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Resko SM, Pasman E, Hicks DL, Lee G, Ellis JD, O'Shay S, Brown S, Agius E. Naloxone Knowledge and Attitudes Towards Overdose Response Among Family Members of People who Misuse Opioids. J Community Health 2024; 49:70-77. [PMID: 37450091 DOI: 10.1007/s10900-023-01257-x] [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] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Providing family members of individuals with opioid use disorders (OUD) naloxone is a cost-effective way to prevent overdose deaths. However, misconceptions and negative attitudes towards naloxone hinder family engagement with naloxone programs. This study examines factors associated with knowledge and attitudes toward naloxone among adults with close family members who misused opioids. Adults with family members (parent, step-parent, child, spouse, sibling, or step-sibling) who misused opioids (N = 299) completed a web-based survey. Participants were recruited through treatment providers, community groups, and social media. Surveys assessed naloxone knowledge, attitudes toward overdose response, demographics, completion of naloxone training, attitude toward medications for OUD, and family members' overdose history. Multiple regression was used to identify factors associated with naloxone knowledge (Model 1) and attitudes toward overdose response (Model 2). A graduate degree (B = .35, p < .003) and a history of overdose (B = 0.21, p = .032) were associated with greater naloxone knowledge. Age (B = .11, p < .001), race/ethnicity (B = -1.39, p = .037), naloxone training (B = 2.70, p < .001), and more positive attitude toward medications for OUD (B = 1.50, p = .003) were associated with attitudes toward overdose response. Family members are potential allies in reducing drug overdose deaths, and families may need broader education about naloxone. Awareness of previous overdose was associated with greater naloxone knowledge. Findings related to race/ethnicity suggest the need to reach family members of minoritized racial groups to provide access to naloxone training. Findings point to where education and distribution efforts may focus on increasing knowledge and improving attitudes among those closest to people with OUD.
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Affiliation(s)
- Stella M Resko
- School of Social Work, Wayne State University, Detroit, MI, US.
- Wayne State University, Merrill Palmer Skillman Institute, Detroit, MI, US.
| | - Emily Pasman
- School of Social Work, Wayne State University, Detroit, MI, US
| | | | - Guijin Lee
- School of Public Health, University of Memphis, Memphis, TN, US
| | | | - Sydney O'Shay
- Communication Studies and Philosophy, Utah State University, Logan, UT, US
| | - Suzanne Brown
- School of Social Work, Wayne State University, Detroit, MI, US
| | - Elizabeth Agius
- School of Social Work, Wayne State University, Detroit, MI, US
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Urmanche AA, Harocopos A. Experiences Administering Naloxone Among People in Different Social Roles: People Who Use Opioids and Family Members and Friends. JOURNAL OF DRUG ISSUES 2023; 53:475-489. [PMID: 37829614 PMCID: PMC10569559 DOI: 10.1177/00220426221133024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Unintentional drug overdose deaths continue to be a critical public health issue. Naloxone, a nonscheduled, safe, and effective drug that reverses opioid-involved overdoses is available to non-medically trained individuals ("lay people"), but there is scant information about how people in different social roles experience naloxone administration. We conducted 24 in-depth interviews with people who use opioids (PWUO; n = 15) and family members and friends of people who use opioids (FF; n = 9) who had administered naloxone in response to an opioid overdose. Compared with PWUO, members of the FF group were less reticent to administer naloxone in response to an overdose. PWUO and FF had different perspectives of law enforcement and demonstrated varied knowledge of the Good Samaritan Law. While PWUO found that having and administering naloxone was empowering, FF took a more pragmatic approach, reporting the need for naloxone as an unfortunate reality of their loved one's drug use.
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Affiliation(s)
- Adelya A Urmanche
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care and Treatment, NY, USA
| | - Alex Harocopos
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care and Treatment, NY, USA
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Kohli S, Garg J, Velasquez DE, Weiner SG. Designing a public access naloxone program for public transportation stations. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100694. [PMID: 37247465 DOI: 10.1016/j.hjdsi.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
The opioid overdose epidemic has caused over 600,000 deaths in the U.S. since 1999. Public access naloxone programs show great potential as a strategy for reducing opioid overdose-related deaths. However, their implementation within public transit stations, often characterized as opioid overdose hotspots, has been limited, partly because of a lack of understanding in how to structure such programs. Here, we propose a comprehensive framework for implementing public access naloxone programs at public transit stations to curb opioid overdose-related deaths. The framework, tailored to local contexts, relies on coordination between local public health organizations to provide naloxone at public access points and bystander training, local academic institutions to oversee program evaluation, and public transit organizations to manage naloxone maintenance. We use the city of Cambridge, Massachusetts as a case study to demonstrate how it and other municipalities may implement such an initiative.
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Affiliation(s)
| | | | - David E Velasquez
- Harvard Medical School, USA; Harvard Business School, USA; Harvard Kennedy School of Government, USA
| | - Scott G Weiner
- Harvard Medical School, USA; Brigham and Women's Hospital, USA.
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Bohler RM, Freeman PR, Villani J, Hunt T, Linas BS, Walley AY, Green TC, Lofwall MR, Bridden C, Frazier LA, Fanucchi LC, Talbert JC, Chandler R. The policy landscape for naloxone distribution in four states highly impacted by fatal opioid overdoses. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100126. [PMID: 36643788 PMCID: PMC9838196 DOI: 10.1016/j.dadr.2022.100126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Expanding access to naloxone is one of the most impactful interventions in decreasing opioid-related mortality. However, state distribution rates of naloxone are insufficient to meet community need. The current study sought to better understand this gap by focusing on state policies that may facilitate or impede naloxone distribution in four states highly impacted by fatal opioid overdoses - Kentucky, Massachusetts, New York, and Ohio. Methods We provide a descriptive analysis of the policy landscape impacting naloxone distribution through pharmacy and community channels in the four states participating in the HEALing Communities Study (HCS). Publicly available data and the expertise of the research team were used to describe each state's naloxone access laws (NALs), Medicaid coverage of naloxone, and community overdose education and naloxone distribution infrastructure. Data presented in this study represent the most current policy landscape through September 2022. Results Variation exists between specific components of the NALs of each state, the structure of Medicaid coverage of naloxone, and the community distribution infrastructure networks. Massachusetts and New York have a statewide standing order, but other states use different strategies short of a statewide standing order to expand access to naloxone. Quantity limits specific to naloxone may limit access to Medicaid beneficiaries in some states. Conclusion States participating in the HCS have developed innovative but different mechanisms to ensure naloxone access. Policies were dynamic and moved towards greater access. Research should consider the policy landscape in the implementation and sustainability of interventions as well as the analysis of outcomes.
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Affiliation(s)
- Robert M. Bohler
- Institute for Behavioral Health, Brandeis University, 415 South Street, Waltham, MA 02453, United States,Corresponding author. (R.M. Bohler)
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Tim Hunt
- School of Social Work, Social Intervention Group (SIG), Center for Healing of Opioid and Other Substance Use Disorders (CHOSEN), Columbia University, New York, NY, United States
| | - Beth S. Linas
- RTI International, Research Triangle Park, NC, United States
| | - Alexander Y. Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Traci C. Green
- Institute for Behavioral Health, Brandeis University, 415 South Street, Waltham, MA 02453, United States
| | - Michelle R. Lofwall
- Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Carly Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Lisa A. Frazier
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Laura C. Fanucchi
- Department of Internal Medicine, Division of Infectious Disease, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Jeffery C. Talbert
- Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Redonna Chandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
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Macmadu A, Yolken A, Frueh L, Toussaint JR, Newman R, Jacka BP, Collins AB, Marshall BDL. Characteristics of events in which police responded to overdoses: an examination of incident reports in Rhode Island. Harm Reduct J 2022; 19:116. [PMID: 36258209 PMCID: PMC9578237 DOI: 10.1186/s12954-022-00698-2] [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] [Received: 06/13/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Narrow or non-existent Good Samaritan Law protections and harsh drug selling statutes in the USA have been shown to deter bystanders from seeking medical assistance for overdoses. Additionally, little is known about the actions that police take when responding to overdose events. The objectives of this study were to assess the prevalence and correlates of naloxone administration by police, as well as to examine overdose events where arrests were made and those in which the person who overdosed was described as combative. Methods We analyzed incident reports of police responding to an overdose between September 1, 2019, and August 31, 2020 (i.e., 6 months prior to and during the COVID-19 pandemic), from a city in Rhode Island. We examined characteristics of incidents, as well as individual characteristics of the person who overdosed. Correlates of police naloxone administration were assessed using Wilcoxon rank sum tests and Fisher’s exact tests, and we examined incidents where arrests occurred and incidents in which the person who overdosed was described as combative descriptively. Results Among the 211 incidents in which police responded to an overdose during the study period, we found that police administered naloxone in approximately 10% of incidents. In most incidents, police were the last group of first responders to arrive on scene (59%), and most often, naloxone was administered by others (65%). Police were significantly more likely to administer naloxone when they were the first professionals to arrive, when naloxone had not been administered by others, and when the overdose occurred in public or in a vehicle. Arrests at overdose events were rarely reported (1%), and people who overdosed were rarely (1%) documented in incident reports as being ‘combative.’ Conclusions Considering these findings, ideally, all jurisdictions should have sufficient first responder staffing and resources to ensure a rapid response to overdose events, with police rarely or never dispatched to respond to overdoses. However, until this ideal can be achieved, any available responders should be dispatched concurrently, with police instructed to resume patrol once other professional responders arrive on scene; additionally, warrant searches of persons on scene should be prohibited. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00698-2.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | | | - Lisa Frueh
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Jai'el R Toussaint
- Department of Africana Studies, Brown University Churchill House, 155 Angell Street, Providence, RI, USA
| | - Roxxanne Newman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Brendan P Jacka
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - 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.
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Slocum S, Ozga JE, Joyce R, Walley AY, Pollini RA. If we build it, will they come? Perspectives on pharmacy-based naloxone among family and friends of people who use opioids: a mixed methods study. BMC Public Health 2022; 22:735. [PMID: 35418048 PMCID: PMC9006069 DOI: 10.1186/s12889-022-13078-z] [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] [Received: 12/13/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose "bystanders" (friends or family of people who use opioids) that may be amenable to intervention. METHODS Eligible bystanders were Massachusetts residents ≥ 18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22) were conducted April-July 2018, to inform the development of a subsequent quantitative survey (N = 260), conducted February-July 2020. RESULTS Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one's drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone. CONCLUSIONS Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma, and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jenny E Ozga
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Rebecca Joyce
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Alexander Y Walley
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA.,Grayken Center for Addiction, Clinical Addiction Research Education Unit, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA. .,Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA.
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7
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Parkes T, Foster R, McAuley A, Steven D, Matheson C, Baldacchino A. Chronic pain, prescribed opioids and overdose risk: a qualitative exploration of the views of affected individuals and family members. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2021.2022100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Alex Baldacchino
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews, UK
- NHS Addiction Services, NHS Fife, Kirkcaldy, UK
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Cano M, Agan A, Bandoian L, Larochelle L. Individual and County-Level Disparities in Drug and Opioid Overdose Mortality for Hispanic Men in Massachusetts and the Northeast United States. Subst Use Misuse 2022; 57:1131-1143. [PMID: 35459423 DOI: 10.1080/10826084.2022.2064507] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to identify individual- and county-level inequalities that may underlie disparities in drug overdose mortality for Hispanic men in Massachusetts and the broader Northeast region. METHODS The study first used data from the State Unintentional Drug Overdose Reporting System to compare the 635 Hispanic and 3593 Non-Hispanic (NH) White men who died of unintentional/undetermined opioid-related overdoses in Massachusetts in 2016-2018. Next, the study used 2015-2019 data from the Multiple Cause of Death online platform to: a) compare rates of drug overdose mortality in Hispanic versus NH White men in 54 counties in the Northeast United States; and b) examine associations with inequalities in poverty, educational attainment, unemployment, and uninsurance (from 2015-2019 American Community Survey data). RESULTS At the individual level, in Massachusetts, Hispanic and NH White men who died of opioid-related overdose differed in terms of educational attainment, birthplace, urbanicity, substance use disorder treatment history, and specific drugs involved in death. At the county level, in the Northeast region, each one-standard deviation increase in the ratio of the Hispanic to NH White poverty rate was associated with a 27% increase in the ratio of Hispanic to NH White male overdose mortality; each one-standard deviation increase in the ratio of the Hispanic to NH White unemployment rate was associated with a 43% increase in the ratio of Hispanic to NH White male overdose mortality. CONCLUSIONS Findings underscore the importance of equitable interventions and efforts to address inequalities in social determinants of health for Hispanic populations in the Northeast.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Anna Agan
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lisa Bandoian
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lauren Larochelle
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
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Zang X, Macmadu A, Krieger MS, Behrends CN, Green TC, Morgan JR, Murphy SM, Nolen S, Walley AY, Schackman BR, Marshall BDL. Targeting community-based naloxone distribution using opioid overdose death rates: A descriptive analysis of naloxone rescue kits and opioid overdose deaths in Massachusetts and Rhode Island. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103435. [PMID: 34482264 PMCID: PMC8671216 DOI: 10.1016/j.drugpo.2021.103435] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rates of fatal opioid overdose in Massachusetts (MA) and Rhode Island (RI) far exceed the national average. Community-based opioid education and naloxone distribution (OEND) programs are effective public health interventions to prevent overdose deaths. We compared naloxone distribution and opioid overdose death rates in MA and RI to identify priority communities for expanded OEND. METHODS We compared spatial patterns of opioid overdose fatalities and naloxone distribution through OEND programs in MA and RI during 2016 to 2019 using public health department data. The county-level ratio of naloxone kits distributed through OEND programs per opioid overdose death was estimated and mapped to identify potential gaps in naloxone availability across geographic regions and over time. RESULTS From 2016 to 2019, the statewide community-based naloxone distribution to opioid overdose death ratio improved in both states, although more rapidly in RI (from 11.8 in 2016 to 35.6 in 2019) than in MA (from 12.3 to 17.2), driven primarily by elevated and increasing rates of naloxone distribution in RI. We identified some urban/non-urban differences, with higher naloxone distribution relative to opioid overdose deaths in more urban counties, and we observed some counties with high rates of overdose deaths but low rates of naloxone kits distributed through OEND programs. CONCLUSIONS We identified variations in spatial patterns of opioid overdose fatalities and naloxone availability, and these disparities appeared to be widening in some areas over time. Data on the spatial distribution of naloxone distribution and opioid overdose deaths can inform targeted, community-based naloxone distribution strategies that optimize resources to prevent opioid overdose fatalities.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Alexandria Macmadu
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Maxwell S Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Czarina N Behrends
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, United States
| | - Traci C Green
- Institute for Behavioral Health, School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Sean M Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, United States
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, United States
| | - Brandon DL Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
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Shrestha S, Stopka TJ, Hughto JMW, Case P, Palacios WR, Reilly B, Green TC. Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017-2019. Harm Reduct J 2021; 18:93. [PMID: 34461922 PMCID: PMC8404353 DOI: 10.1186/s12954-021-00538-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People who experience non-fatal overdose (NFOD) are at high risk of subsequent overdose. With unprecedented increases in fentanyl in the US drug supply, many Massachusetts (MA) communities have seen a surge in opioid-related overdoses. The objective of this study was to determine factors associated with lifetime and past year NFOD in at-risk MA communities. METHODS We conducted multiple rapid assessments among people who use drugs (PWUD) in eight MA communities using non-probability sampling (purposive, chain referral, respondent-driven) methods. We collected sociodemographic, substance use, overdose history, substance use treatment, and harm reduction services utilization data. We examined the prevalence of NFOD (lifetime and past year) and identified factors associated with NFOD through multivariable logistic regression analyses in a subset of 469 study participants between 2017 and 2019. RESULTS The prevalence of lifetime and last year non-fatal opioid overdose was 62.5% and 36.9%, respectively. Many of the study participants reported heroin (64%) and fentanyl (45%) use during the 30 days preceding the survey. Nonprescription buprenorphine and fentanyl use were independently associated with higher odds of lifetime NFOD, while marijuana use was associated with lower odds of lifetime NFOD (p < 0.05). Injection as the route of administration, benzodiazepine, nonprescription buprenorphine, heroin, and fentanyl use were independently associated with higher odds, while methadone use was associated with lower odds of past year NFOD (p < 0.05). CONCLUSION We documented a high prevalence of past year and lifetime NFOD among PWUD in MA. Our findings provide indicators that can help inform interventions to prevent overdoses among PWUD, including overdose prevention, medication treatment, and naloxone distribution.
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Affiliation(s)
- Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Jaclyn M W Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Patricia Case
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Wilson R Palacios
- School of Criminology and Justice Studies, University of Massachusetts, Lowell, MA, USA
| | - Brittni Reilly
- Massachusetts Department of Public Health, Bureau of Substance Addiction Services, Boston, MA, USA
| | - Traci C Green
- Opioid Policy Research Collaborative, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
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11
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Bohler RM, Hodgkin D, Kreiner PW, Green TC. Predictors of US states' adoption of naloxone access laws, 2001-2017. Drug Alcohol Depend 2021; 225:108772. [PMID: 34052687 PMCID: PMC8282714 DOI: 10.1016/j.drugalcdep.2021.108772] [Citation(s) in RCA: 3] [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] [Received: 02/12/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The opioid crisis has put an increasing strain on US states over the last two decades. In response, all states have passed legislation to implement a portfolio of policies to address the crisis. Although effects of some of these policies have been studied, research into factors associated with state policy adoption decisions has largely been lacking. We address this gap by focusing on factors associated with adoption of naloxone access laws (NAL), which aim to increase the accessibility and availability of naloxone in the community as a harm reduction strategy to reduce opioid-related morbidity and mortality. METHODS We used event history analysis (EHA) to identify predictors of the diffusion of naloxone access laws (NAL) from 2001, when the first NAL was passed, to 2017, when all states had adopted NAL. A variety of state characteristics were included in the model as potential predictors of adoption. RESULTS We found that state adoption of NAL increased gradually, then more rapidly starting in 2013. Consistent with this S-shaped diffusion process, the strongest predictor of adoption was prior adoption by neighboring states. Having a more conservative political ideology and having a higher percentage of residents who identified as evangelical Protestants were associated with later adoption of NAL. CONCLUSION States appear to be influenced by their neighbors in deciding whether and when to adopt NAL. Advocacy for harm reduction policies like NAL should take into account the political and religious culture of a state.
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Affiliation(s)
- Robert M Bohler
- Institute for Behavioral Health, Brandeis University, Waltham, MA, United States.
| | - Dominic Hodgkin
- Institute for Behavioral Health, Brandeis University, Waltham, MA, United States
| | - Peter W Kreiner
- Institute for Behavioral Health, Brandeis University, Waltham, MA, United States
| | - Traci C Green
- Institute for Behavioral Health, Brandeis University, Waltham, MA, United States
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Uzwiak BA, Hudgins A, Pizzicato LN. Legacies of the war on drugs: Next of kin of persons who died of opioid overdose and harm reduction interventions in Philadelphia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103351. [PMID: 34252788 DOI: 10.1016/j.drugpo.2021.103351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Between the years 2017-2019 in Philadelphia, more than 70% of all deaths from opioid overdose occurred in a private residence. To learn more about home-based opioid use and overdose, researchers conducted qualitative interviews with next of kin of overdose victims to learn their perceptions about the decedent's drug use and their opinions about city-led harm reduction efforts, specifically naloxone administration and collaborative efforts to open an overdose prevention site. METHODS In 2019, researchers conducted 35 qualitative interviews with next of kin of persons who died of opioid overdose in Philadelphia in 2017. Data were coded and analyzed using NVivo software. RESULTS Data reveal that while persons who use drugs may benefit from enhanced harm reduction interventions that target their family members and caregivers including naloxone education and public health messaging about overdose prevention, these efforts may be up against other realities that Philadelphia families navigate-in particular structural inequalities exacerbated by decades of "War on Drugs" policies. CONCLUSION Existing health disparities and structural barriers to care increase vulnerability to overdose and highlight the urgency to collaborate with impacted families and communities to design relevant harm reduction interventions. Without efforts to redress the consequences of war on drug policies, however, harm reduction interventions will not reach their full potential.
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Affiliation(s)
| | | | - Lia N Pizzicato
- Division of Substance Use and Harm Reduction, Philadelphia Department of Public Health, United States
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13
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Risk Stratification for Naloxone Rescue Kit Interventions at a Veterans Affairs Teaching Hospital. J Clin Psychopharmacol 2021; 40:513-515. [PMID: 32796390 DOI: 10.1097/jcp.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antoniou T, Martins D, Campbell T, Tadrous M, Munro C, Leece P, Mamdani M, Juurlink DN, Gomes T. Impact of policy changes on the provision of naloxone by pharmacies in Ontario, Canada: a population-based time-series analysis. Addiction 2021; 116:1514-1520. [PMID: 33207025 PMCID: PMC8247272 DOI: 10.1111/add.15324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS In June 2016, the Ontario, Canada government implemented the Ontario Naloxone Program for Pharmacies (ONPP), authorizing pharmacists to provide injectable naloxone kits at no charge to all Ontario residents. In March 2018, the program was amended to include intranasal naloxone and remove the requirement to present a government health card to the dispensing pharmacist. We examined whether these changes increased naloxone dispensing through the ONPP. DESIGN Population-based time-series analysis using interventional autoregressive integrated moving average models. SETTING Ontario, Canada. PARTICIPANTS All Ontario residents between 1 July 2016 and 31 March 2020. MEASUREMENTS Monthly rates of pharmacy naloxone dispensing. FINDINGS Overall, 199 484 individuals were dispensed a naloxone kit during the study period. In the main analysis, the rate of pharmacy naloxone dispensing increased by 65.1% following program changes (55.6-91.8 kits per 100 000 population between February 2018 and May 2018; P = 0.01). In subgroup analyses, naloxone dispensing increased among individuals receiving opioid agonist therapy (OAT) (3374.9-7264.2 kits per 100 000 OAT recipients; P = 0.04) among individuals receiving other prescription opioids (192.8-381.8 kits per 100 000 population prescribed opioids; P < 0.01), among individuals with past opioid exposure (134.7-205.6 kits per 100 000 population with past opioid exposure; P < 0.01) and in urban centers (56.2-91.4 kits per 100 000 population; P < 0.01). We did not observe a clear impact on pharmacy-dispensed naloxone to individuals with no or unknown opioid exposure (34.4-39.3 kits per 100 000 population with no/unknown opioid exposure; P = 0.42) and in rural regions (50.4-97.2 kits per 100 000 population; P = 0.09). CONCLUSIONS Changes to the Ontario Naloxone Program for Pharmacies to add intranasal naloxone and remove the requirement to present a government health card appeared to increase pharmacy-based naloxone dispensing uptake in Ontario, Canada, particularly among individuals at high risk of inadvertent opioid overdose.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada,ICESTorontoOntarioCanada,Department of Family and Community Medicine, Unity HealthTorontoOntarioCanada,Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Diana Martins
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada
| | | | - Mina Tadrous
- ICESTorontoOntarioCanada,Women's College HospitalTorontoOntarioCanada,Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Charlotte Munro
- Ontario Drug Policy Research Network Lived Experience Advisory GroupTorontoOntarioCanada
| | | | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada,ICESTorontoOntarioCanada,Family and Community MedicineUniversity of TorontoTorontoOntarioCanada,Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoOntarioCanada,Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - David N. Juurlink
- ICESTorontoOntarioCanada,Department of PediatricsUniversity of TorontoTorontoOntarioCanada,Family and Community MedicineUniversity of TorontoTorontoOntarioCanada,Department of MedicineUniversity of TorontoTorontoOntarioCanada,The Sunnybrook Research InstituteTorontoCanada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada,ICESTorontoOntarioCanada,Family and Community MedicineUniversity of TorontoTorontoOntarioCanada,Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoOntarioCanada
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Wood CA, Green L, La Manna A, Phillips S, Werner KB, Winograd RP, Stuckenschneider A. Balancing need and risk, supply and demand: Developing a tool to prioritize naloxone distribution. Subst Abus 2021; 42:974-982. [PMID: 33759727 DOI: 10.1080/08897077.2021.1901174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Opioid overdose deaths continue to rise nationally. The demand for naloxone, the opioid overdose antidote, is outpacing the supply. With increasing naloxone requests, tools to prioritize distribution are critical to ensure available supplies will reach those at highest risk of overdose. Methods: We developed a standardized "Naloxone Request Form" (NRF) and corresponding weighted prioritization algorithm to serve as decisional aid to better enable grant staff to prioritize naloxone distribution in a data-driven manner. The algorithm computed raw priority scores for each agency, which were then separated into the predetermined quintiles. Historical naloxone distribution decisions were compared with agencies' prioritization quintile. Results: Results demonstrated that the NRF and corresponding algorithm was successful at prioritizing agencies based on potential impact. Although, overall, naloxone was distributed more heavily to the agencies deemed highest priority, our algorithm identified significant shortcomings of the "first come, first served" method of distribution we had initially deployed. Conclusions: This work has laid the foundation to use this tool prospectively to allow for data-driven decision-making for naloxone distribution. Our tool is flexible and can be customized to best fit the needs of a variety of programs and locations to ensure the distribution of limited supplies of naloxone have the greatest impact.
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Affiliation(s)
- Claire A Wood
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Lauren Green
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Anna La Manna
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Sarah Phillips
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Kimberly B Werner
- College of Nursing, University of Missouri-St. Louis, St Louis, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Angie Stuckenschneider
- Division of Behavioral Health, Missouri Department of Mental Health, Jefferson City, MO, USA
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Dezfulian C, Orkin AM, Maron BA, Elmer J, Girotra S, Gladwin MT, Merchant RM, Panchal AR, Perman SM, Starks MA, van Diepen S, Lavonas EJ. Opioid-Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e836-e870. [PMID: 33682423 DOI: 10.1161/cir.0000000000000958] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Opioid overdose is the leading cause of death for Americans 25 to 64 years of age, and opioid use disorder affects >2 million Americans. The epidemiology of opioid-associated out-of-hospital cardiac arrest in the United States is changing rapidly, with exponential increases in death resulting from synthetic opioids and linear increases in heroin deaths more than offsetting modest reductions in deaths from prescription opioids. The pathophysiology of polysubstance toxidromes involving opioids, asphyxial death, and prolonged hypoxemia leading to global ischemia (cardiac arrest) differs from that of sudden cardiac arrest. People who use opioids may also develop bacteremia, central nervous system vasculitis and leukoencephalopathy, torsades de pointes, pulmonary vasculopathy, and pulmonary edema. Emergency management of opioid poisoning requires recognition by the lay public or emergency dispatchers, prompt emergency response, and effective ventilation coupled to compressions in the setting of opioid-associated out-of-hospital cardiac arrest. Effective ventilation is challenging to teach, whereas naloxone, an opioid antagonist, can be administered by emergency medical personnel, trained laypeople, and the general public with dispatcher instruction to prevent cardiac arrest. Opioid education and naloxone distributions programs have been developed to teach people who are likely to encounter a person with opioid poisoning how to administer naloxone, deliver high-quality compressions, and perform rescue breathing. Current American Heart Association recommendations call for laypeople and others who cannot reliably establish the presence of a pulse to initiate cardiopulmonary resuscitation in any individual who is unconscious and not breathing normally; if opioid overdose is suspected, naloxone should also be administered. Secondary prevention, including counseling, opioid overdose education with take-home naloxone, and medication for opioid use disorder, is important to prevent recurrent opioid overdose.
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Winhusen T, Walley A, Fanucchi LC, Hunt T, Lyons M, Lofwall M, Brown JL, Freeman PR, Nunes E, Beers D, Saitz R, Stambaugh L, Oga EA, Herron N, Baker T, Cook CD, Roberts MF, Alford DP, Starrels JL, Chandler RK. The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study. Drug Alcohol Depend 2020; 217:108325. [PMID: 33091842 PMCID: PMC7533113 DOI: 10.1016/j.drugalcdep.2020.108325] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The number of opioid-involved overdose deaths in the United States remains a national crisis. The HEALing Communities Study (HCS) will test whether Communities That HEAL (CTH), a community-engaged intervention, can decrease opioid-involved deaths in intervention communities (n = 33), relative to wait-list communities (n = 34), from four states. The CTH intervention seeks to facilitate widespread implementation of three evidence-based practices (EBPs) with the potential to reduce opioid-involved overdose fatalities: overdose education and naloxone distribution (OEND), effective delivery of medication for opioid use disorder (MOUD), and safer opioid analgesic prescribing. A key challenge was delineating an EBP implementation approach useful for all HCS communities. METHODS A workgroup composed of EBP experts from HCS research sites used literature reviews and expert consensus to: 1) compile strategies and associated resources for implementing EBPs primarily targeting individuals 18 and older; and 2) determine allowable community flexibility in EBP implementation. The workgroup developed the Opioid-overdose Reduction Continuum of Care Approach (ORCCA) to organize EBP strategies and resources to facilitate EBP implementation. CONCLUSIONS The ORCCA includes required and recommended EBP strategies, priority populations, and community settings. Each EBP has a "menu" of strategies from which communities can select and implement with a minimum of five strategies required: one for OEND, three for MOUD, and one for prescription opioid safety. Identification and engagement of high-risk populations in OEND and MOUD is an ORCCArequirement. To ensure CTH has community-wide impact, implementation of at least one EBP strategy is required in healthcare, behavioral health, and criminal justice settings, with communities identifying particular organizations to engage in HCS-facilitated EBP implementation.
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Affiliation(s)
- Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Alexander Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Laura C Fanucchi
- Division of Infectious Diseases, Department of Medicine, University of Kentucky College of Medicine, Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Tim Hunt
- Columbia University, School of Social Work, Center for Healing of Opioid and Other Substance Use Disorders (CHOSEN), 1255 Amsterdam, Avenue, Rm 806, New York, NY 10027, USA
| | - Mike Lyons
- Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA; Department of Emergency Medicine, University of Cincinnati College of Medicine 231 Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Michelle Lofwall
- Departments of Behavioral Science and Psychiatry, University of Kentucky College of Medicine, Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Jennifer L Brown
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, 789 S Limestone St, Lexington, KY 40536, USA
| | - Edward Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, Division on Substance Use, 1051 Riverside Drive, New York, NY 10032, USA
| | - Donna Beers
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Richard Saitz
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue 4th Floor, Boston, MA, 02118, USA
| | - Leyla Stambaugh
- Center for Applied Public Health Research, Research Triangle Institute (RTI) International, 6110 Executive Boulevard, Suite 902, Rockville. MD 20852, USA
| | - Emmanuel A Oga
- Center for Applied Public Health Research, Research Triangle Institute (RTI) International, 6110 Executive Boulevard, Suite 902, Rockville. MD 20852, USA
| | - Nicole Herron
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Trevor Baker
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Christopher D Cook
- Opioid/Substance Use Priority Research Area, University of Kentucky, 845 Angliana Ave Lexington, KY 40508, USA
| | - Monica F Roberts
- Opioid/Substance Use Priority Research Area, University of Kentucky, 845 Angliana Ave Lexington, KY 40508, USA
| | - Daniel P Alford
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA
| | - Redonna K Chandler
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Rockville, MD 20892, USA
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Chichester K, Drawve G, Sisson M, McCleskey B, Dye DW, Cropsey K. Examining the neighborhood-level socioeconomic characteristics associated with fatal overdose by type of drug involved and overdose setting. Addict Behav 2020; 111:106555. [PMID: 32717498 DOI: 10.1016/j.addbeh.2020.106555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fatal drug overdose in the United States is a public health crisis fueled by increased opioid and polysubstance use. Few studies have compared the neighborhood-level socioeconomic characteristics associated with overdoses of various substance classes and, to our knowledge, no investigation has yet assessed these factors in relation to polysubstance overdoses. Further, no study has determined whether socioeconomic conditions predict other contextually relevant aspects of overdoses such as whether they occur at-home or out-of-home. METHODS Overdose data (2015-2018) were obtained from the Coroner/Medical Examiner's Office of Jefferson County, Alabama. The toxicology results of decedents with a known overdose locations (N = 768) were assessed for the presence of synthetic opioids, natural and semi-synthetic opioids, heroin, stimulants, benzodiazepines, and alcohol. Socioeconomic characteristics were obtained from the Unites States Census Bureau at the census tract level. RESULTS Stimulant overdoses occurred in neighborhoods with the highest rates of disadvantage relative to other substance and polysubstance overdose types. The majority of included overdoses occurred at-home (63.7%) and an index of socioeconomic disadvantage predicted overdose rates for both at-home and out-of-home overdoses. Heroin overdose deaths were more likely to occur at-home while polysubstance stimulant-heroin overdoses were more common out-of-home. CONCLUSIONS An index of socioeconomic disadvantage was generally predictive of overdose, regardless of the setting in which the overdose occurred (in-home vs. out-of-home). The associations between neighborhood-level socioeconomic characteristics and fatal overdose can be tailored by substance type to create targeted interventions. Overdose setting may be an important consideration for future policy efforts, as overdoses were nearly twice as likely to occur at-home.
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Kernan WD, Basch CH, Segall LE, Garcia P. A Review of YouTube Videos About the Opioid Antagonist Medication Naloxone. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2020.1752079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- William D. Kernan
- Department of Health, William Paterson University, Wayne, New Jersey, USA
| | - Corey H. Basch
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
| | - Leslie E. Segall
- Columbia University Irving Medical Center, New York, New York, USA
| | - Philip Garcia
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
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20
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Riggs KR, Hoge AE, DeRussy AJ, Montgomery AE, Holmes SK, Austin EL, Pollio DE, Kim YI, Varley AL, Gelberg L, Gabrielian SE, Blosnich JR, Merlin J, Gundlapalli AV, Jones AL, Gordon AJ, Kertesz SG. Prevalence of and Risk Factors Associated With Nonfatal Overdose Among Veterans Who Have Experienced Homelessness. JAMA Netw Open 2020; 3:e201190. [PMID: 32181829 PMCID: PMC7078753 DOI: 10.1001/jamanetworkopen.2020.1190] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE Individuals with a history of homelessness are at increased risk for drug or alcohol overdose, although the proportion who have had recent nonfatal overdose is unknown. Understanding risk factors associated with nonfatal overdose could guide efforts to prevent fatal overdose. OBJECTIVES To determine the prevalence of recent overdose and the individual contributions of drugs and alcohol to overdose and to identify characteristics associated with overdose among veterans who have experienced homelessness. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted from November 15, 2017, to October 1, 2018, via mailed surveys with telephone follow-up for nonrespondents. Eligible participants were selected from the records of 26 US Department of Veterans Affairs medical centers and included veterans who had received primary care at 1 of these Veterans Affairs medical centers and had a history of experiencing homelessness according to administrative data. Preliminary analyses were conducted in October 2018, and final analyses were conducted in January 2020. MAIN OUTCOMES AND MEASURES Self-report of overdose (such that emergent medical care was obtained) in the previous 3 years and substances used during the most recent overdose. All percentages are weighted according to propensity to respond to the survey, modeled from clinical characteristics obtained in electronic health records. RESULTS A total of 5766 veterans completed the survey (completion rate, 40.2%), and data on overdose were available for 5694 veterans. After adjusting for the propensity to respond to the survey, the mean (SD) age was 56.4 (18.3) years; 5100 veterans (91.6%) were men, 2225 veterans (38.1%) were black, and 2345 veterans (40.7%) were white. A total of 379 veterans (7.4%) reported any overdose during the past 3 years; 228 veterans (4.6%) reported overdose involving drugs, including 83 veterans (1.7%) who reported overdose involving opioids. Overdose involving alcohol was reported by 192 veterans (3.7%). In multivariable analyses, white race (odds ratio, 2.44 [95% CI, 2.00-2.98]), self-reporting a drug problem (odds ratio, 1.66 [95% CI, 1.39-1.98]) or alcohol problem (odds ratio, 2.54 [95% CI, 2.16-2.99]), and having witnessed someone else overdose (odds ratio, 2.34 [95% CI, 1.98-2.76]) were associated with increased risk of overdose. CONCLUSIONS AND RELEVANCE These findings suggest that nonfatal overdose is relatively common among veterans who have experienced homelessness. While overdose involving alcohol was more common than any specific drug, 1.7% of veterans reported overdose involving opioids. Improving access to addiction treatment for veterans who are experiencing homelessness or who are recently housed, especially for those who have experienced or witnessed overdose, could help to protect this population.
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Affiliation(s)
- Kevin R. Riggs
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | | | | | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Public Health, Birmingham
| | | | - Erika L. Austin
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Public Health, Birmingham
| | | | - Young-il Kim
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | - Allyson L. Varley
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, California
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles
| | - Sonya E. Gabrielian
- VA Greater Los Angeles Health Care System, Los Angeles, California
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles
| | | | | | - Adi V. Gundlapalli
- University of Utah School of Medicine, Salt Lake City
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Audrey L. Jones
- University of Utah School of Medicine, Salt Lake City
- VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Adam J. Gordon
- University of Utah School of Medicine, Salt Lake City
- VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Stefan G. Kertesz
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
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Lim JK, Forman LS, Ruiz S, Xuan Z, Callis BP, Cranston K, Walley AY. Factors associated with help seeking by community responders trained in overdose prevention and naloxone administration in Massachusetts. Drug Alcohol Depend 2019; 204:107531. [PMID: 31526959 DOI: 10.1016/j.drugalcdep.2019.06.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Community overdose responders do not always seek help from emergency services when administering naloxone. We aimed to identify responder, overdose event, and community characteristics associated with help seeking from emergency services during overdoses reported by Massachusetts Overdose Education and Naloxone Distribution (OEND) enrollees, and to assess trends in help seeking over time. METHODS We analyzed overdose reports submitted between 2007 and 2017 to the Massachusetts Department of Public Health. We used logistic regression, stratified by responder drug use status, to assess associations of characteristics with help seeking during an overdose. RESULTS From January 2007 through December 2017, there were 69,870 OEND enrollees. 5,588 enrollees reported 10,246 overdoses. Help seeking was more likely among responders who did not use drugs. Among responders who did not use drugs, help seeking was more likely when: the responder was older or female, the victim was a stranger or client, and when naloxone did not work. Among responders who used drugs, help seeking was more likely when: the responder was female or had not previously reported responding to an overdose, the victim was a stranger or client or did not use fentanyl, naloxone took a longer time to work, and when the overdose was public or occurred more recently. The percentage of overdoses where help seeking occurred reached a maximum in 2016 at 50%. CONCLUSIONS Help seeking by OEND enrollees was significantly associated with several responder, victim, and event characteristics. Targeted interventions to promote help seeking are warranted, particularly as the lethality of opioid supplies rises.
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Affiliation(s)
- Jamie K Lim
- Department of Pediatrics, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, 02118, USA.
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 715 Albany St., Boston, MA, 02118, USA.
| | - Sarah Ruiz
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 305 South St., Jamaica Plain, MA, 02130, USA; Bureau of Substance Addiction Services, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108, USA.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA; Grayken Center for Addiction, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave., Boston, MA, 02118, USA.
| | - Barry P Callis
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 305 South St., Jamaica Plain, MA, 02130, USA.
| | - Kevin Cranston
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 305 South St., Jamaica Plain, MA, 02130, USA.
| | - Alexander Y Walley
- Grayken Center for Addiction, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave., Boston, MA, 02118, USA; Bureau of Substance Addiction Services, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108, USA.
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Wenger LD, Showalter D, Lambdin B, Leiva D, Wheeler E, Davidson PJ, Coffin PO, Binswanger IA, Kral AH. Overdose Education and Naloxone Distribution in the San Francisco County Jail. JOURNAL OF CORRECTIONAL HEALTH CARE 2019; 25:394-404. [DOI: 10.1177/1078345819882771] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - David Showalter
- Sociology Department, University of California, Berkeley, CA, USA
| | | | - David Leiva
- San Francisco Department of Public Health, Jail Health Services, CA, USA
| | | | | | - Phillip O. Coffin
- Population Health Division, San Francisco Department of Public Health, Community Health Equity & Promotion Branch, San Francisco, CA, USA
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Rouhani S, Park JN, Morales KB, Green TC, Sherman SG. Harm reduction measures employed by people using opioids with suspected fentanyl exposure in Boston, Baltimore, and Providence. Harm Reduct J 2019; 16:39. [PMID: 31234942 PMCID: PMC6591810 DOI: 10.1186/s12954-019-0311-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Exposure to potent synthetic opioids such as illicitly manufactured fentanyl (IMF) has fueled the escalating overdose crisis in the USA, particularly in the east coast. Drug checking services, which allow people who use drugs (PWUD) to learn about the contents of their drugs, remain limited and even criminalized in many states. Further, there is a persistent belief that PWUD are not willing or able to change their behaviors despite being aware of their potential exposure to fentanyl through drug use. METHODS We conducted a multi-site cross-sectional study among PWUD to assess what behaviors, if any, were employed in the case of suspected fentanyl exposure, and the correlates of engaging in harm reduction behaviors (HRB). PWUD (N = 334) were recruited in Boston (n = 80), Providence (n = 79), and in Baltimore (n = 175). At the time of the survey, no legal drug checking services were available in these cities. RESULTS The majority of PWUD (84%) expressed concern about fentanyl. Among those who suspected fentanyl exposure prior to using their drugs (n = 196), 39% reported employing HRB including using less of the drug (12%) or abstaining altogether (10%), using more slowly (5%), and doing a tester shot (5%). In adjusted logistic regression models, the odds (aOR) of practicing HRB after suspecting fentanyl exposure were increased among PWUD who were non-White (aOR 2.1; p = 0.004) and older (aOR 1.52 per decade of age; p < 0.001). Daily injection (aOR 0.50; p < 0.001), using drugs in public (aOR 0.58; p = 0.001), using drugs alone (aOR 0.68; p < 0.001), and experiencing multiple recent overdoses (aOR 0.55; p < 0.001) were associated with decreased odds of practicing HRB. CONCLUSIONS These data illustrate that PWUD employ a number of practices to reduce overdose risk in a context of unknown drug purity and content. Results may also guide efforts to identify early adopters of drug checking services and engage them in peer-outreach to target the most socially and structurally vulnerable PWUD, who are not reporting behavior change, with harm reduction messaging.
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Affiliation(s)
- Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Kenneth B Morales
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Traci C Green
- Miriam Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
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24
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Whitmore CC, White MN, Buntin MB, Fry CE, Calamari K, Patrick SW. State laws and policies to reduce opioid-related harm: A qualitative assessment of PDMPs and naloxone programs in ten U.S. States. Prev Med Rep 2018; 13:249-255. [PMID: 30705812 PMCID: PMC6348390 DOI: 10.1016/j.pmedr.2018.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 11/25/2022] Open
Abstract
As the magnitude of the opioid epidemic grew in recent years, individual states across the United States of America enacted myriad policies to address its complications. We conducted a qualitative examination of the structure, successes, and challenges of enacted state laws and policies aimed at the opioid epidemic, with an in-depth focus on prescription drug monitoring programs (PDMPs) and naloxone access efforts. A set of 10 states (Florida, Kentucky, Massachusetts, Michigan, Missouri, New York, North Carolina, Tennessee, Washington, and West Virginia) was chosen a priori to achieve a varied sample of state policies and timing, as well as population opioid complications. Archival research was conducted to identify state-level policies aimed at the opioid epidemic and semi-structured interviews were conducted with 31 key stakeholders between March and September 2016. The most frequently mentioned key to success was an identifiable champion instrumental in leading the passage of these policies. The lack of a unified legislature and physician pushback were challenges many states faced in implementing policies. Champion-led task forces, stakeholders' personal stories garnering buy-in, ongoing education and feedback to PDMP users, and inclusive stakeholder engagement are critical aspects of passing and implementing state policies aimed at combating the opioid epidemic. Engaging all interested stakeholders and providing continuing feedback are ongoing challenges in all states. Leveraging stakeholders' personal stories of how opioids affected their lives helped propel state efforts.
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Affiliation(s)
- Christine C Whitmore
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 1200, Nashville, TN 37203, United States of America
| | - Mary N White
- Vanderbilt Center for Child Health Policy, 2525 West End Ave, Suite 1200, Nashville, TN 37232, United States of America.,Department of Pediatrics, Vanderbilt University School of Medicine, 2200 Children's Way, Nashville, TN 37232, United States of America
| | - Melinda B Buntin
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 1200, Nashville, TN 37203, United States of America
| | - Carrie E Fry
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 1200, Nashville, TN 37203, United States of America
| | - Kevin Calamari
- Vanderbilt University College of Arts and Sciences, 301 Kirkland Hall, Nashville, TN 37240, United States of America
| | - Stephen W Patrick
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 1200, Nashville, TN 37203, United States of America.,Vanderbilt Center for Child Health Policy, 2525 West End Ave, Suite 1200, Nashville, TN 37232, United States of America.,Department of Pediatrics, Vanderbilt University School of Medicine, 2200 Children's Way, Nashville, TN 37232, United States of America.,Mildred Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University School of Medicine, 2200 Children's Way, Nashville, TN 37232, United States of America
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25
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Olsen A, Dwyer R, Lenton S. Take-home naloxone in Australia and beyond. Drug Alcohol Rev 2018; 37:437-439. [PMID: 29744978 DOI: 10.1111/dar.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Olsen
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Australia
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26
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Haas E, Truong C, Bartolomei-Hill L, Baier M, Bazron B, Rebbert-Franklin K. Local Overdose Fatality Review Team Recommendations for Overdose Death Prevention. Health Promot Pract 2018; 20:553-564. [DOI: 10.1177/1524839918797617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erin Haas
- Maryland Department of Health, Catonsville, MD, USA
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27
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Hines J, Deja E, Black EP. Student pharmacist perceptions of participation in hands-on naloxone counseling. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:712-716. [PMID: 30025770 DOI: 10.1016/j.cptl.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/01/2017] [Accepted: 03/02/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND PURPOSE Opioid overdose is a leading cause of death across the United States. Rho Chi Pharmacy Honor Society students at the University of Kentucky initiated a project to provide fellow students a volunteer opportunity to educate at-risk patients about naloxone using a physician-approved protocol. The goal was to improve student counseling skills by allowing them to apply knowledge learned during didactic and simulated training. EDUCATIONAL ACTIVITY AND SETTING Third and fourth year pharmacy students at the University of Kentucky voluntarily provided opioid overdose and naloxone counseling to patients at the health department and other locations. Students who counseled at the health department were asked to complete an Institutional Review Board (IRB)-approved, anonymous, electronic survey at the end to gauge their perceptions of the experience. FINDINGS Thirty-five of forty-five participating students responded to the survey, indicating a 78% response rate. The results suggested that student comfort with naloxone counseling increased after real-world counseling, compared with their perceived comfort levels entering the experience. The majority of the respondents (77%, n = 27) reported a change in their personal views on drug addiction and the associated patient population. Ninety-one percent (n = 32) of students plan to pursue certification to dispense naloxone as part of their future pharmacy practice. Most (94%, n = 33) perceived the counseling experience as practical application of their didactic education. DISCUSSION AND CONCLUSIONS As opioid addiction and accidental overdose plagues the nation, pharmacists are prepared to lead the battle against this disease. Pharmacy education and hands-on opportunities provide students with the practical knowledge and skills necessary to have impact on their patients and the opioid epidemic.
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Affiliation(s)
- Julie Hines
- University of Kentucky, College of Pharmacy, Lexington, KY 40536, United States.
| | - Erin Deja
- University of Kentucky, College of Pharmacy, Lexington, KY 40536, United States.
| | - Esther P Black
- University of Kentucky, College of Pharmacy, Lexington, KY 40536, United States.
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28
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Farrugia A, Fraser S, Dwyer R. Assembling the Social and Political Dimensions of Take-Home Naloxone. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/0091450917723350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adrian Farrugia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Suzanne Fraser
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Robyn Dwyer
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
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