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Byrne CJ, Sani F, Thain D, Fletcher EH, Malaguti A. Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis. Harm Reduct J 2024; 21:81. [PMID: 38622647 PMCID: PMC11017611 DOI: 10.1186/s12954-024-00999-8] [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: 09/18/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND AND AIMS Psychological and social status, and environmental context, may mediate the likelihood of experiencing overdose subsequent to illicit drug use. The aim of this systematic review was to identify and synthesise psychosocial factors associated with overdose among people who use drugs. METHODS This review was registered on Prospero (CRD42021242495). Systematic record searches were undertaken in databases of peer-reviewed literature (Medline, Embase, PsycINFO, and Cinahl) and grey literature sources (Google Scholar) for work published up to and including 14 February 2023. Reference lists of selected full-text papers were searched for additional records. Studies were eligible if they included people who use drugs with a focus on relationships between psychosocial factors and overdose subsequent to illicit drug use. Results were tabulated and narratively synthesised. RESULTS Twenty-six studies were included in the review, with 150,625 participants: of those 3,383-4072 (3%) experienced overdose. Twenty-one (81%) studies were conducted in North America and 23 (89%) reported polydrug use. Psychosocial factors associated with risk of overdose (n = 103) were identified and thematically organised into ten groups. These were: income; housing instability; incarceration; traumatic experiences; overdose risk perception and past experience; healthcare experiences; perception of own drug use and injecting skills; injecting setting; conditions with physical environment; and social network traits. CONCLUSIONS Global rates of overdose continue to increase, and many guidelines recommend psychosocial interventions for dependent drug use. The factors identified here provide useful targets for practitioners to focus on at the individual level, but many identified will require wider policy changes to affect positive change. Future research should seek to develop and trial interventions targeting factors identified, whilst advocacy for key policy reforms to reduce harm must continue.
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Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK.
| | - Fabio Sani
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
| | - Donna Thain
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Emma H Fletcher
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Amy Malaguti
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
- Tayside Drug and Alcohol Recovery Psychology Service, NHS Tayside, Dundee, UK
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Nall SK, Jurecka C, Ammons A, Rodriguez A, Craft B, Waleed C, Dias D, Henderson J, Boyer J, Yamkovoy K, Swathi PA, Patil P, Behne F, LeMasters K, Brinkley-Rubinstein L, Barocas JA. Identifying structural risk factors for overdose following incarceration: a concept mapping study. HEALTH & JUSTICE 2024; 12:11. [PMID: 38472497 DOI: 10.1186/s40352-024-00265-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Currently, there are more than two million people in prisons or jails, with nearly two-thirds meeting the criteria for a substance use disorder. Following these patterns, overdose is the leading cause of death following release from prison and the third leading cause of death during periods of incarceration in jails. Traditional quantitative methods analyzing the factors associated with overdose following incarceration may fail to capture structural and environmental factors present in specific communities. People with lived experiences in the criminal legal system and with substance use disorder hold unique perspectives and must be involved in the research process. OBJECTIVE To identify perceived factors that impact overdose following release from incarceration among people with direct criminal legal involvement and experience with substance use. METHODS Within a community-engaged approach to research, we used concept mapping to center the perspectives of people with personal experience with the carceral system. The following prompt guided our study: "What do you think are some of the main things that make people who have been in jail or prison more and less likely to overdose?" Individuals participated in three rounds of focus groups, which included brainstorming, sorting and rating, and community interpretation. We used the Concept Systems Inc. platform groupwisdom for our analyses and constructed cluster maps. RESULTS Eight individuals (ages 33 to 53) from four states participated. The brainstorming process resulted in 83 unique factors that impact overdose. The concept mapping process resulted in five clusters: (1) Community-Based Prevention, (2) Drug Use and Incarceration, (3) Resources for Treatment for Substance Use, (4) Carceral Factors, and (5) Stigma and Structural Barriers. CONCLUSIONS Our study provides critical insight into community-identified factors associated with overdose following incarceration. These factors should be accounted for during resource planning and decision-making.
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Affiliation(s)
- Samantha K Nall
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
| | - Cole Jurecka
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
| | - Anthony Ammons
- The Ahimsa Collective, Oakland, CA, USA
- Third City Community Advisory Board, Chapel Hill, NC, USA
| | - Avel Rodriguez
- WORTH CAB (Wellness, Opportunity, Resilience Through Health Community Advisory Board), Aurora, CO, USA
| | - Betsy Craft
- WORTH CAB (Wellness, Opportunity, Resilience Through Health Community Advisory Board), Aurora, CO, USA
- Colorado Drug Policy Coalition, Denver, CO, USA
| | - Craig Waleed
- Third City Community Advisory Board, Chapel Hill, NC, USA
- Disability Rights North Carolina (DRNC), Raleigh, NC, USA
| | - Daniel Dias
- WORTH CAB (Wellness, Opportunity, Resilience Through Health Community Advisory Board), Aurora, CO, USA
- Denver Dream Center, Denver, CO, USA
| | - Jessie Henderson
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
- WORTH CAB (Wellness, Opportunity, Resilience Through Health Community Advisory Board), Aurora, CO, USA
| | - Joshua Boyer
- Third City Community Advisory Board, Chapel Hill, NC, USA
- Hopwood and Singhal PLLC, Alexandria, VA, USA
| | - Kristina Yamkovoy
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
| | - Pallavi Aytha Swathi
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
| | - Prasad Patil
- Boston University School of Public Health, Boston, MA, USA
| | | | | | | | - Joshua A Barocas
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA.
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Marotta P, Hass A, Viera A, Doernberg M, Barbour R, Grau LE, Heimer R. Technical violations and infractions are drivers of disengagement from methadone treatment among people with opioid use disorder discharged from Connecticut jails 2014-2018. Subst Abuse Treat Prev Policy 2023; 18:43. [PMID: 37420271 PMCID: PMC10329353 DOI: 10.1186/s13011-023-00541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/25/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND We investigated the interaction between arrests for technical violations vs. receiving new charges with receiving community-based methadone treatment on time-to reincarceration (TTR) in a cohort of men with opioid use disorder (OUD) released from custody from two Connecticut jails from 2014 to 2018. METHODS Hazard ratios (HR) were estimated for time to reincarceration for technical violations/infractions, misdemeanors only, felonies only, and both misdemeanors and felonies after adjusting for age, race/ethnicity, and receiving methadone treatment during incarceration or in the community following release. Moderation analyses tested the hypotheses that the benefits of receiving methadone in jail or the community on TTR were significantly different for people with only technical violations and infractions compared to misdemeanor and felony charges. RESULTS In the sample of 788 men who were reincarcerated, 29.4% received technical violations with no new charges (n = 232) with the remainder of the sample receiving new charges consisting of 26.9% new misdemeanor charges, 6.5% felony charges, and 37.2% both felony and misdemeanor charges. Compared to men who received new misdemeanor charges, TTR was significantly shorter among those who received technical violations and infractions with no new charges amounting to a 50% increase in TTR (334.5 days, SD = 321.3 vs. 228.1 days, SD = 308.0, p < 0.001; aHR = 1.5, 95% CI = 1.3, 1.8, p < 0.001). TTR of men who resumed methadone and were charged with a new crime was 50% longer than those who resumed methadone and received technical violations/infractions with no new charges. (230.2 days, SD = 340.2 vs. 402.3 days, SD = 231.3; aHR = 1.5, 95%CI = 1.0, 2.2, p = 0.038). CONCLUSIONS Reducing technical violations may enhance the benefits of providing community-based methadone following release from incarceration on extending the time between incarcerations during the vulnerable time post-incarceration and reduce the burden on correctional systems.
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Affiliation(s)
- Phillip Marotta
- Brown School, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO USA
| | - Alissa Hass
- Indiana University School of Medicine, Bloomington, USA
| | - Adam Viera
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Molly Doernberg
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Russell Barbour
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Lauretta E. Grau
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Robert Heimer
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
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Tverborgvik T, Stavseth MR, Bukten A. The association between drug use and mortality in a norwegian prison cohort: a prospective cohort study. HEALTH & JUSTICE 2023; 11:22. [PMID: 37058181 PMCID: PMC10103423 DOI: 10.1186/s40352-023-00223-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Elevated mortality rates are found among people who have experienced incarceration, even long after release from prison. The mechanisms related to this excess mortality are complex products of both individual and situational factors. The aim of this study was to describe all-cause and cause-specific mortality among people with a history of imprisonment, and to examine both individual and situational factors associated with mortality. METHODS In this prospective cohort study we used baseline survey data from the Norwegian Offender Mental Health and Addiction (NorMA) study (N = 733) linked with data from the Norwegian Cause of Death Registry during eight years of follow-up (2013-2021). RESULTS At end of follow-up, 56 persons (8%) of the cohort were deceased; 55% (n = 31) due to external causes such as overdoses or suicides, and 29% (n = 16) to internal causes such as cancer or lung disease. Having a score > 24 on the Drug Use Disorders Identification Test (DUDIT), indicating likely drug dependence was highly associated with external causes of death (OR 3.31, 95% CI 1.34-8.16), while having a job before baseline imprisonment had a protective effect on all-cause mortality (OR 0.51, ,95% CI 0.28-0.95). CONCLUSIONS High DUDIT score at baseline were highly associated with external causes of death, even years after the DUDIT screening was done. Screening incarcerated people using validated clinical tools, such as the DUDIT, together with initiation of appropriate treatment, may contribute to reduced mortality in this marginalized population.
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Affiliation(s)
- Torill Tverborgvik
- Norwegian Centre for Addiction Research, University of Oslo, P.O. Box 1074, Blindern, Oslo, 0316, Norway.
| | - Marianne Riksheim Stavseth
- Norwegian Centre for Addiction Research, University of Oslo, P.O. Box 1074, Blindern, Oslo, 0316, Norway
- Section for Clinical Addiction Research, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, 0424, Norway
| | - Anne Bukten
- Norwegian Centre for Addiction Research, University of Oslo, P.O. Box 1074, Blindern, Oslo, 0316, Norway
- Section for Clinical Addiction Research, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, 0424, Norway
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Cano M, Oh S, Osborn P, Olowolaju SA, Sanchez A, Kim Y, Moreno AC. County-level predictors of US drug overdose mortality: A systematic review. Drug Alcohol Depend 2023; 242:109714. [PMID: 36463764 DOI: 10.1016/j.drugalcdep.2022.109714] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This systematic review summarized published literature on county-level predictors of drug overdose mortality in the United States (US). METHODS Peer-reviewed studies and doctoral dissertations published in English between 1990 and July 19, 2022 were identified from PubMed, Web of Science, ProQuest Dissertations & Theses, PsycINFO, CINAHL, and EconLit. Eligible studies examined at least one county-level predictor of drug overdose mortality in US counties. Two reviewers independently completed screening, quality assessment (with an adapted National Institutes of Health Quality Assessment Tool), and data extraction. Results were qualitatively summarized and grouped by predictor categories. RESULTS Of 56 studies included, 42.9% were subnational, and 53.6% were limited to opioid overdose. In multiple studies, measures related to opioid prescribing, illness/disability, economic distress, mining employment, incarceration, family distress, and single-parent families were positively associated with drug overdose mortality outcomes, while measures related to cannabis dispensaries, substance use treatment, social capital, and family households were negatively associated with drug overdose mortality outcomes. Both positive and negative associations were documented for smoking, uninsurance, healthcare professional shortage status, physicians per capita, unemployment, income, poverty, educational attainment, racial composition, and rurality. Findings within studies also differed by subpopulation (by race/ethnicity, gender, age, or rurality) and the type of drugs involved in overdose. CONCLUSIONS The findings of this review provide relatively mixed evidence regarding many county-level predictors of overdose mortality, several of which also vary between subpopulations, supporting the importance of additional research to elucidate pathways through which the county context may shape risk of fatal overdose.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, USA.
| | - Sehun Oh
- College of Social Work, The Ohio State University, USA
| | | | | | - Armando Sanchez
- Department of Social Work, University of Texas at San Antonio, USA
| | - Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, USA; School of Social Work, University of Texas at Arlington, USA
| | - Alberto Cano Moreno
- Department of Public Policy, Universidad Autónoma del Estado de Hidalgo, México
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Anticipated Barriers to Sustained Engagement in Treatment With Medications for Opioid Use Disorder After Release From Incarceration. J Addict Med 2023; 17:54-59. [PMID: 35916404 PMCID: PMC9892350 DOI: 10.1097/adm.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the burden of opioid use disorder is disproportionately high among persons who are incarcerated, medications for opioid use disorder are often unavailable in correctional settings. The Rhode Island Department of Corrections provides all 3 classes of medications for opioid use disorder to clinically eligible persons who are incarcerated. Despite a decrease in fatal overdoses among persons with recent criminal legal system involvement since the program's implementation, barriers to continued engagement in treatment after release from incarceration still exist. METHODS We conducted 40 semistructured, qualitative interviews with people who were incarcerated and enrolled in the comprehensive medications for opioid use disorder program at the Rhode Island Department of Corrections. Analysis applied a general, inductive approach using NVivo 12. RESULTS Participants discussed barriers to treatment engagement before incarceration, as well as anticipated barriers to medications to treat opioid use disorder continuation after release from incarceration. Structural factors including housing, health insurance, transportation, and the treatment program structure, as well as social factors such as social support networks were perceived to influence retention in medications to treat opioid use disorder post-release. CONCLUSION Our findings suggest that people with opioid use disorder who are incarcerated encounter unique challenges upon community reentry. Addressing structural factors that pose barriers to post-release engagement is essential to sustaining retention. We recommend utilization of peer recovery specialists to alleviate some of the stress of navigating the structural barriers identified by participants.
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Park H, Linthwaite B, Dussault C, Halavrezos A, Chalifoux S, Sherman J, Del Balso L, Buxton JA, Cox J, Kronfli N. Factors associated with changes in illicit opioid use during the COVID-19 pandemic among incarcerated people who use drugs in Quebec, Canada. Int J Prison Health 2022; 19:464-473. [PMID: 36519779 PMCID: PMC10598516 DOI: 10.1108/ijph-06-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among incarcerated PWUD in Quebec, Canada, during the pandemic. DESIGN/METHODOLOGY/APPROACH The authors conducted an observational, cross-sectional study in three Quebec provincial prisons. Participants completed self-administered questionnaires. The primary outcome, "changes in illicit opioid consumption," was measured using the question "Has your consumption of opioid drugs that were not prescribed to you by a medical professional changed since March 2020?" The association of independent variables and recent changes (past six months) in opioid consumption were examined using mixed-effects Poisson regression models with robust standard errors. Crude and adjusted risk ratios with 95% confidence intervals (95% CIs) were calculated. FINDINGS A total of 123 participants (median age 37, 76% White) were included from January 19 to September 15, 2021. The majority (72; 59%) reported decreased illicit opioid consumption since March 2020. Individuals over 40 were 11% less likely (95% CI 14-8 vs 18-39) to report a decrease, while those living with others and with a history of opioid overdose were 30% (95% CI 9-55 vs living alone) and 9% (95% CI 0-18 vs not) more likely to report decreased illicit opioid consumption since March 2020, respectively. ORIGINALITY/VALUE The authors identified possible factors associated with changes in illicit opioid consumption among incarcerated PWUD in Quebec. Irrespective of opioid consumption patterns, increased access to opioid agonist therapy and enhanced discharge planning for incarcerated PWUD are recommended to mitigate the harms from opioids and other drugs.
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Affiliation(s)
- Hyejin Park
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Camille Dussault
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Sylvie Chalifoux
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jessica Sherman
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Lina Del Balso
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Canada; McGill University, Montreal, Canada and McGill University Health Centre, Montreal, Canada
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre, Montreal, Canada; McGill University, Montreal, Canada and McGill University Health Centre, Montreal, Canada
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