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Lundstrom EW, Dai Z, Groth CP, Hendricks B, Winstanley EL, Abate M, Smith GS. Comparing the effects of decreasing prescription opioid shipments and the release of an abuse deterrent OxyContin formulation on opioid overdose fatalities in WV: an interrupted time series study. Subst Abuse Treat Prev Policy 2024; 19:4. [PMID: 38178238 PMCID: PMC10768117 DOI: 10.1186/s13011-023-00587-2] [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: 06/21/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The 2010 release of an abuse deterrent formulation (ADF) of OxyContin, a brand name prescription opioid, has been cited as a major driver for the reduction in prescription drug misuse and the associated increasing illicit opioid use and overdose rates. However, studies of this topic often do not account for changes in supplies of other prescription opioids that were widely prescribed before and after the ADF OxyContin release, including generic oxycodone formulations and hydrocodone. We therefore sought to compare the impact of the ADF OxyContin release to that of decreasing prescription opioid supplies in West Virginia (WV). METHODS Opioid tablet shipment and overdose data were extracted from The Washington Post ARCOS (2006-2014) and the WV Forensic Drug Database (2005-2020), respectively. Locally estimated scatterplot smoothing (LOESS) was used to estimate the point when shipments of prescription opioids to WV began decreasing, measured via dosage units and morphine milligram equivalents (MMEs). Interrupted time series analysis (ITSA) was used to compare the impact LOESS-identified prescription supply changes and the ADF OxyContin release had on prescription (oxycodone and hydrocodone) and illicit (heroin, fentanyl, and fentanyl analogues) opioid overdose deaths in WV. Model fit was compared using Akaike Information Criteria (AIC). RESULTS The majority of opioid tablets shipped to WV from 2006 to 2014 were generic oxycodone or hydrocodone, not OxyContin. After accounting for a 6-month lag from ITSA models using the LOESS-identified change in prescription opioid shipments measured via dosage units (2011 Q3) resulted in the lowest AIC for both prescription (AIC = -188.6) and illicit opioid-involved overdoses (AIC = -189.4), indicating this intervention start date resulted in the preferred model. The second lowest AIC was for models using the ADF OxyContin release as an intervention start date. DISCUSSION We found that illicit opioid overdoses in WV began increasing closer to when prescription opioid shipments to the state began decreasing, not when the ADF OxyContin release occurred. Similarly, the majority of opioid tablets shipped to the state for 2006-2014 were generic oxycodone or hydrocodone. This may indicate that diminishing prescription supplies had a larger impact on opioid overdose patterns than the ADF OxyContin release in WV.
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Affiliation(s)
- Eric W Lundstrom
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US.
| | - Zheng Dai
- Health Affairs Institute, Health Sciences Center, West Virginia University, 405 Capitol Street, Suite 514, Charleston, WV, 25301, US
| | - Caroline P Groth
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
| | - Brian Hendricks
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
| | - Erin L Winstanley
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, 930 Chestnut Ridge Rd, Morgantown, WV, 26505, US
| | - Marie Abate
- School of Pharmacy, West Virginia University, 64 Medical Center Drive, P.O. Box 9500, Morgantown, WV, 26506-9500, US
| | - Gordon S Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
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Sansone A, Limoncin E, Colonnello E, Mollaioli D, Ciocca G, Corona G, Jannini EA. Harm Reduction in Sexual Medicine. Sex Med Rev 2021; 10:3-22. [DOI: 10.1016/j.sxmr.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
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Lyle Cooper R, Thompson J, Edgerton R, Watson J, MacMaster SA, Kalliny M, Huffman MM, Juarez P, Mathews-Juarez P, Tabatabai M, Singh KP. Modeling dynamics of fatal opioid overdose by state and across time. Prev Med Rep 2020; 20:101184. [PMID: 32995141 PMCID: PMC7516293 DOI: 10.1016/j.pmedr.2020.101184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022] Open
Abstract
Opioid overdose fatalities include deaths from natural opioids (morphine and codeine), semi-synthetic opioids (oxycodone, hydrocodone), synthetic opioids (prescription and illicit fentanyl, tramadol), methadone, and heroin. From 1999 to 2017, there were 702,568 drug overdose deaths in the U.S., with 399,230 attributed to opioids. This study aimed to assess the dynamics of opioid related fatalities throughout the U.S. from 2006-2016. This study is a secondary analysis of data obtained through the Kaiser Family Foundation's analysis of Centers for Disease Control and Prevention data, 1999-2016. The data obtained were from all 50 states and the District of Columbia. A total of 272,130 individuals were included in the analysis. This represents the number of opioid overdose deaths in the United States from 2006-2016. Descriptive analysis of overall rates was conducted and mapped for visualization. Novel predictive models of increase for each drug overdose category were developed and used to calculate rate changes. Finally, the elasticity of change in rate for each drug category was calculated annually for the past 11 years. The highest rate of opioid overdose-related death occurred in West Virginia (40.03 per 100,000). In our secondary analysis, we explored the change in the rate of opioid-related deaths from 2015 to 2016. The changing dynamics of fatal opioid overdose at the state level is critical to guiding policy makers in addressing this crisis. Rates of fatal opioid overdose vary across the states, but we identify some trends. Regional differences are identified in states with the highest overdose rates from all opioids combined.
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Affiliation(s)
- R. Lyle Cooper
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd Nashville, TN 37208, United States
| | - Janese Thompson
- Meharry Medical College, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, United States
| | - Ryan Edgerton
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd Nashville, TN 37208, United States
| | - Julia Watson
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd Nashville, TN 37208, United States
| | - Samuel A. MacMaster
- Department of Family and Community Medicine at Baylor College of Medicine in Houston, Texas, United States
| | - Medhat Kalliny
- Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd Nashville, TN 37208, United States
| | - Miranda M. Huffman
- Meharry Medical College, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, United States
| | - Paul Juarez
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd Nashville, TN 37208, United States
| | - Patricia Mathews-Juarez
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd Nashville, TN 37208, United States
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College 1005 Dr. D.B. Todd Jr. Blvd Nashville, TN 37208, United States
| | - Karan P. Singh
- Department of Epidemiology and Biostatistics, School of Community and Rural Health, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, United States
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Stoicea N, Costa A, Periel L, Uribe A, Weaver T, Bergese SD. Current perspectives on the opioid crisis in the US healthcare system: A comprehensive literature review. Medicine (Baltimore) 2019; 98:e15425. [PMID: 31096439 PMCID: PMC6531094 DOI: 10.1097/md.0000000000015425] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The administration of opioids has been used for centuries as a viable option for pain management. When administered at appropriate doses, opioids prove effective not only at eliminating pain but further preventing its recurrence in long-term recovery scenarios. Physicians have complied with the appropriate management of acute and chronic pain; however, this short or long-term opioid exposure provides opportunities for long-term opioid misuse and abuse, leading to addiction of patients who receive an opioid prescription and/or diversion of this pain medication to other people without prescription. Several reviews attempted to summarize the epidemiology and management of opioid misuse, this integrative review seeks to summarize the current literature related with responsible parties of this opioid abuse crisis and discuss potential associations between demographics (ethnicity, culture, gender, religion) and opioid accessibility, abuse and overdose. METHODS We performed an extensive literature search in Google Scholar and Pub Med databases that were published between December 7, 1999 and January 9, 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) guidelines. Searches were referenced using medical subject headings (MeSH) that included "opioids", "over-prescription", "opioid consumption", or "opioid epidemic". The final review of all data bases was conducted on July 24, 2018. RESULTS A total of 7160 articles were originally identified. After 3340 duplicate articles were removed, 3820 manuscripts were removed after title and abstract screening. Following this, 120 manuscripts underwent eligibility selection with only 70 publications being selected as reliable full-texts addressing related factors surrounding the opioid crisis. CONCLUSION With approximately 100 million people suffering from both chronic and acute pain in the United States (US) in 2016, opiates will continue to remain a prominent class of medication in healthcare facilities and homes across the US. Over 66% of total overdose episodes in 2016 were opioid-related, a figure that attests to the severity and wide-spread nature of this issue. A three-point approach accentuating the prevention, treatment, and rehabilitation of both those currently affected and at-risk in the future may be the comprehensive solution.
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Affiliation(s)
| | | | | | | | - Tristan Weaver
- Department of Anesthesiology
- Department of Anesthesiology, Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
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Butler JM, Becker WC, Humphreys K. Big Data and the Opioid Crisis: Balancing Patient Privacy with Public Health. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:440-453. [PMID: 30146994 DOI: 10.1177/1073110518782952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parts I through III of this paper will examine several, increasingly comprehensive forms of aggregation, ranging from insurance reimbursement "lock-in" programs to PDMPs to completely unified electronic medical records (EMRs). Each part will advocate for the adoption of these aggregation systems and provide suggestions for effective implementation in the fight against opioid misuse. All PDMPs are not made equal, however, and Part II will, therefore, focus on several elements - mandating prescriber usage, streamlining the user interface, ensuring timely data uploads, creating a national data repository, mitigating privacy concerns, and training doctors on how to respond to perceived doctor-shopping - that can make these systems more effective. In each part, we will also discuss the privacy concerns of aggregating data, ranging from minimal to significant, and highlight the unique role of stigma in motivating these concerns. In Part IV, we will conclude by suggesting remedial steps to offset this loss of privacy and to combat the stigma around SUDs and mental health disorders in general.
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Affiliation(s)
- John Matthew Butler
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
| | - William C Becker
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
| | - Keith Humphreys
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
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James K, Jordan A. The Opioid Crisis in Black Communities. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:404-421. [PMID: 30146996 DOI: 10.1177/1073110518782949] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
While much of the social and political attention surrounding the nationwide opioid epidemic has focused on the dramatic increase in overdose deaths among white, middle-class, suburban and rural users, the impact of the epidemic in Black communities has largely been unrecognized. Though rates of opioid use at the national scale are higher for whites than they are for Blacks, rates of increase in opioid deaths have been rising more steeply among Blacks (43%) than whites (22%) over the last five years. Moreover, the rate of opioid overdose deaths among Blacks already exceeds that of whites in several states. The lack of discussion of Black overdose deaths in the national opioid discourse further marginalizes Black people, and is highly consistent with a history of framing the addictions of people of color as deserving of criminal punishment, rather than worthy of medical treatment. This article argues that, because racial inequalities are embedded in American popular and political cultures as well as in medicine, the federal and state governments should develop more culturally targeted programs to benefit Black communities in the opioid crisis. Such programs include the use of faith-based organizations to deliver substance use prevention and treatment services, the inclusion of racial impact assessments in the implementation of drug policy proposals, and the formal consideration of Black people's interaction with the criminal justice system in designing treatment options.
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Affiliation(s)
- Keturah James
- Keturah James is a student at Yale Law School in New Haven, Connecticut. Ayana Jordan, M.D., Ph.D., is an Assistant Professor, Addiction Psychiatrist, and Attending Physician at Yale University School of Medicine
| | - Ayana Jordan
- Keturah James is a student at Yale Law School in New Haven, Connecticut. Ayana Jordan, M.D., Ph.D., is an Assistant Professor, Addiction Psychiatrist, and Attending Physician at Yale University School of Medicine
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