1
|
Baker R, Fredericksen RJ, Rudolph AE, Stopka TJ, Walters SM, Fadanelli M, Bolinski RS, Sibley AL, Stack E, Crane HM, Korthuis PT, Seal DW. Overdose responses among rural people who use drugs: A multi-regional qualitative study. Harm Reduct J 2024; 21:107. [PMID: 38822387 PMCID: PMC11140975 DOI: 10.1186/s12954-024-01007-9] [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: 08/29/2023] [Accepted: 04/16/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Efforts to distribute naloxone have equipped more people with the ability to reverse opioid overdoses but people who use drugs are often reluctant to call 911 due to concerns for legal repercussions. Rural communities face unique challenges in reducing overdose deaths compared to urban communities, including limited access to harm reduction services as well as greater concerns about stigma and privacy. METHODS The Rural Opioid Initiative was funded in 2017 to better understand the health-related harms associated with the opioid crisis in rural US communities and consists of eight studies spanning ten states and 65 counties. Each study conducted semi-structured qualitative interviews with people who use drugs to understand contextual factors influencing drug use and health behaviors. We analyzed qualitative data from seven studies with data available at the time of analysis to understand peer response to overdose. RESULTS Of the 304 participants interviewed, 55% were men, 70% were white, 80% reported current injection drug use, and 60% reported methamphetamine use. Similar to what has been found in studies focused on urban settings, people who use drugs in rural communities use a range of strategies to reverse overdoses, including non-evidence-based approaches. Several reported that multiple doses of naloxone are needed to reverse overdose. Three themes emerged around the willingness to call 911, including (1) hesitancy to call 911 for fear of legal consequences, (2) negative perceptions or experiences with law enforcement officers, and (3) efforts to obtain medical intervention while avoiding identification/law enforcement involvement. CONCLUSION People who use drugs employ multiple strategies to attempt overdose reversal, including non-evidence-based approaches. Greater education about the most effective and least harmful strategies is needed. Reluctance to call 911 is rooted in concerns about potential legal consequences as well as perceptions about law enforcement officers, which may be heightened in rural communities where people who use drugs are more easily identified by law enforcement. People who use drugs will go to great strides to connect their peers to needed medical services, suggesting that comprehensive interventions to reduce interactions with law enforcement officers and eliminate legal consequences for reporting overdoses are critical.
Collapse
Affiliation(s)
- Robin Baker
- OHSU-PSU School of Public Health, Portland, OR, USA.
- Learning Design & Innovation, 37 Dewey Field Rd, Suite 201-205, 03755, Hanover, NH, USA.
| | | | - Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Suzan M Walters
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Monica Fadanelli
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Adams L Sibley
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - P Todd Korthuis
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David W Seal
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| |
Collapse
|
2
|
Curry J, Coaston T, Vadlakonda A, Sakowitz S, Mallick S, Chervu N, Khoraminejad B, Benharash P. Trends, outcomes, and factors associated with in-hospital opioid overdose following major surgery. Surg Open Sci 2024; 18:111-116. [PMID: 38523845 PMCID: PMC10957460 DOI: 10.1016/j.sopen.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
Background With the growing opioid epidemic across the US, in-hospital utilization of opioids has garnered increasing attention. Using a national cohort, this study sought to characterize trends, outcomes, and factors associated with in-hospital opioid overdose (OD) following major elective operations. Methods We identified all adult (≥18 years) hospitalizations entailing select elective procedures in the 2016-2020 National Inpatient Sample. Patients who experienced in-hospital opioid overdose were characterized as OD (others: Non-OD). The primary outcome of interest was in-hospital OD. Multivariable logistic and linear regression models were developed to evaluate the association between in-hospital OD and mortality, length of stay (LOS), hospitalization costs, and non-home discharge. Results Of an estimated 11,096,064 hospitalizations meeting study criteria, 5375 (0.05 %) experienced a perioperative OD. Compared to others, OD were older (66 [57-73] vs 64 [54-72] years, p < 0.001), more commonly female (66.3 vs 56.7 %, p < 0.001), and in the lowest income quartile (26.4 vs 23.2 %, p < 0.001). After adjustment, female sex (Adjusted Odds Ratio [AOR] 1.68, 95 % Confidence Interval [CI] 1.47-1.91, p < 0.001), White race (AOR 1.19, CI 1.01-1.42, p = 0.04), and history of substance use disorder (AOR 2.51, CI 1.87-3.37, p < 0.001) were associated with greater likelihood of OD. Finally, OD was associated with increased LOS (β +1.91 days, CI [1.60-2.21], p < 0.001), hospitalization costs (β +$7500, CI [5900-9100], p < 0.001), and greater odds of non-home discharge (AOR 2.00, CI 1.61-2.48, p < 0.001). Conclusion Perioperative OD remains a rare but costly complication after elective surgery. While pain control remains a priority postoperatively, protocols and recovery pathways must be re-examined to ensure patient safety.
Collapse
Affiliation(s)
- Joanna Curry
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Troy Coaston
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, CA, USA
| | - Baran Khoraminejad
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, CA, USA
| |
Collapse
|
3
|
Romo E, Stopka TJ, Jesdale BM, Wang B, Mazor KM, Friedmann PD. Association of spatial proximity to fixed-site syringe services programs with HCV serostatus and injection equipment sharing practices among people who inject drugs in rural New England, United States. Harm Reduct J 2024; 21:23. [PMID: 38282000 PMCID: PMC10822149 DOI: 10.1186/s12954-023-00916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) disproportionately affects rural communities, where health services are geographically dispersed. It remains unknown whether proximity to a syringe services program (SSP) is associated with HCV infection among rural people who inject drugs (PWID). METHODS Data are from a cross-sectional sample of adults who reported injecting drugs in the past 30 days recruited from rural counties in New Hampshire, Vermont, and Massachusetts (2018-2019). We calculated the road network distance between each participant's address and the nearest fixed-site SSP, categorized as ≤ 1 mile, 1-3 miles, 3-10 miles, and > 10 miles. Staff performed HCV antibody tests and a survey assessed past 30-day injection equipment sharing practices: borrowing used syringes, borrowing other used injection equipment, and backloading. Mixed effects modified Poisson regression estimated prevalence ratios (aPR) and 95% confidence intervals (95% CI). Analyses were also stratified by means of transportation. RESULTS Among 330 PWID, 25% lived ≤ 1 mile of the nearest SSP, 17% lived 1-3 miles of an SSP, 12% lived 3-10 miles of an SSP, and 46% lived > 10 miles from an SSP. In multivariable models, compared to PWID who lived within 1 mile of an SSP, those who lived 3 to 10 miles away had a higher prevalence of HCV seropositivity (aPR: 1.25, 95% CI 1.06-1.46), borrowing other used injection equipment (aPR: 1.23, 95% CI 1.04-1.46), and backloading (aPR: 1.48, 95% CI 1.17-1.88). Similar results were observed for PWID living > 10 miles from an SSP: aPR [HCV]: 1.19, 95% CI 1.01-1.40; aPR [borrowing other used equipment]:1.45, 95% CI 1.29-1.63; and aPR [backloading]: 1.59, 95% CI 1.13-2.24. Associations between living 1 to 3 miles of an SSP and each outcome did not reach statistical significance. When stratified by means of transportation, associations between distance to SSP and each outcome (except borrowing other used injection equipment) were only observed among PWID who traveled by other means (versus traveled by automobile). CONCLUSIONS Among PWID in rural New England, living farther from a fixed-site SSP was associated with a higher prevalence of HCV seropositivity, borrowing other used injection equipment, and backloading, reinforcing the need to increase SSP accessibility in rural areas. Means of transportation may modify this relationship.
Collapse
Affiliation(s)
- Eric Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Chan Medical, Worcester, MA, USA
| | - Peter D Friedmann
- Office of Research, University of MA Chan Medical School - Baystate, Springfield, MA, USA
| |
Collapse
|
4
|
Nolte K, Romo E, Stopka TJ, Drew A, Dowd P, Del Toro-Mejias L, Bianchet E, Friedmann PD. "I've been to more of my friends' funerals than I've been to my friends' weddings": Witnessing and responding to overdose in rural Northern New England. J Rural Health 2023; 39:197-211. [PMID: 35301749 PMCID: PMC9481744 DOI: 10.1111/jrh.12660] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Overdose is a leading cause of death among people who use drugs (PWUDs), but policies to reduce fatal overdose have had mixed results. Summaries of naloxone access and Good Samaritan Laws (GSLs) in prior studies provide limited information about local context. Witnessing overdoses may also be an important consideration in providing services to PWUDs, as it contributes to post traumatic stress disorder (PTSD) symptoms, which complicate substance use disorder treatment. METHODS We aim to estimate the prevalence and correlates of witnessing and responding to an overdose, while exploring overdose context among rural PWUD. The Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) mixed-methods study characterized substance use and risk behaviors in 11 rural Massachusetts, Vermont, and New Hampshire counties between 2018 and 2019. PWUD completed surveys (n = 589) and in-depth interviews (n = 22). FINDINGS Among the survey participants, 84% had ever witnessed an overdose, which was associated with probable PTSD symptoms. Overall, 51% had ever called 911 for an overdose, though some experienced criminal legal system consequences despite GSL. Although naloxone access varied, 43% had ever used naloxone to reverse an overdose. CONCLUSIONS PWUD in Northern New England commonly witnessed an overdose, which they experienced as traumatic. Participants were willing to respond to overdoses, but faced barriers to effective overdose response, including limited naloxone access and criminal legal system consequences. Equipping PWUDs with effective overdose response tools (education and naloxone) and enacting policies that further protect PWUDs from criminal legal system consequences could reduce overdose mortality.
Collapse
Affiliation(s)
- Kerry Nolte
- Department of Nursing, College of Health and Human Services, University of New Hampshire, Hewitt Hall, 4 Library Way, Durham, NH, 03824, USA
| | - Eric Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Public Health, 136 Harrison Ave., Boston, MA
| | - Aurora Drew
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Patrick Dowd
- Office of Research, University of Massachusetts Medical School-Baystate, 3601 Main Street, 3 Floor, Springfield, MA, 01199, USA
| | - Lizbeth Del Toro-Mejias
- Office of Research, University of Massachusetts Medical School-Baystate, 3601 Main Street, 3 Floor, Springfield, MA, 01199, USA
| | - Elyse Bianchet
- Office of Research, University of Massachusetts Medical School-Baystate, 3601 Main Street, 3 Floor, Springfield, MA, 01199, USA
| | - Peter D. Friedmann
- Office of Research, University of Massachusetts Medical School-Baystate, 3601 Main Street, 3 Floor, Springfield, MA, 01199, USA
| |
Collapse
|
5
|
Romo E, Rudolph AE, Stopka TJ, Wang B, Jesdale BM, Friedmann PD. HCV serostatus and injection sharing practices among those who obtain syringes from pharmacies and directly and indirectly from syringe services programs in rural New England. Addict Sci Clin Pract 2023; 18:2. [PMID: 36597153 PMCID: PMC9809047 DOI: 10.1186/s13722-022-00358-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Among people who inject drugs (PWID), obtaining syringes via syringe services programs (SSPs) and pharmacies reduces injection sharing practices associated with hepatitis C virus (HCV). Whether indirect use of SSPs via secondary exchange confers a similar benefit remains unknown, particularly in rural settings. We compared HCV serostatus and injection sharing practices by primary syringe source among a sample of rural PWID. METHODS Data are from a cross-sectional study of adults who use drugs recruited from eleven rural counties in New Hampshire, Vermont, and Massachusetts using respondent-driven sampling (2018-2019). Study staff performed HCV antibody testing. An audio computer-assisted self-interview assessed sociodemographic characteristics, past 30-day injection practices, and past 30-day primary syringe source. Primary syringe source was classified as direct SSP, pharmacy, indirect SSP (secondary exchange), or "other" (friend/acquaintance, street seller, partner/relative, found them). Mixed effects modified Poisson models assessed the association of primary syringe source with HCV seroprevalence and injection sharing practices. RESULTS Among 397 PWID, the most common primary syringe source was "other" (33%), then pharmacies (27%), SSPs (22%), and secondary exchange (18%). In multivariable models, compared with those obtaining most syringes from "other" sources, those obtaining most syringes from pharmacies had a lower HCV seroprevalence [adjusted prevalence ratio (APR):0.85, 95% confidence interval (CI) 0.73-0.9985]; however, the upper bound of the 95% CI was close to 1.0. Compared with those obtaining most syringes from other sources, PWID obtaining most syringes directly from SSPs or pharmacies were less likely to report borrowing used syringes [APR(SSP):0.60, 95% CI 0.43-0.85 and APR(Pharmacies):0.70, 95% CI 0.52-0.93], borrowing used injection equipment [APR(SSP):0.59, 95% CI 0.50-0.69 and APR (Pharmacies):0.81, 95% CI 0.68-0.98], and backloading [APR(SSP):0.65, 95% CI 0.48-0.88 and APR(Pharmacies):0.78, 95% CI 0.67-0.91]. Potential inverse associations between obtaining most syringes via secondary exchange and injection sharing practices did not reach the threshold for statistical significance. CONCLUSIONS PWID in rural New England largely relied on informal syringe sources (i.e., secondary exchange or sources besides SSPs/pharmacies). Those obtaining most syringes from an SSP or pharmacy were less likely to share injection equipment/syringes and had a lower HCV seroprevalence, which suggests using these sources reduces the risk of new HCV infections or serves as proxy for past injection behavior.
Collapse
Affiliation(s)
- Eric Romo
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Abby E. Rudolph
- grid.264727.20000 0001 2248 3398Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA USA
| | - Thomas J. Stopka
- grid.67033.310000 0000 8934 4045Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Bo Wang
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Bill M. Jesdale
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Peter D. Friedmann
- grid.266683.f0000 0001 2166 5835Office of Research, University of Massachusetts Chan Medical School-Baystate, Springfield, MA USA
| |
Collapse
|
6
|
Auty SG, Barr KD, Frakt AB, Garrido MM, Strombotne KL. Effect of a Veterans Health Administration mandate to case review patients with opioid prescriptions on mortality among patients with opioid use disorder: a secondary analysis of the STORM randomized control trial. Addiction 2022; 118:870-879. [PMID: 36495477 DOI: 10.1111/add.16110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
AIMS The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) to reduce the risk of serious adverse events (SAE) among patients with opioid analgesic prescriptions. VHA facilities were mandated to case review patients identified as high risk by STORM. The aim of this study was to measure the effect of this mandate on all-cause mortality and SAEs among VHA patients newly diagnosed with opioid use disorder (OUD). DESIGN Secondary analysis of a stepped-wedged cluster randomized controlled trial conducted at all 140 VHA facilities, with facility as the unit of randomization, from 2018 to 2020. SETTING AND PARTICIPANTS United States VHA facilities were randomized to case review the top 1 or 5% of high-risk patients prescribed opioid analgesics identified by STORM. A total of 28 251 patients were diagnosed with OUD during the trial and were considered control or treatment depending on the status of the facility where they received their OUD diagnosis. Post-hoc analyses among patients who had at least one opioid analgesic prescription in the 90 days prior to diagnosis were conducted and were then stratified by receipt of a prescription in the 90 days following diagnosis to assess the sensitivity of results to opioid discontinuation. MEASUREMENTS All-cause mortality and opioid-related, drug-related, suicide-related and other SAEs within 90 days of OUD diagnosis. FINDINGS Mandated case review increased the odds of 90-day mortality [odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.06, 2.87], but did not significantly change the odds of SAEs. Among patients who received an opioid prescription prior to but not after OUD diagnosis, the odds of all-cause mortality within 90 days was 5.87 (95% CI = 1.85, 18.58) relative to control patients. CONCLUSIONS Veterans Health Administration patients newly diagnosed with opioid use disorder experienced increased all-cause mortality following expansion of a case review mandate for high-risk patients prescribed opioids.
Collapse
Affiliation(s)
- Samantha G Auty
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Kyle D Barr
- Partnered Evidence-Based Policy Resource Center, Veterans Administration Boston Healthcare System, Boston, MA, USA
| | - Austin B Frakt
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Partnered Evidence-Based Policy Resource Center, Veterans Administration Boston Healthcare System, Boston, MA, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Melissa M Garrido
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Partnered Evidence-Based Policy Resource Center, Veterans Administration Boston Healthcare System, Boston, MA, USA
| | - Kiersten L Strombotne
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Partnered Evidence-Based Policy Resource Center, Veterans Administration Boston Healthcare System, Boston, MA, USA
| |
Collapse
|
7
|
Scott K, Salas MDH, Bayles D, Sanchez R, Martin RA, Becker SJ. Substance use workforce training needs during intersecting epidemics: an analysis of events offered by a regional training center from 2017 to 2020. BMC Public Health 2022; 22:1063. [PMID: 35643515 PMCID: PMC9142727 DOI: 10.1186/s12889-022-13500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intersecting opioid overdose, COVID-19, and systemic racism epidemics have brought unprecedented challenges to the addiction treatment and recovery workforce. From 2017 to 2020, the New England Addiction Technology Transfer Center (ATTC) collected data in real-time on the training and technical assistance (TA) requested and attended by the front-line workforce. This article synthesizes practice-based evidence on the types of TA requests, topics of TA, attendance numbers, and socio-demographics of TA attendees over a 3-year period spanning an unprecedented public health syndemic.
Methods
We assessed TA events hosted by the New England ATTC using SAMHSA’s Performance Accountability and Reporting System post-event survey data from 2017 to 2020. Events were coded by common themes to identify the most frequently requested training types/topics and most frequently attended training events. We also evaluated change in training topics and attendee demographics over the three-year timeline.
Results
A total of 258 ATTC events reaching 10,143 participants were analyzed. The number of TA events and attendance numbers surged in the 2019–2020 fiscal year as TA events shifted to fully virtual during the COVID-19 pandemic. The absolute number of opioid-related events increased, but the relative proportion remained stable over time. The relative proportions of events and attendance rates focused on evidence-based practice and health equity both increased over the 3-year period, with the largest increase after the onset of the pandemic and the murder of George Floyd. As events shifted to virtual, events were attended by providers with a broader range of educational backgrounds.
Conclusions
Results of the current analysis indicate that the demand for TA increased during the pandemic, with a prioritization of TA focused on evidence-based practice and health equity. The practice-based evidence generated from the New England ATTC may help other training and TA centers to anticipate and nimbly respond to the needs of the workforce in the face of the intersecting epidemics.
Collapse
|
8
|
Karasz A, Merchant K, Arnstein J, Feinberg J, Kim A, McKee M, Meissner P. A Video Observed Treatment (VOT) Strategy to Improve Adherence to Treatment Among Persons who Inject Drugs infected with Hepatitis C Virus: A Qualitative Study of Stakeholder Perceptions and Experiences (Preprint). J Med Internet Res 2022. [DOI: 10.2196/38176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
|
9
|
Shrestha S, Bauer CX, Hendricks B, Stopka TJ. Spatial epidemiology: An empirical framework for syndemics research. Soc Sci Med 2022; 295:113352. [PMID: 32950331 PMCID: PMC7962030 DOI: 10.1016/j.socscimed.2020.113352] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 02/03/2023]
Abstract
Syndemics framework describes two or more co-occurring epidemics that synergistically interact with each other and the complex structural social forces that sustain them leading to excess disease burden. The term syndemic was first used to describe the interaction between substance abuse, violence, and AIDS by Merrill Singer. A broader range of syndemic studies has since emerged describing the framework's applicability to other public health scenarios. With syndemic theory garnering significant attention, the focus is shifting towards developing robust empirical analytical approaches. Unfortunately, the complex nature of the disease-disease interactions nested within several social contexts complicates empirical analyses. In answering the call to analyze syndemics at the population level, we propose the use of spatial epidemiology as an empirical framework for syndemics research. Spatial epidemiology, which typically relies on geographic information systems (GIS) and statistics, is a discipline that studies spatial variations to understand the geographic landscape and the risk environment within which disease epidemics occur. GIS maps provide visualization aids to investigate the spatial distribution of disease outcomes, the associated social factors, and environmental exposures. Analytical inference, such as estimation of disease risks and identification of spatial disease clusters, can provide a detailed statistical view of spatial distributions of diseases. Spatial and spatiotemporal models can help us to understand, measure, and analyze disease syndemics as well as the social, biological, and structural factors associated with them in space and time. In this paper, we present a background on syndemics and spatial epidemiological theory and practice. We then present a case study focused on the HIV and HCV syndemic in West Virginia to provide an example of the use of GIS and spatial analytical methods. The concepts described in this paper can be considered to enhance understanding and analysis of other syndemics for which space-time data are available.
Collapse
Affiliation(s)
- Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, USA
| | - Cici X.C. Bauer
- Department of Biostatistics and Data Science, University of Texas, Health Sciences Center at Houston, USA
| | - Brian Hendricks
- Department of Epidemiology, School of Public Health, West Virginia University, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, USA,Corresponding author. Department of Public Health and Community Medicine, Clinical and Translational Science Institute, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA. , (T.J. Stopka)
| |
Collapse
|
10
|
Scott K, Salas MDH, Bayles D, Sanchez R, Martin RA, Becker SJ. Substance Use Workforce Training Needs during Intersecting Epidemics: An Analysis of Events Offered by a Regional Training Center from 2017-2020. RESEARCH SQUARE 2021:rs.3.rs-956280. [PMID: 34642690 PMCID: PMC8509100 DOI: 10.21203/rs.3.rs-956280/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Intersecting opioid overdose, COVID-19, and systemic racism epidemics havebrought unprecedented challenges to the addiction treatment and recovery workforce. From 2017-2020, the New England Addiction Technology Transfer Center (ATTC) collected data in real-time on the training and technical assistance (TA) requested and attended by the front-line workforce. This article synthesizes practice-based evidence on the types of TA requests, topics of TA, attendance numbers, and socio-demographics of TA attendees over a 3-year period spanning an unprecedented public health syndemic. Methods: We assessed TA events hosted by the New England ATTC using SAMHSA’s Performance Accountability and Reporting System post-event survey data from 2017-2020. Events were coded by common themes to identify the most frequently requested training types/topics and most frequently attended training events. We also evaluated change in training topics and attendee demographics over the three-year timeline. Results: A total of 258 ATTC events reaching 10,143 participants were analyzed. The number of TA events and attendance numbers surged in the 2019-2020 fiscal year as TA events shifted to fully virtual during the COVID-19 pandemic. The absolute number of opioid-related events increased, but the relative proportion remained stable over time. The relative proportions of events and attendance rates focused on evidence-based practice and health equity both increased over the 3-year period, with the largest increase after the onset of the pandemic and the murder of George Floyd. As events shifted to virtual, events were attended by providers with a broader range of educational backgrounds. Conclusions: Results of the current analysis indicate that the demand for TA increased during the pandemic, with a prioritization of TA focused on evidence-based practice and health equity. The practice-based evidence generated from the New England ATTC may help other training and TA centers to anticipate and nimbly respond to the needs of the workforce in the face of the intersecting epidemics.
Collapse
|
11
|
Blake A, Smith JE. Modeling Hepatitis C Elimination Among People Who Inject Drugs in New Hampshire. JAMA Netw Open 2021; 4:e2119092. [PMID: 34342652 PMCID: PMC8335578 DOI: 10.1001/jamanetworkopen.2021.19092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/27/2021] [Indexed: 12/09/2022] Open
Abstract
Importance The success of direct-acting antiviral therapies for chronic hepatitis C virus (HCV) infection led the World Health Organization to set elimination targets by 2030. For the United States to achieve these benchmarks, public health responses must target high-risk populations, such as people who inject drugs (PWID), a group with high rates of HCV incidence and low rates of treatment uptake. Objective To evaluate potential improvements in the HCV care cascade among PWID, focusing on improved testing, treatment uptake, and access to harm reduction. Design, Setting, and Participants This decision analytic model used a differential equation-based dynamic transmission model based on data from New Hampshire, an illustrative state with a large number of PWID and limited HCV treatment infrastructure. Surveillance data through 2020 was used for model parameterization, and the final analysis was conducted in May 2021. Main Outcomes and Measures Model forecasts of chronic HCV cases and advanced-stage HCV outcomes from 2022 to 2045. Results A total of 6 scenarios were tested: (1) the base case, (2) improved harm reduction, (3) improved testing, (4) improved treatment, (5) improved testing and treatment, and (6) improved testing, treatment, and harm reduction. All scenarios with improved testing, treatment uptake, and/or access to harm reduction were associated with decreases in forecasted HCV prevalence and HCV-associated mortality compared with the base case. Improving harm reduction, testing, and treatment individually were forecast to reduce prevalence of HCV in 2045 from 69.7% in the base case to 62.8%, 45.7%, and 35.5%, respectively. Combining treatment and testing improvements was associated with a 2045 prevalence of 0.3%; adding harm reduction improvements was associated with further reductions in prevalence forecasts (to 0.2%), with fewer total treatments (10 960 vs 13 219 from 2022-2045). Conclusions and Relevance In this modeling study, no single intervention was projected to achieve World Health Organization HCV elimination targets. Scenarios with improvements in both testing and treatment were associated with a prevalence of less than 3% by 2030 and achieved elimination targets. Adding improvements in harm reduction was associated with faster reductions in prevalence and fewer treatments.
Collapse
Affiliation(s)
- Andrew Blake
- Brigham and Women's Hospital, Boston, Massachusetts
| | - James E. Smith
- Tuck School of Business at Dartmouth, Hanover, New Hampshire
| |
Collapse
|
12
|
Higgins TM, Pham M, McDonald J, Le Neveu M, Haslett W, Erekson E, Wilkinson-Ryan I. The Effect of State Legislation on Opioid Prescribing Practices Following Gynecologic Surgery. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Tara M. Higgins
- Department of Obstetrics and Gynecology, UPMC Pinnacle Health System, Lititz, Pennsylvania, USA
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Melissa Pham
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julia McDonald
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Margot Le Neveu
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - William Haslett
- Biomedical Data Science Department, Dartmouth College, Hanover, New Hampshire, USA
| | - Elisabeth Erekson
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine, USA
| | - Ivy Wilkinson-Ryan
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Biomedical Data Science Department, Dartmouth College, Hanover, New Hampshire, USA
| |
Collapse
|
13
|
Evaluation of Policy Effectiveness by Mathematical Modeling for the Opioid Crisis with Spatial Study and Trend Analysis. Healthcare (Basel) 2021; 9:healthcare9050585. [PMID: 34069018 PMCID: PMC8155830 DOI: 10.3390/healthcare9050585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
The current opioid epidemic in the US presents a great problem which calls for policy supervision and regulation. In this work, the opioid cases of five states were used for trend analysis and modeling for the estimation of potential policy effects. An evaluation model was established to analyze the severity of the opioid abuse based on the entropy weight method (EWM) and rank sum ratio (RSR). Four indexes were defined to estimate the spatial distribution of development and spread of the opioid crisis. Thirteen counties with the most severe opioid abuse in five states were determined using the EWM-RSR model and those indexes. Additionally, a forecast of the development of opioid abuse was given based on an autoregressive (AR) model. The RSR values of the thirteen counties would increase to the range between 0.951 and 1.226. Furthermore, the least absolute shrinkage and selection operator (LASSO) method was adopted. The previous indexes were modified, incorporating the comprehensive socioeconomic effects. The optimal penalty term was found to facilitate the stability and reliability of the model. By using the comprehensive model, it was found that three factors—VC112, VC114, VC115—related to disabled people have a great influence on the development of opioid abuse. The simulated policies were performed in the model to decrease the values of the indicators by 10%–50%. The corresponding RSR values can decline to the range between 0.564 and 0.606. Adopting policies that benefit the disabled population should inhibit the trend of opioid abuse.
Collapse
|
14
|
Nolte K, Drew AL, Friedmann PD, Romo E, Kinney LM, Stopka TJ. Opioid initiation and injection transition in rural northern New England: A mixed-methods approach. Drug Alcohol Depend 2020; 217:108256. [PMID: 32947174 PMCID: PMC7769168 DOI: 10.1016/j.drugalcdep.2020.108256] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 08/14/2020] [Accepted: 08/22/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND In rural northern New England, located in the northeastern United States, the overdose epidemic has accelerated with the introduction of fentanyl. Opioid initiation and transition to opioid injection have been studied in urban settings. Little is known about opioid initiation and transition to injection drug use in rural northern New England. METHODS This mixed-methods study characterized opioid use and drug injection in 11 rural counties in Massachusetts, Vermont, and New Hampshire between 2018 and 2019. People who use drugs completed audio computer-assisted self-interview surveys on substance use and risk behaviors (n = 589) and shared personal narratives through in-depth interviews (n = 22). The objective of the current study is to describe initiation of opioid use and drug injection in rural northern New England. RESULTS Median age of first injection was 22 years (interquartile range 18-28 years). Key themes from in-depth interviews that led to initiating drug injection included normalization of drug use in families and communities, experiencing trauma, and abrupt discontinuation of an opioid prescription. Other factors that led to a transition to injecting included lower cost, increased effect/ rush, greater availability of heroin/ fentanyl, and faster relief of withdrawal symptoms with injection. CONCLUSIONS Trauma, normalization of drug use, over-prescribing of opioids, and abrupt discontinuation challenge people who use drugs in rural northern New England communities. Inadequate opioid tapering may increase transition to non-prescribed drug use. The extent and severity of traumatic experiences described highlights the importance of enhancing trauma-informed care in rural areas.
Collapse
Affiliation(s)
- Kerry Nolte
- Department of Nursing, College of Health and Human Services, University of New Hampshire, Hewitt Hall, 4 Library Way, Durham, NH, 03824, USA.
| | - Aurora L. Drew
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA,Synergy Center for Translational Science, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Peter D. Friedmann
- Baystate Office of Research, University of Massachusetts Medical School, 3601 Main Street, 3rdFloor, Springfield, MA, 01199, USA
| | - Eric Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Linda M. Kinney
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| |
Collapse
|
15
|
Sharareh N, Hess R, White S, Dunn A, Singer PM, Cochran J. A vulnerability assessment for the HCV infections associated with injection drug use. Prev Med 2020; 134:106040. [PMID: 32097755 DOI: 10.1016/j.ypmed.2020.106040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/22/2020] [Accepted: 02/22/2020] [Indexed: 12/27/2022]
Abstract
After the 2014-2015 HIV outbreak in Scott County, Indiana, United States Centers for Disease Control and Prevention (CDC) conducted a nationwide analysis to identify vulnerable counties to an outbreak of Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) and prevent such an outbreak in the future. We developed a jurisdiction-level vulnerability assessment for HCV infections associated with injection drug use (IDU) in Utah. We used three years of data (2015-2017) from 15 data sources to construct a regression model to identify significant indicators of IDU. A ZIP Code, county, or individual-level measure of IDU does not exist, therefore, CDC has suggested using HCV cases as a proxy for IDU. We used the Social Vulnerability Index to highlight vulnerable areas to HCV outbreaks and applied Geographical Information System (GIS) to identify hot spots of HCV infections (i.e. current/ongoing HCV transmissions). Rates of skin infection, buprenorphine prescription, administered naloxone, teen birth, and per capita income were associated with HCV infections. The opioid epidemic is dynamic and over time, it impacts different communities through its sequelae such as HCV outbreaks. We need to conduct this vulnerability assessment frequently, using updated data, to better target our resources. Moreover, we should consider evaluating whether the improvement of HCV screening has an impact on controlling HCV outbreaks. The analysis informs Utah's agencies and healthcare officials to target resources and interventions to prevent IDU-related HCV outbreaks. Our results inform policymakers at the national level on possible indicators of HCV outbreaks as well.
Collapse
Affiliation(s)
- Nasser Sharareh
- Health System Innovation and Research Division, Population Health Sciences Department, School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
| | - Rachel Hess
- Health System Innovation and Research Division, Population Health Sciences Department, School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
| | - Scott White
- Utah Department of Health, United States of America.
| | - Angela Dunn
- Utah Department of Health, United States of America.
| | - Phillip M Singer
- Political Science Department, University of Utah, Salt Lake City, UT, United States of America.
| | - Jerry Cochran
- Adult Psychiatry and Epidemiology Divisions, Internal Medicine Department, University of Utah, Salt Lake City, UT, United States of America.
| |
Collapse
|
16
|
Abstract
This Special Issue of Preventive Medicine (PM) is the 6th in a series on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad consensus that personal behavior patterns or lifestyle such as substance abuse, physical inactivity/obesity, and non-adherence with medical regimens are among the most important modifiable causes of chronic disease, premature death and population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. In this issue we devote the majority of space (14 of 20 reports) to the U.S. opioid epidemic, especially the ongoing but still woefully inadequate efforts to build the necessary clinical infrastructure in rural communities to effectively address the epidemic. The remaining six reports focus on addressing the substantive challenges that tobacco use and non-adherence with medical regimens represent in these same communities. While giving the opioid epidemic the attention that it well deserves, we cannot afford to do so at the expense of these other longstanding and also devastating public health problems. Across each of these topics we include contributions from well-regarded investigators, clinicians, and policymakers to acquaint readers with recent accomplishments while also noting knowledge gaps and unmet challenges.
Collapse
Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, United States of America.
| |
Collapse
|