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Smith MK, Nelson I, Davis E, Coleman J, Evans P, Lewis G, Nissly T, Levy R. "I don't want it in any form:" A qualitative study on black perceptions of buprenorphine in the fentanyl era. Drug Alcohol Depend 2025; 271:112638. [PMID: 40158300 DOI: 10.1016/j.drugalcdep.2025.112638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 02/08/2025] [Accepted: 02/25/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND The current phase of the US opioid overdose epidemic is marked by growing racial inequities, driven in part by unequal access to medications for opioid use disorder (MOUD) including buprenorphine. This report provides a much needed update on the racialized patterns of treatment uptake in an evolving drug use and treatment landscape. METHODS We conducted semi-structured qualitative interviews with 28 African American people with a self-reported history of OUD who had lived in the Twin Cities (Minneapolis and Saint Paul), Minnesota for at least a year. Interviews explored participants' attitudes, knowledge, and perceptions of medications for OUD (MOUD) with a focus on methadone and buprenorphine. FINDINGS 67.9 % of participants were male and the mean age was 53.4. More participants knew about and had taken methadone (100 %, 89.3 %, respectively) as compared to buprenorphine (89.3 %, 75 % respectively). We identified three key themes: 1) the unfamiliarity of buprenorphine; 2) the remembered damage of buprenorphine-induced precipitated withdrawal; and 3) readiness to quit and its impact on medication choice. CONCLUSIONS Black perceptions of MOUD consist of universally dim views toward methadone and highly ambiguous attitudes toward buprenorphine. Strategies to improve Black access to buprenorphine must therefore be grounded in a better understanding of the historical context of MOUDs in this community and the medical mistrust it engenders. Better strategies for safe induction of people with fentanyl dependence are also needed, particularly those informed by the concerns and priorities of Black and other racially minoritized communities.
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Affiliation(s)
- M Kumi Smith
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, 1300 South 2nd Street, Minneapolis, MN 55454, USA.
| | - Ivan Nelson
- African American Survivor Services, 9333 Nesbit Road, Bloomington, MN 55437, USA
| | - Ernest Davis
- African American Survivor Services, 9333 Nesbit Road, Bloomington, MN 55437, USA
| | - Jessica Coleman
- School of Social Work, University of Minnesota Twin Cities, 1404 Gortner Avenue, St. Paul, MN 55108, USA
| | - Pearl Evans
- Motivational Consulting, P.O. Box 2011, Burnsville, MN 55306, USA
| | - George Lewis
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota Twin Cities, 516 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Tanner Nissly
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota Twin Cities, 516 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Robert Levy
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota Twin Cities, 516 Delaware St. SE, Minneapolis, MN 55455, USA
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Syvertsen J, Cabral A, Knaap E, Rey S, Pollini RA. The emergence of fentanyl in a stimulant landscape: Un/intentional use, social relations, and developing communities of care. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2025; 140:104807. [PMID: 40286467 DOI: 10.1016/j.drugpo.2025.104807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 04/11/2025] [Accepted: 04/11/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND The introduction of fentanyl into the unregulated drug supply has drastically altered drug landscapes across the United States and increasingly contributed to overdose. As part of a larger study about opioid overdose, we assessed how the emergence of fentanyl has shaped health outcomes and social relations in an underserved region of California. METHODS From 2022-2024, we engaged in ethnographic fieldwork, surveys, and qualitative interviews with people 18+ years old and reporting opioid or stimulant use in the prior three months. We generated descriptive statistics and examined un/intentional fentanyl use among people using opioids (regardless of stimulant use) compared to those exclusively using stimulants. Qualitative interviews were thematically coded to lend insight into the social contexts of fentanyl use. RESULTS Of 195 survey participants, 31 % were women, and 60 % identified as racialized groups, with an average age of 43; the qualitative sub-sample (n = 53 interviews) was similar. People using opioids were often initially unintentionally exposed to fentanyl through the heroin supply or prescription pills, but shifted to intentional use. People using stimulants attributed unintentional fentanyl use to adulterated methamphetamine, mistaking fentanyl for other drugs, and sharing smoking tools. Socially, fentanyl heightened overdose risk and fueled community stigma, while paradoxically instantiating forms of community care (i.e., overdose response, warning those experimenting with fentanyl). CONCLUSION Our research calls for evidence-based education about fentanyl, expanded access to harm reduction services, including community drug checking and safer smoking supplies, and low-barrier drug treatment as part of broader efforts to promote community care.
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Affiliation(s)
- Jennifer Syvertsen
- Department of Anthropology, University of California, Riverside, CA, USA.
| | - Alejandra Cabral
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Elijah Knaap
- Center for Open Geographical Science, San Diego State University, CA, USA
| | - Sergio Rey
- Center for Open Geographical Science, San Diego State University, CA, USA
| | - Robin A Pollini
- Departments of Behavioral Medicine & Psychiatry and Epidemiology & Biostatistics, West Virginia University, Morgantown, WV, USA
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Gicquelais RE, Conway CJ, Becker M, Bailey EJ, Bosworth C, Miller R, Mijal K, Curran E, Barredo B, Taylor S, Salisbury-Afshar E, Seal DW, Burns M, Westergaard RP. Exploration of novel harm reduction approaches to increase client engagement (ENHANCE): protocol for a prospective cohort study. Harm Reduct J 2025; 22:81. [PMID: 40390064 PMCID: PMC12087053 DOI: 10.1186/s12954-025-01212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 03/31/2025] [Indexed: 05/21/2025] Open
Abstract
BACKGROUND Syringe services programs (SSPs) reduce the risk of overdose by distributing supplies like naloxone. SSPs also support clients in meeting their basic needs via referrals to organizations providing food, housing, and healthcare. This paper describes the Exploration of Novel Harm Reduction Approaches to Increase Client Engagement (ENHANCE) Project, a prospective cohort study developed in partnership with people who use drugs that aims to characterize the influence of longitudinal engagement in SSPs on overdose risk behaviors. METHODS The ENHANCE Project protocol was developed with a community leadership team of 16 people with living experience of drug use who were clients from four SSPs in Wisconsin that serve as study recruitment sites. The community leadership team met five times to conceptualize the study priorities, protocol, recruitment strategies, and measures. ENHANCE will enroll 400 people who use opioids and/or stimulants via recruitment of clients from study sites and peer referrals. Clients will report on primary outcomes (overdose experiences and risk behaviors) and other covariates (substance use history and behaviors, mental and physical health, satisfaction of basic needs, stigma, and others) over a 2-year follow-up period. At enrollment, clients select a self-generated identification code that is documented in all subsequent harm reduction services received from ten SSPs in Wisconsin. These data will be linked to study survey data using probabilistic methods and used for the primary exposure variable, frequency of using SSP services. ENHANCE will test the primary hypothesis that more frequently using SSP services is associated with reduced overdose risk behavior frequency. PRELIMINARY RESULTS Among the first 125 clients enrolled, 22.4% (N = 28) reported personally experiencing an opioid overdose in the 6 months before enrollment and 38.4% (N = 48) experienced adverse effects after using stimulants. The most common overdose risk behaviors reported in the past 30 days were using opioids while alone (mean: 9.9 days [standard deviation: 10.7]) and injecting heroin (mean: 9.3 days [standard deviation: 12.8]). CONCLUSIONS This study will identify aspects of harm reduction services that are most effective in reducing overdose risk to inform future service provision, funding, and policy efforts.
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Affiliation(s)
- Rachel E Gicquelais
- Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut Street, Madison, WI, 53726, USA.
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut St, Madison, WI, 53726, USA.
| | - Caitlin J Conway
- University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, 53705, USA
| | - Mikaela Becker
- Vivent Health, 1311 N 6 Th St, Milwaukee, WI, 53212, USA
| | - Erika J Bailey
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut St, Madison, WI, 53726, USA
| | - Cullen Bosworth
- University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, 53705, USA
| | - Rebecca Miller
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut St, Madison, WI, 53726, USA
| | - Katy Mijal
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut St, Madison, WI, 53726, USA
| | - Emmie Curran
- Vivent Health, 1311 N 6 Th St, Milwaukee, WI, 53212, USA
| | - Bianca Barredo
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut St, Madison, WI, 53726, USA
| | - Sydney Taylor
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut St, Madison, WI, 53726, USA
| | - Elizabeth Salisbury-Afshar
- Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut Street, Madison, WI, 53726, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, 610 N Whitney Way, Madison, WI, 53705, USA
| | - David W Seal
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut Street, Madison, WI, 53726, USA
| | - Ryan P Westergaard
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, 610 Walnut St, Madison, WI, 53726, USA
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Richeri A, McGregor R, Scorza C. Psychostimulant and opioid abuse: A perspective from Uruguay. Neuroscience 2025; 574:104-113. [PMID: 40073930 DOI: 10.1016/j.neuroscience.2025.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 02/07/2025] [Accepted: 03/07/2025] [Indexed: 03/14/2025]
Abstract
The number of people suffering from substance use disorder (SUD) worldwide has increased 45 % compared to the last decade according to the latest United Nations World Drug Report. This staggering increase, partly due to the recent COVID-19 pandemic, further raises the social and economic burden for nations. Prevention and treatment, two of the main strategies employed to curb the increase in SUD, have shown limited success despite our increasing understanding of the underlying processes of SUD. This review will focus on two main drug categories, psychostimulants, especially cocaine, and opioids since these are two of the most prevalent illicit drugs abused by the general public in low, middle, and high-income countries. The use of active adulterants (e.g. caffeine and illegally manufactured fentanyl, IMF) commonly employed in the preparation of illicit drugs will also be covered considering recent data which has shown that these adulterants may increase the health risk of psychostimulant and opioid users. Especially the high risk of the combined use of cocaine and IMF is detailed. An additional section will address drug abuse in women during pregnancy, as it constitutes a major public health concern due to the negative consequences on newborns and infants. Data from Uruguay is presented and compared to illegal drug use in other countries of South and North America. The rapidly changing drug market, together with the current prevalence of SUD, establishes the urgent need for new strategies and innovative treatments to manage this issue.
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Affiliation(s)
- Analía Richeri
- Departamento de Neurofarmacología Experimental, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay
| | - Ronald McGregor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA; Veterans Administration Greater Los Angeles Healthcare System, North Hills, Los Angeles, California, USA
| | - Cecilia Scorza
- Departamento de Neurofarmacología Experimental, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay.
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Zhu DT, Friedman J, Tamang S, Gone JP. Drug overdose mortality rates among non-Hispanic American Indian/Alaska Native individuals, 1999-2022. Ann Epidemiol 2025; 105:80-88. [PMID: 40220940 DOI: 10.1016/j.annepidem.2025.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 03/29/2025] [Accepted: 04/07/2025] [Indexed: 04/14/2025]
Abstract
PURPOSE To examine epidemiological trends in drug overdose deaths for non-Hispanic American Indian/Alaska Native (AIAN) individuals compared to White individuals. METHODS We obtained data from the CDC WONDER database to examine crude drug overdose death rates per 100,000 among AIAN and White individuals from 1999-2022. Rates were further stratified by manner of death, sex, age, urbanization, Census region, state, and specific drug types. RESULTS From 1999-2022, drug overdose death rates for AIAN individuals increased from 3.17 (95 % CI, 2.48-4.00) to 40.73 (95 % CI, 38.19-43.27), representing a 12-fold increase; in contrast, rates rose by five-fold for White individuals. In 2022, methamphetamine was the leading driver of overdose death rates for AIAN individuals, at 31.39 (95 % CI, 29.16-33.62) per 100,000, followed by fentanyl, at 22.35 (95 % CI, 20.46-24.23) per 100,000. Geographical variations were notable, with the highest rates for AIAN individuals in large central metropolitan regions (53.54 per 100,000) and the Midwest (50.31 per 100,000). Rates were higher for AIAN than White individuals in 20 of the 21 states (95.2 %) included in our analysis. CONCLUSIONS AIAN individuals are disproportionately impacted by the overdose crisis. Further efforts are needed to expand access to harm reduction-informed, culturally-competent health education, addiction treatment, and social services in the AIAN population.
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Affiliation(s)
- David T Zhu
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.
| | - Joseph Friedman
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Suzanne Tamang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Center for Population Health Sciences, Palo Alto, CA, United States
| | - Joseph P Gone
- Department of Anthropology, Harvard University, Cambridge, MA, United States; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Kline DM, White BN, Lancaster KE, Egan KL, Murphy E, Miller WC, Hepler SA. Estimating Prevalence of Opioid Misuse in North Carolina Counties From 2016 to 2021: An Integrated Abundance Model Approach. Epidemiology 2025; 36:310-318. [PMID: 39855258 PMCID: PMC11991883 DOI: 10.1097/ede.0000000000001838] [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] [Indexed: 01/27/2025]
Abstract
BACKGROUND The overdose epidemic remains largely driven by opioids, but the county-level prevalence of opioid misuse is unknown. Without this information, public health and policy responses are limited by a lack of knowledge on the scope of the problem. METHODS Using an integrated abundance model, we estimate the annual county-level prevalence of opioid misuse for counties in North Carolina from 2016 to 2021. The model integrates county-level observed counts of illicit opioid overdose deaths, people receiving prescriptions for buprenorphine, and people served by treatment programs. It also incorporates state-level survey estimates of misuse prevalence. County-level social and environmental covariates are also accounted for in the model. Data are integrated through a Bayesian hierarchical model to estimate posterior distributions of the parameters. RESULTS In general, the estimated prevalence of misuse was decreasing over the study period. Estimated prevalence was above average in the western and southeastern parts of the state. We also estimated that the proportion of people who misuse opioids who fatally overdosed increased sharply over the study period as the median estimated proportion in 2021 was more than 8 times greater than in 2016. The proportion of people who misuse opioids who received buprenorphine and were served by treatment programs increased over the study period. CONCLUSIONS Estimates from our integrated abundance model fill an important gap in public health knowledge about the local prevalence of people who misuse opioids and can be used to inform an adequate and equitable allocation of resources to communities across the state.
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Affiliation(s)
- David M. Kline
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Brian N. White
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E. Lancaster
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathleen L. Egan
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Eva Murphy
- Department of Statistical Sciences, College of Arts and Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - William C. Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Staci A. Hepler
- Department of Statistical Sciences, College of Arts and Sciences, Wake Forest University, Winston-Salem, North Carolina
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Banks DE, Paschke ME, Campbell KD, Bradshaw-Glenn DD, Ghonasgi R, Barr B, Collins A, Dennis G, Lofton K, Long A, Montgomery H, Prince A, Winograd RP. CENTER-ing Black voices: incorporating lived experience across the research process to advance equity in drug treatment and outcomes. Harm Reduct J 2025; 22:64. [PMID: 40259379 PMCID: PMC12010516 DOI: 10.1186/s12954-025-01202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 04/01/2025] [Indexed: 04/23/2025] Open
Abstract
BACKGROUND Black people in the United States face persistent and increasing inequities in addiction treatment access and drug overdose death. Incorporating people with lived experience through community based participatory research (CBPR) approaches can improve understanding of drivers of and solutions to such inequities. However, practical and systemic challenges limit incorporating Black people with lived experience with substance use across each step of the research process. This paper describes the methods, recommendations, and lessons learned from a research team and Black-led community advisory board (CAB) working together across the research process to promote equity in harm reduction and addiction treatment. METHODS The CENTER Initiative is an academic-community partnership established to address increasing drug overdose deaths affecting the Black community in St. Louis, Missouri. The CAB comprised 10 Black people with lived experience recruited with the help of community-based agency partners. Academic staff dedicated to liaising with the CAB encouraged establishing structure and bylaws toward a self-governing CAB with decision-making power independent of agency partner and research teams. RESULTS The CAB and research team collaborated across all stages of the research process including design (e.g., deciding inclusion criteria), recruitment (e.g., flier development and participant referrals), data collection (e.g., conducting qualitative interviews), analysis (e.g., qualitative coding), and dissemination. Aligned with CBPR principles, dissemination activities extended the impact of the research to create sustainability and community empowerment (e.g., through advocacy, direct intervention, capacity building, and funding). Key lessons learned for working with a CAB facing intersectional oppression include a balanced approach incorporating structure and flexibility, a need for adequate personnel and funding support, and the importance of relationship building. CONCLUSION Integrating people with lived experience into the research process through CBPR can mitigate the harms and inefficiencies of research while enhancing its community impact. The CENTER CAB and research partners creatively collaborated across each step of the research and translated their findings to practical community empowerment and sustainability in innovative ways. Research institutions, funders and other stakeholders must support building relationships and capacity among academics and people with lived experience to advance racial health equity and justice in substance use research and outcomes.
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Affiliation(s)
- Devin E Banks
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA.
- Department of Psychological Sciences, University of Missouri - St. Louis, One University Dr., 325 Stadler Hall, St. Louis, MO, 63121, USA.
| | - Maria E Paschke
- Missouri Institute of Mental Health, University of Missouri-St. Louis, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Kaytryn D Campbell
- Department of Psychological Sciences, University of Missouri - St. Louis, One University Dr., 325 Stadler Hall, St. Louis, MO, 63121, USA
| | - Daje D Bradshaw-Glenn
- Missouri Institute of Mental Health, University of Missouri-St. Louis, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Rashmi Ghonasgi
- Department of Psychological Sciences, University of Missouri - St. Louis, One University Dr., 325 Stadler Hall, St. Louis, MO, 63121, USA
| | - Burton Barr
- CENTER Community Advisory Board, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Arial Collins
- CENTER Community Advisory Board, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Gerald Dennis
- CENTER Community Advisory Board, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Keith Lofton
- CENTER Community Advisory Board, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Alfred Long
- CENTER Community Advisory Board, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Harriet Montgomery
- CENTER Community Advisory Board, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Andreas Prince
- CENTER Community Advisory Board, One University Dr., B2017, St. Louis, MO, 63121, USA
| | - Rachel P Winograd
- Department of Psychological Sciences, University of Missouri - St. Louis, One University Dr., 325 Stadler Hall, St. Louis, MO, 63121, USA
- Missouri Institute of Mental Health, University of Missouri-St. Louis, One University Dr., B2017, St. Louis, MO, 63121, USA
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Richardson J, Banks DE, Brown KL, Nance M, Carpenter RW, Winograd RP. Patterns of Drugs Involved in Fatal Overdose and Demographic Correlates: A Latent Class Analysis of Polysubstance-Involved Deaths in the Urban Midwest. SUBSTANCE USE & ADDICTION JOURNAL 2025:29767342251330411. [PMID: 40243035 DOI: 10.1177/29767342251330411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2025]
Abstract
BACKGROUND Fentanyl contributes to the majority of overdose deaths in the United States but the risk of fatal overdose increases when other substances are involved. Although polysubstance overdose involving fentanyl and stimulants has been characterized as increasing nationally and in urban coastal cities, little is known about patterns of drugs involved in fatal overdose in the urban Midwest. METHODS The current study examined drug-involved death data from St. Louis City and County. Cases included were drug overdose deaths occurring from 2016 to 2021 (N = 4088; 73% male; 50% white, 49% black). Latent class analysis was used to examine prototypical patterns and demographic associations. RESULTS Results indicated fentanyl was involved in the majority (75.0%) of overdose deaths. A five-class solution best fit the data, characterized by deaths involving: predominant fentanyl (48.5%), fentanyl and heroin (20.0%), fentanyl and psychostimulants (12.8%), prescription opioid/undifferentiated (10.6%), and predominant cocaine (8.0%). Relative to predominant fentanyl, decedents in the fentanyl and heroin class and predominant cocaine class were more likely to be black (Ps < .05) whereas those in the fentanyl and methamphetamine class and prescription opioid/undifferentiated class were more likely to be white (Ps < .05). Females comprised a larger proportion of decedents in the fentanyl and heroin, predominant cocaine, and prescription opioid/undifferentiated classes (Ps < .05). Deaths in the predominant fentanyl class were more likely to occur in urban versus suburban environments (Ps < .05). CONCLUSIONS Findings diverge from previous research and national patterns highlighting the importance of local data for informing health care and policy in mid-sized and Midwest cities. Overdose prevention that addresses both intentional ingestion and unintentional ingestion of fentanyl with other substances, particularly stimulants, are warranted as its ubiquity in the drug supply persists.
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Affiliation(s)
- Julia Richardson
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Devin E Banks
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kanila L Brown
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Melissa Nance
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Ryan W Carpenter
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Rachel P Winograd
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
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Cadet K, Smith BD, Martins SS. Intersectional Racial and Sex Disparities in Unintentional Overdose Mortality. JAMA Netw Open 2025; 8:e252728. [PMID: 40168026 PMCID: PMC11962664 DOI: 10.1001/jamanetworkopen.2025.2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/27/2025] [Indexed: 04/02/2025] Open
Abstract
Importance There are several apparent research gaps based on the intersectional sociodemographic dimensions of drug-related mortality disparities. Relatively marginal evidence exists on the potential roles of intersecting forms of race and sexual marginalization on the disparities across drug-related mortality. Objective To examine intersectional sex-specific White and Black racial disparities in drug poisoning mortality across states from 2010 to 2020. Design, Setting, and Participants This cross-sectional study used unintentional fatal drug poisoning mortality data from the Centers for Disease Control and Prevention's Web-Based Injury Statistics Query and Reporting System. Trends from 2010 through 2020 were analyzed by Black men, Black women, White men, and White women across states. One-sided Mann-Kendall trend analysis was used to examine statistically significant increasing or decreasing trends in age-adjusted mortality rates. Statistical analysis was performed from June to July 2024. Exposures White and Black groups intersecting with male and female sex. Main Outcomes and Measures Analysis of age-adjusted mortality rates, excess years of potential life lost (reference group: White men), years of potential life lost ratios (reference group: White men), and percentage change to highlight state differences. Results From a total sample of 518 724 unintentional fatal drug poisoning deaths (9.0% in Black men, 3.9% in Black women, 29.0% in White women, and 58.1% in White men), 11 820 781 years of potential life lost were recorded. Black men had the highest mean (SD) age-adjusted mortality rate (23.25 [22.65]), followed by White men (22.49 [14.32]), with lower rates for White women (11.71 [5.96]) and Black women (9.01 [8.04]) (P < .001). Compared with White men, both Black men (τ = 0.298, slope = 0.002, intercept = 0.381, P < .001) and Black women (τ = 0.157, slope = 0.0004, intercept = 0.271, P < .001) had worsening YPLL over time, while White women (τ = -0.146, slope = -0.0003, intercept = 0.5252, P < .001) showed improvement in their YPLL over time compared with White men. At the state level, there was a disproportionate burden of deaths due to drug poisonings, with Maryland showing the highest increase in mortality rates among Black men (485.4%), while decreases were observed for White women in states such as Alaska (-23.0%). Conclusions and Relevance In this cross-sectional study of overdose deaths, disparities in overdose mortality were evident, with Black men and Black women experiencing a pronounced and increasing burden of mortality compared with their White counterparts. Addressing these disparities will require a multipronged approach targeting the social, physical, economic, and policy risk environments.
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Affiliation(s)
- Kechna Cadet
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Bianca D. Smith
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Doonan SM, Wheeler-Martin K, Davis C, Mauro C, Bruzelius E, Crystal S, Mannes Z, Gutkind S, Keyes KM, Rudolph KE, Samples H, Henry SG, Hasin DS, Martins SS, Cerdá M. How do restrictions on opioid prescribing, harm reduction, and treatment coverage policies relate to opioid overdose deaths in the United States in 2013-2020? An application of a new state opioid policy scale. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2025; 137:104713. [PMID: 39847857 PMCID: PMC11875926 DOI: 10.1016/j.drugpo.2025.104713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 01/13/2025] [Accepted: 01/14/2025] [Indexed: 01/25/2025]
Abstract
BACKGROUND Identifying the most effective state laws and provisions to reduce opioid overdose deaths remains critical. METHODS Using expert ratings of opioid laws, we developed annual state scores for three domains: opioid prescribing restrictions, harm reduction, and Medicaid treatment coverage. We modeled associations of state opioid policy domain scores with opioid-involved overdose death counts in 3133 counties, and among racial/ethnic subgroups in 1485 counties (2013-2020). We modeled a second set of domain scores based solely on experts' highest 20 ranked provisions to compare with the all-provisions model. RESULTS From 2013 to 2020, moving from non- to full enactment of harm reduction domain laws (i.e., 0 to 1 in domain score) was associated with reduced county-level relative risk (RR) of opioid overdose death in the subsequent year (adjusted RR = 0.84, 95 % credible interval (CrI): 0.77, 0.92). Moving from non- to full enactment of opioid prescribing restrictions and Medicaid treatment coverage domains was associated with higher overdose in 2013-2016 (aRR 1.69 (1.35, 2.11) and aRR 1.20 (1.11, 1.29) respectively); both shifted to the null in 2017-2020. Effect sizes and direction were similar across racial/ethnic groups. Results for experts' highest 20 ranked provisions did not differ from the all-provision model. CONCLUSIONS More robust state harm reduction policy scores were associated with reduced overdose risk, adjusting for other policy domains. Harmful associations with opioid prescribing restrictions in 2013-2016 may reflect early unintended consequences of these laws. Medicaid coverage domain findings did not align with experts' perceptions, though data limitations precluded inclusion of several highly ranked Medicaid policies.
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Affiliation(s)
- Samantha M Doonan
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York University, New York City, NY, USA
| | - Katherine Wheeler-Martin
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York University, New York City, NY, USA
| | - Corey Davis
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York University, New York City, NY, USA
| | - Christine Mauro
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Zachary Mannes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kara E Rudolph
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Hillary Samples
- Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
| | - Stephen G Henry
- Division of General Internal Medicine and Bioethics, University of California Davis, Sacramento CA, USA
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York University, New York City, NY, USA.
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11
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Cooper HL, D'Souza RR, Chang HH, Peterson E, Rogers E, Wien S, Blake SC, Kramer MR. Patterns of non-fatal overdose and injection-related bacterial infections during pregnancy and the postpartum year among New York State residents. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.01.21.25320879. [PMID: 39974006 PMCID: PMC11838968 DOI: 10.1101/2025.01.21.25320879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
Objectives Overdoses are a leading cause of maternal mortality in the US, but limited evidence exists about patterns of nonfatal overdose, a key risk factor for subsequent fatal overdose, or of other drug-related harms. Here, we estimate prevalences of nonfatal overdose and injection-related endocarditis and abscesses/cellulitis across the 21 months spanning pregnancy and the postpartum year. Methods Among people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N=330,872), we estimated the prevalences of hospital-based diagnoses of nonfatal overdose and of injection-related bacterial infections (i.e., endocarditis, abscesses, and cellulitis) across these 21 months; by trimester and postpartum quarter; and by social position (e.g., race/ethnicity, rurality, payor). Results The 21-month nonfatal overdose prevalence was 158/100,000 births (CI: 145/100,000, 172/100,000); the 21-month prevalence of injection-related bacterial infections was 56/100,000 births (CI: 49/100,000, 65/100,000). There was a trend such that rates of overdose and of injection-related bacterial infections declined as pregnancy progressed and rebounded postpartum. Rates of all outcomes were highest outside of large metropolitan areas and among publicly insured residents. Conclusions for Practice The trend toward diminished rates during pregnancy is supported by past qualitative studies. If confirmed by future research in other geographical regions and with larger sample sizes, this finding holds promise for programmatic and policy interventions. Interventions co-designed with people who use drugs could complement and support harm reduction efforts that pregnant people are already engaging in independently. Such efforts can help people who use drugs survive the pregnancy and postpartum year. Significance "What is already known on this subject?Fatal overdoses are a leading cause of maternal mortality in the US. Little evidence exists, however, about patterns of nonfatal overdose, a strong predictor of future fatal overdose, or about other serious injection-related bacterial infections."What this study adds?We find trends suggesting that rates of nonfatal overdose and injection-related bacterial infections decline during pregnancy and then rebound postpartum. These findings, if confirmed in future research, suggest a clear path toward intervention development: partnering with people who use drugs to design interventions that complement and support their existing harm reduction interventions during pregnancy and in the postpartum period.
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Winograd RP, Brown KC, Newman ST, Banks DE, Carpenter RW, Budesa Z, Lunceford J, Siddiqui ST, Jasdanwala S, Wing B, Orson W. What About Nights, Weekends, and Wait Times? Adding an On-Demand Facilitated Telemedicine Buprenorphine Component to a Community-Based Peer Support Outreach Program. SUBSTANCE USE & ADDICTION JOURNAL 2025:29767342241311123. [PMID: 39800886 DOI: 10.1177/29767342241311123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Abstract
BACKGROUND In 2020, loosened federal regulations allowed for buprenorphine for opioid use disorder to be initiated via telemedicine. In response to these regulatory changes and growing racial inequities in overdose in St. Louis, MO, a local, peer-led outreach program incorporated a new rapid access (RA) to buprenorphine program. RA facilitated same-day buprenorphine access by conducting peer-facilitated telemedicine visits in community settings. METHODS This study used logistic regression to compare 1- and 3-month treatment and buprenorphine retention between clients in the RA and Traditional (ie, linkage to brick-and-mortar prescribers within 1-3 days) programmatic arms of a peer-led outreach program between December 2020 and June 2022. Propensity score matching allowed participants across groups to be matched on key factors (eg, sex, race, homelessness). Racial differences in program receipt/enrollment were also assessed through Chi-squared tests. RESULTS Total program participation (N = 4139) included 1% (n = 52) in the RA program. Those in RA were more likely to be in treatment at 1 and 3 months and more likely to be on buprenorphine at 3 months compared to those in the Traditional group. The RA program included more White and fewer Black clients than expected. Four of the 8 reasons for non-enrollment differed by race, with Black individuals more likely to already have treatment secured but also more likely to decline the program or be unable to be contacted. CONCLUSIONS This study is the first to demonstrate sustained benefits in treatment and medication engagement following same-day access to buprenorphine via community-based, peer-facilitated telemedicine. Lower-than-expected enrollment of Black individuals indicates a need for more culturally responsive implementation strategies for peer- and telemedicine-facilitated programs.
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Affiliation(s)
- Rachel P Winograd
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Katherine C Brown
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Schyler T Newman
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
| | - Devin E Banks
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
| | - Zach Budesa
- Advocates for Human Potential, St. Louis, MO, USA
| | | | - Saad T Siddiqui
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
| | | | - Bradley Wing
- Behavioral Health Network - St. Louis, St. Louis, MO, USA
| | - Wendy Orson
- Behavioral Health Network - St. Louis, St. Louis, MO, USA
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Weitzman ER, Alegria M, Caplan A, Dowling D, Evans J, Fisher CE, Jordan A, Kossowsky J, Landau M, Larson H, Levy O, Levy S, Mnookin S, Reif S, Ross J, Sherman AC. Social complexity of a fentanyl vaccine to prevent opioid overdose conference proceedings: Radcliffe Institute for Advanced Study conference proceedings. Vaccine 2025; 44:126324. [PMID: 39317618 DOI: 10.1016/j.vaccine.2024.126324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 09/04/2024] [Indexed: 09/26/2024]
Abstract
Despite significant public health attention and investment, hundreds of thousands of individuals have suffered fatal opioid overdose since the onset of the opioid crisis. Risk of opioid overdose has been exacerbated by the influx of fentanyl, a powerful synthetic opioid, into the drug supply. The National Institutes of Health Helping End Addiction Long-term (HEAL) Initiative is supporting the development of vaccines targeting fentanyl to protect against overdose. If successful, a vaccine would induce anti-fentanyl antibodies to sequester fentanyl (but not other opioids) in the blood, preventing fentanyl from crossing into the brain and reaching the central nervous system where it can cause overdose. Introduction of an overdose preventing strategy that relies on a vaccine to confer passive protection may be impactful. However, vaccines are poorly understood by the public and politicized. Moreover, the overdose ecosystem is complex and extends across numerous social, economic, medical, and cultural systems. As such, optimal use of a vaccine strategy to address overdose may benefit from multidisciplinary consideration of the social, ethical, and systemic factors that influence substance use and overdose that may also impact the acceptability of a fentanyl vaccine and related implementation strategies. In March 2022, Dr. Elissa Weitzman convened a two-day conference at the Harvard Radcliffe Institute for Advanced Study on the Social Complexity of a Fentanyl Vaccine to Prevent Opioid Overdose. In all, 19 professionals from diverse disciplines (medicine, psychology, history, ethics, immunology, vaccinology, communications, policy) attended the conference and led discussions that centered on population health and epidemiology, history of medicine and frameworks for understanding substance use, ethics, decision-making and attitudes, and operational issues to the question of a novel immunotherapy targeting fentanyl overdose. Participants also debated the risks and benefits of vaccine administration in response to fictional clinical case vignettes. A summary of the conference presentations and discussions follows.
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Affiliation(s)
- Elissa R Weitzman
- Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Computational Health Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States.
| | - Margarita Alegria
- Department of Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, United States
| | - Arthur Caplan
- New York University Grossman School of Medicine, 550 1(st) Ave, New York, NY 10016, United States
| | - David Dowling
- Precision Vaccines Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Jay Evans
- Inimmune Corporation, 1121 E Broadway St, Missoula, MT 59802, United States
| | - Carl Erik Fisher
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York 10032, United States
| | - Ayana Jordan
- New York University Grossman School of Medicine, 550 1(st) Ave, New York, NY 10016, United States
| | - Joe Kossowsky
- Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Department of Anesthesia, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | | | - Heidi Larson
- Department of Infectious Disease Epidemiology and Dynamics, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Ofer Levy
- Precision Vaccines Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; The Broad Institute, 415 Main St, Cambridge, MA 02142, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Sharon Levy
- Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Seth Mnookin
- School of Humanities, Arts, and Social Sciences, Massachusetts Institute of Technology, 160 Memorial Dr, Cambridge, MA 02139, United States
| | - Sharon Reif
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453, United States
| | - Jennifer Ross
- Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Amy Caryn Sherman
- Precision Vaccines Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Division of Infectious Disease, Brigham and Women's Hospital, 15 Francis St., Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
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14
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Zhu DT, Park A. National trends in drug overdose mortality among Asian American, Native Hawaiian, and Pacific Islander populations. Ann Epidemiol 2025; 101:36-41. [PMID: 39706382 DOI: 10.1016/j.annepidem.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 12/04/2024] [Accepted: 12/08/2024] [Indexed: 12/23/2024]
Abstract
PURPOSE To analyze drug overdose mortality trends among Asian American and Native Hawaiian/Pacific Islander (AANHPI) populations. METHODS We obtained data on drug overdose deaths and population totals from CDC WONDER and the American Community Survey (2018-2022). Crude mortality rates per 100,000 were calculated overall and by sex, U.S. Census Division, and drug type. Disaggregated analyses included six Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and three NHPI subgroups (Native Hawaiian, Guamanian, and Samoan). RESULTS In 2022, Asian Americans had 1226 drug overdose deaths and NHPI individuals had 154. The mortality rate for NHPI individuals (17.52 [95 % CI: 14.76-20.29] per 100,000) tripled that of Asian Americans (5.85 [95 % CI: 5.52-6.18] per 100,000). Fentanyl was the leading drug-related death among Asian Americans (3.17 [95 % CI: 2.93-3.41] per 100,000), while methamphetamine led for NHPI individuals (11.38 [95 % CI: 9.15-13.61] per 100,000). Disaggregated mortality rates were highest for Korean Americans (9.06 [95 % CI: 8.88-9.24] per 100,000) and Guamanians (43.16 [95 % CI: 39.05-48.24] per 100,000) among the Asian American and NHPI subgroups, respectively. CONCLUSIONS AANHPI populations experience distinct overdose mortality patterns, with NHPI individuals and specific ethnic subgroups disproportionately affected, warranting targeted public health interventions.
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Affiliation(s)
- David T Zhu
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States; School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.
| | - Andrew Park
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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15
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Zhu DT. Racial and Ethnic Disparities in Fentanyl and Polysubstance Overdose Deaths. JAMA Psychiatry 2025; 82:99-100. [PMID: 39504001 PMCID: PMC11581714 DOI: 10.1001/jamapsychiatry.2024.3435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/28/2024] [Indexed: 11/24/2024]
Abstract
This cross-sectional study describes US overdose death patterns for fentanyl and fentanyl combined with opioids, heroin, cocaine, methamphetamine, or benzodiazepines by race and ethnicity from 2010 to 2022.
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Affiliation(s)
- David T. Zhu
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond
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16
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Cano M, Zachmeyer M, Salinas LA, Ferguson KM. Racial/ethnic inequality in homelessness and drug overdose deaths in US States. Soc Psychiatry Psychiatr Epidemiol 2025; 60:149-161. [PMID: 38597978 DOI: 10.1007/s00127-024-02667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE This study examined whether state-level racial disproportionality in homelessness is associated with racial disproportionality in overdose mortality. METHODS Counts of individuals experiencing homelessness (2015-2017; by state and racial/ethnic group) were obtained from the US Department of Housing and Urban Development; population estimates and counts of drug overdose deaths (2018-2021; by state and racial/ethnic group) were obtained from the National Center for Health Statistics. Homelessness and overdose mortality disproportionality scores were calculated to indicate the extent to which each racial group was over- or under- represented among those experiencing homelessness, or among overdose deaths, respectively (relative to each racial group's proportional share in the general population). For each racial group examined, ordinary least squares regression models with robust standard errors (SEs) examined associations between state-level disproportionality in homelessness and disproportionality in overdose mortality, adjusting for percent aged 18-64 and US Census Region, as well as disproportionality in educational attainment and unemployment. RESULTS State-level racial disproportionality in homelessness was significantly and positively associated with racial disproportionality in overdose mortality for Black (b = 0.16 [SE = 0.05]; p < .01), American Indian/Alaska Native (b = 0.71 [SE = 0.23]; p < .01), and Hispanic populations (b = 0.17 [SE = 0.05]; p < .01), in models adjusting for region and percent aged 18-64. The significant positive associations in these three populations persisted after adjusting for educational attainment disproportionality, yet the association was no longer significant in the Black population after adjusting for unemployment disproportionality. CONCLUSION States with the highest levels of racial/ethnic minority overrepresentation in homelessness generally also had relatively higher levels of racial/ethnic minority overrepresentation in overdose deaths.
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Affiliation(s)
- Manuel Cano
- Arizona State University, 411 N. Central Ave Suite 863, Phoenix, AZ, 85004, USA.
| | | | - Luis A Salinas
- University of Texas at San Antonio, San Antonio, TX, USA
| | - Kristin M Ferguson
- Arizona State University, 411 N. Central Ave Suite 863, Phoenix, AZ, 85004, USA
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Marotta PL, Leach BC, Hutson WD, Caplan JM, Lohmann B, Hughes C, Banks D, Roll S, Chun Y, Jabbari J, Ancona R, Mueller K, Cooper B, Anasti T, Dell N, Winograd R, Heimer R. A place-based spatial analysis of racial inequities in overdose in St. Louis County Missouri, United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 134:104611. [PMID: 39488868 DOI: 10.1016/j.drugpo.2024.104611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 09/30/2024] [Accepted: 10/01/2024] [Indexed: 11/05/2024]
Abstract
OBJECTIVE The objective of this study was to identify place features associated with increased risk of drug-involved fatalities and generate a composite score measuring risk based on the combined effects of features of the built environment. METHODS We conducted a geospatial analysis of overdose data from 2022 to 2023 provided by the St. Louis County Medical Examiner's Office to test whether drug-involved deaths were more likely to occur near 54 different place features using Risk Terrain Modeling (RTM). RTM was used to identify features of the built environment that create settings of heightened overdose risk. Risk was estimated using Relative Risk Values (RRVs) and a composite score measuring Relative Risk Scores (RRS) across the county was produced for drugs, opioids, and stimulants, as well as by Black and White decedents. RESULTS In the model including all drugs, deaths were more likely to occur in close proximity to hotels/motels (RRV=39.65, SE=0.34, t-value=10.81 p<.001), foreclosures (RRV=4.42, SE=0.12, t-value = 12.80, p<.001), police departments (RRV=3.13, SE=0.24, t-score=4.86, p<.001), and restaurants (RRV=2.33, SE=0.12, t-value=7.16, p<.001). For Black decedents, deaths were more likely to occur near foreclosures (RRV=9.01, SE=0.18, t-value =11.92, p<.001), and places of worship (RRV= 2.51, SE=0.18, t-value = 11.92, p<.001). For White decedents, deaths were more likely to occur in close proximity to hotels/motels (RRV=38.97, SE=0.39, t-value=9.30, p<.001) foreclosures (RRV=2.57, SE=0.16, t-value =5.84, p<.001), restaurants (RRV=2.52, SE=0.17, t-value=5.33, p<.001) and, auto painting/repair shops (RRV=0.04, SE=0.18, t-value =3.39, p<.001). CONCLUSION These findings suggest that places of worship, the hospitality industry, and housing authorities may be physical features of the environment that reflect social conditions that are conducive to overdose. The scaling up of harm reduction strategies could be enhanced by targeting places where features are co-located.
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Affiliation(s)
- Phillip L Marotta
- Washington University in St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA; Social Policy Institute, Washington University in St. Louis, MO, USA.
| | - Benjamin Cb Leach
- Washington University in St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA; University of California San Francisco, Department of Medicine, Division of Health Equity and Society, San Francisco, California, United States
| | - William D Hutson
- Washington University in St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA; School of Medicine, Washington University in St. Louis, MO, USA; Department of Psychiatry, Washington University in St. Louis, MO, USA
| | - Joel M Caplan
- Simsi, Inc. NJ, USA; Rutgers University School of Criminal Justice Center on Public Security Newark, NJ, USA
| | - Brenna Lohmann
- St Louis County - Circuit Attorney's Office Law Enforcement Assisted Diversion Program (LEAD) St. Louis, MO, USA
| | - Charlin Hughes
- St Louis County - Circuit Attorney's Office Law Enforcement Assisted Diversion Program (LEAD) St. Louis, MO, USA
| | - Devin Banks
- Washington University in St. Louis, MO, USA; School of Medicine, Washington University in St. Louis, MO, USA; Department of Psychiatry, Washington University in St. Louis, MO, USA
| | - Stephen Roll
- Washington University in St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA; Social Policy Institute, Washington University in St. Louis, MO, USA
| | - Yung Chun
- Washington University in St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA; Social Policy Institute, Washington University in St. Louis, MO, USA
| | - Jason Jabbari
- Washington University in St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA; Social Policy Institute, Washington University in St. Louis, MO, USA
| | - Rachel Ancona
- Washington University in St. Louis, MO, USA; School of Medicine, Washington University in St. Louis, MO, USA; Institute for Informatics, Washington University in St. Louis, MO, USA
| | - Kristen Mueller
- Washington University in St. Louis, MO, USA; School of Medicine, Washington University in St. Louis, MO, USA; Department of Psychiatry, Washington University in St. Louis, MO, USA; Department of Emergency Medicine, Washington University in St. Louis, USA
| | - Ben Cooper
- Washington University in St. Louis, MO, USA; School of Medicine, Washington University in St. Louis, MO, USA; Institute for Informatics, Washington University in St. Louis, MO, USA; Public Health Data & Training Center, Institute for Public Health Washington University in St. Louis, St. Louis, Missouri, United States
| | - Theresa Anasti
- Washington University in St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA; Social Policy Institute, Washington University in St. Louis, MO, USA
| | - Nathaniel Dell
- Washington University in St. Louis, MO, USA; School of Medicine, Washington University in St. Louis, MO, USA; Department of Psychiatry, Washington University in St. Louis, MO, USA
| | - Rachel Winograd
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Robert Heimer
- Department of the Epidemiology of Microbial Diseases and the Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
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Paradise RK, Bazzi AR, Clarke J, Desmarais J, Hoyos-Cespedes A, Nurani A, O'Malley SE, Taylor S, Walley AY, Dooley D, Kimmel SD. Multilevel Factors Impacting Substance Use Treatment Access, Engagement, and Racial Equity Among Opioid Overdose Survivors in Boston, MA. J Gen Intern Med 2024; 39:2390-2399. [PMID: 38997532 PMCID: PMC11436504 DOI: 10.1007/s11606-024-08918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND There are well-documented racial/ethnic inequities in drug-related overdoses and access to evidence-based opioid use services nationally and in Boston, MA. OBJECTIVE To qualitatively explore the drivers of racial/ethnic inequities in access to opioid use disorder treatment and services in Boston. DESIGN Semi-structured qualitative interviews. PARTICIPANTS Using purposive sampling, researchers recruited 59 opioid overdose survivors in Boston who self-identified as Black, Hispanic or Latino/a/x, and/or White. APPROACH Interviewers administered a socio-demographic and drug use survey, and used a semi-structured interview guide to explore experiences with and perspectives on substance use treatment and services. KEY RESULTS Participants' racial/ethnic identities were distributed across three subgroups: non-Hispanic Black (n = 18; 31%), non-Hispanic White (n = 18; 31%), and Latino/a/x (n = 23; 39%). Qualitative analysis identified multiple themes that were organized into four social-ecological levels after analysis. At the individual level, some participants emphasized the importance of personal responsibility and individual motivation in determining access to services. Participants expressed a range of perspectives about using medication for opioid use disorder treatment; Black and Latino/a/x participants were more likely than White participants to have critical perspectives. At the interpersonal level, experiences of bias, stigma, and racism from staff in healthcare and treatment settings were common. At the program/process level, participants described challenges connecting to services following overdose and barriers within specific programs, with Black and Latino/a/x participants experiencing particular gaps. At the systems level, the limited availability of housing, employment, and mental health care negatively impacted treatment access and engagement. CONCLUSION A racism lens was used during data interpretation to apply the themes at a broader population level. Through this lens, the identified barriers can be understood to have a disproportionate impact on people of color. Findings call for programmatic and policy solutions that address racism, break down stigma, and ensure equitable access to evidence-based services and social supports.
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Affiliation(s)
- Ranjani K Paradise
- Institute for Community Health, Malden, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
| | - Angela R Bazzi
- University of California, San Diego, La Jolla, CA, USA
- Boston University School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | - Alexander Y Walley
- Boston Medical Center, Boston, MA, USA
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | | | - Simeon D Kimmel
- Boston Medical Center, Boston, MA, USA
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
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19
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Banks DE, Paschke M, Ghonasgi R, Thompson VLS. Benefits and challenges of geographic information systems (GIS) for data-driven outreach in black communities experiencing overdose disparities: results of a stakeholder focus group. BMC Public Health 2024; 24:2103. [PMID: 39098915 PMCID: PMC11299267 DOI: 10.1186/s12889-024-19541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Black individuals in the U.S. face increasing racial disparities in drug overdose related to social determinants of health, including place-based features. Mobile outreach efforts work to mitigate social determinants by servicing geographic areas with low drug treatment and overdose prevention access but are often limited by convenience-based targets. Geographic information systems (GIS) are often used to characterize and visualize the overdose crisis and could be translated to community to guide mobile outreach services. The current study examines the initial acceptability and appropriateness of GIS to facilitate data-driven outreach for reducing overdose inequities facing Black individuals. METHODS We convened a focus group of stakeholders (N = 8) in leadership roles at organizations conducting mobile outreach in predominantly Black neighborhoods of St. Louis, MO. Organizations represented provided adult mental health and substance use treatment or harm reduction services. Participants were prompted to discuss current outreach strategies and provided feedback on preliminary GIS-derived maps displaying regional overdose epidemiology. A reflexive approach to thematic analysis was used to extract themes. RESULTS Four themes were identified that contextualize the acceptability and utility of an overdose visualization tool to mobile service providers in Black communities. They were: 1) importance of considering broader community context; 2) potential for awareness, engagement, and community collaboration; 3) ensuring data relevance to the affected community; and 4) data manipulation and validity concerns. CONCLUSIONS There are several perceived benefits of using GIS to map overdose among mobile providers serving Black communities that are overburdened by the overdose crisis but under resourced. Perceived potential benefits included informing location-based targets for services as well as improving awareness of the overdose crisis and facilitating collaboration, advocacy, and resource allocation. However, as GIS-enabled visualization of drug overdose grows in science, public health, and community settings, stakeholders must consider concerns undermining community trust and benefits, particularly for Black communities facing historical inequities and ongoing disparities.
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Affiliation(s)
- Devin E Banks
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA.
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA.
| | - Maria Paschke
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Rashmi Ghonasgi
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
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20
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Saunders EC, Budney AJ, Cavazos-Rehg P, Scherer E, Bell K, John D, Marsch LA. Evaluating preferences for medication formulation and treatment model among people who use opioids non-medically: A web-based cross-sectional study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209383. [PMID: 38670531 PMCID: PMC11180569 DOI: 10.1016/j.josat.2024.209383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 02/19/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Over the past decade, treatment for opioid use disorder has expanded to include long-acting injectable and implantable formulations of medication for opioid use disorder (MOUD), and integrated treatment models systematically addressing both behavioral and physical health. Patient preference for these treatment options has been underexplored. Gathering data on OUD treatment preferences is critical to guide the development of patient-centered treatment for OUD. This cross-sectional study assessed preferences for long-acting MOUD and integrated treatment using an online survey. METHODS An online Qualtrics survey assessed preferences for MOUD formulation and integrated treatment models. The study recruited participants (n = 851) in October and November 2019 through advertisements or posts on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (mTurk). Eligible participants scored a two or higher on the opioid pain reliever or heroin scales of the Tobacco, Alcohol Prescription Medication and other Substance Use (TAPS) Tool. Structured survey items obtained patient preference for MOUD formulation and treatment model. Using stated preference methods, the study assessed preference via comparison of preferred options for MOUD and treatment model. RESULTS In the past year, 824 (96.8 %) participants reported non-prescribed use of opioid pain relievers (mean TAPS score = 2.72, SD = 0.46) and 552 (64.9 %) reported heroin or fentanyl use (mean TAPS score = 2.73, SD = 0.51). Seventy-four percent of participants (n = 631) reported currently or previously receiving OUD treatment, with 407 (48.4 %) receiving MOUD. When asked about preferences for type of MOUD formulation, 452 (53.1 %) preferred a daily oral formulation, 115 (13.5 %) preferred an implant, 114 (13.4 %) preferred a monthly injection and 95 (11.2 %) preferred a weekly injection. Approximately 8.8 % (n = 75) would not consider MOUD regardless of formulation. The majority of participants (65.2 %, n = 555) preferred receiving treatment in a specialized substance use treatment program distinct from their medical care, compared with receiving care in an integrated model (n = 296, 34.8 %). CONCLUSIONS Though most participants expressed willingness to try long-acting MOUD formulations, the majority preferred short-acting formulations. Likewise, the majority preferred non-integrated treatment in specialty substance use settings. Reasons for these preferences provide insight on developing effective educational tools for patients and suggesting targets for intervention to develop a more acceptable treatment system.
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Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
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21
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Hébert AH, Hill AL. Impact of opioid overdoses on US life expectancy and years of life lost, by demographic group and stimulant co-involvement: a mortality data analysis from 2019 to 2022. LANCET REGIONAL HEALTH. AMERICAS 2024; 36:100813. [PMID: 38978785 PMCID: PMC11228948 DOI: 10.1016/j.lana.2024.100813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 07/10/2024]
Abstract
Background The United States' opioid crisis is worsening, with the number of deaths reaching 81,806 in 2022 after more than tripling over the past decade. This study aimed to comprehensively characterize changes in burden of opioid overdose mortality in terms of life expectancy reduction and years of life lost between 2019 and 2022, including differential burden across demographic groups and the contribution of polysubstance use. Methods Using life tables and counts for all-cause and opioid overdose deaths from the National Center for Health Statistics, we constructed cause-eliminated life tables to estimate mortality by age in the absence of opioid-related deaths. We calculated the loss in life expectancy at birth (LLE) and total years of life lost (YLL) due to opioid overdose deaths by state of residency, sex, racial/ethnic group, and co-involvement of cocaine and psychostimulants. Findings Opioid-related deaths in the US led to an estimated 3.1 million years of life lost in 2022 (38 years per death), compared to 2.0 million years lost in 2019. Relative to a scenario with no opioid mortality, we estimate that opioid-related deaths reduced life expectancy nationally by 0.67 years in 2022 vs 0.52 years in 2019. This LLE worsened in all racial/ethnic groups during the study period: 0.76 y-0.96 y for white men, 0.36 y-0.55 y for white women, 0.59 y-1.1 y for Black men, 0.27 y-0.53 y for Black women, 0.31 y-0.82 y for Hispanic men, 0.19 y-0.31 y for Hispanic women, 0.62 y-1.5 y for American Indian/Alaska Native (AI/AN) men, 0.43 y-1 y for AI/AN women, 0.09 y-0.2 y for Asian men, and 0.08 y-0.13 y for Asian women. Nearly all states experienced an increase in years of life lost (YLL) per capita from 2019 to 2022, with YLL more than doubling in 16 states. Cocaine or psychostimulants with abuse potential (incl. methamphetamines) were involved in half of all deaths and years of life lost in 2022, with substantial variation in the predominant drug class by state and racial/ethnic group. Interpretation The burden of opioid-related mortality increased dramatically in the US between 2019 and 2022, coinciding with the period of the COVID-19 pandemic and the associated disruptions to social, economic, and health systems. Opioid overdose deaths are an important contributor to decreasing US life expectancy, and Black, Hispanic, and Native Americans now experience mortality burdens approaching or exceeding white Americans. Funding None.
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Affiliation(s)
- Anne H. Hébert
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alison L. Hill
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
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22
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Beletsky L, Tiako MJN. Costs and Essential Drug Access-The Case of Naloxone. JAMA 2024; 332:109-110. [PMID: 38869858 DOI: 10.1001/jama.2024.7012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Affiliation(s)
- Leo Beletsky
- School of Law, Bouve College of Health Sciences and the Action Lab, Northeastern University, Boston, Massachusetts
- Department of Infectious Disease and Global Public Health, School of Medicine, University of California-San Diego, La Jolla
| | - Max Jordan Nguemeni Tiako
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
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23
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Hawk M, Kay ES, Jawa R. Relational Harm Reduction for Internists: A Call to Action. J Gen Intern Med 2024; 39:1746-1748. [PMID: 38424343 PMCID: PMC11255156 DOI: 10.1007/s11606-024-08693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Mary Hawk
- Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 6127 Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
| | - Emma Sophia Kay
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raagini Jawa
- Center for Research On Healthcare, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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24
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Rivera BD, Friedman SR. What would it really take to solve the overdose epidemic in the United States? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104435. [PMID: 38729061 PMCID: PMC11220856 DOI: 10.1016/j.drugpo.2024.104435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024]
Abstract
The high overdose mortality rates in the United States poses several questions: Why have they been increasing exponentially since 1979? Why are they so high? And how can they be greatly reduced? Building on past research, the causes of the increase seem to be deeply rooted in US social and economic structures and processes, rather than due only to opioid prescription patterns or the advent of synthetic opioids. Given this, we consider what changes might be needed to reverse the exponentially-increasing overdose mortality. We use a path dependency argument to argue that the United States political, economic, and public health systems have helped create this crisis and, unfortunately, continue to heighten it. These same systems suggest that proposals to expand harm reduction and drug treatment capacity, to decriminalize or legalize drugs, or to re-industrialize the country sufficiently to reduce "communities of despair" will not be enacted at a scale sufficient to end the overdose crisis. We thus suggest that in the United States serious improvements in overdose rates and related policies and structures require massive social movements with a broad social change agenda.
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Affiliation(s)
- Bianca D Rivera
- SUNY Downstate Health Sciences University School of Public Health, Brooklyn, NY, USA
| | - Samuel R Friedman
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, USA.
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25
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D'Souza RR, Cooper HL, Chang HH, Rogers E, Wien S, Blake SC, Kramer MR. Person-centered hospital discharge data: Essential existing infrastructure to enhance public health surveillance of maternal substance use disorders in the midst of a national maternal overdose crisis. Ann Epidemiol 2024; 94:64-71. [PMID: 38677568 PMCID: PMC11423709 DOI: 10.1016/j.annepidem.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES As crises of drug-related maternal harms escalate, US public health surveillance capacity remains suboptimal for drug-related maternal morbidities. Most state hospital discharge databases (HDDs) are encounter-based, and thus limit ascertainment of morbidities to delivery visits and ignoring those occurring during the 21 months spanning pregnancy and postpartum year. This study analyzes data from a state that curates person-centered HDD to compare patterns of substance use disorder (SUD) diagnoses at delivery vs. the full 21 pregnancy/postpartum months, overall and by maternal social position. METHODS Among people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N = 330,872), we estimated SUD diagnosis (e.g., opioids, stimulants, benzodiazepines, cannabis) prevalence at delivery; across the full 9 months of pregnancy and 12 postpartum months; and by trimester and postpartum quarter. Risk ratio and risk difference estimated disparities by race/ethnicity, age, rurality, and payor. RESULTS The 21-month SUD prevalence rate per 100,000 was 2671 (95% CI 2616-2726), with 31% (29.5%-31.5%) missing SUD indication when ascertained at delivery only (1866; 95% CI 1820-1912). Quarterly rates followed a roughly J-shaped trajectory. Structurally marginalized individuals suffered the highest 21-month SUD prevalence (e.g., Black:White risk ratio=1.80 [CI:1.73-1.88]). CONCLUSION By spanning the full 21 months of pregnancy/postpartum, person-centered HDD reveal than the maternal SUD crisis is far greater than encounter-based delivery estimates had revealed. Generating person-centered HDD will improve efforts to tailor interventions to help people who use drugs survive while pregnant and postpartum, and eliminate inequities.
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Affiliation(s)
- Rohan R D'Souza
- Emory University Rollins School of Public Health, Biostatistics, USA
| | - Hannah Lf Cooper
- Emory University, Department of Behavioral Sciences and Health Education, USA
| | - Howard H Chang
- Emory University Rollins School of Public Health, Biostatistics, USA
| | - Erin Rogers
- Emory University Rollins School of Public Health, Epidemiology, USA
| | - Simone Wien
- Emory University Rollins School of Public Health, Epidemiology, USA
| | - Sarah C Blake
- Rollins School of Public Health, Emory University, Health Policy & Management, USA
| | - Michael R Kramer
- Emory University Rollins School of Public Health, Epidemiology, USA
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26
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Kennedy-Hendricks A, Ettman CK, Gollust SE, Bandara SN, Abdalla SM, Castrucci BC, Galea S. Experience of Personal Loss Due to Drug Overdose Among US Adults. JAMA HEALTH FORUM 2024; 5:e241262. [PMID: 38819798 PMCID: PMC11143465 DOI: 10.1001/jamahealthforum.2024.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
Importance Since 1999, over 1 million people have died of a drug overdose in the US. However, little is known about the bereaved, meaning their family, friends, and acquaintances, and their views on the importance of addiction as a policy priority. Objectives To quantify the scope of the drug overdose crisis in terms of personal overdose loss (ie, knowing someone who died of a drug overdose) and to assess the policy implications of this loss. Design, Setting, and Participants This cross-sectional study used data from a nationally representative survey of US adults (age ≥18 years), the fourth wave of the COVID-19 and Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, which was conducted from March to April 2023. Main Outcomes and Measures Respondents reported whether they knew someone who died of a drug overdose and the nature of their relationship with the decedent(s). They also reported their political party affiliation and rated the importance of addiction as a policy issue. Logistic regression models estimated the associations between sociodemographic characteristics and political party affiliation and the probability of experiencing a personal overdose loss and between the experience of overdose loss and the perceived salience of addiction as a policy issue. Survey weights adjusted for sampling design and nonresponse. Results Of the 7802 panelists invited to participate, 2479 completed the survey (31.8% response rate); 153 were excluded because they did not know whether they knew someone who died of a drug overdose, resulting in a final analytic sample of 2326 (51.4% female; mean [SD] age, 48.12 [0.48] years). Of these respondents, 32.0% (95% CI, 28.8%-34.3%) reported any personal overdose loss, translating to 82.7 million US adults. A total of 18.9% (95% CI, 17.1%-20.8%) of all respondents, translating to 48.9 million US adults, reported having a family member or close friend die of drug overdose. Personal overdose loss was more prevalent among groups with lower income (<$30 000: 39.9%; ≥$100 000: 26.0%). The experience of overdose loss did not differ across political party groups (Democrat: 29.0%; Republican: 33.0%; independent or none: 34.2%). Experiencing overdose loss was associated with a greater odds of viewing addiction as an extremely or very important policy issue (adjusted odds ratio, 1.37; 95% CI, 1.09-1.72) after adjustment for sociodemographic and geographic characteristics and political party affiliation. Conclusions and Relevance This cross-sectional study found that 32% of US adults reported knowing someone who died of a drug overdose and that personal overdose loss was associated with greater odds of endorsing addiction as an important policy issue. The findings suggest that mobilization of this group may be an avenue to facilitate greater policy change.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine K. Ettman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah E. Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Sachini N. Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Salma M. Abdalla
- Department of Epidemiology and Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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27
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Richardson L, Geddes C, Palis H, Buxton J, Slaunwhite A. An ecological study of the correlation between COVID-19 support payments and overdose events in British Columbia, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104362. [PMID: 38484530 DOI: 10.1016/j.drugpo.2024.104362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/21/2023] [Accepted: 02/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Pandemic income support payments have been speculatively linked to an increased incidence of illicit drug poisoning (overdose). However, existing research is limited. METHODS Collating Canadian Emergency Response Benefit (CERB) payment data with data on paramedic attended overdose and illicit drug toxicity deaths for the province of British Columbia at the Local Health Area (LHA) level, we conducted a correlation analysis to compare overdose rates before, during and after active CERB disbursement. RESULTS There were 20,014,270 CERB-entitled weeks identified among residents of British Columbia for the duration of the pandemic response program. Approximately 52 % of all CERB entitled weeks in the study were among females and approximately 48 % were among males. Paramedic-attended overdoses increased uniformly across the pre-CERB, CERB and post-CERB periods, while illicit drug toxicity deaths sharply increased and then remained high over the period of the study. Correlation analyses between overdose and CERB-entitled weeks approached zero for both paramedic-attended overdoses and illicit drug toxicity deaths. CONCLUSIONS These findings suggest that attributing the pandemic increase in overdose to income support payments is unfounded. Sustained levels of unacceptably high non-fatal and fatal drug poisonings that further increased at the start of the pandemic are reflective of complex pre-existing and pandemic-driven changes to overdose risk.
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Affiliation(s)
- Lindsey Richardson
- Department of Sociology, University of British Columbia, Vancouver, Canada; British Columbia Centre on Substance Use, Vancouver, Canada.
| | - Cameron Geddes
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Heather Palis
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Slaunwhite
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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28
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Xu JJ, Seamans MJ, Friedman JR. Drug overdose mortality rates by educational attainment and sex for adults aged 25-64 in the United States before and during the COVID-19 pandemic, 2015-2021. Drug Alcohol Depend 2024; 255:111014. [PMID: 38142465 PMCID: PMC11837773 DOI: 10.1016/j.drugalcdep.2023.111014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/01/2023] [Accepted: 10/24/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Dramatic increases in U.S. drug overdose deaths involving synthetic opioids, especially fentanyl, beginning around 2014 have driven a marked progression in overall drug overdose deaths in the U.S., which sharply rose to unprecedented levels amid the COVID-19 pandemic. Disparities in drug overdose deaths by educational attainment (EA) during the fentanyl era of the drug overdose epidemic and its intersection with the COVID-19 pandemic have not been widely scrutinized. METHODS Utilizing restricted-use mortality data from the National Vital Statistics System and population estimates from the American Community Survey, we estimated annual national age-adjusted mortality rates (AAMRs) from drug overdoses jointly stratified by EA and sex for adults aged 25-64 from 2015 to 2021. State-level AAMRs in 2015 and 2021 were also estimated to examine the geographic variation in the cumulative evolution of EA-related disparities over the course of the analysis period. RESULTS Nationally, AAMRs rose fastest among persons with at most a high school-level education, whereas little to no change was observed for bachelor's degree holders, widening pre-existing disparities. During the analysis period, the difference in national AAMRs between persons with at most a high school-level education and bachelor's degree holders increased from less than 8-fold (2015) to approximately 13-fold (2021). The national widening of EA-related disparities accelerated amid the COVID-19 pandemic, and they widened in nearly every state. Among non-bachelor's degree holders, national AAMRs increased markedly faster for males. CONCLUSIONS The widening disparities in drug overdose deaths by EA are a likely indicator of a rapidly increasing socioeconomic divide in drug overdose mortality more broadly. Policy strategies should address upstream socioeconomic drivers of drug use and overdose, particularly among males.
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Affiliation(s)
- Jay J Xu
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Marissa J Seamans
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Joseph R Friedman
- Center for Social Medicine and Humanities, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Jones AA, Segel JE, Skogseth EM, Apsley HB, Santos-Lozada AR. Drug overdose deaths among women 1999-2021 in the United States: Differences by race, ethnicity, and age. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241307088. [PMID: 39686730 PMCID: PMC11650567 DOI: 10.1177/17455057241307088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 11/19/2024] [Accepted: 11/28/2024] [Indexed: 12/18/2024]
Abstract
BACKGROUND The U.S. drug overdose epidemic is increasingly severe and steep increases have been seen among women. OBJECTIVE To explore trends in drug overdose deaths among women in the United States by race, ethnicity, and age group. DESIGN This study is a retrospective observational study of drug overdose deaths among U.S. women from 1999 to 2021. METHODS We use CDC WONDER Multiple Causes of Death files data using International Classification of Diseases, 10th Revision (ICD-10) codes X40-X44, X60-X64, X85, and Y10-Y14 to identify overall drug overdose deaths, T40.5 for cocaine-related deaths, T40.0-T40.4, T40.6 for opioid-related deaths, T42.4 for benzodiazepines, and T43.6 to identify psychostimulants. Race and ethnicity were defined as non-Hispanic Black, White, American Indian/Alaska Native (AI/AN), Asian, and Hispanic. We calculated overdose death rates per 100,000 women for all overdose deaths and for specific drugs by year, stratified by race and ethnicity. RESULTS From 1999 to 2021, overdose deaths among all women in the United States increased by 480%. Overdose deaths rose 750% for non-Hispanic AI/AN women, 490% for non-Hispanic Black women, 450% for non-Hispanic White women, 325% for Hispanic women, and 150% for non-Hispanic Asian or Pacific Islander women. Women ages 35-44 and 45-54 saw the largest increases in overall overdose deaths. Cocaine-related deaths were more prevalent among non-Hispanic Black women, opioid and methamphetamine-related deaths were more prevalent among non-Hispanic AI/AN women, and benzodiazepine-related deaths were more prevalent among non-Hispanic White women. CONCLUSION Increases in overdose deaths were noted in all races, ethnicities, and age groups, with deaths continuing to accelerate in 2021. Our study highlights a need for interventions expanding access to medications for opioid use disorder, naloxone, fentanyl test strips, and contingency management while accounting for gendered roles and vulnerabilities.
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Affiliation(s)
- Abenaa A Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA, USA
| | - Joel E Segel
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA, USA
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Emma M Skogseth
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Hannah B Apsley
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Alexis R Santos-Lozada
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA, USA
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Powell D. Growth in Suicide Rates Among Children During the Illicit Opioid Crisis. Demography 2023; 60:1843-1875. [PMID: 38009202 PMCID: PMC12101483 DOI: 10.1215/00703370-11077660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
This article documents child suicide rates from 1980 to 2020 in the United States using the National Vital Statistics System Multiple Cause of Death database. After generally declining for decades, suicide rates among children aged 10-17 accelerated from 2011 to 2018 in an unprecedented rise in both duration and magnitude. I consider the role of the illicit opioid crisis in driving this mental health crisis. In August 2010, an abuse-deterrent version of OxyContin was introduced and the original formulation was removed from the market, leading to a shift to illicit opioids and stimulating growth in illicit opioid markets. Areas more exposed to reformulation-as measured by pre-reformulation rates of OxyContin misuse in the National Survey on Drug Use and Health-were more affected by the transition to illicit opioids and experienced sharper growth in child suicide rates. The evidence suggests that children's illicit opioid use did not increase, implying that the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children, such as increasing rates of child neglect and altering household living arrangements. In complementary analyses, I document how living conditions declined for children during this time period.
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Rawson RA, Erath TG, Clark HW. The fourth wave of the overdose crisis: Examining the prominent role of psychomotor stimulants with and without fentanyl. Prev Med 2023; 176:107625. [PMID: 37468073 DOI: 10.1016/j.ypmed.2023.107625] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
The current overdose and broader public health crisis involving illicit drug use is often referred to as the "opioid" or "fentanyl" crisis. Clearly there is extensive data on the profound damage done by opioids over the past 20 years and specifically by fentanyl in the past 5 years. However, there is an extensive array of data that suggests there is more to the current crisis than opioids/fentanyl. Much recent evidence indicates that methamphetamine and cocaine are playing a substantial and increasing role in the illicit drug crisis in the US-the 4th wave. This paper reviews data that illustrate the role of psychomotor stimulants in fatal overdoses, nonfatal overdoses, and emergency department visits. Despite the major detrimental role that stimulants are having on the public health in the US in 2023, there is virtually no evidence-based treatment available in practice for people with stimulant use disorder (StimUD). Although there are no medications with FDA-approval for the treatment of StimUD, there is a behavioral treatment, contingency management (CM), with over 3 decades of robust research supporting its efficacy for individuals with StimUD. Despite the overwhelming evidence supporting CM, it is not being widely used in routine treatment outside the VA healthcare system. This paper reviews some of the (a) evidence for CM, (b) CM protocol design elements that require consideration, (c) current obstacles to the widespread implementation of CM, and (d) strategies for addressing these obstacles. Overcoming these obstacles is a priority to allow routine use of CM as a treatment for StimUD.
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Affiliation(s)
- Richard A Rawson
- Vermont Center on Behavior and Health, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Motivational Incentives Policy Group, United States of America.
| | - Tyler G Erath
- Vermont Center on Behavior and Health, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Motivational Incentives Policy Group, United States of America
| | - H Westley Clark
- Motivational Incentives Policy Group, United States of America
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Powell D. Educational Attainment and US Drug Overdose Deaths. JAMA HEALTH FORUM 2023; 4:e233274. [PMID: 37801307 PMCID: PMC10559184 DOI: 10.1001/jamahealthforum.2023.3274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Educational attainment in the US is associated with life expectancy. As the opioid crisis worsens, it is critical to understand how overdose death rate trends evolve across education groups. Objective To investigate the association between educational attainment and overdose death rates, with emphasis on trends during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study used National Vital Statistics System Mortality Multiple Cause-of-Death data describing overdose death rates in the US by educational attainment from January 1, 2000, to December 31, 2021, with a focus on 2018 to 2021. Overdose deaths were aggregated by year and educational level for decedents aged 25 years or older. Exposure Educational attainment, categorized as no high school (HS) diploma, HS diploma (or General Educational Development) but no college, some college but no bachelor's degree, and bachelor's degree or more. Main Outcomes and Measures The main outcomes were rates of all overdose deaths, overdose deaths involving opioids, and overdose deaths involving synthetic opioids. Results Of 912 057 overdose deaths with education information from 2000 to 2021 (mean [SD] age at death, 44.9 [12.3] years; 64.1% male), there were 625 400 deaths (68.6%) among individuals with no college education and 286 657 deaths (31.4%) among those with at least some college. The overdose death rate was 19.9 per 100 000 population. From 2018 to 2021, there were 301 557 overdose deaths, including 58 319 (19.3%) among individuals without an HS diploma, 153 603 (50.9%) among people with an HS diploma, 64 682 (21.4%) among individuals with some college, and 24 953 (8.3%) among individuals with a bachelor's degree. There were 3324 overdose deaths (1.1%) among American Indian or Alaska Native individuals, 2968 (1.0%) among Asian American or Pacific Islander individuals, 49 152 (16.3%) among Black individuals, 31 703 (10.5%) among Hispanic individuals, 211 359 (70.1%) among White individuals, and 3051 (1.0%) among multiracial individuals. From 2018 to 2021, the overdose death rate was 33.4 per 100 000 population, the opioid-related overdose death rate was 24.2 per 100 000 population, and the synthetic opioid overdose death rate was 19.1 per 100 000 population. From 2018 to 2021, the overdose death rate for those without a HS diploma increased by 35.4 per 100 000 population compared with 1.5 per 100 000 population for those with a bachelor's degree. This differential growth was primarily due to increased rates of death involving synthetic opioids. Conclusions and Relevance In this cross-sectional study, lower educational attainment was found to be associated with higher growth in overdose deaths. As the opioid crisis has transitioned to fentanyl and polysubstance use, overdose deaths have become more prevalent in groups with lower socioeconomic status, potentially exacerbating existing life-expectancy disparities.
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Jordan A, Costa M, Nich C, Swarbrick M, Babuscio T, Wyatt J, O'Connell M, Guy K, Blackman K, Anderson RR, Reis G, Ocasio L, Crespo M, Bellamy C. Breaking through social determinants of health: Results from a feasibility study of Imani Breakthrough, a community developed substance use intervention for Black and Latinx people. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 153:209057. [PMID: 37207836 DOI: 10.1016/j.josat.2023.209057] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/21/2023]
Abstract
Racial and ethnic disparities in substance use intervention design, implementation, and dissemination have been recognized for years, yet few intervention programs have been designed and conducted by and for people who use substances. Imani Breakthrough is a two-phase 22-week intervention developed by the community, run by facilitators with lived experience and church members, that is implemented in Black and Latinx church settings. This community-based participatory research (CBPR) approach is a concept developed in response to a call for action from the State of Connecticut Department of Mental Health and Addiction Services (DMHAS) with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to address rising rates of death due to opioid overdose, and other negative consequences of substance misuse. After nine months of didactic community meetings, the final design involved twelve weeks of education in a group setting related to the recovery process, including the impact of trauma and racism on substance use, and a focus on citizenship and community participation and the 8 dimensions of wellness, followed by ten weeks of mutual support, with intensive wraparound support and life coaching focused on the social determinants of health (SDOH). We found the Imani intervention was feasible and acceptable, with 42 % of participants retained at 12 weeks. In addition, in a subset of participants with complete data, we found a significant increase in both citizenship scores and dimensions of wellness from baseline to week 12, with the greatest improvements in the occupational, intellectual, financial, and personal responsibility dimensions. As drug overdose rates among Black and Latinx people who use substances continue to increase, it is imperative that we address the inequities in the SDOH that contribute to this disparity gap so that we can develop interventions tailored to the specific needs of Black and Latinx people who use drugs. The Imani Breakthrough intervention shows promise as a community-driven approach that can address these disparities and promote health equity.
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Affiliation(s)
- Ayana Jordan
- New York University Grossman School of Medicine, USA
| | | | | | - Margaret Swarbrick
- FAOTA - Rutgers University, Center of Alcohol and Substance Use Studies, Collaborative Programs of NJ (CSPNJ), USA
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Cano M, Mendoza N, Ignacio M, Rahman A, Daniulaityte R. Overdose deaths involving synthetic opioids: Racial/ethnic and educational disparities in the eastern and western US. Drug Alcohol Depend 2023; 251:110955. [PMID: 37699286 PMCID: PMC11906140 DOI: 10.1016/j.drugalcdep.2023.110955] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND This study examined racial/ethnic and educational disparities in US synthetic opioid overdose mortality East and West of the Mississippi River. METHODS Using restricted-access 2018-2021 mortality data from the Centers for Disease Control and Prevention and population estimates from the American Community Survey, age-standardized rate ratios (SRRs) and 95% Confidence Intervals (CIs) were used to compare rates of synthetic opioid mortality by race/ethnicity and educational attainment level in the regions East and West of the Mississippi River. RESULTS Racial/ethnic disparities in synthetic opioid mortality rates, relative to the Non-Hispanic (NH) White population, were observed in the NH Black (SRR, 1.5 [95% CI, 1.5-1.6]) and NH American Indian/Alaska Native (SRR, 2.1 [95% CI, 1.9-2.2]) populations in the West, and the Puerto Rican (SRR, 1.3 [95% CI, 1.3-1.3]) and NH American Indian/Alaska Native (SRR, 1.5 [95% CI, 1.4-1.6]) populations in the East. Relative to those with a Bachelor's degree or higher: in the West, the synthetic opioid mortality rate was more than seven times as high for those with a high school diploma only (SRR 7.7 [95% CI, 7.4-8.0]), and in the East, approximately thirteen times as high for those with a high school diploma only (SRR, 13.0 [95% CI, 12.7-13.3]) or less than a high school diploma (SRR, 13.3 [95% CI, 13.0-13.7]). CONCLUSION Disparities in rates of synthetic opioid mortality differ in the eastern and western US, supporting tailored responses within each region.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ, USA.
| | - Natasha Mendoza
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Matt Ignacio
- School of Social Work, Arizona State University, Tucson, AZ, USA
| | - Abir Rahman
- Cabell-Huntington Health Department, Huntington, WV, USA
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Zhu DT. Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review. Harm Reduct J 2023; 20:131. [PMID: 37700329 PMCID: PMC10498612 DOI: 10.1186/s12954-023-00867-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Xylazine, an α2-adrenoceptor agonist sedative commonly used in veterinary medicine, is not approved for human use. Nevertheless, xylazine-involved overdose rates have surged in recent years, fueled by an increasingly toxic and synthetic illicit drug supply in North America. METHODS This narrative review assessed major epidemiological trends in xylazine-involved overdoses in North America, aiming to identify harm reduction priorities. A literature search was conducted using four bibliographic databases (PubMed, Scopus, Embase, and ScienceDirect) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) on May 28, 2023, to capture articles related to combinations of keywords such as "xylazine", "opioid", and "harm reduction". RESULTS Xylazine emerged as an adulterant in Puerto Rico in 2001, likely diverted from veterinary supplies. By the mid-2010s, it began proliferating across unregulated US drug markets, often contemporaneously with illicitly manufactured fentanyl (IMF), displaying characteristics of a syndemic. Initially concentrated in Northeastern regions (e.g., Philadelphia, Connecticut, Maryland), xylazine-involved overdoses later extended to the Rust Belt, Southern, and Western regions of the USA in the late 2010s and early 2020s. During this time, xylazine-involved overdoses also surged in Canada, particularly in Western provinces (British Columbia and Alberta) and Ontario with established IMF-dominated unregulated drug markets. DISCUSSION Over the past two decades, xylazine-involved overdoses have been rapidly rising in North America and exhibit few signs of slowing down, representing a serious public health epidemic. Numerous factors may have contributed to this, including limited epidemiological surveillance and drug checking for xylazine and emerging novel adulterants; further, barriers to comprehensive, trauma-informed, non-stigmatizing treatment and social services have also exacerbated this issue. While several epidemiological and ethnographic studies have assessed these factors in the USA, limited evidence is available in Canada where xylazine emerged more recently. This underscores the need for additional research and harm reduction measures. CONCLUSION Harm reduction-informed public health guidelines and programs are urgently needed to promote a safer supply, strengthen the healthcare system capacity to prevent and respond to xylazine-involved overdoses, and address social and structural disparities in health outcomes.
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Affiliation(s)
- David T Zhu
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, 1201 E Marshall St, Richmond, VA, 23298, USA.
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Gicquelais RE, Astemborski J, Werb D, Kirk GD, Mehta SH, Genberg BL. Context and correlates of providing assistance with someone's first injection in the AIDS linked to the IntraVenous Experience cohort, Baltimore, MD. Drug Alcohol Depend 2023; 250:110909. [PMID: 37517262 PMCID: PMC10529208 DOI: 10.1016/j.drugalcdep.2023.110909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The social processes around initiating injection may be well-suited to intervention, yet there is substantial heterogeneity in the reported experiences of people who inject drugs (PWID) who assist with another individual's first drug injection. We aimed to describe the lifetime prevalence and context of providing initiation assistance among a cohort of PWID. METHODS Participants of the AIDS Linked to the IntraVenous Experience (ALIVE) cohort of PWID in Baltimore, Maryland (n=848) were surveyed during 2019-2020 about assisting with another person's first injection. Associations between factors related to injection risk and history of providing assistance were estimated using logistic regression models adjusted for sociodemographic and behavioral characteristics. RESULTS At baseline, participants were primarily male (66.1%), black (82.9%), aged a median of 42 years, and had been injecting a median of 18 years. Overall, 19% (n=157) of participants reported ever providing assistance for a median of 2 people (Interquartile Range: 1-4). Having hepatitis C infection (adjusted Odds Ratio [95% Confidence Interval]: 2.5 [1.4-4.6]), syringe sharing (2.2 [1.2-3.9]), and injecting ≥3 times per day (2.0 [1.2-3.4]) at study enrollment were associated with a history of assistance. Participants primarily assisted friends (58.0%), acquaintances (29.9%), and partners (21.7%). Common reasons for assisting were the other person's lack of injection knowledge (73.7%) or sharing drugs (44.9%). Additional reasons included to prevent injury. CONCLUSION PWID with a history of assisting with another person's first injection exhibited heightened vulnerability to infections and more frequent substance use. Expanding implementation of interventions with an emphasis on harm reduction is needed.
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Affiliation(s)
- Rachel E Gicquelais
- University of Wisconsin-Madison School of Nursing, 701 Highland AveMadisonWI53705, United States
| | - Jacqueline Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe StBaltimoreMD21205, United States
| | - Daniel Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's HospitalTorontoOntario, Canada; Department of Medicine, University of California San DiegoSan DiegoCA92161, United States
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe StBaltimoreMD21205, United States; Johns Hopkins University School of Medicine, Division of Infectious DiseasesBaltimoreMD21205, United States
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe StBaltimoreMD21205, United States
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe StBaltimoreMD21205, United States.
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Ondocsin J, Ciccarone D, Moran L, Outram S, Werb D, Thomas L, Arnold EA. Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5999. [PMID: 37297603 PMCID: PMC10252652 DOI: 10.3390/ijerph20115999] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
The year 2021 was the most deadly year for overdose deaths in the USA and Canada. The stress and social isolation stemming from the COVID-19 pandemic coupled with a flood of fentanyl into local drug markets created conditions in which people who use drugs were more susceptible to accidental overdose. Within territorial, state, and local policy communities, there have been longstanding efforts to reduce morbidity and mortality within this population; however, the current overdose crisis clearly indicates an urgent need for additional, easily accessible, and innovative services. Street-based drug testing programs allow individuals to learn the composition of their substances prior to use, averting unintended overdoses while also creating low threshold opportunities for individuals to connect to other harm reduction services, including substance use treatment programs. We sought to capture perspectives from service providers to document best practices around fielding community-based drug testing programs, including optimizing their position within a constellation of other harm reduction services to best serve local communities. We conducted 11 in-depth interviews from June to November 2022 via Zoom with harm reduction service providers to explore barriers and facilitators around the implementation of drug checking programs, the potential for integration with other health promotion services, and best practices for sustaining these programs, taking the local community and policy landscape into account. Interviews lasted 45-60 min and were recorded and transcribed. Thematic analysis was used to reduce the data, and transcripts were discussed by a team of trained analysts. Several key themes emerged from our interviews: (1) the instability of drug markets amid an inconsistent and dangerous drug supply; (2) implementing drug checking services in dynamic environments in response to the rapidly changing needs of local communities; (3) training and ongoing capacity building needed to create sustainable programs; and (4) the potential for integrating drug checking programs into other services. There are opportunities for this service to make a difference in overdose deaths as the contours of the drug market itself have changed over time, but a number of challenges remain to implement them effectively and sustain the service over time. Drug checking itself represents a paradox within the larger policy context, putting the sustainability of these programs at risk and challenging the potential to scale these programs as the overdose epidemic worsens.
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Affiliation(s)
- Jeff Ondocsin
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Daniel Ciccarone
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Lissa Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Simon Outram
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Dan Werb
- Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Division of Infectious Diseases & Global Public Health, UC San Diego School of Medicine, University of California, San Diego, CA 92093, USA
| | - Laura Thomas
- San Francisco AIDS Foundation, San Francisco, CA 94103, USA
| | - Emily A. Arnold
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
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Romero R, Friedman JR, Goodman-Meza D, Shover CL. US drug overdose mortality rose faster among hispanics than non-hispanics from 2010 to 2021. Drug Alcohol Depend 2023; 246:109859. [PMID: 37031488 PMCID: PMC11195918 DOI: 10.1016/j.drugalcdep.2023.109859] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Historically, overdose mortality rates among Hispanics have been lower than non-Hispanics. The purpose of this analysis was to characterize the U.S. overdose crisis among Hispanics compared to non-Hispanics. METHODS We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (WONDER) platform to obtain drug overdose mortality rates per 100,000 population between 2010 and 2021 for Hispanics and non-Hispanics. We examined the relative percent change and specific drug involvement (2010-2021) and state-level disparities (2010-2020) among Hispanics versus non-Hispanics. We calculated rate ratios by state and annual percent change in total and for each specific drug. Statistical analyses were performed using R software version 4.0.3 (R Project for Statistical Computing). RESULTS Nationally, from 2010 to 2021, Hispanic overdose rates rose from 5.6 to 21.7 per 100,000, an increase of 287.5 % compared to 13.5-35.1 per 100,000, an increase of 160 % among non-Hispanics. The average annual percent change was 12 % for Hispanics and 9 % for non-Hispanics. The three most common drug classes involved in overdose deaths among both groups included: Fentanyls and synthetic opioids; cocaine; and prescription opioids. Hispanic overdose rates were higher than non-Hispanic rates in New Mexico, Colorado, Massachusetts, and Pennsylvania in 2020, versus only Michigan in 2010. CONCLUSIONS We observed disparities in overdose mortality growth among Hispanics compared to non-Hispanics from 2010 to 2021. These disparities highlight the urgency to develop community-centered solutions that take into consideration the social and structural inequalities that exacerbate the effects of the opioid overdose crisis on Hispanic communities.
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Affiliation(s)
- Ruby Romero
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | | | - David Goodman-Meza
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
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CERDÁ MAGDALENA, KRAWCZYK NOA, KEYES KATHERINE. The Future of the United States Overdose Crisis: Challenges and Opportunities. Milbank Q 2023; 101:478-506. [PMID: 36811204 PMCID: PMC10126987 DOI: 10.1111/1468-0009.12602] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Policy Points People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm-reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm-reduction services. Priorities for action include investing in evidence-based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.
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Affiliation(s)
- MAGDALENA CERDÁ
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | - NOA KRAWCZYK
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
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Korona-Bailey J, Riley Saint S, Sizemore L, Wingate H, Shoup P, Hawes A, Mukhopadhyay S. Prevalence of hepatitis C virus among fatal drug overdoses in Tennessee: an analysis using 2019-2020 Tennessee State Unintentional Drug Overdose Reporting System Data. Ann Epidemiol 2023; 80:1-8. [PMID: 36758846 DOI: 10.1016/j.annepidem.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE Given the nature of the co-occurring epidemics of hepatitis C virus (HCV) and fatal stimulant overdose, we sought to assess the prevalence of HCV among opioid and stimulant-positive overdoses. METHODS We conducted a cross-sectional study to examine the prevalence of HCV among fatal drug overdoses in Tennessee using 2019-2020 data from the State Unintentional Drug Overdose Reporting System. We defined history of HCV using surveillance data and autopsy reports. Descriptive statistics were calculated for circumstances of overdose deaths for different categories of opioid and stimulant positivity on toxicology. RESULTS Between 2019 and 2020, 3570 unintentional or undetermined drug overdose deaths occurred in Tennessee with an available autopsy. History of HCV was found in 24.6% of deaths. When assessing different involvement between stimulants and opioids, the highest prevalence of HCV was found for deaths where methamphetamine and opioids were present in toxicology (35.4%). Scene evidence of injection drug use occurred more frequently among decedents with a history of HCV (P < .0001). CONCLUSIONS This analysis while descriptive highlights the importance of linking datasets to enhance infectious disease and drug overdose surveillance. Partnership between communicable disease and drug overdose surveillance teams should continue to identify relationships between disease and drug overdose and strengthen the evidence to tailor crucial treatment and prevention activities.
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Affiliation(s)
- Jessica Korona-Bailey
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN.
| | - Sarah Riley Saint
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN.
| | - Lindsey Sizemore
- Tennessee Department of Health, Communicable and Environmental Disease and Emergency Preparedness, Andrew Johnson Tower, 4th Floor, 710 James Robertson Parkway, Nashville, TN.
| | - Heather Wingate
- Tennessee Department of Health, Communicable and Environmental Disease and Emergency Preparedness, Andrew Johnson Tower, 4th Floor, 710 James Robertson Parkway, Nashville, TN.
| | - Paula Shoup
- Tennessee Department of Health, Communicable and Environmental Disease and Emergency Preparedness, Andrew Johnson Tower, 4th Floor, 710 James Robertson Parkway, Nashville, TN.
| | - Amy Hawes
- Tennessee Department of Health, Office of the State Chief Medical Examiner, Andrew Johnson Tower, 7th Floor, 710 James Robertson Parkway, Nashville, TN.
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN.
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Russell E, Johnson J, Kosinski Z, Kaplan C, Barnes N, Allen S, Haroz E. A scoping review of implementation considerations for harm reduction vending machines. Harm Reduct J 2023; 20:33. [PMID: 36927354 PMCID: PMC10018614 DOI: 10.1186/s12954-023-00765-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Community-based harm reduction vending machines (HRVM) are not new to the field of public health; numerous countries have implemented them in response to the needs of people who use drugs over the last three decades. However, until recently, few existed in the United States. Given the rapidity with which communities are standing up harm reduction vending machines, there is a pressing need for a consolidated examination of implementation evidence. This scoping review summarizes existing literature using multiple implementation science frameworks. METHODS The scoping review was conducted in five stages including (1) Identify the research question; (2) Identify relevant studies; (3) Select the publications based on inclusion/exclusion criteria; (4) Review and extract data; and, (5) Summarize results. PubMed, Embase, and Web of Science were searched and authors screened publications in English from any year. Data were extracted by applying implementation constructs from RE-AIM and the Consolidated Framework for Implementation Research (CFIR). Both frameworks provided a useful lens through which to develop knowledge about the facilitators and barriers to HRVM implementation. The review is reported according to PRISMA guidelines. RESULTS After applying the full inclusion and exclusion criteria, including the intervention of interest ("vending machines") and population of interest ("people who use drugs"), a total of 22 studies were included in the scoping review. None of the studies reported on race, making it difficult to retroactively apply a racial equity lens. Among those articles that examined effectiveness, the outcomes were mixed between clear effectiveness and inconclusive results. Evidence emerged, however, to address all CFIR constructs, and positive outcomes were observed from HRVM's after-hour availability and increased program reach. RECOMMENDATIONS HRVM implementation best practices include maximizing accessibility up to 24 h, 7 days a week, offering syringe disposal options, ensuring capability of data collection, and allowing for anonymity of use. Organizations that implement HRVM should establish strong feedback loops between them, their program participants, and the broader community upfront. Considerations for future research include rigorous study designs to evaluate effectiveness outcomes (e.g. reduced drug overdose deaths) and examination of HRVM reach among ethnic and racial communities.
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Merians AN, Gross G, Spoont MR, Bellamy CD, Harpaz-Rotem I, Pietrzak RH. Racial and ethnic mental health disparities in U.S. Military Veterans: Results from the National Health and Resilience in Veterans Study. J Psychiatr Res 2023; 161:71-76. [PMID: 36905842 DOI: 10.1016/j.jpsychires.2023.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/14/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023]
Abstract
Despite military veterans having a higher prevalence of several common psychiatric disorders relative to non-veterans, scarce population-based research has examined racial/ethnic differences in these disorders. The aim of this study was to examine racial/ethnic differences in the prevalence of psychiatric outcomes in a population-based sample of White, Black, and Hispanic military veterans, and to examine the role of intersectionality between sociodemographic variables and race/ethnicity in predicting these outcomes. Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary, nationally representative survey of 4069 US veterans conducted in 2019-2020. Outcomes include self-report screening measures of lifetime and current psychiatric disorders, and suicidality. Results revealed that Hispanic and Black veterans were more likely than White veterans to screen positive for lifetime posttraumatic stress disorder (PTSD; 17.8% and 16.7% vs. 11.1%, respectively); Hispanic veterans were more likely than White veterans to screen positive for lifetime major depressive disorder (22.0% vs. 16.0%); Black veterans were more likely than White veterans to screen positive for current PTSD (10.1% vs. 5.9%) and drug use disorder (12.9% vs. 8.7%); and Hispanic veterans were more likely than Black veterans to report current suicidal ideation (16.2% vs. 8.1%). Racial/ethnic minority status interacted with lower household income, younger age, and female sex in predicting greater likelihood of some of these outcomes. Results of this population-based study suggest a disproportionate burden of certain psychiatric disorders among racial/ethnicity minority veterans, and identify high-risk subgroups that can be targeted in prevention and treatment efforts.
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Affiliation(s)
- Addie N Merians
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
| | - Georgina Gross
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA; Northeast Program Evaluation Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Michele R Spoont
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA; Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Chyrell D Bellamy
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
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Buprenorphine involvement in opioid overdose deaths: A retrospective analysis of postmortem toxicology in Marion County, Indiana, 2015-2021. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100131. [PMID: 36777895 PMCID: PMC9910498 DOI: 10.1016/j.dadr.2023.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Amidst an unprecedented overdose epidemic, the opioid partial agonist buprenorphine is a medication for opioid use disorder associated with reductions in overdose. Despite its efficacy, buprenorphine prescribing remains closely regulated, owing to concerns about misuse, and its possible role in overdoses. Methods A retrospective analysis of the Marion County, Indiana coroner's postmortem toxicology data for unintentional opioid-involved overdose deaths from 2015 through 2021. The county was chosen as a novel setting whose corner provided comprehensive overdose data. It contains Indianapolis, a large city in the US Midwest The 2,369 opioid-involved overdoses were analyzed for the presence of buprenorphine and its metabolite, as wel as potent substances associated with illicit drug use and overdose. Results Of the 2,369 postmortem toxicology records analyzed, 55 (2.3%) indicated presence of buprenorphine. Of buprenorphine-involved cases, 51 (92.7%) involved other potent substances such as fentanyl, heroin, cocaine, methadone, and amphetamines; 4 (7.3%) were attributed to buprenorphine and liver failure, diabetic ketoacidosis, or relatively less potent substances. Fentanyl was present in 28 cases (50.9%), benzodiazepines were present in 24 (43.6%). Black opioid decedents were considerably less likely to have buprenorphine in their toxicology than White decedents. Conclusions Buprenorphine was rarely detected in the postmortem toxicology of unintentional opioid overdoses in a major US city in the Midwest. In nearly all cases it was accompanied by other potent substances that more frequently cause fatal overdoses on their own. This study confirms findings from other geographic settings that the overdose mortality risks associated with buprenorphine are low.
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Individuals Reporting Past 3-month Smoked Stimulant Use Are Placed at Risk for Infection and Injury Amid COVID-19. J Addict Med 2023; 17:e129-e131. [PMID: 36731105 PMCID: PMC10022522 DOI: 10.1097/adm.0000000000001060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Smoking stimulants, such as methamphetamine and "crack" cocaine, can spread infections, including hepatitis C and COVID-19, and lead to injuries, particularly when individuals share or use makeshift pipes. The purpose of the study was to assess the practices of people who inhale ("smoke") stimulants to guide future clinical harm reduction efforts. METHODS Anonymous surveys were administered to participants reporting inhalation of crack cocaine and/or methamphetamine in the past 3 months. Participants were eligible if they sought services from an outreach team staffed by a municipal syringe service program (SSP) or if they were patients at a low-threshold substance use disorder treatment program, the Massachusetts General Hospital Bridge Clinic. RESULTS The survey was administered to 68 total participants, 30% of whom were recruited in the Massachusetts General Hospital Bridge Clinic and 70% through SSP outreach. Unsafe smoking practices were reported by 93% of participants. Among the 46% of participants surveyed who both smoked and injected stimulants, 61% of those participants stated that they injected instead of smoked stimulants because of lack of access to pipes. Amid COVID-19, 35% of participants adopted safer smoking practices. Most participants reported that they would be more likely to attend an SSP or health center if pipes were provided. CONCLUSIONS Inhalational practices that place participants at risk of injury and illness are common. Providing safer smoking equipment may promote health and engage individuals in care.
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Banks DE, Duello A, Paschke ME, Grigsby SR, Winograd RP. Identifying drivers of increasing opioid overdose deaths among black individuals: a qualitative model drawing on experience of peers and community health workers. Harm Reduct J 2023; 20:5. [PMID: 36639769 PMCID: PMC9839206 DOI: 10.1186/s12954-023-00734-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Black individuals in the USA face disproportionate increases in rates of fatal opioid overdose despite federal efforts to mitigate the opioid crisis. The aim of this study was to examine what drives increases in opioid overdose death among Black Americans based on the experience of key stakeholders. METHODS Focus groups were conducted with stakeholders providing substance use prevention services in Black communities in St. Louis, MO (n = 14). One focus group included peer advocates and volunteers conducting outreach-based services and one included active community health workers. Focus groups were held at community partner organizations familiar to participants. Data collection was facilitated by an interview guide with open-ended prompts. Focus groups were audio recorded and professionally transcribed. Transcripts were analyzed using grounded theory to abstract line-by-line codes into higher order themes and interpret their associations. RESULTS A core theme was identified from participants' narratives suggesting that opioid overdose death among Black individuals is driven by unmet needs for safety, security, stability, and survival (The 4Ss). A lack of The 4Ss was reflective of structural disinvestment and healthcare and social service barriers perpetuated by systemic racism. Participants unmet 4S needs are associated with health and social consequences that perpetuate overdose and detrimentally impact recovery efforts. Participants identified cultural and relationship-based strategies that may address The 4Ss and mitigate overdose in Black communities. CONCLUSIONS Key stakeholders working in local communities to address racial inequities in opioid overdose highlighted the importance of upstream interventions that promote basic socioeconomic needs. Local outreach efforts utilizing peer services can provide culturally congruent interventions and promote harm reduction in Black communities traditionally underserved by US health and social systems.
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Affiliation(s)
- Devin E. Banks
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA
| | - Alex Duello
- grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
| | - Maria E. Paschke
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA
| | - Sheila R. Grigsby
- grid.266757.70000000114809378College of Nursing, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
| | - Rachel P. Winograd
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA ,grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
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Korona-Bailey J, Mukhopadhyay S. Characteristics of fatal drug overdoses among college age decedents in Tennessee, 2019-2020. DIALOGUES IN HEALTH 2022; 1:100050. [PMID: 38515907 PMCID: PMC10953990 DOI: 10.1016/j.dialog.2022.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 03/23/2024]
Abstract
Purpose College age persons experienced unique disruptions to their regular lives during the COVID-19 pandemic, sometimes resulting in negative coping mechanisms. We examined changes in the number of and characteristics of college age fatal drug overdoses before and during the early COVID-19 pandemic. Methods We conducted a statewide cross-sectional study to determine the changes in the number and characteristics of college age fatal drug overdose decedents before and during the COVID-19 pandemic using 2019-2020 data from the Tennessee State Unintentional Drug Overdose Reporting System. We defined college age as 18-24 years. Frequencies and rates were generated to compare demographics, circumstances, and toxicology between 2019 and 2020. Results From 2019 to 2020, 336 college age persons experienced an unintentional or undetermined fatal drug overdose in Tennessee. Characteristics of college age decedents: mean age 21.7 years, 68.5% males, and 71.4% White. Rates of fatal overdoses among college age persons increased 50.0% overall, 150.1% for female decedents, and 141.7% for Black decedents. Fewer people were treated for substance use disorder or mental health conditions (p = 0.0243) in 2020. Conclusion This analysis can inform local and regional public health workers to implement focused prevention and intervention efforts to curtail the overdose epidemic among college age persons in Tennessee.
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Affiliation(s)
- Jessica Korona-Bailey
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7 Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7 Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
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Friedman J, Hansen H. Sex and Drug Overdose Mortality Trends, 1999-2020-Reply. JAMA Psychiatry 2022; 79:834. [PMID: 35793104 DOI: 10.1001/jamapsychiatry.2022.1685] [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: 11/14/2022]
Affiliation(s)
- Joseph Friedman
- Medical Scientist Training Program, University of California, Los Angeles.,Center for Social Medicine and Humanities, University of California, Los Angeles
| | - Helena Hansen
- Center for Social Medicine and Humanities, University of California, Los Angeles
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Frost MC, Austin EJ, Corcorran MA, Briggs ES, Behrends CN, Juarez AM, Frank ND, Healy E, Prohaska SM, LaKosky PA, Kapadia SN, Perlman DC, Schackman BR, Des Jarlais DC, Williams EC, Glick SN. Responding to a surge in overdose deaths: perspectives from US syringe services programs. Harm Reduct J 2022; 19:79. [PMID: 35854351 PMCID: PMC9295104 DOI: 10.1186/s12954-022-00664-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND US overdose deaths have reached a record high. Syringe services programs (SSPs) play a critical role in addressing this crisis by providing multiple services to people who use drugs (PWUD) that help prevent overdose death. This study examined the perspectives of leadership and staff from a geographically diverse sample of US SSPs on factors contributing to the overdose surge, their organization's response, and ongoing barriers to preventing overdose death. METHODS From 2/11/2021 to 4/23/2021, we conducted semi-structured interviews with leadership and staff from 27 SSPs sampled from the North American Syringe Exchange Network directory. Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process. RESULTS Respondents reported that increased intentional and unintentional fentanyl use (both alone and combined with other substances) was a major driver of the overdose surge. They also described how the COVID-19 pandemic increased solitary drug use and led to abrupt increases in use due to life disruptions and worsened mental health among PWUD. In response to this surge, SSPs have increased naloxone distribution, including providing more doses per person and expanding distribution to people using non-opioid drugs. They are also adapting overdose prevention education to increase awareness of fentanyl risks, including for people using non-opioid drugs. Some are distributing fentanyl test strips, though a few respondents expressed doubts about strips' effectiveness in reducing overdose harms. Some SSPs are expanding education and naloxone training/distribution in the broader community, beyond PWUD and their friends/family. Respondents described several ongoing barriers to preventing overdose death, including not reaching certain groups at risk of overdose (PWUD who do not inject, PWUD experiencing homelessness, and PWUD of color), an inconsistent naloxone supply and lack of access to intranasal naloxone in particular, inadequate funding, underestimates of overdoses, legal/policy barriers, and community stigma. CONCLUSIONS SSPs remain essential in preventing overdose deaths amid record numbers likely driven by increased fentanyl use and COVID-19-related impacts. These findings can inform efforts to support SSPs in this work. In the face of ongoing barriers, support for SSPs-including increased resources, political support, and community partnership-is urgently needed to address the worsening overdose crisis.
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Affiliation(s)
- Madeline C Frost
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA.
| | - Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Elsa S Briggs
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - Alexa M Juarez
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Noah D Frank
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Elise Healy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Stephanie M Prohaska
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street Suite 113, Tacoma, WA, 98402, USA
| | - Paul A LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street Suite 113, Tacoma, WA, 98402, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
- Division of Infectious Diseases, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - David C Perlman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
- Center for Drug Use and HIV/HCV Research, 708 Broadway, 4th Floor, New York, NY, 10003, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
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Kiang MV, Acosta RJ, Chen YH, Matthay EC, Tsai AC, Basu S, Glymour MM, Bibbins-Domingo K, Humphreys K, Arthur KN. Sociodemographic and geographic disparities in excess fatal drug overdoses during the COVID-19 pandemic in California: A population-based study. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100237. [PMID: 35342895 PMCID: PMC8934030 DOI: 10.1016/j.lana.2022.100237] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic is co-occurring with a drug addiction and overdose crisis. Methods We fit overdispersed Poisson models, accounting for seasonality and secular trends, to estimate the excess fatal drug overdoses (i.e., deaths greater than expected), using data on all deaths in California from 2016 to 2020. Findings Between January 5, 2020 and December 26, 2020, there were 8605 fatal drug overdoses—a 44% increase over the same period one year prior. We estimated 2084 (95% CI: 1925 to 2243) fatal drug overdoses were excess deaths, representing 5·28 (4·88 to 5·68) excess fatal drug overdoses per 100,000 population. Excess fatal drug overdoses were driven by opioids (4·48 [95% CI: 4·18 to 4·77] per 100,000), especially synthetic opioids (2·85 [95% CI: 2·56 to 3·13] per 100,000). The non-Hispanic Black and Other non-Hispanic populations were disproportionately affected with 10·1 (95% CI: 7·6 to 12·5) and 13·26 (95% CI: 11·0 to 15·5) excess fatal drug overdoses per 100,000 population, respectively, compared to 5·99 (95% CI: 5.2 to 6.8) per 100,000 population in the non-Hispanic white population. There was a steep, nonlinear educational gradient with the highest rate among those with only a high school degree. There was a strong spatial patterning with the highest levels of excess mortality in the southernmost region and consistently lower levels at progressively more northern latitudes (7·73 vs 1·96 per 100,000). Interpretation Fatal drug overdoses disproportionately increased in 2020 among structurally marginalized populations and showed a strong geographic gradient. Local, tailored public health interventions are urgently needed to reduce growing inequities in overdose deaths. Funding US National Institutes of Health and Department of Veterans Affairs.
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Affiliation(s)
- Mathew V Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, Stanford, CA 94304, USA
| | - Rolando J Acosta
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Ellicott C Matthay
- Center for Health and Community, University of California, San Francisco, CA, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sanjay Basu
- Research and Development, Station Health, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Keith Humphreys
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristen N Arthur
- Substance and Addiction Prevention Branch, California Department of Public Health, Sacramento, CA, USA
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Watson DP, Staton MD, Grella CE, Scott CK, Dennis ML. Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic. Subst Abuse Treat Prev Policy 2022; 17:22. [PMID: 35303913 PMCID: PMC8931576 DOI: 10.1186/s13011-022-00449-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.
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Affiliation(s)
- Dennis P. Watson
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Monte D. Staton
- grid.185648.60000 0001 2175 0319Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL 60613 USA
| | - Christine E. Grella
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Christy K. Scott
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Michael L. Dennis
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761 USA
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