Population Health, Syracuse University. Elyse R. Grossman is with the Epidemiology Research Branch, US National Institute on Drug Abuse, Gaithersburg, MD
| | - Jennifer Karas Montez
- Douglas A. Wolf, Emily E. Wiemers, Yue Sun, and Jennifer Karas Montez are with the Aging Studies Institute, Syracuse University, Syracuse, NY. Shannon M. Monnat and Xue Zhang are with the Lerner Center for Public Health Promotion and Population Health, Syracuse University. Elyse R. Grossman is with the Epidemiology Research Branch, US National Institute on Drug Abuse, Gaithersburg, MD
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Chandra J, Charpignon ML, Bhaskar A, Therriault A, Chen YH, Mooney A, Dahleh MA, Kiang MV, Dominici F. Excess Fatal Overdoses in the United States During the COVID-19 Pandemic by Geography and Substance Type: March 2020-August 2021. Am J Public Health 2024; 114:599-609. [PMID: 38718338 PMCID: PMC11079842 DOI: 10.2105/ajph.2024.307618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 05/12/2024]
Abstract
Objectives. To assess heterogeneity in pandemic-period excess fatal overdoses in the United States, by location (state, county) and substance type. Methods. We used seasonal autoregressive integrated moving average (SARIMA) models to estimate counterfactual death counts in the scenario that no pandemic had occurred. Such estimates were subtracted from actual death counts to assess the magnitude of pandemic-period excess mortality between March 2020 and August 2021. Results. Nationwide, we estimated 25 668 (95% prediction interval [PI] = 2811, 48 524) excess overdose deaths. Specifically, 17 of 47 states and 197 of 592 counties analyzed had statistically significant excess overdose-related mortality. West Virginia, Louisiana, Tennessee, Kentucky, and New Mexico had the highest rates (20-37 per 100 000). Nationally, there were 5.7 (95% PI = 1.0, 10.4), 3.1 (95% PI = 2.1, 4.2), and 1.4 (95% PI = 0.5, 2.4) excess deaths per 100 000 involving synthetic opioids, psychostimulants, and alcohol, respectively. Conclusions. The steep increase in overdose-related mortality affected primarily the southern and western United States. We identified synthetic opioids and psychostimulants as the main contributors. Public Health Implications. Characterizing overdose-related excess mortality across locations and substance types is critical for optimal allocation of public health resources. (Am J Public Health. 2024;114(6):599-609. https://doi.org/10.2105/AJPH.2024.307618).
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Affiliation(s)
- Jay Chandra
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
| | - Marie-Laure Charpignon
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
| | - Anushka Bhaskar
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
| | - Andrew Therriault
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
| | - Yea-Hung Chen
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
| | - Alyssa Mooney
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
| | - Munther A Dahleh
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
| | - Mathew V Kiang
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
| | - Francesca Dominici
- Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston
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Wang K, Fenton BT, Skanderson M, Black AC, Becker WC, Seng EK, Anthony SE, Guirguis AB, Altalib HH, Kimber A, Lorenze N, Scholten JD, Graham GD, Sandbrink F, Sico JJ. Changes in opioid prescribing in veterans with headache during the COVID-19 pandemic: A regression discontinuity in time analysis. Headache 2023; 63:1295-1303. [PMID: 37596904 DOI: 10.1111/head.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To determine changes in opioid prescribing among veterans with headaches during the coronavirus disease of 2019 (COVID-19) pandemic by comparing the stay-at-home phase (March 15 to May 30, 2020) and the reopening phase (May 31 to December 31, 2020). BACKGROUND Opioid prescribing for chronic pain has declined substantially since 2016; however, changes in opioid prescribing during the COVID-19 pandemic among veterans with headaches remain unknown. METHODS This retrospective cohort study utilized regression discontinuity in time and difference-in-differences design to analyze veterans aged ≥18 years with a previous diagnosis of headache disorders and an outpatient visit to the Veterans Health Administration (VHA) during the study period. We measured the weekly number of opioid prescriptions, the number of days supplied, the daily dose in morphine milligram equivalents (MMEs), and the number of prescriptions with ≥50 morphine equivalent daily doses (MEDD). RESULTS A total of 81,376 veterans were analyzed with 589,950 opioid prescriptions. The mean (SD) age was 51.6 (13.5) years, 57,242 (70.3%) were male, and 53,464 (65.7%) were White. During the pre-pandemic period, 323.6 opioid prescriptions (interquartile range 292.1-325.8) were dispensed weekly, with an median (IQR) of 24.1 (24.0-24.4) days supplied and 31.8 (31.2-32.5) MMEs. Transition to stay-at-home was associated with a 7.7% decrease in the number of prescriptions (incidence rate ratio [IRR] 1.077, 95% confidence interval [CI] 0.866-0.984) and a 9.8% increase in days supplied (IRR 1.098, 95% CI 1.078-1.119). Similar trends were observed during the reopening period. Subgroup analysis among veterans on long-term opioid therapy also revealed 1.7% and 1.4% increases in days supplied during the stay-at-home (IRR 1.017, 95% CI 1.009-1.025) and reopening phase (IRR 1.014, 95% CI 1.007-1.021); however, changes in the total number of prescriptions, MME/day, or the number of prescriptions >50 MEDD were insignificant. CONCLUSION Prescription opioid access was maintained for veterans within VHA during the pandemic. The de-escalation of opioid prescribing observed prior to the pandemic was not seen in our study.
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Affiliation(s)
- Kaicheng Wang
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Brenda T Fenton
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Melissa Skanderson
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
| | - Anne C Black
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - William C Becker
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth K Seng
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sarah E Anthony
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Hamada H Altalib
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Addison Kimber
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nancy Lorenze
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joel D Scholten
- Physical Medicine and Rehabilitation Service, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Glenn D Graham
- Department of Neurology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Friedhelm Sandbrink
- Pain Management Specialty Services, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Jason J Sico
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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Moghtaderi A, Zocchi MS, Pines JM, Venkat A, Black B. Estimating the uncertain effect of the COVID pandemic on drug overdoses. PLoS One 2023; 18:e0281227. [PMID: 37561686 PMCID: PMC10414597 DOI: 10.1371/journal.pone.0281227] [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: 01/17/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE U.S. drug-related overdose deaths and Emergency Department (ED) visits rose in 2020 and again in 2021. Many academic studies and the news media attributed this rise primarily to increased drug use resulting from the societal disruptions related to the coronavirus (COVID-19) pandemic. A competing explanation is that higher overdose deaths and ED visits may have reflected a continuation of pre-pandemic trends in synthetic-opioid deaths, which began to rise in mid-2019. We assess the evidence on whether increases in overdose deaths and ED visits are likely to be related primarily to the COVID-19 pandemic, increased synthetic-opioid use, or some of both. METHODS We use national data from the Centers for Disease Control and Prevention (CDC) on rolling 12-month drug-related deaths (2015-2021); CDC data on monthly ED visits (2019-September 2020) for EDs in 42 states; and ED visit data for 181 EDs in 24 states staffed by a national ED physician staffing group (January 2016-June 2022). We study drug overdose deaths per 100,000 persons during the pandemic period, and ED visits for drug overdoses, in both cases compared to predicted levels based on pre-pandemic trends. RESULTS Mortality. National overdose mortality increased from 21/100,000 in 2019 to 26/100,000 in 2020 and 30/100,000 in 2021. The rise in mortality began in mid-to-late half of 2019, and the 2020 increase is well-predicted by models that extrapolate pre-pandemic trends for rolling 12-month mortality to the pandemic period. Placebo analyses (which assume the pandemic started earlier or later than March 2020) do not provide evidence for a change in trend in or soon after March 2020. State-level analyses of actual mortality, relative to mortality predicted based on pre-pandemic trends, show no consistent pattern. The state-level results support state heterogeneity in overdose mortality trends, and do not support the pandemic being a major driver of overdose mortality. ED visits. ED overdose visits rose during our sample period, reflecting a worsening opioid epidemic, but rose at similar rates during the pre-pandemic and pandemic periods. CONCLUSION The reasons for rising overdose mortality in 2020 and 2021 cannot be definitely determined. We lack a control group and thus cannot assess causation. However, the observed increases can be largely explained by a continuation of pre-pandemic trends toward rising synthetic-opioid deaths, principally fentanyl, that began in mid-to-late 2019. We do not find evidence supporting the pandemic as a major driver of rising mortality. Policymakers need to directly address the synthetic opioid epidemic, and not expect a respite as the pandemic recedes.
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Affiliation(s)
- Ali Moghtaderi
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Mark S. Zocchi
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
| | - Jesse M. Pines
- US Acute Care Solutions, Canton, Ohio, United States of America
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, United States of America
| | - Arvind Venkat
- US Acute Care Solutions, Canton, Ohio, United States of America
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, United States of America
| | - Bernard Black
- Pritzker School of Law, Northwestern University, Evanston, Illinois, United States of America
- Kellogg School of Management, Northwestern University, Evanston, Illinois, United States of America
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Leventelis C, Katsouli A, Stavropoulos V, Karasavvidou A, Papadopoulos P, Barmpas PT, Tasoulis S, Veskoukis AS, Tsironi M. The development and validation of the pandemic medication-assisted treatment questionnaire for the assessment of pandemic crises impact on medication management and administration for patients with opioid use disorders. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:76-94. [PMID: 36793483 PMCID: PMC9893127 DOI: 10.1177/14550725221135574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Pandemic and the globally applied restriction measures mainly affect vulnerable population groups, such as patients with opioid use disorders. Towards inhibiting SARS-Cov-2 spread, the medication-assisted treatment (MAT) programs follow strategies targeting the reduction of in-person psychosocial interventions and an increase of take-home doses. However, there is no available instrument to examine the impact of such modifications on diverse health aspects of patients under MAT. The aim of this study was to develop and validate the PANdemic Medication-Assisted Treatment Questionnaire (PANMAT/Q) to address the pandemic effect on the management and administration of MAT. In total, 463 patients under ΜΑΤ participated. Our findings indicate that PANMAT/Q has been successfully validated exerting reliability and validity. It can be completed within approximately 5 min, and its implementation in research settings is advocated. PANMAT/Q could serve as a useful tool to identify the needs of patients under MAT being at high risk of relapse and overdose.
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Affiliation(s)
- Christonikos Leventelis
- Christonikos Leventelis, Toxicology Scientist, Department of Nursing, University of Peloponnese, Tripoli, 22100, Greece.
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| | | | | | | | | | - Petros T. Barmpas
- Department of Computer science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Sotiris Tasoulis
- Department of Computer science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | | | - Maria Tsironi
- Nursing Department, University of Peloponnese, Panarcadian Hospital Erythrou, Tripoli, Greece
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Marom A, Levy I, Rosca P. Changes and trends in medication-assisted treatment in Israel. Isr J Health Policy Res 2023; 12:1. [PMID: 36698178 PMCID: PMC9876650 DOI: 10.1186/s13584-022-00551-8] [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: 01/18/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND As opioid prescription in Israel is increasing, there is a growing need for monitoring opioid use disorder and providing opioid agonist therapy. Our goal is to describe, sub-analyze, and identify obstacles in the treatment of opioid misuse in the Israeli medication assisted treatment centers. METHODS Data on methadone, buprenorphine, and buprenorphine combined with naloxone for the indication of opioid addiction treatment for the period 2013-2020 were obtained from pharmaceutical companies that distribute them in Israel. Data on utilization of these drugs were also extracted from the database maintained by the Israel Ministry of Health's Pharmaceutical Administration Division. The data were converted to defined daily doses (DDD)/1000 inhabitants/day. RESULTS The number of patients receiving medication assisted treatment increased by 10% since 2013, with a shift from buprenorphine alone to buprenorphine/naloxone in government-run centers. Methadone remains the most popular maintenance drug. CONCLUSIONS The change in opioid maintenance prescription does not match the significant increase in opioid consumption. Optimization of treatment can be achieved by the creation of a comprehensive database, cooperation between healthcare organizations and the government and further development of non-stigmatic and accessible services.
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Affiliation(s)
- Adi Marom
- grid.9619.70000 0004 1937 0538The Hebrew University- Hadassah Medical School, Campus Ein Kerem, 9112102 Jerusalem, Israel
| | - Iris Levy
- grid.414840.d0000 0004 1937 052XDepartment for the Treatment of Substance Abuse, Israeli Ministry of Health, 39 Yirmiyahu St., 9446724 Jerusalem, Israel
| | - Paola Rosca
- grid.9619.70000 0004 1937 0538The Hebrew University- Hadassah Medical School, Campus Ein Kerem, 9112102 Jerusalem, Israel ,grid.414840.d0000 0004 1937 052XDepartment for the Treatment of Substance Abuse, Israeli Ministry of Health, 39 Yirmiyahu St., 9446724 Jerusalem, Israel
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Pregnancy, Opioid Use Disorder and COVID-19: An Evaluation of Acute Care Presentations During a Pandemic. J Addict Med 2022:01271255-990000000-00120. [PMID: 36729932 DOI: 10.1097/adm.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The opioid epidemic has been exacerbated by the COVID-19 pandemic, resulting in increased acute care opioid-related and overdose visits. We sought to assess how the pandemic may have impacted an obstetric cohort impacted by opioid misuse in the acute care context. METHODS A retrospective review of acute care presentations of patients with concomitant pregnancy (Z33.1) and opioid-related diagnostic codes (T10 codes and/or F11) was conducted over a 24-month period (pre-COVID = March 2019 through February 2020, post-COVID = March 2020 through February 2021). Descriptive statistics and χ2 analysis of pre- versus post-COVID presentations were performed. RESULTS A total of 193 individuals, 104 (53.9%) pre- and 89 (46.1%) post-COVID, accounting for 292 total encounters, 160 (54.8%) pre- and 132 (45.2%) post-COVID, were seen for acute care visits (P = 0.84). Age (P = 0.15), race (P = 0.59), and insurance status (P = 0.17) were similar pre- versus post-COVID. The majority of presentations, pre- (40.4%) and post-COVID (44.9%), were for opioid withdrawal (P = 0.74). Although post-COVID individuals were more likely to lack prenatal care (48.3% versus 39.4% pre-COVID), this trend was not significant (P = 0.19). Similar proportions of individuals were affected by pregnancy complications (51.9% pre-, 44.9% post-COVID; P = 0.30). Similar proportions of individuals were affected by adverse pregnancy outcomes (44.2% pre-, 48.3% post-COVID; P = 0.64). CONCLUSION The COVID-19 pandemic did not have a statistically significant effect on opioid-related acute care presentations or outcomes for obstetric patients. In this acute care cohort, however, opioid misuse had significant general impact on pregnancy complications and outcomes, suggesting unmet needs in this population.
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Garcia GGP, Stringfellow EJ, DiGennaro C, Poellinger N, Wood J, Wakeman S, Jalali MS. Opioid overdose decedent characteristics during COVID-19. Ann Med 2022; 54:1081-1088. [PMID: 35467475 PMCID: PMC9045762 DOI: 10.1080/07853890.2022.2067350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/13/2022] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Alongside the emergence of COVID-19 in the United States, several reports highlighted increasing rates of opioid overdose from preliminary data. Yet, little is known about how state-level opioid overdose death trends and decedent characteristics have evolved using official death records. METHODS We requested vital statistics data from 2018-2020 from all 50 states and the District of Columbia, receiving data from 14 states. Accounting for COVID-19, we excluded states without data past March 2020, leaving 11 states for analysis. We defined state-specific analysis periods from March 13 until the latest reliable date in each state's data, then conducted retrospective year-over-year analyses comparing opioid-related overdose death rates, the presence of specific opioids and other psychoactive substances, and decedents' sex, race, and age from 2020 to 2019 and 2019 to 2018 within each state's analysis period. We assessed whether significant changes in 2020 vs. 2019 in opioid overdose deaths were new or continuing trends using joinpoint regression. RESULTS We found significant increases in opioid-related overdose death rates in Alaska (55.3%), Colorado (80.2%), Indiana (40.1%), Nevada (50.0%), North Carolina (30.5%), Rhode Island (29.6%), and Virginia (66.4%) - all continuing previous trends. Increases in synthetic opioid-involved overdose deaths were new in Alaska (136.5%), Indiana (27.6%), and Virginia (16.5%), whilst continuing in Colorado (44.4%), Connecticut (3.6%), Nevada (75.0%), and North Carolina (14.6%). We found new increases in male decedents in Indiana (12.0%), and continuing increases in Colorado (15.2%). We also found continuing increases in Black non-Hispanic decedents in Massachusetts (43.9%) and Virginia (33.7%). CONCLUSION This research analyzes vital statistics data from 11 states, highlighting new trends in opioid overdose deaths and decedent characteristics across 10 of these states. These findings can inform state-specific public health interventions and highlight the need for timely and comprehensive fatal opioid overdose data, especially amidst concurrent crises such as COVID-19. Key messages:Our results highlight shifts in opioid overdose trends during the COVID-19 pandemic that cannot otherwise be extracted from aggregated or provisional opioid overdose death data such as those published by the Centres for Disease Control and Prevention.Fentanyl and other synthetic opioids continue to drive increases in fatal overdoses, making it difficult to separate these trends from any possible COVID-19-related factors.Black non-Hispanic people are making up an increasing proportion of opioid overdose deaths in some states.State-specific limitations and variations in data-reporting for vital statistics make it challenging to acquire and analyse up-to-date data on opioid-related overdose deaths. More timely and comprehensive data are needed to generate broader insights on the nature of the intersecting opioid and COVID-19 crises.
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Affiliation(s)
| | | | | | - Nicole Poellinger
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaden Wood
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Wakeman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Rezaeiahari M, Fairman BJ. Impact of COVID-19 on the characteristics of opioid overdose deaths in Arkansas. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103836. [PMID: 36027767 PMCID: PMC9376304 DOI: 10.1016/j.drugpo.2022.103836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/18/2022] [Accepted: 08/10/2022] [Indexed: 11/20/2022]
Abstract
Background In the US, spikes in drug overdose deaths overlapping with the COVID-19 pandemic create concern that persons who use drugs are especially vulnerable. This study aimed to compare the trends in opioid overdose deaths and characterize opioid overdose deaths by drug subtype and person characteristics pre-COVID (2017-2019) and one-year post-COVID-19 emergence (2020). Methods We obtained death certificates on drug overdose deaths in Arkansas from January 1, 2017, through December 31, 2020. Our analyses consisted of an interrupted time-series and segmented regression analysis to assess the impact of COVID-19 on the number of opioid overdose deaths. Results The proportion of opioid overdose deaths increased by 36% post-COVID emergence (95% CI: 14%, 59%). The trend in overdose deaths involving synthetic narcotics other than methadone, such as fentanyl and tramadol, has increased since 2018 (74 in 2018 vs 79 in 2019; p =0.02 and 79 in 2019 versus 158 in 2020; p = 0.03). Opioid overdose deaths involving methamphetamine have more than doubled (36 in 2019 vs 82 in 2020; p = 0.06) despite remaining steady from 2018 to 2019. Synthetic narcotics have surpassed methamphetamine (71% vs. 37%) as the leading cause of opioid overdose deaths in Arkansas during the pandemic. This study found that synthetic narcotics are the significant drivers of the increase in opioid overdose deaths in Arkansas during the pandemic. Conclusions The co-occurrence of the COVID-19 pandemic and the drug abuse epidemic further highlights the increased need for expanding awareness and availability of resources for treating substance use disorders.
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Affiliation(s)
- Mandana Rezaeiahari
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Brian J Fairman
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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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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