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Gagnon M, Goodyear T, Riley S, Sedgemore KO, Leyland H. Addressing overdose risks and fatalities in public bathrooms: insights from the development of a Safer Bathroom Toolkit in British Columbia, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:934-942. [PMID: 37581749 PMCID: PMC10726679 DOI: 10.17269/s41997-023-00810-4] [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: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 08/16/2023]
Abstract
SETTING In British Columbia (BC), over 11,000 people have died of an overdose since 2016. Recently, an all-party standing committee on health tabled a report identifying several gaps in BC's overdose response. Chief among these is the inequitable distribution of supervised consumption and overdose prevention services across BC and barriers to accessing services that are currently available. In this context, public bathrooms continue to act as consumption spaces and contribute to overdose-related risks and fatalities. INTERVENTION The Safer Bathroom project sought to address long-standing policy and practice gaps by developing a toolkit to improve bathroom overdose prevention and response. Activities included a literature review and cross-sectoral, province-wide consultation (Fall 2021), the creation and launch of the Safer Bathroom Toolkit (Fall 2022), and knowledge transfer activities (ongoing). OUTCOMES The toolkit meets four objectives. First, it provides a bathroom safety checklist that helps identify and, most importantly, mitigate safety risks. Second, it offers organizational guidance on developing a bathroom safety policy and procedure. Third, it includes practical resources such as staff training material and signs that communicate bathroom safety messages in a non-stigmatizing manner. Finally, it identifies bathroom architecture and design features that can increase or decrease overdose-related risks. IMPLICATIONS The Safer Bathroom Toolkit is a highly comprehensive resource developed in response to the overdose crisis. However, significant reporting, research, policy, and practice gaps remain. This paper concludes with an overview of recommendations for advancing overdose prevention and response efforts within and beyond the bathroom context.
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Affiliation(s)
- Marilou Gagnon
- School of Nursing, University of Victoria, Victoria, BC, Canada.
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada.
| | - Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Shannon Riley
- Overdose Emergency Response, Vancouver Coastal Health Authority, Vancouver, BC, Canada
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Oreskovic J, Kaufman J, Thommandram A, Fossat Y. A Radar-Based Opioid Overdose Detection Device for Public Restrooms: Design, Development, and Evaluation Study. JMIR BIOMEDICAL ENGINEERING 2023; 8:e51754. [PMID: 38875668 PMCID: PMC11041516 DOI: 10.2196/51754] [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: 08/11/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The opioid epidemic is a growing crisis worldwide. While many interventions have been put in place to try to protect people from opioid overdoses, they typically rely on the person to take initiative in protecting themselves, requiring forethought, preparation, and action. Respiratory depression or arrest is the mechanism by which opioid overdoses become fatal, but it can be reversed with the timely administration of naloxone. OBJECTIVE In this study, we described the development and validation of an opioid overdose detection radar (ODR), specifically designed for use in public restroom stalls. In-laboratory testing was conducted to validate the noncontact, privacy-preserving device against a respiration belt and to determine the accuracy and reliability of the device. METHODS We used an ODR system with a high-frequency pulsed coherent radar sensor and a Raspberry Pi (Raspberry Pi Ltd), combining advanced technology with a compact and cost-effective setup to monitor respiration and detect opioid overdoses. To determine the optimal position for the ODR within the confined space of a restroom stall, iterative testing was conducted, considering the radar's bounded capture area and the limitations imposed by the stall's dimensions and layout. By adjusting the orientation of the ODR, we were able to identify the most effective placement where the device reliably tracked respiration in a number of expected positions. Experiments used a mock restroom stall setup that adhered to building code regulations, creating a controlled environment while maintaining the authenticity of a public restroom stall. By simulating different body positions commonly associated with opioid overdoses, the ODR's ability to accurately track respiration in various scenarios was assessed. To determine the accuracy of the ODR, testing was performed using a respiration belt as a reference. The radar measurements were compared with those obtained from the belt in experiments where participants were seated upright and slumped over. RESULTS The results demonstrated favorable agreement between the radar and belt measurements, with an overall mean error in respiration cycle duration of 0.0072 (SD 0.54) seconds for all recorded respiration cycles (N=204). During the simulated overdose experiments where participants were slumped over, the ODR successfully tracked respiration with a mean period difference of 0.0091 (SD 0.62) seconds compared with the reference data. CONCLUSIONS The findings suggest that the ODR has the potential to detect significant deviations in respiration patterns that may indicate an opioid overdose event. The success of the ODR in these experiments indicates the device should be further developed and implemented to enhance safety and emergency response measures in public restrooms. However, additional validation is required for unhealthy opioid-influenced respiratory patterns to guarantee the ODR's effectiveness in real-world overdose situations.
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Affiliation(s)
| | | | | | - Yan Fossat
- Klick Labs, Klick Inc, Toronto, ON, Canada
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3
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Stephenson A, Calvo-Friedman A, Altshuler L, Zabar S, Hanley K. Educational training to improve opioid overdose response among health center staff: a quality improvement initiative. Harm Reduct J 2023; 20:83. [PMID: 37391790 PMCID: PMC10311901 DOI: 10.1186/s12954-023-00803-z] [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: 08/28/2022] [Accepted: 06/06/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND There were seven opioid overdoses in this New York City (NYC) federally qualified health center from December 2018 through February 2019, reflecting the rising rate of overdose deaths in NYC overall at the time. In response to these overdoses, we sought to increase the readiness of health center staff to recognize and respond to opioid overdoses and decrease stigmatizing attitudes around opioid use disorder (OUD). METHODS An hour-long training focusing on opioid overdose response was administered to clinical and non-clinical staff of all levels at the health center. This training included didactic education on topics such as the overdose epidemic, stigma around OUD, and opioid overdose response, as well as discussion. A structured assessment was administered immediately before and following the training to evaluate change in knowledge and attitudes. Additionally, participants completed a feedback survey immediately after the training to assess acceptability. Paired t-tests and analysis of variance tests were used to assess changes in pre- and post-test scores. RESULTS Over 76% of the health center staff participated in the training (N = 310). There were large and significant increases in mean knowledge and attitudinal scores from pre- to post-test (p < .001 and p < .001, respectively). While there was no significant effect of profession on attitudinal change scores, profession did have a significant effect on knowledge change scores, with administrative staff, non-clinical support staff, other healthcare staff, and therapists learning significantly more than providers (p < .001). The training had high acceptability among participants from diverse departments and levels. CONCLUSIONS An interactive educational training increased staff's knowledge and readiness to respond to an overdose as well as improved attitudes toward individuals living with OUD. TRIAL REGISTRATION This project was undertaken as a quality improvement initiative at the health center and as such was not formally supervised by the Institutional Review Board per their policies. Further, per the guidelines of the International Committee of Medical Journal Editors, registration is not necessary for clinical trials whose sole purpose is to assess an intervention's effect on providers.
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Affiliation(s)
- Audrey Stephenson
- NYC Health + Hospitals/Gotham Health, Gouverneur, 227 Madison St., New York, NY, 10002, USA
- West Chester University of Pennsylvania, West Chester, PA, USA
| | - Alessandra Calvo-Friedman
- NYC Health + Hospitals/Gotham Health, Gouverneur, 227 Madison St., New York, NY, 10002, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Lisa Altshuler
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Sondra Zabar
- NYC Health + Hospitals/Gotham Health, Gouverneur, 227 Madison St., New York, NY, 10002, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Kathleen Hanley
- NYC Health + Hospitals/Gotham Health, Gouverneur, 227 Madison St., New York, NY, 10002, USA.
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
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4
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Smoyer AB, Pittman A, Borzillo P. Humans peeing: Justice-involved women's access to toilets in public spaces. PLoS One 2023; 18:e0282917. [PMID: 36897925 PMCID: PMC10004595 DOI: 10.1371/journal.pone.0282917] [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: 10/27/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Justice-involved women face myriad challenges as they negotiate the terms of community supervision and manage the long-term implications and stigma of living with a criminal record. Major tasks that women juggle include securing safe, affordable housing, finding and retaining employment, accessing physical and mental health care (including substance use treatment), and handling relationships with family, friends, children, and intimate partners. In addition to these responsibilities, women must meet their basic physiological needs to eat, sleep, and use the toilet. Women's ability to safely meet their personal care needs may impact their capacity to manage their criminal-legal challenges. This study uses qualitative methods to understand justice-involved women's lived experiences related to urination. Specifically, the study reports on a thematic analysis of 8 focus groups conducted with justice-involved women (n = 58) and the results of a toilet audit conducted in the downtown areas of the small city in the United States where the focus group participants were living. Findings suggest that women had limited access to restrooms and reported urinating outside. Lack of restroom access impacted their engagement with social services support and employment and their ability to travel through public spaces. Women perceived their public toilet options as unsafe, increasing their sense of vulnerability and reinforcing the idea that they did not have full access to citizenship in the community because of their criminal-legal involvement. The exclusion and denial of women's humanity that is perpetuated by a lack of public toilet access impacts women's psychosocial outcomes. City governments, social service agencies, and employers are encouraged to consider how lack of toilet access may impact their public safety and criminal-legal objectives and expand opportunities for people to access safe restroom facilities.
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Affiliation(s)
- Amy B. Smoyer
- Department of Social Work, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Adam Pittman
- Department of Sociology, College of Arts and Sciences, Southern Connecticut State University, New Haven, Connecticut, United States of America
| | - Peter Borzillo
- Department of Curriculum and Learning, College of Education, Southern Connecticut State University, New Haven, Connecticut, United States of America
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5
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Febres-Cordero S, Smith DJ, Wulkan AZ, Béliveau AJ, Gish A, Zine S, Fugitt L, Giordano NA. It's what the community demands: Results of community-based emergency opioid overdose trainings. Public Health Nurs 2023; 40:44-53. [PMID: 36377302 DOI: 10.1111/phn.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/23/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In response to a surge of drug overdoses involving polysubstance use among Atlanta service industry workers that resulted in the deaths of five people in the Atlanta area in the summer of 2021, a local community of harm reductionists and nurses organized opioid education and naloxone distribution (OEND) training sessions specifically customized for service industry workers in Atlanta. After the sessions, the nurses and harm reductionists asked attendants to participate in a study concerning their response to overdoses. The reason nurses and harm reductionists conducted the study was to determine the efficacy of OEND training adapted for those working in the service industries as well as to evaluate and possibly modify the training sessions for future use. This pre-post study examined if and how participants' knowledge and attitudes toward an opioid-involved overdose changed after engaging with the OEND training. If the study determined that the sessions were successful in teaching service industry workers how to mitigate the immediate and devastating effects of overdose, we recommend expanding and implementing both adaptable training sessions like the OEND training referenced, as well as accompanying studies to improve the training sessions' effectiveness. DESIGN The pre-post study used convenience sampling to recruit participants in emergent OEND training. Participants completed an abbreviated version the Opioid Overdose Attitudes Scale (OOAS) which measured how, and to what degree, they changed their attitudes towards overdoses and their responses to them. Participants also completed an abbreviated version of the Opioid Overdose Knowledge Scale (OOKS) which measured how effectively the OEND increased their knowledge when it came to properly responding to an overdose, which included implementing naloxone as part of immediate rehabilitation treatment. Paired nonparametric tests assessed changes in participants' OOAS/OOKS scores. RESULTS A total of 161 individuals attended, and 72 consented to be in the study. The sample predominately consisted of white (76.4%) and female (66.7%) adults whose age averaged 34.3 years. Attitude and knowledge score improvements were statistically significant: approximately 11 points (p < .001) and 3 points (p < .001), respectively. CONCLUSIONS This rapidly implemented training was associated with improving attitudes and knowledge about responding to an opioid-involved overdose. We recommend expanding the scope of studies like these in order to develop and examine effective, dynamic, and targeted OEND training tailored towards specific community groups and situations, such as polysubstance overdose among service industry workers. As the opioid epidemic worsens, it is critical to equip community members themselves with the skills and tools to recognize and respond to opioid overdoses as a frontline prevention to overdose deaths.
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Affiliation(s)
| | - Daniel J Smith
- M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | | | | | - Andy Gish
- Atlanta Harm Reduction Coalition, Atlanta, Georgia.,Georgia Overdose Prevention, Atlanta, Georgia
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6
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Febres-Cordero S, Smith DJ. Stayin' Alive in Little 5: Application of Sentiment Analysis to Investigate Emotions of Service Industry Workers Responding to Drug Overdoses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13103. [PMID: 36293685 PMCID: PMC9603661 DOI: 10.3390/ijerph192013103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The opioid epidemic has increasingly been recognized as a public health issue and has challenged our current legal, social, and ethical beliefs regarding drug use. The epidemic not only impacts persons who use drugs, but also those around them, including people who do not expect to witness an overdose. For example, in the commercial district of Little 5 Points, Atlanta, GA, many service industry workers have become de facto responders to opioid overdoses when a person experiences an opioid-involved overdose in their place of employment. To provide additional insights into >300 pages of interview data collected from service industry workers that have responded to an opioid overdose while at work, we utilized a mixed-methods approach to conduct this sentiment analysis. First, using R version 4.2.1, a data-science based textual analytic approach was applied to the interview data. Using a corpus algorithm, each line of interview text was characterized as one of the eight following sentiments, anger, anticipation, disgust, fear, joy, sadness, surprise, or trust. Once having identified statements that fit into each of these eight codes, qualitative thematic analysis was conducted. The three most prevalent emotions elucidated from these interviews with service industry workers were trust, anticipation, and joy with 20.4%, 16.2%, and 14.7% across all statements, respectively labeled as each emotion. Thematic analysis revealed three themes in the data: (1) individuals have a part to address in the opioid epidemic, (2) communities have many needs related to the opioid crisis, and (3) structural forces create pathways and barriers to opioid overdose response and rescue. This analysis thematically identified roles service industry workers have in addressing the opioid crisis in Atlanta. Similarly, community needs and barriers to responding to an opioid-involved overdose were characterized. Uniquely, this study found key sentiments related to each of these themes. Future research can leverage these findings to inform the development of overdose prevention and response interventions for service industry works that systematically address common emotions and beliefs trainees may have.
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Affiliation(s)
- Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30332, USA
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7
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Feuerstein-Simon R, Lowenstein M, Dupuis R, Dolan A, Marti XL, Harvey A, Ali H, Meisel ZF, Grande DT, Lenstra N, Cannuscio CC. Substance Use and Overdose in Public Libraries: Results from a Five-State Survey in the US. J Community Health 2022; 47:344-350. [PMID: 35020100 PMCID: PMC8753323 DOI: 10.1007/s10900-021-01048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
In the U.S., overdoses have become a health crisis in both public and private places. We describe the impact of the overdose crisis in public libraries across five U.S. states, and the front-line response of public library workers. We conducted a cross-sectional survey, inviting one worker to respond at each public library in five randomly selected states (CO, CT, FL, MI, and VA), querying participants regarding substance use and overdose in their communities and institutions, and their preparedness to respond. We describe substance use and overdose patterns, as well as correlates of naloxone uptake, in public libraries. Participating library staff (N = 356) reported witnessing alcohol use (45%) and injection drug use (14%) in their libraries in the previous month. Across states surveyed, 12% of respondents reported at least one on-site overdose in the prior year, ranging from a low of 10% in MI to a high of 17% in FL. There was wide variation across states in naloxone uptake at libraries, ranging from 0% of represented libraries in FL to 33% in CO. Prior on-site overdose was associated with higher odds of naloxone uptake by the library (OR 2.5, 95% CI 1.1-5.7). Although 24% of respondents had attended a training regarding substance use in the prior year, over 90% of respondents wanted to receive additional training on the topic. Public health professionals should partner with public libraries to expand and strengthen substance use outreach and overdose prevention efforts.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA.
| | - Margaret Lowenstein
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Abby Dolan
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Alexandra Harvey
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA
| | - Heba Ali
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA
| | - Zachary F Meisel
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - David T Grande
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Noah Lenstra
- Department of Library and Information Science School of Education, The University of North Carolina at Greensboro (UNCG), Greensboro, USA
| | - Carolyn C Cannuscio
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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8
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Basham C, Cerles A, Rush M, Alexander-Scott M, Greenawald L, Chiu S, Broadwater K, Hirst D, Snawder J, Roberts J, Weber A, Knuth M, Casagrande R. Occupational Safety and Health and Illicit Opioids: State of the Research on Protecting Against the Threat of Occupational Exposure. New Solut 2021; 31:315-329. [PMID: 34407666 DOI: 10.1177/10482911211039566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The nationwide opioid crisis continues to affect not only people who use opioids but also communities at large by increasing the risk of accidental occupational exposure to illicit opioids. In addition, the emergence of highly potent synthetic opioids such as fentanyl and carfentanil increases the need to protect workers who may encounter unknown drug substances during job activities. To support the National Institute for Occupational Safety and Health Opioids Research Gaps Working Group, we examined the state of the literature concerning methods to protect workers against accidental occupational exposure to illicit opioids, and have identified unmet research needs concerning personal protective equipment, decontamination methods, and engineering controls. Additional studies are needed to overcome gaps in technical knowledge about personal protective equipment, decontamination, and control methods, and gaps in understanding how these measures are utilized by workers. Increasing our knowledge of how to protect against exposure to illicit opioids has the potential to improve occupational health across communities.
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Affiliation(s)
| | | | | | - Marissa Alexander-Scott
- Health Effects Laboratory, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Lee Greenawald
- National Institute for Occupational Safety and Health, Pittsburg, PA, USA
| | - Sophia Chiu
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Kendra Broadwater
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Deborah Hirst
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - John Snawder
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Jennifer Roberts
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Angela Weber
- National Institute for Occupational Safety and Health, Atlanta, GA, USA
| | - Martha Knuth
- Stephen B Thacker Library, Centers for Disease Control and Prevention, Atlanta, GA, USA
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9
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van Draanen J, Satti S, Morgan J, Gaudette L, Knight R, Ti L. Using passive surveillance technology for overdose prevention: Key ethical and implementation issues. Drug Alcohol Rev 2021; 41:406-409. [PMID: 34355446 DOI: 10.1111/dar.13373] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/21/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Abstract
Passive surveillance technology has the potential to increase safety through monitoring spaces where people are at risk of overdose. One key opportunity for the use of passive surveillance technology to prevent overdose fatality is in bathrooms where people may be using drugs. However, uncertainty remains with regards to how to attain informed consent, implications for data storage and privacy and potential negative socio-legal ramifications for people who use drugs. In addition, there are issues regarding responsibility and liability for the devices. Transparency with regards to data privacy and security may also be needed before bathroom users will feel comfortable with such solutions. In this article, we discuss these issues and offer recommendations to provide a foundation for future research and policy development.
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Affiliation(s)
- Jenna van Draanen
- British Columbia Centre on Substance Use, Vancouver, Canada.,Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | | | - Jeffrey Morgan
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Laural Gaudette
- Overdose Prevention Society, Overdose Prevention Participatory Research Assistant Program, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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10
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Bennett AS, Elliott L. Naloxone's role in the national opioid crisis-past struggles, current efforts, and future opportunities. Transl Res 2021; 234:43-57. [PMID: 33684591 PMCID: PMC8327685 DOI: 10.1016/j.trsl.2021.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023]
Abstract
Over the past 25 years, naloxone has emerged as a critical lifesaving overdose antidote. Public health advocates and community activists established early methods for naloxone distribution to people who inject drugs, but a legacy of stigmatization and opposition to universal naloxone access continues to limit the drug's full potential to reduce opioid-related mortality. The establishment of naloxone distribution programs under the umbrella of syringe exchange programs faces the same practical, ideological and financial barriers to expansion similar to those faced by syringe exchange programs themselves. The expansion of naloxone from the confines of a few syringe exchange programs to what we see today represents an enormous triumph for the grass-roots activists, service providers, and public health professionals who have fought to guarantee lay access to naloxone. Despite the extensive efforts to expand access to naloxone, naloxone continues to remains a scarce resource in many US localities. Considerable naloxone "deserts" remain and even where there is naloxone access, it does not always reach those at risk. Promising areas for expansion include the development of more robust telehealth methods for naloxone distribution, including subsidized mail delivery programs; lowering barriers to pharmacy access; working with hospitals, ambulances, and law enforcement to expand naloxone "leave behind" programs; providing naloxone co-prescription with medications for opioid use disorder; and working with prisons, shelters, and networks of people who use drugs to increase access to the lifesaving medication. Efforts to ensure over-the-counter and low- or no-cost naloxone are ongoing and stand alongside medication-assisted treatments as efficacious, readily-actionable, and cost-efficient population-level interventions available for combatting opioid-related overdose in the United States.
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Affiliation(s)
- Alex S Bennett
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York; Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York.
| | - Luther Elliott
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York; Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York
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11
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Buchheit BM, Crable EL, Lipson SK, Drainoni ML, Walley AY. "Opening the door to somebody who has a chance." - The experiences and perceptions of public safety personnel towards a public restroom overdose prevention alarm system. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103038. [PMID: 33232885 DOI: 10.1016/j.drugpo.2020.103038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 09/23/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioid overdose deaths have surged due to fentanyl in the illicit opioid supply, which causes overdose more rapidly than other opioids. Public restrooms are venues where fentanyl overdoses commonly occur. In response, some organizations have implemented anti-motion alarm systems as a prevention approach. We aimed to describe the experiences and perceptions of public safety personnel after the installation of an anti-motion alarm system in public restrooms at an urban medical center. METHODS From February to June 2019, we conducted semi-structured qualitative interviews to explore the experiences and perceptions of hospital public safety personnel who responded to overdoses in public restrooms with and without an anti-motion alarm system. We interviewed 11 personnel, with interviews lasting an average of twenty-six minutes. We conducted inductive thematic analysis to synthesize and identify salient themes. RESULTS Ten participants were male; the average age was 40 with an average time employed by the hospital of 12 years. Four themes were identified: Public safety personnel 1) believe responding to overdoses is an appropriate responsibility; 2) focus on their training rather than individual emotions when responding to an overdose; 3) view the anti-motion alarm system as an acceptable tool for preventing overdoses, despite technological challenges; and 4) report concern for potential unintended consequences of the anti-motion alarm system. CONCLUSIONS Overdose response in public restrooms has been incorporated into the daily duties of public safety personnel at an academic medical center. Anti-motion alarm systems are an innovation with potential to improve overdose response and safety, though the technology warrants ongoing development and unintended consequences should be assessed. To optimize restroom safety in the midst of fentanyl use, more research is needed among first responders, people who use drugs in restrooms, and other restroom patrons.
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Affiliation(s)
- Bradley M Buchheit
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code: L475, Portland, OR, 97239, USA; Department of Family Medicine, Oregon Health & Science University, 3303 S Bond Avenue, Mail Code: CH9F, Portland, OR, 97239, USA.
| | - Erika L Crable
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, T2W, Boston, MA, 02118, USA; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Sarah K Lipson
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, T2W, Boston, MA, 02118, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, T2W, Boston, MA, 02118, USA; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
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12
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Brooks HL, Husband C, Taylor M, Sherren A, Hyshka E. Supporting the full participation of people who use drugs in policy fora: Provision of a temporary, conference-based overdose prevention site. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102878. [PMID: 32739614 DOI: 10.1016/j.drugpo.2020.102878] [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: 03/16/2020] [Revised: 07/03/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022]
Abstract
The overdose epidemic in North America remains acute and interventions are needed to mitigate harm and prevent death. People who use/d drugs (PWUD) hold essential knowledge to guide the development of these interventions and conferences are vital fora for hearing their perspectives and building support for new policies and programs. However, little guidance exists on how to best ensure the safety of PWUD during conferences. In October 2018, a low-threshold overdose prevention site (OPS) was implemented at a national drug policy and harm reduction conference in Edmonton, Canada. The OPS provided delegates with a monitored space to consume drugs and access drug consumption supplies. This commentary describes the implementation of the OPS with the aim of providing practical guidance for organizers of future substance use-related conferences, meetings, and other events.
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Affiliation(s)
- Hannah L Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta, Canada, T6G 1C9
| | - Cassandra Husband
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta, Canada, T6G 1C9
| | - Marliss Taylor
- Program Manager, Streetworks, Boyle Street Community Services, 10116-105 Ave, Edmonton, Alberta, Canada, T5H 0K2
| | - Arthur Sherren
- Harm Reduction Support Worker, Supervised Consumption Services, Boyle Street Community Services, 10116-105 Ave, Edmonton, Alberta, Canada, T5H 0K2
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta, Canada, T6G 1C9.
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13
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Li ZR, Xie E, Crawford FW, Warren JL, McConnell K, Copple JT, Johnson T, Gonsalves GS. Suspected heroin-related overdoses incidents in Cincinnati, Ohio: A spatiotemporal analysis. PLoS Med 2019; 16:e1002956. [PMID: 31714940 PMCID: PMC6850525 DOI: 10.1371/journal.pmed.1002956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/30/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Opioid misuse and deaths are increasing in the United States. In 2017, Ohio had the second highest overdose rates in the US, with the city of Cincinnati experiencing a 50% rise in opioid overdoses since 2015. Understanding the temporal and geographic variation in overdose emergencies may help guide public policy responses to the opioid epidemic. METHODS AND FINDINGS We used a publicly available data set of suspected heroin-related emergency calls (n = 6,246) to map overdose incidents to 280 census block groups in Cincinnati between August 1, 2015, and January 30, 2019. We used a Bayesian space-time Poisson regression model to examine the relationship between demographic and environmental characteristics and the number of calls within block groups. Higher numbers of heroin-related incidents were found to be associated with features of the built environment, including the proportion of parks (relative risk [RR] = 2.233; 95% credible interval [CI]: [1.075-4.643]), commercial (RR = 13.200; 95% CI: [4.584-38.169]), manufacturing (RR = 4.775; 95% CI: [1.958-11.683]), and downtown development zones (RR = 11.362; 95% CI: [3.796-34.015]). The number of suspected heroin-related emergency calls was also positively associated with the proportion of male population, the population aged 35-49 years, and distance to pharmacies and was negatively associated with the proportion aged 18-24 years, the proportion of the population with a bachelor's degree or higher, median household income, the number of fast food restaurants, distance to hospitals, and distance to opioid treatment programs. Significant spatial and temporal heterogeneity in the risks of incidents remained after adjusting for covariates. Limitations of this study include lack of information about the nature of incidents after dispatch, which may differ from the initial classification of being related to heroin, and lack of information on local policy changes and interventions. CONCLUSIONS We identified areas with high numbers of reported heroin-related incidents and features of the built environment and demographic characteristics that are associated with these events in the city of Cincinnati. Publicly available information about opiate overdoses, combined with data on spatiotemporal risk factors, may help municipalities plan, implement, and target harm-reduction measures. In the US, more work is necessary to improve data availability in other cities and states and the compatibility of data from different sources in order to adequately measure and monitor the risk of overdose and inform health policies.
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Affiliation(s)
- Zehang Richard Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Evaline Xie
- Yale College, New Haven, Connecticut, United States of America
| | - Forrest W. Crawford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, United States of America
- Department of Statistics & Data Science, Yale University, New Haven, Connecticut, United States of America
- Yale School of Management, New Haven, Connecticut, United States of America
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Kathryn McConnell
- Yale School of Forestry & Environmental Studies, New Haven, Connecticut, United States of America
| | - J. Tyler Copple
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Tyler Johnson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Gregg S. Gonsalves
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Yale Law School, New Haven, Connecticut, United States of America
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14
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Fozouni L, Buchheit B, Walley AY, Testa M, Chatterjee A. Public restrooms and the opioid epidemic. Subst Abus 2019; 41:432-436. [DOI: 10.1080/08897077.2019.1640834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Laila Fozouni
- Department of Quantitative Methods, Harvard T. Chan School of Public Health, Boston, Massachusetts, USA
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Bradley Buchheit
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alexander Y. Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA; University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
| | - Marcia Testa
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Avik Chatterjee
- Boston Health Care for the Homeless Program, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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15
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Wolfson-Stofko B, Elliott L, Bennett AS, Curtis R, Gwadz M. Perspectives on supervised injection facilities among service industry employees in New York City: A qualitative exploration. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:67-73. [PMID: 30359875 PMCID: PMC6279482 DOI: 10.1016/j.drugpo.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/08/2018] [Accepted: 08/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Approximately 100 supervised injection facilities (SIFs) operate in 66 cities around the world to reduce overdose deaths, the spread of disease and public disorder, though none legally exist in the United States. Public bathrooms are among the most common public places for injection reported by people who inject drugs in New York City (NYC) and service industry employees (SIEs) inadvertently become first-responders when overdoses occur in business bathrooms. The goal of this study was to assess SIE acceptability of SIFs and the perceived effects that SIFs would have on them, their colleagues, their businesses and communities. METHODS Semi-structured qualitative interviews were conducted with 15 SIEs recruited through convenience sampling throughout NYC. Participants were provided with peer-reviewed scientific evidence prior to discussing SIFs. Data were analysed using a hybrid deductive and inductive approach. RESULTS Most SIEs had encountered drug use (93%, n = 14/15) and syringes (73%, n = 11/15) in their business bathrooms and three had encountered unresponsive individuals. Nearly all workers (93%, n = 14/15) were supportive of SIFs and believed SIFs would reduce injection drug use in their business bathrooms. Participants also believed that 'not in my backyard' arguments from community boards may impede SIF operation. CONCLUSIONS Service industry employees are critical stakeholders due to their exposure to occupational health hazards related to public injection. Those interviewed were amenable to SIF operation as a form of occupational harm reduction and their experiences provide an important dimension to the political debate surrounding SIFs.
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Affiliation(s)
- Brett Wolfson-Stofko
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States; National Development & Research Institute, Center on Community and Health Disparities Research, 71 W. 23rd St, 4th Fl, New York, NY, 10010, United States.
| | - Luther Elliott
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States; National Development & Research Institute, Center on Community and Health Disparities Research, 71 W. 23rd St, 4th Fl, New York, NY, 10010, United States
| | - Alex S Bennett
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States; National Development & Research Institute, Center on Community and Health Disparities Research, 71 W. 23rd St, 4th Fl, New York, NY, 10010, United States
| | - Ric Curtis
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States; John Jay College of Criminal Justice, City University of New York, Department of Law, Police Science and Criminal Justice Administration, Department of Anthropology, 524 W. 59th St, New York, NY, 10019, United States
| | - Marya Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States
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16
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Wolfson-Stofko B, Gwadz MV, Elliott L, Bennett AS, Curtis R. "Feeling confident and equipped": Evaluating the acceptability and efficacy of an overdose response and naloxone administration intervention to service industry employees in New York City. Drug Alcohol Depend 2018; 192:362-370. [PMID: 30287108 PMCID: PMC6237076 DOI: 10.1016/j.drugalcdep.2018.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/20/2018] [Accepted: 08/12/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The problem of injection drug use in public bathrooms has been documented from the perspectives of people who inject drugs and service industry employees (SIEs). Previous studies suggest that SIEs are unaware of how to respond to opioid overdoses, yet there are no behavioral interventions designed for SIEs to address their specific needs. In response to this gap in the field, we constructed, implemented, and evaluated a three-module behavioral intervention for SIEs grounded in the Information-Motivation-Behavioral skills model. This paper focuses on the evaluation of one module, namely, the intervention component addressing overdose response and naloxone administration (ORNA). METHODS Participants were SIEs (N = 18 from two separate business establishments) recruited using convenience sampling. The study utilized a pre-/post-test concurrent nested mixed method design and collected quantitative and qualitative data including an evaluation of the intervention module. The primary outcomes were opioid overdose-related knowledge and attitudes. Acceptability was also assessed. RESULTS SIEs demonstrated significant improvements (p < 0.01, Cohen's d = 1.45) in opioid overdose-related knowledge as well as more positive opioid overdose-related attitudes (p< 0.01, Cohen's d = 2.45) following the intervention. Participants also reported high levels of acceptability of the module and suggestions for improvement (i.e., more role-playing). CONCLUSIONS This study highlights the acceptability and evidence of efficacy of the ORNA module, as well as the utility of training SIEs in ORNA. The expansion of this training to other SIEs and public employees (librarians, etc.) who manage public bathrooms warrants further investigation.
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Affiliation(s)
- Brett Wolfson-Stofko
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, United States; National Development and Research Institutes, Inc., Center for Community and Health Disparities Research, 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States.
| | - Marya V Gwadz
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, United States
| | - Luther Elliott
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, United States; National Development and Research Institutes, Inc., Center for Community and Health Disparities Research, 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States
| | - Alex S Bennett
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, United States; National Development and Research Institutes, Inc., Center for Community and Health Disparities Research, 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States
| | - Ric Curtis
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, United States; John Jay College of Criminal Justice, City University of New York, Department of Law and Police Science and Criminal Justice Administration, and Department of Anthropology, 524 W. 59th Street, New York, NY 10019, United States
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17
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Pergolizzi JV, Taylor R, LeQuang JA, Raffa RB. What’s holding back abuse-deterrent opioid formulations? Considering 12 U.S. stakeholders. Expert Opin Drug Deliv 2018; 15:567-576. [DOI: 10.1080/17425247.2018.1473374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | | | | | - Robert B. Raffa
- College of Pharmacy, University of Arizona College of Pharmacy, Tucson, Ariz, USA
- School of Pharmacy, Temple University School of Pharmacy, Philadelphia, PA, USA
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18
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Fairbairn N, Coffin PO, Walley AY. Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:172-179. [PMID: 28687187 PMCID: PMC5783633 DOI: 10.1016/j.drugpo.2017.06.005] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/28/2017] [Accepted: 06/12/2017] [Indexed: 01/12/2023]
Abstract
Community-based overdose prevention programs first emerged in the 1990's and are now the leading public health intervention for overdose. Key elements of these programs are overdose education and naloxone distribution to people who use opioids and their social networks. We review the evolution of naloxone programming through the heroin overdose era of the 1990's, the prescription opioid era of the 2000's, and the current overdose crisis stemming from the synthetic opioid era of illicitly manufactured fentanyl and its analogues in the 2010's. We present current challenges arising in this new era of synthetic opioids, including variable potency of illicit drugs due to erratic adulteration of the drug supply with synthetic opioids, potentially changing efficacy of standard naloxone formulations for overdose rescue, potentially shorter overdose response time, and reports of fentanyl exposure among people who use drugs but are opioid naïve. Future directions for adapting naloxone programming to the dynamic opioid epidemic are proposed, including scale-up to new venues and social networks, new standards for post-overdose care, expansion of supervised drug consumption services, and integration of novel technologies to detect overdose and deliver naloxone.
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Affiliation(s)
- Nadia Fairbairn
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada.
| | - Phillip O Coffin
- San Francisco Department of Public Health, United States; University of California, San Francisco, United States
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Boston University School of Medicine, Boston Medical Center, United States
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The Portapotty Experiment: Neoliberal approaches to the intertwined epidemics of opioid-related overdose and HIV/HCV, and why we need cultural anthropologists in the South Bronx. DIALECTICAL ANTHROPOLOGY 2016; 40:395-410. [PMID: 27917016 DOI: 10.1007/s10624-016-9443-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The following report from the field focuses on the authors' collective efforts to operate an ad hoc safer injection facility (SIF) out of portapotties (portable toilets) in an area of the South Bronx that has consistently experienced some of the highest overdose morbidity and mortality rates in New York City over the past decade (New York City Department of Health and Mental Hygiene, 2011, 2015, 2016). Safer injection facilities (also known as supervised injection facilities, drug consumption rooms, etc.) operating outside the US provide a legal, hygienic, and supervised environment for individuals to use drugs in order to minimize the likelihood of fatal overdose and the spread of blood-borne infections while reducing public injection. In the US, the operation of SIFs is federally prohibited by the federal "Crack House" statute though federal, state, and local elected officials can sanction their operation to various degrees (Beletsky, Davis, Anderson, & Burris, 2008). The activists, researchers, undergraduate students and peers from syringe exchange programs who came together to operate the portapotties discovered that they were, in many ways, emblematic of neoliberal solutions to disease prevention: primarily focused on auditing individual risk behaviors and virtually blind to the wider social context that shapes those lives. That social context - the culture of drug injection - was and is out in the open for all of us to see. Going forward, the cultural anthropologist's toolbox will be opened up and used by large groups of undergraduate students to better understand the culture of drug use and how it is changing.
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