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Fabbri A, Voza A, Riccardi A, Serra S, Iaco FD. The Pain Management of Trauma Patients in the Emergency Department. J Clin Med 2023; 12:jcm12093289. [PMID: 37176729 PMCID: PMC10179230 DOI: 10.3390/jcm12093289] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/20/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
The vast majority of injured patients suffer from pain. Systematic assessment of pain on admission to the emergency department (ED) is a cornerstone of translating the best treatment strategies for patient care into practice. Pain must be measured with severity scales that are validated in clinical practice, including for specific populations (such as children and older adults). Although primary care ED of trauma patients focuses on resuscitation, diagnosis and treatment, pain assessment and management remains a critical element as professionals are not prepared to provide effective and early therapy. To date, most EDs have pain assessment and management protocols that take into account the patient's hemodynamic status and clinical condition and give preference to non-pharmacological approaches where possible. When selecting medications, the focus is on those that are least disruptive to hemodynamic status. Pain relief may still be necessary in hemodynamically unstable patients, but caution should be exercised, especially when using opioids, as absorption may be impaired or shock may be exacerbated. The analgesic dose of ketamine is certainly an attractive option. Fentanyl is clearly superior to other opioids in initial resuscitation and treatment as it has minimal effects on hemodynamic status and does not cause central nervous system depression. Inhaled analgesia techniques and ultrasound-guided nerve blocks are also increasingly effective solutions. A multimodal pain approach, which involves the use of two or more drugs with different mechanisms of action, plays an important role in the relief of trauma pain. All EDs must have policies and promote the adoption of procedures that use multimodal strategies for effective pain management in all injured patients.
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Affiliation(s)
- Andrea Fabbri
- Emergency Department, AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forlì, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, 20089 Milano, Italy
| | | | - Sossio Serra
- Emergency Department, AUSL Romagna, Ospedale M. Bufalini, 47521 Cesena, Italy
| | - Fabio De Iaco
- Struttura Complessa di Medicina di Emergenza Urgenza, Ospedale Maria Vittoria, ASL Città di Torino, 10144 Torino, Italy
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Vyas R, Bailey K, Vyas N, Compton P. College students' knowledge about opioids and implications for the opioid crisis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:147-153. [PMID: 34156325 DOI: 10.1080/07448481.2021.1881102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study assessed undergraduate unhealthy substance use, levels of knowledge about opioid pharmacology, unhealthy use and safety, and students' perceptions about their level of knowledge. PARTICIPANTS Participants were undergraduate students at a large, private university in the Northeast. METHODS This study employed a cross-sectional study design using an online survey. A convenience sample of undergraduate students (N = 317) described their actual and perceived levels of opioid knowledge and their self-reported substance use. RESULTS Objective answers to quiz-style questions about opioids showed knowledge deficits. Participants rated themselves as slightly less knowledgeable than the "average student." Ten percent of students surveyed had used opioids unhealthily at some point in their lifetime. Those reporting unhealthy opioid use had higher subjective and objective opioid knowledge scores. CONCLUSIONS University students' subjective and objective knowledge of opioids warrants more effective and engaging substance use education on college campuses.
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Affiliation(s)
- Ridhi Vyas
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Kaylin Bailey
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Niraj Vyas
- Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Peggy Compton
- School of Nursing, Family and Community Health, University of Pennsylvania, Philadelphia, USA
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Weyandt LL, Gudmundsdottir BG, Holding EZ, Marraccini ME, Keith M, May SE, Shepard E, Francis A, Wilson ED, Channell I, Sweeney C. Prescription opioid misuse among university students: A systematic review. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1119-1137. [PMID: 32780647 DOI: 10.1080/07448481.2020.1786095] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/08/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
Misuse of prescription opioids has substantially increased in the past decade among the general population, including among university students. Relative to the literature concerning opioid misuse among the general population, little information is available regarding the college student population. Objective: The purpose of the present study was to conduct a systematic review of the literature concerning the prevalence of prescription opioid misuse among the university student population. Results: The lifetime estimate for prescription opioid misuse among general populations of students ranged from 4% to 19.7%, with higher estimates for special student populations. Students most at risk for misuse of prescription opioids are those who report higher rates of psychological distress, depression, and suicidal thoughts and behaviors, and white, male students who use alcohol and illicit drugs. Conclusions: Findings from this study underscore the need for opioid prevention and intervention programs on university campuses.
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Affiliation(s)
- Lisa L Weyandt
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | | | - Emily Z Holding
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marisa E Marraccini
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Megan Keith
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Shannon E May
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, Connecticut, USA
| | - Emily Shepard
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Alyssa Francis
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Elizabeth D Wilson
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Isabella Channell
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Caroline Sweeney
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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New and Emerging Opioid Overdose Risk Factors. CURRENT ADDICTION REPORTS 2021; 8:319-329. [PMID: 33907663 PMCID: PMC8061156 DOI: 10.1007/s40429-021-00368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/16/2022]
Abstract
Purpose of Review The purpose of this review is to provide a review of the current literature surrounding opioid overdose risk factors, focusing on relatively new factors in the opioid crisis. Recent Findings Both a market supply driving force and a subpopulation of people who use opioids actively seeking out fentanyl are contributing to its recent proliferation in the opioid market. Harm reduction techniques such as fentanyl testing strips, naloxone education and distribution, drug sampling behaviors, and supervised injection facilities are all seeing expanded use with increasing amounts of research being published regarding their effectiveness. Availability and use of interventions such as medication for opioid use disorder and peer recovery coaching programs are also on the rise to prevent opioid overdose. Summary The opioid epidemic is an evolving crisis, necessitating continuing research to identify novel overdose risk factors and the development of new interventions targeting at-risk populations.
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Linton SL, Winiker A, Tormohlen KN, Schneider KE, McLain G, Sherman SG, Johnson RM. "People Don't Just Start Shooting Heroin on Their 18 th Birthday": A Qualitative Study of Community Stakeholders' Perspectives on Adolescent Opioid Use and Opportunities for Intervention in Baltimore, Maryland. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:621-632. [PMID: 33826057 PMCID: PMC8024438 DOI: 10.1007/s11121-021-01226-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2021] [Indexed: 11/26/2022]
Abstract
Initiation of non-medical prescription opioid use (NMPO) during early adolescence is tightly linked to heroin and other drug use disorders and related sequelae in later adolescence and young adulthood. Few studies explore stakeholders’ perspectives on the burden and determinants of youth opioid use and barriers and facilitators to engaging youth in opioid use prevention and treatment services in urban settings with longstanding opioid epidemics. In-depth interviews were conducted with 22 stakeholders representing health and social service agencies in Baltimore, Maryland from May 2018- February 2019, to examine their perspectives on the burden and context of adolescent opioid use and identify barriers and facilitators to preventing and responding to adolescent opioid use. Transcripts were analyzed using the constant comparison method to identify themes. Most respondents described a recent uptick in opioid use independently, and in combination with other substances. As compared to heroin, NMPO was perceived to be more frequently used and less stigmatized among youth. Stakeholders perceived the process of transitioning from using NMPO to heroin as more common among White vs. Black youth and was perceived as occurring faster among White vs. Black youth. Some stakeholders believed racial differences in internal stigma against heroin use, and differential health service use among Black youth and White youth may have influenced these differences. Trauma and poverty were noted determinants of youth opioid use. Barriers to service provision included youth cognitive development, stigma and structural factors (e.g., disinvestment, lack of youth-centered and integrated services). Stakeholders perceive prevalent NMPO among Baltimore youth and identify multilevel barriers to delivering prevention, treatment and harm reduction services to this population. These findings encourage further investigation of determinants and consequences of opioid use among diverse racial/ethnic groups of youth in urban settings, and development of multilevel, youth-driven and youth-centered approaches to prevention and treatment.
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Affiliation(s)
- Sabriya L Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, US.
| | - Abigail Winiker
- Department of Health Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, US
| | - Kayla N Tormohlen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, US
| | - Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, US
| | - Grace McLain
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, US
| | - Susan G Sherman
- Department of Health Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, US
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, US
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Monico LB, Ludwig A, Lertch E, Dionne R, Fishman M, Schwartz RP, Mitchell SG. Opioid overdose experiences in a sample of US adolescents and young adults: a thematic analysis. Addiction 2021; 116:865-873. [PMID: 32770757 DOI: 10.1111/add.15216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/20/2020] [Accepted: 07/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Opioid overdose deaths among adolescents and young adults have risen sharply in the United States over recent decades. This study aimed to explore the nature of adolescent and young adult perspectives on overdose experiences. DESIGN This study involved thematic analysis of interviews undertaken as part of a mixed-methods, randomized trial of extended release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for adolescents and young adults (aged 15-21 years) with opioid use disorder (OUD). SETTING Participants were recruited during a residential treatment episode at Mountain Manor Treatment Center, in Baltimore, MD, USA. PARTICIPANTS/CASES As part of the qualitative component of this study, 35 adolescents/young adults completed up to three interviews: at baseline, 3 and 6 months after release from residential opioid use disorder treatment. MEASUREMENTS Semi-structured interviews solicited participant experiences with opioid use disorder treatment; their satisfaction with the medications used to treat opioid use disorder; counseling received; current substance use; issues related to treatment retention; their treatment goals; and their future outlook. FINDINGS Four broad themes emerged: (1) adolescents/young adults had difficulty identifying overdoses due to interpreting subjective symptoms and a lack of memory of the event, (2) this sample had difficulty perceiving risk that is misaligned with traditional understandings of overdose intentionality, (3) adolescents/young adults did not interpret personal overdose events as a catalyst for behavior change and (4) this sample experienced a greater impact to behavior change through witnessing an overdose of someone in their social network. CONCLUSIONS The sample of US adolescents and young adults in treatment for opioid use disorder expressed difficulty identifying whether or not they had experienced an overdose, expressed fluctuating intentionality for those events and did not have clear intentions to change their behavior. Witnessing an overdose appeared to be as salient an experience as going through an overdose oneself.
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Affiliation(s)
| | | | | | - Ross Dionne
- Pacifica Graduate Institute, Carpinteria, CA, USA
| | - Marc Fishman
- Mountain Manor Treatment Center, Baltimore, MD, USA
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Delamerced A, Zonfrillo MR, Monteiro K, Watson-Smith D, Wills HE. Factors affecting opioid management for injured children after hospital discharge. J Pediatr Surg 2021; 56:506-511. [PMID: 33246575 DOI: 10.1016/j.jpedsurg.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prescription opioid misuse is a national crisis. Injured children often receive opioid medication at hospital discharge, but the role these prescriptions play in the opioid crisis has not been fully elucidated. Whether these opioids are administered, the duration of severe pain requiring opioids, and what the final disposition of unused opioids is in this population remain unknown. METHODS A survey of parent/guardian perceptions of their child's pain after injury, duration of opioid administration, opioid storage and disposal, and perceptions of opioid education was designed. During a 12-month period, parents of injured children admitted to an ACS Level 1 Pediatric Trauma Center were prospectively enrolled by convenience sample. Surveys were in two steps with an enrollment survey prior to discharge and a follow-up survey 7-10 days after discharge. RESULTS Seventy of 114 (61.4%) enrolled parents/guardians completed follow-up survey. Of the 79.1% that reported an opioid prescription for their child, 92.5% filled it. Of those reporting on opioid usage, 10.4% never used the opioid, 75% used opioids <3 days, 12.5% 4-7 days, 2% >7 days. Of those who filled the opioid prescription, 83.7% reported having leftover doses. Reasons for discontinuing opioids included the child no longer had pain (87.2%), the child ran out of medication (5.1%), other (7.7%). Regarding storage, 53.3% reported utilizing an unlocked bathroom cabinet, and 81.3% unlocked kitchen space. Of those reporting unused opioids, 83.3% reported not disposing them, and 38.2% reported no plan for disposal. CONCLUSION The majority of parents/guardians of injured children report resolution of severe pain requiring opioids within 72 h of hospital discharge, and virtually all by 7 days. The majority of injured children were prescribed a greater number of doses than they needed to treat their pain. Many parents/guardians store opioids in unsecure locations and a significant proportion report no plan to dispose of unused opioid doses. Further investigation is warranted to quantify and address the gap between pain control needs and opioid prescribing practices. The rate of unsecure storage and plan to retain unused opioids are potential targets for discharge opioid education. TYPE OF STUDY Cross-sectional survey. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Anna Delamerced
- Primary Care-Population Medicine Program, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903
| | - Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903
| | - Kristina Monteiro
- Office of Medical Education and Continuous Quality Improvement, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903
| | - Debra Watson-Smith
- Division of Pediatric Surgery, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02905
| | - Hale E Wills
- Division of Pediatric Surgery, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02905; Department of Surgery, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903.
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8
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Roberson PNE, Cortez G, Trull LH, Lenger K. In Their Own Words: How Opioids Have Impacted the Lives of "Everyday" People Living in Appalachia. JOURNAL OF APPALACHIAN HEALTH 2020; 2:26-36. [PMID: 35769637 PMCID: PMC9150495 DOI: 10.13023/jah.0204.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction The opioid epidemic is ravaging people, families, and communities in Appalachia. However, limited research has examined how "everyday" people (e.g., not chronic pain patients, not medical professionals) living in these communities how opioids have impacted their lives. Objective Identify the perception of the opioid epidemic on individuals, families, and communities from people living in region most impacted regions. Methods Patients were recruited at Remote Area Medical clinics throughout Central and Southern Appalachia to complete interviews online (N = 169) or over the phone (N = 26), including one open-ended question about how opioids have impacted their lives. Results Using the qualitative method content analysis, several themes were identified, including both the positive and negative impact of opioids from the online interviews. Additionally, resiliency was found to be a common theme and a theme not often emphasized by scholars and the media. These themes also highlight the importance of social support in these communities. Further, in the phone interviews, we were able to replicate the themes, and an additional theme was identified: Systemic Cause of Opioids. Conclusion Opioid intervention must be comprehensive and include the cultural context that recognizes community ties, family and kinship support, resilience, and systemic barriers to addressing the opioid epidemic. Future interventions must harness the existing resiliency and social support in these communities to effectively combat the opioid crisis in Appalachia. Otherwise, opioids will remain the insider and further insulate Appalachian communities from systemic recovery.
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Harbaugh CM, Vu JV, DeJonckheere M, Kim N, Nichols LP, Chang T. Youth Perspectives of Prescription Pain Medication in the Opioid Crisis. J Pediatr 2020; 221:159-164. [PMID: 32143929 DOI: 10.1016/j.jpeds.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To characterize current youth perspectives of prescription pain medication. STUDY DESIGN In total, 1047 youths aged 14-24 years were recruited by targeted social media advertisements to match national demographic benchmarks. Youths were queried by open-ended text message prompts about exposure and access to prescription pain medication, perceived safety of prescribed and nonprescribed medication, and associations with the word "opioid." Responses were analyzed inductively for emerging themes and frequencies. RESULTS Among 745 respondents (71.2% response rate), 439 identified as female (59.3%), 561 as white (75.8%), and mean age was 18.3 ± 3.2 years. Previous exposure to prescription pain medication was reported by 377 respondents (52.0%), most commonly related to dentistry (32.8%), surgery (19.2%), and injury (12.0%). Nonmedical sources of access to prescription pain medication were identified by 256 respondents (36.9%) and medical sources other than their doctor by an additional 111 respondents (16.0%). Three additional themes emerged from youth responses: (1) prescribed medication was thought to be safer than nonprescribed medication, based on trust in doctors; (2) risks of addiction and overdose were thought to be greater for nonprescribed medication; (3) respondents had a widely ranging understanding of the word "opioid," from historical to current events, medical to illicit substances, and personal to public associations. CONCLUSIONS Although youths are aware of the opioid crisis, they perceive less risk of prescription pain medication prescribed by a doctor, than from other sources. Policies should target education to youth in clinical and nonclinical settings, highlighting the risks of addiction and overdose with all opioids.
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Affiliation(s)
| | - Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Noa Kim
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Lauren P Nichols
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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Thompson JR, Creasy SL, Mair CF, Burke JG. Drivers of opioid use in Appalachian Pennsylvania: Cross-cutting social and community-level factors. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102706. [PMID: 32151913 DOI: 10.1016/j.drugpo.2020.102706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Four Appalachian states including Pennsylvania (PA) have the highest drug overdose rates in the country, calling for better understanding of the social and economic drivers of opioid use in the region. Using key informant interviews, we explored the social and community drivers of opioid use in a non-urban Appalachian Pennsylvania community. METHODS In 2017, we conducted qualitative interviews with 20 key stakeholders from a case community selected using the results from quantitative spatial models of hospitalizations for opioid use disorders. In small town located 10 miles outside Pittsburgh, PA, we asked participants to share their perceptions of contextual factors that influence opioid use among residents. We then used qualitative thematic analysis to organize and generate the results. RESULTS Participants identified several contextual factors that influence opioid use among residents. Three cross-cutting thematic topics emerged: 1) acceptance and denial of use through familial and peer influences, community environments, and social norms; 2) impacts of economic shifts and community leadership on availability of programs and opportunities; and 3) the role of coping within economic disadvantage and social depression. CONCLUSION Uncovering multi-level, contextual drivers of opioid use can benefit the development of future public health interventions. These results suggest that social and community-level measures of structural deprivation, acceptance and/or denial of the opioid epidemic, community engagement and development, social support, and social depression are important for future research and programmatic efforts in the Appalachian region.
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Affiliation(s)
- Jessica R Thompson
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, United States; Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, United States.
| | - Stephanie L Creasy
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, United States; Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, United States
| | - Christina F Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, United States; Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, United States
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, United States; Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, United States
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Bowen EA, Irish A. A policy mapping analysis of goals, target populations, and punitive notions in the U.S. congressional response to the opioid epidemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:90-97. [DOI: 10.1016/j.drugpo.2019.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/26/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
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Persmark A, Wemrell M, Evans CR, Subramanian SV, Leckie G, Merlo J. Intersectional inequalities and the U.S. opioid crisis: challenging dominant narratives and revealing heterogeneities. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1626002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Anna Persmark
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Maria Wemrell
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Clare R. Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health; Harvard Center for Population and Development Studies, Boston, MA, USA
| | - George Leckie
- Centre for Multilevel Modelling, University of Bristol, Bristol, UK
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
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Chen YT, Issema RS, Khanna AS, Pho MT, Schneider JA. Prescription Opioid Use in a Population-Based Sample of Young Black Men Who Have Sex with Men: A Longitudinal Cohort Study. Subst Use Misuse 2019; 54:1991-2000. [PMID: 31198077 PMCID: PMC6764892 DOI: 10.1080/10826084.2019.1625400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Prescription opioid use (POU) among young adults is increasing. This represents a major public health concern due to the increased risks of opioid use misuse and opioid-related overdose. Limited research has examined the POU among young black men who have sex with men (YBMSM), a diverse group experiencing continued increases in HIV incidence over the past decade. Objective: This study aims to examine the prevalence and both the individual and network characteristics of POU among YBMSM. Methods: Data were from a longitudinal cohort study of 16-29 year old YBMSM (N = 514) between 2013 and 2016 in Chicago. Bivariate and multivariable associations were estimated using general estimating equations (GEE). Results: Approximately 4.2% of YBMSM reported POU in the past 12 months with a cumulative incidence rate of 4.1% over the 18-month follow-up period. YBMSM having criminal justice involvements, experiencing violence, or using any illicit drug other than marijuana in the past 12 months were more likely to report POU in the past 12 months. The presence of a mother figure, however, was associated with a decreased risk of POU in the past 12 months, while engaging in condomless anal sex with their named sexual partners was associated with an increased risk of POU in the past 12 months. Conclusions: This is one of the first studies to describe POU among a population-based sample of YBMSM. The high incidence rate of POU among YBMSM is alarming, and it underscores the need for further analysis on POU among this key population.
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Affiliation(s)
- Yen-Tyng Chen
- Chicago Center for HIV Elimination , Chicago , IL , USA.,Department of Medicine, University of Chicago , Chicago , IL , USA
| | - Rodal S Issema
- Chicago Center for HIV Elimination , Chicago , IL , USA.,Department of Medicine, University of Chicago , Chicago , IL , USA
| | - Aditya S Khanna
- Chicago Center for HIV Elimination , Chicago , IL , USA.,Department of Medicine, University of Chicago , Chicago , IL , USA
| | - Mai T Pho
- Department of Medicine, University of Chicago , Chicago , IL , USA
| | - John A Schneider
- Chicago Center for HIV Elimination , Chicago , IL , USA.,Department of Medicine, University of Chicago , Chicago , IL , USA.,Department of Public Health Sciences, University of Chicago , Chicago , IL , USA
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Krieger MS, Goedel WC, Buxton JA, Lysyshyn M, Bernstein E, Sherman SG, Rich JD, Hadland SE, Green TC, Marshall BDL. Use of rapid fentanyl test strips among young adults who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 61:52-58. [PMID: 30344005 PMCID: PMC6701177 DOI: 10.1016/j.drugpo.2018.09.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The overdose epidemic has been exacerbated by a dramatic increase in deaths involving illicitly manufactured fentanyl (IMF). Drug checking is a novel strategy to identify IMF in illicit drugs. We examined the uptake and acceptability of rapid fentanyl test strips among young adults. METHODS From May to September 2017, we recruited 93 young adults in Rhode Island who reported injecting drugs or using heroin, cocaine, or illicitly obtained prescription pills in the past 30 days. Participants were asked to test either their urine after drug use (post-consumption) or a drug sample prior to use (pre-consumption) using rapid fentanyl test strips. After a questionnaire and a brief training, participants received ten strips for their personal use and were asked to return for a one-month follow-up visit, which assessed the uptake and acceptability of the rapid strips tests and the behavioral outcomes associated with receipt of a positive test. RESULTS Of the 81 (87%) participants who returned for follow-up and who had complete data, the mean age was 27, 45 (56%) were male, and 37 (46%) were non-white. A total of 62 participants (77%) reported using at least one test strip. Of these, 31 (50%) received at least one positive result. A positive result was associated with older age, homelessness, heroin use, injection drug use, ever witnessing an overdose, and concern about overdose or drugs being laced with fentanyl (all p < 0.05). Receiving a positive result was significantly associated with reporting a positive change in overdose risk behavior between baseline and follow-up (p ≤ 0.01). Among all participants, 79 (98%) reported confidence in their ability to use the test strips and 77 (95%) wanted to use them in the future. CONCLUSIONS Young adults reported high uptake and acceptability of fentanyl test strips to detect IMF in illicit drugs.
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Affiliation(s)
- Maxwell S Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Vancouver Coastal Health, Vancouver, Canada
| | - Edward Bernstein
- Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, USA; Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Josiah D Rich
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
| | - Scott E Hadland
- Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, USA; Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, USA
| | - Traci C Green
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Emergency Medicine, Grayken Center for Addiction, Boston University School of Medicine, Boston, USA; Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, USA; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
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Marshall BD, Green TC, Elston B, Yedinak JL, Hadland SE, Clark MA. The Effectiveness of Internet- and Field-Based Methods to Recruit Young Adults Who Use Prescription Opioids Nonmedically. Subst Use Misuse 2018; 53:1688-1699. [PMID: 29364768 PMCID: PMC6128140 DOI: 10.1080/10826084.2018.1425725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nonmedical prescription opioid (NMPO) use is a problem among young adults, yet young NMPO users are a diverse population that has been challenging to engage in overdose prevention and harm reduction programs. OBJECTIVES This study compared the effectiveness and characteristics of persons recruited through two different sampling strategies to inform research and intervention efforts with young adult NMPO users. METHODS We analyzed data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which enrolled persons aged 18 to 29 who reported past 30-day NMPO use. We compared the characteristics of two samples recruited simultaneously between February 2015 and February 2016. One sample was recruited using field-based strategies (e.g., respondent-driven sampling, transit ads), and a second from internet sources (e.g., online classifieds). RESULTS Among 198 eligible participants, the median age was 25 (IQR: 22, 27), 130 (65.7%) were male, 123 (63.1%) were white, and 150 (78.1%) resided in urban areas. A total of 79 (39.9%) were recruited using field-based strategies and 119 (60.1%) were recruited from internet sources. Internet-recruited persons were younger (median = 24 [IQR: 21, 27] vs. 26 [IQR: 23, 28] years) and more likely to reside in rural areas (16.2% vs. 5.3%), although this finding was marginally significant. Field-recruited participants were more likely to have been homeless (36.7% vs. 17.7%), have been incarcerated (39.7% vs. 21.8%), and engage in daily NMPO use (34.6% vs. 14.5%). CONCLUSIONS Multipronged outreach methods are needed to engage the full spectrum of young adult NMPO users in prevention and harm reduction efforts.
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Affiliation(s)
- Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Traci C. Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
- Boston University School of Medicine, Department of Emergency Medicine, 771 Albany Street, Room 1208, Boston, MA, 02118, USA
- The Warren Alpert School of Medicine of Brown University, Department of Emergency Medicine, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jesse L. Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Scott E. Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 332, Boston, MA 02118, USA
- Department of Pediatrics, Boston Medical Center, 850 Harrison Ave, Boston, MA, 02118, USA
| | - Melissa A. Clark
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
- Department of Quantitative Health Sciences & Center for Health Policy and Research, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA
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Le VT, Norris Turner A, McDaniel A, Hale KM, Athas C, Kwiek NC. Nonmedical use of over-the-counter medications is significantly associated with nonmedical use of prescription drugs among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:1-8. [PMID: 28812451 DOI: 10.1080/07448481.2017.1356312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the association between nonmedical use of over-the-counter medications (NMUOTC) and nonmedical use of prescription drugs (NMUPD). PARTICIPANTS University students surveyed on NMUOTC and NMUPD between August and December 2011 (N = 939). METHODS Cross-sectional data analysis of online survey. RESULTS The majority of respondents were women, undergraduate, Caucasian, and not affiliated with Greek life. NMUPD and NMUOTC were reported by 21.4% and 11.2% of students, respectively. NMUOTC was significantly associated with NMUPD in unadjusted analyses and after adjustment for gender, age, race/ethnicity, and Greek membership (odds ratio: 3.37, 95% confidence interval: 2.17, 5.23). Secondary analyses showed a relationship between over-the-counter (OTC) cough medication misuse and NMUPD, OTC stimulant misuse and prescription stimulant misuse, and OTC sleep aid misuse with prescription depressant misuse. CONCLUSIONS Results suggest the importance of both measuring the prevalence of OTC misuse and incorporating its misuse into assessments of polydrug use in the university population.
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Affiliation(s)
- Vi T Le
- a College of Public Health , The Ohio State University , Columbus , Ohio , USA
| | - Abigail Norris Turner
- b Division of Infectious Diseases, College of Medicine , The Ohio State University , Columbus , Ohio , USA
| | - Anne McDaniel
- c The Center for the Study of Student Life, Office of Student Life , The Ohio State University , Columbus , Ohio , USA
| | - Kenneth M Hale
- d Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery , The Ohio State University , Columbus , Ohio , USA
| | - Christina Athas
- c The Center for the Study of Student Life, Office of Student Life , The Ohio State University , Columbus , Ohio , USA
| | - Nicole C Kwiek
- e Division of Pharmacology, College of Pharmacy , The Ohio State University , Columbus , Ohio , USA
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Liebling EJ, Green TC, Hadland SE, Marshall BD. Injection drug use and overdose among young adults who use prescription opioids non-medically. Addict Behav 2018; 76:20-26. [PMID: 28735037 DOI: 10.1016/j.addbeh.2017.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/29/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Non-medical prescription opioid (NMPO) use is a critical public health problem in the United States, with 2.1 million new initiates annually. Young adult NMPO users are at high risk for initiating injection drug use. We assessed correlates of injection drug use among young adult NMPO users in Rhode Island, a state heavily impacted by opioid overdose. METHODS We used data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which recruited 199 residents aged 18-29 who reported past-30-day NMPO use (65.3% male). We compared individuals who reported ever having injected with individuals who reported never injecting, using logistic regression to identify independent correlates of injection. RESULTS Among eligible participants, the mean age was 24.6years and 61.3% were white. Over one-quarter (n=59, 29.6%) of the sample had ever injected drugs. The majority (n=46, 78.0%) of participants who had ever injected drugs reported injecting heroin as her/his first drug; the majority also reported previously snorting her/his first drug that was injected (n=46, 78.0%). In multivariable analyses, white race, older age, lifetime homelessness, and ever having overdosed or seen someone overdose were independently associated with an increased likelihood of ever injecting drugs. CONCLUSIONS These findings demonstrate a high prevalence of lifetime injection drug use among young adults who use prescription opioids non-medically. Given the observed associations between injection drug use and witnessing as well as experiencing overdose, interventions are urgently needed to improve overdose education and naloxone distribution to young adult NMPO users who inject drugs.
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