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Chen Q, Gopaldas M, Castillo F, Leckman-Westin E, Nunes EV, Levin FR, Finnerty MT. Prevalence of Opioid Use Disorder and Opioid Overdose Rates Among People With Mental Illness. Psychiatr Serv 2024:appips20230338. [PMID: 38650488 DOI: 10.1176/appi.ps.20230338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The authors examined the prevalence and correlates of co-occurring opioid use disorder and opioid overdose among individuals receiving psychiatric services. METHODS This was a cross-sectional study of adults with continuous enrollment in New York State Medicaid who received at least one psychiatric service in 2020 (N=523,885). Logistic regression models were used to examine the correlates of both opioid use disorder and overdose. RESULTS In the study sample, the prevalence rate of opioid use disorder was 8.1%; within this group, 7.7% experienced an opioid overdose in the study year. Opioid use disorder rates were lower among younger (18-24 years; 2.0%) and older (≥65 years; 3.1%) adults and higher among men (11.1%) and among those residing in rural areas (9.9%). Compared with Whites (9.4%), opioid use disorder rates were lower for Asian Americans (2.0%, adjusted odds ratio [AOR]=0.22) and Blacks (6.8%, AOR=0.76) and higher for American Indians (13.2%, AOR=1.43) and Hispanics (9.6%, AOR=1.29). Individuals with any substance use (24.9%, AOR=5.20), posttraumatic stress (15.7%, AOR=2.34), bipolar (14.9%, AOR=2.29), or anxiety (11.3%, AOR=2.18) disorders were more likely to have co-occurring opioid use disorder; those with conduct (4.5%, AOR=0.51), adjustment (7.4%, AOR=0.88), or schizophrenia spectrum (7.4%, AOR=0.87) disorders were less likely to have opioid use disorder. Those with suicidality (23.9%, AOR=3.83) or economic instability (23.7%, AOR=3.35) had higher odds of having opioid use disorder. Overdose odds were higher among individuals with suicidality (34.0%, AOR=6.82) and economic instability (16.0%, AOR=2.57). CONCLUSIONS These findings underscore the importance of providing opioid use disorder screening and treatment for patients receiving psychiatric services.
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Affiliation(s)
- Qingxian Chen
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Manesh Gopaldas
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Felipe Castillo
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Edward V Nunes
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Frances R Levin
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Molly T Finnerty
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
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Hyatt A, Mullin B, Hasler V, Madore D, Progovac AM, Cook BL, DeLisi LE. Predictors of relapse and engagement in care one year after ending services in an urban safety net coordinated specialty care program for first episode psychosis. Schizophr Res 2024; 264:140-146. [PMID: 38128345 PMCID: PMC10983670 DOI: 10.1016/j.schres.2023.12.022] [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: 06/23/2023] [Revised: 11/08/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aimed to identify risk factors for relapse (psychiatric emergency department visits or hospitalization) and lack of follow-up with outpatient psychiatric care in the 12 months after ending services in an urban safety net coordinated specialty care (CSC) program for first episode psychosis (FEP). METHODS The study population (n = 143) were individuals with FEP who had any CSC care between 2014 and 2021. To identify risk factors for relapse and follow up after exit, multivariable logistic regression was performed using data from electronic health records and linked insurance claims data. RESULTS Individuals with any emergency department visit or hospitalization 12 months prior to ending CSC (aOR = 4.69, 95 % CI 1.78-12.34) and those who were using cannabis at last CSC contact (aOR = 4.06, 95 % CI 1.56-10.56) had a higher risk of relapse after ending CSC services. Cannabis use at last contact was also associated with lower rates of outpatient psychiatric follow-up (aOR = 0.32, 95 % CI 0.12-0.94), while CSC duration in months had a small positive association with post-CSC psychiatric follow-up. There were no differences in relapse or follow-up by race or ethnicity, primary diagnosis, or medication usage. CONCLUSIONS Prior relapse during CSC predicted relapse in the 12 months after ending CSC services, but not outpatient follow up. Cannabis use predicted both a higher rate of relapse and a lower rate of follow up after ending services. There were no differences by race or ethnicity in our sample, suggesting that once individuals engaged in FEP care there were no evident disparities in the observed outcomes.
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Affiliation(s)
- Andrew Hyatt
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States.
| | - Brian Mullin
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States
| | - Victoria Hasler
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Drew Madore
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Ana M Progovac
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Benjamin Lê Cook
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Lynn E DeLisi
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
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