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Ramezanzadeh H, Khosravi N, Hosseininejad SM, Mahmoodi M, Zakariaei Z, Sadeghi M. Epidemiological Aspects of Opioid Poisoning in Northern Iran: A Registry-Based Clinical Study. Health Serv Insights 2024; 17:11786329241232300. [PMID: 38406177 PMCID: PMC10893883 DOI: 10.1177/11786329241232300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Opioids are a class of drugs that are commonly used to manage pain due to their analgesic and sedative effects. However, the high consumption of opioids in the community has led to an increase in the incidence of overdoses and poisonings caused by various types of these drugs, whether intentional or unintentional. Therefore, comprehending the epidemiological features of patients experiencing opioid poisoning is crucial. We decided to investigate various epidemiological aspects of patients with opioid poisoning in the Mazandaran province, located in northern Iran, during the period of 2020 to 2021. The present investigation was conducted as a descriptive cross-sectional study, wherein we collected data on patients registered in the Mazandaran Registry Center of Opioid Poisoning (MRCOP) who had a history of using any kind of opioid. We collected information on various parameters, including patient demographics, the type of opioid consumed, the mode of consumption, and clinical outcomes. A total of 240 patients were initially registered at the registry center. However, 17 cases were excluded with personal consent, and eventually, a total of 223 patients were included in the investigation. The majority of the patients 70.9% (n = 158) were male, and the average age was 34.4 ± 16.55 years. The most common cause of poisoning reported in our study was intentional, which was mainly due to a suicide attempt. Furthermore, the most prevalent type of opioid consumed was methadone. The most frequently observed symptoms of poisoning among the patients were drowsiness, a decreased level of consciousness, and reduced arterial oxygen saturation levels. Based on the results of our study, several factors were found to be significant in methadone poisoning, including addiction, age, gender, suicide attempt, and a history of psychiatric disorder. These findings highlight the need for public education and awareness campaigns on the risks associated with opioid use, particularly methadone.
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Affiliation(s)
- Hamed Ramezanzadeh
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Navid Khosravi
- Department of Emergency Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mahboobe Mahmoodi
- Department of Internal Medicine, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Zakaria Zakariaei
- Toxicology and Forensic Medicine Division, Mazandaran Registry Center for Opioids Poisoning, Orthopedic Research Centers, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdieh Sadeghi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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Onohuean H, Oosthuizen F. Multinational appraisal of the epidemiological distribution of opioid fatalities: a systematic review and meta-analysis. Front Psychiatry 2024; 14:1290461. [PMID: 38250280 PMCID: PMC10796457 DOI: 10.3389/fpsyt.2023.1290461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024] Open
Abstract
Background The global or multinational scientific evidence on the distribution of opioid fatality is unknown. Hence, the current study collects epidemiological characteristics to shed light on the ongoing global or multinational opioid crisis and to promote the development of public health prevention/management strategies. Method All documents on PRISMA standards were retrieved via electronic databases. Results Among the 47 articles relevant to our studies, which depict a total population size of 10,191 individuals, the prevalence of opioid fatal overdose was 15,022 (14.74%). Among the 47 articles, 14 of them reported the gender of the participants, with 22,125 (15.79%) male individuals and 7,235 (5.17%) female individuals, and the age distribution of the participants that was most affected by the overdose was as follows: 29,272 (31.13%) belonged to the 18-34-year-old age group and 25,316 (26.92%) belonged to the less than 18-year-old age group. Eighteen studies qualified for the meta-analysis of the multinational prevalence of fatal opioid overdose, depicting an overall pooled prevalence estimate of 19.66%, with 95% CIs (0.13-0.29), I2 = 99.76% determined using the random-effects model, and Q statistic of 7198.77 (p < 0.0001). The Egger test models of publication bias revealed an insubstantial level of bias (p = 0.015). The subgroup analysis of the study design (cohort or other) revealed that others have the highest prevalence estimate of 34.37, 95% CIs (0.1600-0.5901), I2 = 97.04%, and a sample size of less than 1,000 shows the highest prevalence of 34.66, 95% CIs (0.2039-0.5234), I2 = 97.82%, compared to that of more than 1,000 with a prevalence of 12.28, 95% CIs (0.0675-0.2131), I2 = 99.85%. The meta-regression analysis revealed that sample size (less-than or greater-than 1,000), (p = 0.0098; R2 = 3.83%) is significantly associated with the observed heterogeneity. Conclusion Research-based findings of fatal opioid overdose are grossly lacking in middle- and low-income nations. We established that there is a need for opioid fatality surveillance systems in developing nations.
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Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Noriega I, Bhullar MK, Gilson TP, Flannery DJ, Deo V, Fulton S. A case study for local data surveillance in opioid overdose fatalities in Cuyahoga County, OH 2016-2020. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100187. [PMID: 37711883 PMCID: PMC10498169 DOI: 10.1016/j.dadr.2023.100187] [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: 03/21/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023]
Abstract
Introduction Fentanyl and fentanyl analogs have increased the overdose mortality rates in the United States, significantly impacting states like Ohio. We examined carfentanil overdose deaths, other contributing Cause of Death (COD) drugs, and drug seizure trends from 2016 to 2020 in Northeast Ohio. Materials and methods We studied death investigation data from the Cuyahoga County, Ohio Medical Examiner's Office (CCMEO) of all fatal accidental opioid overdoses as well as drug seizure data from Cuyahoga County Regional Forensic Science Laboratory (CCRFSL). We also compared decedents' race, gender, age, residential locality, drugs contributing to the COD in opioid cases, and for carfentanil, fentanyl, and cocaine seizures in Cuyahoga County from 2016 to 2020 (N = 2948). Results Decedents' had an average of three different drugs contributing to their COD. A bimodal carfentanil spike was observed in fatal accidental overdoses in Cuyahoga County for the years 2017 and 2019. Decedents in urban residency, who were Non-Hispanic, White and younger, significantly predicted the presence of carfentanil contributing to the COD. In 2020, decedents who were Black and older were significantly associated with cocaine contributing to the COD. Carfentanil and carfentanil-related overdoses were significantly correlated. Discussion The pervasiveness of illicitly manufactured fentanyl and fentanyl analog (e.g., carfentanil) mixtures with other drugs are changing the demographics of persons who fatally overdose in Cuyahoga County, OH. Significant trending shifts can also be observed for the presence of carfentanil in decedent and seizure county data. Conclusions Local data of drug-related overdose deaths and drug seizures from a medical examiner's office and affiliated forensic laboratory lab can be used for timely public health surveillance, and informing prevention, and intervention at the county level.
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Affiliation(s)
- Ivette Noriega
- Case Western Reserve University, 10900 Euclid Ave, SOM WG-57, Cleveland, OH 44106, USA
| | - Manreet K. Bhullar
- Cuyahoga County Medical Examiner's Office, 11001 Cedar Avenue, Cleveland, OH 44106, USA
| | - Thomas P. Gilson
- Cuyahoga County Medical Examiner's Office, 11001 Cedar Avenue, Cleveland, OH 44106, USA
| | - Daniel J. Flannery
- Case Western Reserve University, 10900 Euclid Ave, SOM WG-57, Cleveland, OH 44106, USA
| | - Vaishali Deo
- Case Western Reserve University, 10900 Euclid Ave, SOM WG-57, Cleveland, OH 44106, USA
| | - Sarah Fulton
- Case Western Reserve University, 10900 Euclid Ave, SOM WG-57, Cleveland, OH 44106, USA
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Seth P, Baldwin GT, Davis NL, Jones CM. Clarifying CDC's Efforts to Quantify Overdose Deaths. Public Health Rep 2023; 138:721-726. [PMID: 36184930 PMCID: PMC10467501 DOI: 10.1177/00333549221123586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Puja Seth
- Epidemiology and Surveillance Branch, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Grant T. Baldwin
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole L. Davis
- Overdose Mortality Team, Epidemiology and Surveillance Branch, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher M. Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Marshall T, Viste D, Jones S, Kim J, Lee A, Jafri F, Krieg O, Ghosh SM. Beliefs, attitudes and experiences of virtual overdose monitoring services from the perspectives of people who use substances in Canada: a qualitative study. Harm Reduct J 2023; 20:80. [PMID: 37355610 DOI: 10.1186/s12954-023-00807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Solitary use of substances is a risk factor for substance use-related mortality. Novel e-health harm reduction interventions such as virtual overdose monitoring services (VOMS) have emerged in North America to improve access to emergency overdose support for people who use substances (PWUS). To date, little research has been published, and the perspectives of PWUS are needed to inform evaluation and policy efforts. OBJECTIVE To explore the beliefs, values and perceptions of PWUS around using and accessing VOMS in Canada. METHODS A qualitative study following grounded theory methodology was conducted. Using existing peer networks, purposive and snowball sampling was conducted to recruit PWUS (≥ 18 years) with previous experience with VOMS. Thematic analysis was used to analyze twenty-three interviews. Several methods were employed to enhance rigor, such as independent data coding and triangulation. RESULTS Twenty-three one-on-one telephone interviews of PWUS with previous experience with VOMS were completed and analyzed. The following themes emerged: (1) feelings of optimism around VOMS to save lives; (2) privacy/confidentiality was highly valued due to stigma and fear of arrest; (3) concerns with reliable cell phones negatively impacting VOMS uptake; (4) concerns around emergency response times, specifically in rural/remote communities; (5) desire for trusting relationships with VOMS operators; (6) importance of mental health supports and referrals to psychosocial services; and (7) possible limited uptake due to low public awareness of VOMS. CONCLUSION This qualitative study provided novel insights about the VOMS from the perspectives of PWUS. PWUS generally felt optimistic about the potential of VOMS as a suitable harm reduction intervention, but several potential barriers around accessing VOMS were identified that may limit uptake. Future research is warranted.
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Affiliation(s)
- Tyler Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dylan Viste
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Julia Kim
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amanda Lee
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Farah Jafri
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - S Monty Ghosh
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Byregowda H, Alinsky R, Wang X, Johnson RM. Non-medical prescription opioid use among high school students in 38 U.S. States. Addict Behav Rep 2023; 17:100498. [PMID: 37274538 PMCID: PMC10234833 DOI: 10.1016/j.abrep.2023.100498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/01/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023] Open
Abstract
Background Lifetime prevalence of non-medical prescription opioid use (NMPOU) among adolescents exceeds 10%. Building on that work, we estimate lifetime and recent (i.e., past 30-day) NMPOU and examine associations with alcohol and cannabis use. Methods We used 2019 YRBS data from 38 states with a question on lifetime NMPOU (n = 151,910), a subsample of 8 states also inquired about recent NMPOU (n = 28,439). We estimated the prevalence and frequency of NMPOU for boys and girls in each state. Multivariable logistic regression was used to derive odds ratios (OR) and 95% confidence intervals (CIs) representing recent NMPOU in association with alcohol and cannabis use adjusting for state, race/ethnicity, and grade. Results The prevalence of lifetime NMPOU ranged from 9.4% to 22.7% for girls and 8.6% to 23.2% for boys; significant sex difference in Florida. Recent NMPOU among lifetime users ranged from 33.0% to 50.7% for girls and 40.7% to 52.3% for boys, no significant sex differences. Students reporting recent NMPOU had significantly higher odds of recent alcohol (OR: 5.1, 95% CI: 4.3-6.1) and cannabis use (OR: 3.7, 95% CI: 2.8-4.8). Higher frequency (1-2 and ≥ 3 times vs. 0 times) of NMPOU had significantly greater odds of alcohol (3-9-fold) and cannabis use (3-5-fold). The magnitude of association was higher for boys compared to girls. Conclusion The prevalence of recent NMPOU among lifetime users is high and is associated with alcohol and cannabis use. NMPOU can be a steppingstone towards other forms of opioid use therefore, opioid prevention programs should emphasize prescription drug misuse and consider socio-contextual and geographical variations.
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Affiliation(s)
- Himani Byregowda
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rachel Alinsky
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Xinzi Wang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Renee M. Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Liu GS, Nguyen BL, Lyons BH, Sheats KJ, Wilson RF, Betz CJ, Fowler KA. Surveillance for Violent Deaths - National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2023; 72:1-38. [PMID: 37220104 DOI: 10.15585/mmwr.ss7205a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Problem/Condition In 2020, approximately 71,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2020. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. Period Covered 2020. Description of System NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2020. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (35 California counties, representing 71% of its population, and four Texas counties, representing 39% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results For 2020, NVDRS collected information on 64,388 fatal incidents involving 66,017 deaths that occurred in 48 states (46 states collecting statewide data, 35 California counties, and four Texas counties), and the District of Columbia. In addition, information was collected for 729 fatal incidents involving 790 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 66,017 deaths, the majority (58.4%) were suicides, followed by homicides (31.3%), deaths of undetermined intent (8.2%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known, suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 35-44 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. When circumstances were known, the three most frequent circumstances reported for legal intervention deaths were as follows: the victim's death was precipitated by another crime, the victim used a weapon in the incident, and the victim had a substance use problem (other than alcohol use).Other causes of death included unintentional firearm deaths and deaths of undetermined intent. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. Interpretation This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2020. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black male victims. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. Public Health Action Violence is preventable, and states and communities can use data to guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, the Colorado Violent Death Reporting System (VDRS), Kentucky VDRS, and Oregon VDRS have used their VDRS data to guide suicide prevention efforts and generate reports highlighting where additional focus is needed. In Colorado, VDRS data were used to examine the increased risk for suicide among first and last responders in the state. Kentucky VDRS used local data to highlight how psychological and social effects of the COVID-19 pandemic might increase risk for suicide, particularly among vulnerable populations. Oregon VDRS used their data to develop a publicly available data dashboard displaying firearm mortality trends and rates in support of the state's firearm safety campaign. Similarly, states participating in NVDRS have used their VDRS data to examine homicide in their state. Illinois VDRS, for example, found that state budget cuts were associated with notable increases in homicides among youths in Chicago. With an increase of participating states and jurisdictions, this report marks progress toward providing nationally representative data.
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Affiliation(s)
- Grace S Liu
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Brenda L Nguyen
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Bridget H Lyons
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Kameron J Sheats
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Rebecca F Wilson
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Carter J Betz
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Katherine A Fowler
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
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Wood N, Mells J, Dotson T, Jeffries JE. Enhancing and Leveraging the West Virginia's Prescription Drug Monitoring Program (PDMP) for Public Health Surveillance and Clinical Decision Making: A Case Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E37-E43. [PMID: 36715601 PMCID: PMC9897447 DOI: 10.1097/phh.0000000000001660] [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: 01/31/2023]
Abstract
West Virginia has struggled with an overdose epidemic for many years and continues to have the highest overdose death rate in the nation. However, through successful collaboration between the West Virginia Board of Pharmacy and the West Virginia Department of Health via its Violence and Injury Prevention Program, West Virginia has improved data quality, enhanced program development and implementation, and developed strategies to address the overdose epidemic. This multiagency collaboration plays an important role in addressing the overdose epidemic and promotes lasting interagency relationships. One strategy is overcoming barriers to maximizing and utilizing the Prescription Drug Monitoring Program, or PDMP. This strategy allows for a better understanding of a patient's prescription history and ensures safer prescribing practices. In addition, this strategic partnership facilitates the use of PDMP data for epidemiologic studies and public health surveillance, which results in sustainable analyses and dissemination of actionable data that are now driving public health action in West Virginia.
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Affiliation(s)
- Nathan Wood
- Controlled Substance Monitoring Program, West Virginia Board of Pharmacy, Charleston, West Virginia (Messrs Wood and Dotson); Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (LCDR Mells); and Office of Maternal, Child and Family Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia (Mr Jeffries)
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Thomas SA, Wagner KD, Clements-Nolle KD, Omaye S, Lu M, Yang W. Associations between Circumstances Surrounding Overdose and Underlying Classes of Polysubstance Overdose Deaths. Subst Use Misuse 2023; 58:434-443. [PMID: 36617896 DOI: 10.1080/10826084.2023.2165414] [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: 01/10/2023]
Abstract
BACKGROUND The overdose crisis is worsening, with polysubstance overdose deaths involving psychostimulants increasing in the U.S. Substance-specific prevention and intervention activities may not be as effective for polysubstance use, so we sought to classify substances used among overdose decedents to identify unique factors related to these classes. METHODS We used data from the Nevada State Unintentional Drug Overdose Reporting System, Jan 2019-Jun 2021, which comes from death certificates, coroner/medical examiner reports, and postmortem toxicology. Latent class analysis, multinomial logistic regression, and Chi-squared tests determined underlying drug use classes, differences in characteristics and circumstances surrounding overdose, and assessed relationships between circumstances and drug use classes. RESULTS We identified four latent classes: (1) prescription drugs (19.1%), (2) predominately methamphetamine (31.4%), (3) multi-drug (28.9%), and (4) opioid and stimulant (20.6%). Compared to other classes, the prescription drug class had a higher percentage of female decedents, from rural counties, with mental health diagnoses, who died at home. The predominately methamphetamine class had a higher percentage of decedents experiencing homelessness. The multi-drug use class had higher percentage of younger and Hispanic decedents. Those in the opioid and stimulant class had higher odds of being recently released from an institutional setting, compared to the multi drug class. CONCLUSIONS These underlying classes were associated with several characteristics and circumstances that can prove useful for prevention, treatment, and harm reduction agencies when designing programs and interventions to target specific groups of people at-risk for drug overdose.
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Affiliation(s)
- Shawn A Thomas
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Karla D Wagner
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | | | - Stanley Omaye
- College of Agriculture, Biotechnology, & Natural Resources, University of Nevada, Reno, Reno, NV, USA
| | - Minggen Lu
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Wei Yang
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
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Schneider KE, Allen ST, Rouhani S, Morris M, Haney K, Saloner B, Sherman SG. Increased solitary drug use during COVID-19: An unintended consequence of social distancing. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103923. [PMID: 36521196 PMCID: PMC9678832 DOI: 10.1016/j.drugpo.2022.103923] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/29/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, overdose rates substantially increased in the United States. One possible contributor to this phenomenon may be solitary drug use resulting from social distancing efforts to prevent COVID-19 transmission. METHODS We surveyed 458 people who use drugs (PWUD) who were recruited from harm reduction and drug treatment providers located in nine states and the District of Columbia. We assessed if solitary drug use had increased since the start of COVID-19. Associations between increased solitary drug use and sociodemographic characteristics, drug use characteristics, and COVID-19 prevention behaviors were examined using multiple logistic regression. RESULTS Half the sample identified as men (52.7%), White (49.7%), and single (49.3%). The average age was 43.2 (SD:11.8) years. Two-thirds (66.8%) recently injected drugs. 44% reported increased solitary drug use since COVID-19. Significant correlates of increased solitary drug use included being single (adjusted Odds Ratio [aOR]=1.99, 95% Confidence Interval [CI]: 1.33, 2.98), increasing drug use (aOR=2.74, 95% CI: 1.72, 4.37), using more in private locations (aOR=1.91, 95% CI: 1.34, 2.72), and social distancing behaviors (aOR=1.31, 95% CI: 1.11, 1.54). Experiencing homelessness (aOR=0.45, 95% CI: 0.31, 0.65) and identifying as a sexual minority (aOR=0.53, 95% CI: 0.31, 0.93) were associated with being less likely to increase solitary drug use. CONCLUSIONS Solitary drug use increased during the COVID-19 pandemic. Increases in solitary drug use, in the context of a drug market increasingly permeated by fentanyl, indicates an urgent need for comprehensive harm reduction interventions to reduce overdose mortality.
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Affiliation(s)
- Kristin E. Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA,Corresponding author
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA,School of Global Public Health, New York University, 708 Broadway, New York, NY 10003, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Katherine Haney
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
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Rosen JG, Glick JL, Zhang L, Cooper L, Olatunde PF, Pelaez D, Rouhani S, Sue KL, Park JN. Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection. Addiction 2022; 118:847-854. [PMID: 36468191 PMCID: PMC10073256 DOI: 10.1111/add.16103] [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: 05/26/2022] [Accepted: 11/11/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Solitary drug use (SDU) can amplify risks of fatal overdose. We examined competing risks and drivers of SDU, as well as harm reduction strategies implemented during SDU episodes, among women who inject drugs (WWID). DESIGN A cross-sectional qualitative study, including telephone and face-to-face in-depth interviews. SETTING Baltimore City, MD, USA. PARTICIPANTS Twenty-seven WWID (mean age = 39 years, 67% white, 74% injected drugs daily) recruited via outreach and street intercept (April-September 2021). MEASUREMENTS Interviews explored the physical (i.e. indoor/private, outdoor/public) and social (i.e. alone, accompanied) risk environments in which drug use occurred. Guided by the principles of emergent design, we used thematic analysis to interrogate textual data, illuminating women's preferences/motivations for SDU and strategies for minimizing overdose risks when using alone. FINDINGS Many participants reported experiences with SDU, despite expressed preferences for accompanied drug use. SDU motivations clustered around three primary drivers: (1) avoiding opioid withdrawal, (2) preferences for privacy when using drugs and (3) safety concerns, including threats of violence. Participants nevertheless acknowledged the dangers of SDU and, at times, took steps to mitigate overdose risk, including naloxone possession, communicating to peers when using alone ('spotting') and using drugs in public spaces. CONCLUSIONS WWID appear to engage frequently in SDU due to constraints of the physical and social environments in which they use drugs. They express a preference for accompanied drug use in most cases and report implementing strategies to mitigate their overdose risk, especially when using drugs alone.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Praise F Olatunde
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kimberly L Sue
- National Harm Reduction Coalition, New York, New York, USA.,Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Department of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Center of Biomedical Research Excellent on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
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12
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Delcher C, Harris DR, Anthony N, Stoops WW, Thompson K, Quesinberry D. Substance use disorders and social determinants of health from electronic medical records obtained during Kentucky's "triple wave". Pharmacol Biochem Behav 2022; 221:173495. [PMID: 36427682 PMCID: PMC10082996 DOI: 10.1016/j.pbb.2022.173495] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Social determinants of health (SDOH) play a critical role in the risk of harmful drug use. Examining SDOH as a means of differentiating populations with multiple co-occurring substance use disorders (SUDs) is particularly salient in the era of prevalent opioid and stimulant use known as the "Third Wave". This study uses electronic medical records (EMRs) from a safety net hospital system from 14,032 patients in Kentucky from 2017 to 2019 in order to 1) define three types of SUD cohorts with shared/unique risk factors, 2) identify patients with unstable housing using novel methods for EMRs and 3) link patients to their residential neighborhood to obtain quantitative perspective on social vulnerability. We identified patients in three cohorts with statistically significant unique risk factors that included race, biological sex, insurance type, smoking status, and urban/rural residential location. Adjusting for these variables, we found a statistically significant, increasing risk gradient for patients experiencing unstable housing by cohort type: opioid-only (n = 7385, reference), stimulant-only (n = 4794, odds ratio (aOR) 1.86 95 % confidence interval (CI): 1.66-2.09), and co-diagnosed (n = 1853, aOR = 2.75, 95 % CI: 2.39 to 3.16). At the neighborhood-level, we used 8 different measures of social vulnerability and found that, for the most part, increasing proportions of patients with stimulant use living in a census tract was associated with more social vulnerability. Our study identifies potentially modifiable factors that can be tailored by substance type and demonstrates robust use of EMRs to meet national goals of enhancing research on social determinants of health.
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Affiliation(s)
- Chris Delcher
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America.
| | - Daniel R Harris
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America
| | - Nicholas Anthony
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America
| | - William W Stoops
- Departments of Behavioral Science and Psychiatry, College of Medicine, Department of Psychology, College of Arts & Sciences, University of Kentucky, United States of America
| | - Katherine Thompson
- Department of Statistics, College of Arts & Sciences, University of Kentucky, United States of America
| | - Dana Quesinberry
- Department of Health Management and Policy, College of Public Health, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America
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13
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Amin-Esmaeili M, Gribble A, Johnson RM, Alinsky RH, Oyedele N, Parnham T, Byregowda H, Schneider KE, Park JN, Goddard L, Susukida R. Unsolicited reporting notifications (URNs) through Maryland's prescription drug monitoring program (PDMP): Characteristics of providers. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100111. [PMID: 36844159 PMCID: PMC9948924 DOI: 10.1016/j.dadr.2022.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
Objectives Unsolicited reporting is the activity of analyzing Prescription Drug Monitoring Program (PDMP) data and then sending unsolicited reporting notifications (URNs) to prescribers to notify them of their outlier prescribing behavior. We aimed to describe information about prescribers who were issued URNs. Methods A retrospective study of Maryland's PDMP data from Jan.2018-Apr.2021. All providers who were issued ≥ one URN were included in analyses. We summarized data on types of URNs issued by provider type and years in practice using basic descriptive measures. We also performed logistic regression analysis to provide odds ratio and estimated marginal probability of issuing ≥ one URN to providers in the Maryland health care workforce in comparison with physicians as reference group. Results A total of 4,446 URNs were issued to 2,750 unique providers. Odds ratio (OR) and the population estimated probability of issuing URNs were higher among nurse practitioners [OR: 1.42, 95% Confidence Interval (CI): 1.26-1.59] followed by physician assistants [OR: 1.87, 95% CI: 1.69-2.08], compared to physicians. Physicians and dentists with >10 years in practice comprised the majority of providers who were issued URNs (65.1% and 62.6%, respectively), while majority of nurse practitioners had been in practice for <10 years (75.8%). Conclusion Findings indicate a higher probability of issuing URN for Maryland's physician assistants and nurse practitioners, compared to physicians, and an overrepresentation of physicians and dentists with longer and nurse practitioners with shorter practice experience. The study suggests education programs on safer prescribing practices and management of opioids should target certain types of providers.
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Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University,Corresponding author at: Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway Room 763, Baltimore, MD 21205, United States
| | - Anna Gribble
- Maryland Department of Health (MDH), Office of Provider Engagement and Regulation (OPER)
| | - Renee M. Johnson
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Rachel H Alinsky
- Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine
| | - Natasha Oyedele
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Taylor Parnham
- Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University
| | - Himani Byregowda
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Kristin E. Schneider
- Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University
| | | | - Lindsey Goddard
- Maryland Department of Health (MDH), Office of Provider Engagement and Regulation (OPER)
| | - Ryoko Susukida
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
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14
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Jalali A, Jeng PJ, Polsky D, Poole S, Ku YC, Woody GE, Murphy SM. Cost-effectiveness of extended-release injectable naltrexone among incarcerated persons with opioid use disorder before release from prison versus after release. J Subst Abuse Treat 2022; 141:108835. [PMID: 35933942 PMCID: PMC9508988 DOI: 10.1016/j.jsat.2022.108835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/06/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) is highly prevalent among incarcerated populations, and the risk of fatal overdose following release from prison is substantial. Despite efficacy, few correctional facilities provide evidence-based addiction treatment. Extended-release injectable naltrexone (XR-NTX) administered prior to release from incarceration may improve health and economic outcomes. METHODS We conducted an economic evaluation alongside a randomized controlled trial testing the effectiveness of XR-NTX before release from prison (n = 38) vs. XR-NTX referral after release (n = 48) of incarcerated participants with OUD, both groups continuing treatment at a community addiction treatment center. The incremental cost-effectiveness ratio (ICER) assessed the cost-effectiveness of XR-NTX before release compared to referral after release for three stakeholder perspectives at 12- and 24-week periods: state policymaker, health care sector, and societal. Effectiveness measures included quality-adjusted life-years (QALYs) and abstinent years from opioids. In addition, we categorized resources as OUD-related and non-OUD-related medical care, state transfer payments, and other societal costs (productivity, criminal justice resources, etc.). RESULTS Results showed an association between XR-NTX and greater OUD-related costs and total costs from the state policymaker perspective. QALYs gained were positive but statistically insignificant between arms; however, results showed XR-NTX had an estimated 15.5 more days of opioid abstinence over 24 weeks and statistically significant at a 95 % confidence level based on the distribution of bootstrapped samples. We found that estimated ICERs to be > $500,000 per QALY for all stakeholder perspectives. For the abstinent-year effectiveness measure, we found XR-NTX before release to be cost-effective at a 95 % confidence level for willingness-to-pay values >$49,000 per abstinent-year, across all perspectives. CONCLUSIONS XR-NTX administered to persons who are incarcerated with OUD before release may provide value for stakeholders and bridge a well-known treatment gap for this vulnerable population. Lower than expected participant engagement and missing data limit our results, and study outcomes may be sensitive to methods that address missing data if replicated.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Daniel Polsky
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sabrina Poole
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yi-Chien Ku
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Academy for the Judiciary, Ministry of Justice, Taiwan
| | - George E Woody
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
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15
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Ruhter L, Juhascik M, Watson J, Sweeney K, Daniulaityte R. Tramadol in seized drugs containing non-pharmaceutical fentanyl: Crime lab data from Ohio, USA. EMERGING TRENDS IN DRUGS, ADDICTIONS, AND HEALTH 2022; 2:100042. [PMID: 36743966 PMCID: PMC9897305 DOI: 10.1016/j.etdah.2022.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Introduction Non-pharmaceutical fentanyl and related drugs (NPF) have contributed to increases in drug-related overdose mortality in the U.S. More data are needed to track the shifting composition of fentanyl-containing drug mixtures. The key aims of the study are to characterize the crime lab data from Montgomery County, Ohio on the increased cases of seized drugs containing mixtures of NPF and tramadol. Methods Crime lab data on seized drugs in Montgomery County, Ohio (2015 - 2020) were analyzed to extract information on cases that tested positive for NPF and tramadol. Descriptive statistics are provided to characterize NPF/tramadol mixtures in terms of the quantity, weight, form of the drug seized (powder, tablet, capsule, residue), and the types of fentanyl analogs and other drugs identified. Results In December 2017, the first case of NPF/tramadol mixture was identified in the amount of 0.2 g. Sub-sequently, cases containing NPF/tramadol increased significantly to 149 cases in 2018, 102 in 2019, and 134 in 2020. The total yearly amounts of seized NPF/tramadol mixtures increased to 373.27 g in 2018, 2,601.82 g in 2019, and 13,487.62 g in 2020. The majority (72.6%) of the cases were in powder form. There were 15 other drugs identified along with fentanyl with tramadol mixtures, including heroin (38.8%), 5.7% cocaine (5.7%), and methamphetamine (4.9%). Conclusions The addition of tramadol to NPF may be viewed as a harm mitigation strategy but contributes to the overall unpredictability of the illicit drug supply. According to Ohio legal statutes, identification of schedule IV drugs such as tramadol with fentanyl (schedule II) may provide a reduction in drug-related charges from a felony to a misdemeanor. More research is needed to characterize potential sources of tramadol in NPF-containing drugs.
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Affiliation(s)
- Lance Ruhter
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Matthew Juhascik
- Montgomery County Coroner’s Office and Miami Valley Regional Crime Lab, Dayton, Ohio
| | - Jennifer Watson
- Montgomery County Coroner’s Office and Miami Valley Regional Crime Lab, Dayton, Ohio
| | - Kaylin Sweeney
- College of Health Solutions, Arizona State University, Phoenix, Arizona
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16
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Wilson RF, Liu G, Lyons BH, Petrosky E, Harrison DD, Betz CJ, Blair JM. Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2022; 71:1-40. [PMID: 35588398 PMCID: PMC9129903 DOI: 10.15585/mmwr.ss7106a1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION In 2019, approximately 67,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 42 states, the District of Columbia, and Puerto Rico in 2019. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. PERIOD COVERED 2019. DESCRIPTION OF SYSTEM NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2019. Data were collected from 39 states with statewide data (Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Hawaii, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming), three states with data from counties representing a subset of their population (30 California counties, representing 57% of its population, and 47 Illinois counties and 40 Pennsylvania counties, representing at least 80% of their populations), the District of Columbia, and Puerto Rico. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. RESULTS For 2019, NVDRS collected information on 50,374 fatal incidents involving 51,627 deaths that occurred in 42 states (39 states collecting statewide data, 30 California counties, 47 Illinois counties, and 40 Pennsylvania counties), and the District of Columbia. In addition, information was collected for 831 fatal incidents involving 897 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 51,627 deaths, the majority (64.1%) were suicides, followed by homicides (25.1%), deaths of undetermined intent (8.7%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged 45-54 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic White (White) persons had the highest suicide rates among all racial and ethnic groups. Among males, the most common method of injury for suicide was a firearm, whereas poisoning was the most common method of injury among females. Among all suicide victims, suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 25-29 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. The three most frequent circumstances reported for legal intervention deaths were as follows: the victim's death was precipitated by another crime, the victim used a weapon in the incident, and the victim had a mental health or substance use problem (other than alcohol use). Unintentional firearm deaths were most frequently experienced by males, White persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. The rate of deaths of undetermined intent was highest among males, particularly among Black and AI/AN males, and among adults aged 30-44 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. INTERPRETATION This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2019. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black males. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. PUBLIC HEALTH ACTION Violence is preventable, and data can guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, the New Hampshire Violent Death Reporting System (VDRS), Indiana VDRS, and Colorado VDRS have used their VDRS data to guide suicide prevention efforts and generate reports highlighting where additional focus is needed. In New Hampshire, VDRS data have been used to monitor the increase in suicide rates during 2014-2018 and guide statewide collaborative prevention efforts. Indiana VDRS used local data to demonstrate differences in suicide and other related mental health problems among Black persons and highlight a need for improved suicide awareness and culturally competent mental health care. The Colorado VDRS conducted geospatial and demographic analysis, considering local VDRS data with existing suicide prevention efforts and resources, to identify regions with high suicide rates regions and populations at high risk for suicide. Similarly, states participating in NVDRS have used their VDRS data to examine related to homicide in their state. In North Carolina for example, where homicide rates among AI/AN and Black persons were approximately 2.5 times higher than the statewide homicide rate, the North Carolina VDRS program aims to partner with historically Black colleges and universities in the state to train researchers to use VDRS data to address health equity issues in and around their immediate community.
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Abdelal R, Banerjee AR, Carlberg-Racich S, Darwaza N, Ito D, Epstein J. The need for multiple naloxone administrations for opioid overdose reversals: A review of the literature. Subst Abus 2022; 43:774-784. [PMID: 35112993 DOI: 10.1080/08897077.2021.2010252] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background A growing challenge in the opioid epidemic is the rise of highly potent synthetic opioids, (i.e., illicitly manufactured fentanyl [IMF]) entering the US non-prescription opioid market. Successful reversal may require multiple doses of naloxone, the standard of care for opioid overdose. We conducted a narrative literature review to summarize the rates of multiple naloxone administrations (MNA) for opioid overdose reversal. Methods: A MEDLINE search was conducted for published articles using MESH search terms: opioid overdose, naloxone and multiple naloxone administration. Of the 2,101 studies identified, articles meeting inclusion/exclusion criteria were reviewed, categorized by primary and secondary outcomes of interest and summarized by data source and study design. Results: A total of 24 articles meeting eligibility criteria were included. Among EMS-based studies, MNA rates ranged from 9% to 53%; in general, bystander-reported studies were notably higher, from 16% to 89%. Variation in study design, data sources, year and geography, may have contributed to these ranges. Three studies that included longitudinal results reported a significant percent increase between 26% and 43% in annual MNA rates or a significant increase in mean naloxone doses over time (p < .001). Conclusions: This summary found that multiple naloxone administrations during opioid overdose encounters vary widely, have occurred in up to 89% of all opioid overdoses, and have significantly increased over time. Higher naloxone formulations may fulfill an unmet need in opioid overdose reversals, given the rising rates of overdoses involving IMF. Further studies are needed to gain a better understanding of MNA during opioid overdose encounters, particularly across a wider geographic region in the US in order to inform continuing efforts to combat the opioid epidemic.
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Affiliation(s)
- Randa Abdelal
- Hikma Pharmaceuticals USA Inc, Berkeley Heights, NJ, USA
| | | | | | | | - Diane Ito
- Stratevi, LLC, Santa Monica, CA, USA
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Sheats KJ, Wilson RF, Lyons BH, Jack SP, Betz CJ, Fowler KA. Surveillance for Violent Deaths — National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018. MMWR. SURVEILLANCE SUMMARIES 2022; 71:1-44. [PMID: 35085227 PMCID: PMC8807052 DOI: 10.15585/mmwr.ss7103a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Problem/Condition In 2018, approximately 68,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 39 states the District of Columbia, and Puerto Rico in 2018. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. Period Covered 2018. Description of System NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner reports, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2018. Data were collected from 36 states with statewide data (Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), three states with data from counties representing a subset of their population (21 California counties, 28 Illinois counties, and 39 Pennsylvania counties), the District of Columbia, and Puerto Rico. NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results For 2018, NVDRS collected information on 52,773 fatal incidents involving 54,170 deaths that occurred in 39 states and the District of Columbia. In addition, information was collected on 880 fatal incidents involving 975 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 54,170 deaths, the majority (64.1%) were suicides, followed by homicides (24.8%), deaths of undetermined intent (9.0%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns and circumstances varied by manner of death. The suicide rate was higher among males than among females and was highest among adults aged 35–64 years and non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic White persons. The most common method of injury for suicide was a firearm among males and hanging, strangulation, or suffocation among females. Suicide was most often preceded by a mental health, intimate partner, or physical health problem, or a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was highest among persons aged 20–24 years and was higher among males than females. Non-Hispanic Black males experienced the highest homicide rate of any racial or ethnic group. The most common method of injury for homicide was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicides most often were precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, were related to intimate partner violence. Homicide suspects were primarily male and the highest proportion were aged 25–44 years. When race and ethnicity information was known, non-Hispanic Black persons comprised the largest group of suspects overall and among those aged ≤44 years, and non-Hispanic White persons comprised the largest group of suspects among those aged ≥45 years. Almost all legal intervention deaths were experienced by males, and the legal intervention death rate was highest among males aged 30–34 years. Non-Hispanic AI/AN males had the highest legal intervention death rate, followed by non-Hispanic Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. The most frequent circumstances reported for legal intervention deaths were use of a weapon by the victim in the incident and a mental health or perceived substance use problem (other than alcohol use). Law enforcement officers who inflicted fatal injuries in the context of legal intervention deaths were primarily males aged 25–44 years. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White persons, and persons aged 15–24 years. These deaths most often occurred while the shooter was playing with a firearm and most frequently were precipitated by a person unintentionally pulling the trigger or mistakenly thinking that the firearm was unloaded. The rate of deaths of undetermined intent was highest among males, particularly among non-Hispanic Black and non-Hispanic AI/AN males, and among persons aged 45–54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in approximately 80% of decedents tested for those substances. Interpretation This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2018. The suicide rate was highest among non-Hispanic AI/AN and non-Hispanic White males, and the homicide rate was highest among non-Hispanic Black males. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. Circumstances for suspects of homicide varied by age group and included having prior contact with law enforcement and involvement in incidents that were precipitated by another crime, intimate partner violence, and drug dealing or substance use. Public Health Action NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, Arizona and Wisconsin used their state-level VDRS data to support suicide prevention efforts within their respective states. Wisconsin VDRS used multiple years of data (2013–2017) to identify important risk and protective factors and subsequently develop a comprehensive suicide prevention plan. Arizona VDRS partners with the Arizona Be Connected Initiative to provide customized community-level data on veteran suicide deaths in Arizona. Similarly, states participating in NVDRS have used their VDRS data to examine intimate partner violence–related deaths to support prevention efforts. For example, data from the South Carolina VDRS were used to examine intimate partner homicides that occurred in South Carolina during 2017. South Carolina VDRS found that 12% of all homicides that occurred in 2017 were intimate partner violence–related, with females accounting for 52% of intimate partner homicide–related victims. These data were shared with domestic violence prevention collaborators in South Carolina to bolster their efforts in reducing intimate partner violence–related deaths. In 2018, NVDRS data included four additional states compared with 2017, providing more comprehensive and actionable violent death information for public health efforts to reduce violent deaths.
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Affiliation(s)
- Kameron J. Sheats
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Rebecca F. Wilson
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Bridget H. Lyons
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Shane P.D. Jack
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Carter J. Betz
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Katherine A. Fowler
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
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Fox LM, Shastry S, Harper-Brooks A, Ramdin C, Manini AF. Pilot survey of prescription opioid use patterns and engagement with harm-reduction strategies in emergency department patients. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100062. [PMID: 35480608 PMCID: PMC9031431 DOI: 10.1016/j.rcsop.2021.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background The United States is experiencing an opioid epidemic. The aim of this pilot study was to describe patterns of prescription opioid medication (POM) use, examine factors associated with opioid misuse and overdose, and assess knowledge of take-home naloxone, and other harm-reduction strategies as well as participation in medications for opioid use disorder (MOUD) among emergency department (ED) patients that have been prescribed opioid medications. Methods This was a pilot survey of a convenience sample of adult ED patients with a past opioid prescription at one urban tertiary care hospital. The survey asked participants about patterns of opioid consumption, risk factors associated with opioid misuse, and knowledge of harm-reduction strategies. The survey tool consisted of mixed open- and closed-ended questions. Reported daily POM consumption was converted to milligram morphine equivalents (MME). Responses to survey questions were compared with daily MME in order to generate hypotheses for future research. Results 50 individuals completed a survey. Of these, 56% reported taking opioids daily, and 24% reported greater than 100 MME daily opioid consumption. Many subjects reported history of psychiatric illness (34%) and previous substance abuse treatment (24%). The majority of patients (66%) were not aware of take-home naloxone programs to treat opioid overdose. Conclusions In this pilot survey of ED patients with a pain-related chief complaint, many respondents reported risk factors for opioid misuse, and the majority of participants were unaware of the existence of important harm-reduction strategies, such as take-home naloxone programs, even among those with the highest daily POM use.
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Affiliation(s)
- Lindsay M. Fox
- Rutgers New Jersey Medical School, Department of Emergency Medicine, 185 South Orange Ave, MSB E 609, Newark, NJ 07103, United States of America
| | - Siri Shastry
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Corresponding author at: 555 West 57th, 5th Floor, New York, NY 10019, United States of America.
| | - Avis Harper-Brooks
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Christine Ramdin
- Rutgers New Jersey Medical School, Department of Emergency Medicine, 185 South Orange Ave, MSB E 609, Newark, NJ 07103, United States of America
| | - Alex F. Manini
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Division of Medical Toxicology, Elmhurst Hospital Center, New York, NY, United States of America
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20
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Bonar EE, Kidwell KM, Bohnert ASB, Bourque CA, Carter PM, Clark SJ, Glantz MD, King CA, Losman ED, McCabe SE, Philyaw-Kotov ML, Prosser LA, Voepel-Lewis T, Zheng K, Walton MA. Optimizing scalable, technology-supported behavioral interventions to prevent opioid misuse among adolescents and young adults in the emergency department: A randomized controlled trial protocol. Contemp Clin Trials 2021; 108:106523. [PMID: 34352386 PMCID: PMC8453131 DOI: 10.1016/j.cct.2021.106523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing efficacy of early interventions to reduce escalation of opioid (prescription or illicit) misuse among at-risk AYAs. Interventions are delivered using technology by health coaches. AYAs ages 16-30 in the ED screening positive for prescription opioid use (+ ≥ 1 risk factor) or opioid misuse will be stratified by risk severity, sex, and age group. Participants will be randomly assigned to a condition at intake, either a live video health coach-delivered single session or a control condition of an enhanced usual care (EUC) community resource brochure. They are also randomly assigned to one of two post-intake conditions: health coach-delivered portal-like messaging via web portal over 30 days or EUC delivered at 30 days post-intake. Thus, the trial has four groups: health coach-delivered session+portal, health coach-delivered session+EUC, EUC + portal, and EUC + EUC. Outcomes will be measured at 3-, 6-, and 12-months. The primary outcome is opioid misuse based on a modified Alcohol Smoking and Substance Involvement Screening Test. Secondary outcomes include other opioid outcomes (e.g., days of opioid misuse, overdose risk behaviors), other substance misuse and consequences, and impaired driving. This study is innovative by testing the efficacy of feasible and scalable technology-enabled interventions to reduce and prevent opioid misuse and opioid use disorder. Trial Registration:ClinicalTrials.gov University of Michigan HUM00177625 NCT Registration: NCT04550715.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Amy S B Bohnert
- Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA; Department of Anesthesiology, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Carrie A Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Sarah J Clark
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N. Ingalls Street, Room 6D04, Ann Arbor, MI 48109, USA
| | - Meyer D Glantz
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 3WFN BG 11601 RM 08C79 MSC 6020, 301 North Stonestreet Ave., Bethesda, MD 20892, USA
| | - Cheryl A King
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Eve D Losman
- Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA
| | - Sean Esteban McCabe
- Department of Health Behavior and Biological Sciences and Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor 48109, USA
| | - Meredith L Philyaw-Kotov
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Lisa A Prosser
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N. Ingalls Street, Room 6D04, Ann Arbor, MI 48109, USA
| | - Terri Voepel-Lewis
- Department of Anesthesiology, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Health Behavior and Biological Sciences and Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor 48109, USA
| | - Kai Zheng
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA 92697, USA; Department of Emergency Medicine, School of Medicine, University of California, Irvine, CA 92697, USA
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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21
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Hayes BT, Favaro J, Davis CS, Gonsalves GS, Beletsky L, Vlahov D, Heimer R, Fox AD. Harm Reduction, By Mail: the Next Step in Promoting the Health of People Who Use Drugs. J Urban Health 2021; 98:532-537. [PMID: 33710493 PMCID: PMC7953942 DOI: 10.1007/s11524-021-00534-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Benjamin T Hayes
- Division of General Internal Medicine, Montefiore Medical Center, 3300 Kossuth Ave., Bronx, NY, 10467, USA.
| | | | - Corey S Davis
- The Network for Public Health Law, Los Angeles, CA, USA
| | | | - Leo Beletsky
- School of Law, Bouve College of Health Sciences, and Health in Justice Action Lab, Northeastern University, Boston, MA, USA.,UCSD School of Medicine, La Jolla, CA, USA
| | - David Vlahov
- Yale School of Public Health, New Haven, CT, USA.,Yale School of Nursing, New Haven, CT, USA
| | | | - Aaron D Fox
- Division of General Internal Medicine, Montefiore Medical Center, 3300 Kossuth Ave., Bronx, NY, 10467, USA
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22
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Norris B, Soncrant C, Mills PD, Gunnar W. Root Cause Analysis of Adverse Events Involving Opioid Overdoses in the Veterans Health Administration. Jt Comm J Qual Patient Saf 2021; 47:489-495. [PMID: 34130919 DOI: 10.1016/j.jcjq.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) serves a population with compounding risk factors for opioid misuse, including chronic pain, substance use disorders, and mental health conditions. The objective of this study was to analyze opioid-related adverse events and root causes to inform mitigation strategies associated with opioid prescribing and administration. METHODS The researchers conducted a retrospective analysis of root cause analysis reports of opioid overdose events between August 1, 2012, and September 30, 2019. These adverse events were investigated locally by multidisciplinary hospital teams and reported by VHA facility patient safety managers to the National Center for Patient Safety for further aggregation and analysis. Type of event, location, and root causes were categorized. RESULTS Eighty-two adverse event reports were identified. Patients were primarily male with an average age of 61.4 years. Staff medication administration errors were the most common event type (57.3%), with most events resulting from process errors (65.9%) occurring in the health care setting (85.4%). Overall 36 events (43.9%) resulted in major or catastrophic harm. There were 172 root causes identified. The most common root causes were staff not following existing policy or lack of existing hospital policy on opioid management (18.0%); staff lacked training in areas such as managing the use or administration of opioids, correct use of opioid dispensing equipment, and recognition and proper response to an overdose (12.2%); and poor communication of opioid prescribing or administration during handoffs between clinical teams (11.6%). A lack of standardization in processes, training, and policies on opioid prescribing and screening, medication administration, equipment/pumps purchase and use, and contraband searches was a common theme throughout. CONCLUSION Errors in prescribing and administration of opioid medication can result in significant harm. A lack of standardized opioid administration practices and training, controlled substance policies, and interdisciplinary communication were frequent factors in adverse opioid events and should be a focus for future prevention.
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23
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Vannice K, Hood J, Yarid N, Kay M, Harruff R, Duchin J. Accuracy of Medical Examiner's Assessment for Near-Real-Time Surveillance of Fatal Drug Overdoses, King County, Washington, March 2017-February 2018. Public Health Rep 2021; 137:463-470. [PMID: 33909524 PMCID: PMC9109540 DOI: 10.1177/00333549211008455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Up-to-date information on the occurrence of drug overdose is critical to guide public health response. The objective of our study was to evaluate a near-real-time fatal drug overdose surveillance system to improve timeliness of drug overdose monitoring. METHODS We analyzed data on deaths in the King County (Washington) Medical Examiner's Office (KCMEO) jurisdiction that occurred during March 1, 2017-February 28, 2018, and that had routine toxicology test results. Medical examiners (MEs) classified probable drug overdoses on the basis of information obtained through the death investigation and autopsy. We calculated sensitivity, positive predictive value, specificity, and negative predictive value of MEs' classification by using the final death certificate as the gold standard. RESULTS KCMEO investigated 2480 deaths; 1389 underwent routine toxicology testing, and 361 were toxicologically confirmed drug overdoses from opioid, stimulant, or euphoric drugs. Sensitivity of the probable overdose classification was 83%, positive predictive value was 89%, specificity was 96%, and negative predictive value was 94%. Probable overdoses were classified a median of 1 day after the event, whereas the final death certificate confirming an overdose was received by KCMEO an average of 63 days after the event. CONCLUSIONS King County MEs' probable overdose classification provides a near-real-time indicator of fatal drug overdoses, which can guide rapid local public health responses to the drug overdose epidemic.
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Affiliation(s)
- Kirsten Vannice
- Epidemiology Workforce Branch, Division of Scientific Education
and Professional Development, Epidemic Intelligence Service, Center for
Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and
Prevention, Atlanta, GA, USA, Prevention Division, Public Health–Seattle & King County,
Seattle, WA, USA,Kirsten Vannice, PhD, MHS, Centers for
Disease Control and Prevention, 2400 Century Center, Atlanta, GA 30345, USA;
| | - Julia Hood
- Prevention Division, Public Health–Seattle & King County,
Seattle, WA, USA
| | - Nicole Yarid
- Prevention Division, Public Health–Seattle & King County,
Seattle, WA, USA
| | - Meagan Kay
- Prevention Division, Public Health–Seattle & King County,
Seattle, WA, USA
| | - Richard Harruff
- Prevention Division, Public Health–Seattle & King County,
Seattle, WA, USA
| | - Jeff Duchin
- Prevention Division, Public Health–Seattle & King County,
Seattle, WA, USA
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Sales Cadena MR, Cadena PG, Watson MR, Sarmah S, Boehm Ii SL, Marrs JA. Zebrafish (Danio rerio) larvae show behavioral and embryonic development defects when exposed to opioids at embryo stage. Neurotoxicol Teratol 2021; 85:106964. [PMID: 33621603 DOI: 10.1016/j.ntt.2021.106964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022]
Abstract
Opioid abuse continues to plague society, and in recent years, there has been an epidemic, leading to increased addiction and death. It is poorly understood how prenatal opioid use affects the lives of children. The aim of this work was to evaluate the effect of early embryonic codeine or morphine exposure in zebrafish (Danio rerio), examining gastrulation progression (epiboly), teratogenic effects, mortality and locomotor behavior response to light/dark cycles. Zebrafish embryos were exposed to codeine or morphine (designated C or M) at 1, 5 or 10 mg/L (designated 01, 05 or 10, respectively) from 3 to 24 h postfertilization (hpf) or from 3 to 48 hpf (designated -24 or - 48 for 1 or 2 days of exposure, respectively). The C10-24, C01-48, C05-48 and C10-48 groups showed significantly smaller eyes than control larvae at 7 days postfertilization (dpf). Locomotor behavior of control larvae in light/dark cycles showed greater swimming time and distance in dark cycles. Two-day codeine exposure produced strong effects, showing no significant response due to light/dark cycles in distance moved. Morphine exposed groups showed similar effects as observed in 2-day codeine exposed groups, showing less large movement activity and also no significant difference between inactive duration in response to light/dark cycles. In conclusion, we observed low teratogenic effects and mortality effects. Animals exposed to high levels and higher exposure times of opioids were hypoactive, relative to controls, in the dark period. Future studies will be needed to understand the neural defects producing behavior changes.
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Affiliation(s)
- Marilia R Sales Cadena
- Departamento de Biologia (DB), Universidade Federal Rural de Pernambuco, Av. Dom Manoel de Medeiros s/n, 52171-900, Dois Irmãos, Recife, PE, Brazil.
| | - Pabyton G Cadena
- Departamento de Morfologia e Fisiologia Animal (DMFA), Universidade Federal Rural de Pernambuco, Av. Dom Manoel de Medeiros s/n, 52171-900, Dois Irmãos, Recife, PE, Brazil
| | - Meredith R Watson
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 North Blackford Street, Indianapolis, IN 46202, USA
| | - Swapnalee Sarmah
- Department of Biology, Indiana University - Purdue University Indianapolis, 723 West Michigan Street, Indianapolis, IN 46202, USA
| | - Stephen L Boehm Ii
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 North Blackford Street, Indianapolis, IN 46202, USA
| | - James A Marrs
- Department of Biology, Indiana University - Purdue University Indianapolis, 723 West Michigan Street, Indianapolis, IN 46202, USA.
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Predictors of serious adverse drug events from opioids: Results from the Food and Drug Administration Adverse Events Reporting System. J Am Assoc Nurse Pract 2021; 33:1207-1215. [PMID: 33534282 DOI: 10.1097/jxx.0000000000000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioids pose significant increased risk for serious adverse drug events (ADEs). PURPOSE The purpose was to identify significant predictors and their associated magnitude of risk for serious life-threatening opioid ADEs. METHODS A post hoc design was used to examine predictors of opioid analgesics ADEs with Food and Drug Administration Adverse Events Reporting System (FAERS) data. The sample consisted of all eligible cases from the second quarter of the 2019 FAERS where an opioid analgesic was identified as the primary suspect for an ADE. Logistic regression was used to predict serious life-threatening ADEs. Final predictors included age, gender, misuse/substance use disorder, number of concurrent opioids; use of benzodiazepines, other sedatives, and antidepressants; and use of morphine, fentanyl, and oxycodone. RESULTS Life-threatening ADEs, excluding suicide and suicide attempts, comprised 19.9% of the cases. Protective factors that reduced risk included female gender, use of antidepressants, and use of morphine. Harmful factors that increased risk of a serious ADE included misuse/substance use disorder, use of benzodiazepines, and use of other sedatives. Persons taking an opioid with both a benzodiazepine and another sedative increased risk of a serious ADE by 18.78 times. IMPLICATIONS FOR PRACTICE Results provide risk data helpful to share with people who use prescribed opioids for self-management of pain. Combination of opioids and clinically indicated antidepressants that do not both promote serotonin uptake inhibition may reduce risk for serious opioid ADEs. Practitioners should continue to avoid prescribing benzodiazepines and other sedatives when opioids are used.
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Freibott CE, Walker A, Maio V, Frasso R. Educational programs implemented for pharmacists after state passage of a standing order for naloxone: A systematic review of current practices. J Am Pharm Assoc (2003) 2021; 61:e19-e27. [PMID: 33386240 DOI: 10.1016/j.japh.2020.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This review describes the current educational interventions that have been created for pharmacists after the implementation of a standing order for naloxone. METHODS Search strategies were constructed for 3 databases (PubMed, SCOPUS, and CINAHL), which were queried between February 1, 2019, and March 5, 2019. Two reviewers independently screened 224 titles and abstracts from these databases. The descriptive criteria of each study, such as rationale, design, study location, population, and method of intervention, were included. RESULTS Eight articles met the inclusion criteria; 4 were delivered in person, 2 were online programs, and 2 used combined in-person and online methodologies. Of the 8 studies, 4 were delivered to practicing pharmacists, and 4 were designed for student pharmacists. CONCLUSION Pharmacists seem to engage in more overdose prevention behaviors after participating in the novel educational program as compared with taking the state-mandated training alone. Both student pharmacists and practicing pharmacists had promising postintervention results, with post-test scores indicating a statistically significant increase in knowledge or improvement in naloxone-relevant skills. The results of this review indicate the need to critically analyze the implementation of standing order laws for naloxone, specifically how pharmacists are being trained. The next steps include publication of existing best practices for educational interventions for pharmacists that may not currently be in the literature.
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27
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Petrosky E, Ertl A, Sheats KJ, Wilson R, Betz CJ, Blair JM. Surveillance for Violent Deaths - National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2020; 69:1-37. [PMID: 33270620 PMCID: PMC7713989 DOI: 10.15585/mmwr.ss6908a1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION In 2017, approximately 67,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 34 states, four California counties, the District of Columbia, and Puerto Rico in 2017. Results are reported by sex, age group, race/ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. PERIOD COVERED 2017. DESCRIPTION OF SYSTEM NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner reports, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2017. Data were collected from 34 states (Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), four California counties (Los Angeles, Sacramento, Shasta, and Siskiyou), the District of Columbia, and Puerto Rico. NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. RESULTS For 2017, NVDRS collected information on 45,141 fatal incidents involving 46,389 deaths that occurred in 34 states, four California counties, and the District of Columbia; in addition, information was collected on 961 fatal incidents involving 1,027 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 46,389 deaths in the 34 states, four California counties, and District of Columbia, the majority (63.5%) were suicides, followed by homicides (24.9%), deaths of undetermined intent (9.7%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns and circumstances varied by manner of death. The suicide rate was higher among males than among females and was highest among adults aged 45-64 years and ≥85 years and non-Hispanic American Indians/Alaska Natives and non-Hispanic Whites. The most common method of injury for suicide was a firearm among males and poisoning among females. Suicide was most often preceded by a mental health, intimate partner, or physical health problem or a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was highest among persons aged 20-24 years and was higher among males than females. Non-Hispanic Black males had the highest homicide rate of any racial/ethnic group. The most common method of injury for homicide was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Among intimate partner violence-related homicides, the largest proportion occurred among adults aged 35-54 years, and the most common method of injury was a firearm. When the relationship between an intimate partner violence-related homicide victim and a suspect was known, most female victims were killed by a current or former intimate partner, whereas approximately half of male victims were killed by a suspect who was not their intimate partner. Almost all legal intervention deaths were among males, and the legal intervention death rate was highest among men aged 25-29 years. Non-Hispanic American Indian/Alaska Native males had the highest legal intervention death rate, followed by non-Hispanic Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault/homicide. The most frequent circumstances for legal intervention deaths were reported use of a weapon by the victim in the incident and a mental health or substance use problem (other than alcohol use). Unintentional firearm deaths more frequently occurred among males, non-Hispanic Whites, and persons aged 15-24 years. These deaths most often occurred while the shooter was playing with a firearm and most frequently were precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. The rate of death when the manner was of undetermined intent was highest among males, particularly among non-Hispanic Black and non-Hispanic American Indian/Alaska Native males, and persons aged 30-34 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. INTERPRETATION This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2017. The suicide rate was highest among non-Hispanic American Indian/Alaska Native and non-Hispanic White males, whereas the homicide rate was highest among non-Hispanic Black males. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. PUBLIC HEALTH ACTION NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs and policies to reduce and prevent violent deaths. For example, South Carolina VDRS and Colorado VDRS are using their data to support suicide prevention programs through systems change and the Zero Suicide framework. North Carolina VDRS and Kentucky VDRS data were used to examine intimate partner violence-related deaths beyond homicides to inform prevention efforts. Findings from these studies suggest that intimate partner violence might also contribute to other manners of violent death, such as suicide, and preventing intimate partner violence might reduce the overall number of violent deaths. In 2019, NVDRS expanded data collection to include all 50 states, the District of Columbia, and Puerto Rico, providing more comprehensive and actionable violent death information for public health efforts to reduce violent deaths.
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Affiliation(s)
- Emiko Petrosky
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Allison Ertl
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Kameron J. Sheats
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Rebecca Wilson
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Carter J. Betz
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Janet M. Blair
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
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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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Green TC, Bratberg J, Baird J, Burstein D, Lenz K, Case P, Walley AY, Xuan Z. Rurality and differences in pharmacy characteristics and community factors associated with provision of naloxone in the pharmacy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102602. [DOI: 10.1016/j.drugpo.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/19/2019] [Accepted: 11/10/2019] [Indexed: 02/01/2023]
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Deloney LP, Smith Condeni M, Carter C, Privette A, Leon S, Eriksson EA. Efficacy of Methocarbamol for Acute Pain Management in Young Adults With Traumatic Rib Fractures. Ann Pharmacother 2020; 55:705-710. [PMID: 33045839 DOI: 10.1177/1060028020964796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rib fractures account for more than one-third of blunt thoracic injuries and are associated with serious complications. Use of nonopioid adjunctive agents such as methocarbamol for pain control has increased considerably. OBJECTIVE This study aimed to assess the impact of methocarbamol addition to the pain control regimen on daily opioid requirements for young adults with rib fractures. METHODS This observational, retrospective study included patients aged 18 to 39 years with 3 or more rib fractures who were admitted to a level 1 trauma center between July 2014 and July 2018. Patients were dichotomized based on admission before and after methocarbamol addition to the institutional rib fracture protocol. The primary outcome was to determine the impact of methocarbamol on daily opioid requirements. Secondary outcomes included hospital length of stay (LOS) and diagnosis of pneumonia. RESULTS A total of 50 patients were included, with 22 and 28 patients in the preprotocol and postprotocol groups, respectively. All patients in the latter group received methocarbamol, whereas no patient in the preprotocol group received methocarbamol. Cumulative opioid exposure was significantly less for patients admitted after methocarbamol addition to the protocol (219 vs 337 mg oral morphine equivalents; P = 0.01), and hospital LOS was also decreased (4 vs 3 days; P = 0.03). No significant differences in the incidence of pneumonia or adverse effects were observed. CONCLUSION AND RELEVANCE This is the first study to evaluate the impact of methocarbamol on reducing opioid requirements. Given the risks associated with opioids, use of methocarbamol as an analgesia-optimizing, opioid-sparing multimodal agent may be reasonable.
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Affiliation(s)
| | | | | | | | - Stuart Leon
- Medical University of South Carolina, Charleston, SC, USA
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31
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Blondino CT, Gormley MA, Taylor DDH, Lowery E, Clifford JS, Burkart B, Graves WC, Lu J, Prom-Wormley EC. The Influence of Co-Occurring Substance Use on the Effectiveness of Opiate Treatment Programs According to Intervention Type. Epidemiol Rev 2020; 42:57-78. [PMID: 32944731 DOI: 10.1093/epirev/mxaa005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
This systematic review describes the influence of co-occurring substance use on the effectiveness of opiate treatment programs. MEDLINE/PubMed, Embase, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from database inception to November 28, 2018, to identify eligible opioid treatment studies in the United States that assessed the relationship between co-occurring substance use and treatment outcome (i.e., opioid abstinence and treatment retention). A total of 34 eligible studies were included. Overall, co-occurring substance use was associated with negative treatment outcomes regardless of intervention type. However, patterns varied by substance and intervention type. In particular, co-occurring use of cocaine or marijuana with opioids was associated with reduced treatment retention and opioid abstinence regardless of intervention type. Co-occurring use of amphetamines, compared with no use or reduced use of amphetamines, decreased treatment retention. Co-occurring use of alcohol was both positively and negatively associated with treatment outcomes. One study reported a significant positive association between sedative use and opioid abstinence. Generally, findings suggest that combined interventions reported better health outcomes compared with pharmacological or behavioral intervention studies alone. The findings of this review emphasize the need to comprehensively study and address co-occurring substance use to improve opiate treatment programs.
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Rockett IRH, Caine ED, Connery HS, Nolte KB. Overcoming the limitations of 'accident' as a manner of death for drug overdose mortality: case for a death certificate checkbox. Inj Prev 2020; 27:375-378. [PMID: 32917742 DOI: 10.1136/injuryprev-2020-043830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 01/21/2023]
Abstract
Collectively, the epidemic increases in the United States of opioid-related deaths and suicides during the first two decades of the 21st century have exposed shortcomings in current forensic and epidemiological approaches for determining and codifying manner of death-a vital function fulfilled by medical examiners, coroners and nosologists-the foundation for the National Violent Death Reporting System (NVDRS), an incident-based surveillance system providing individual-level information on decedent characteristics, manner, cause and circumstances of suicide, homicide and other violent injury deaths. Drug intoxication deaths are generally classified as 'accidents' or unintentional, a fundamental mischaracterisation; most arose from repetitive self-harm behaviours related to substance acquisition and misuse. Moreover, given the burden of affirmative evidence required to determine suicide, many of these 'accidents' likely reflected unrecognised intentional acts-that is, suicides. Addition of a simple checkbox for self-injury mortality on the death certificate would enrich the National Death Index and NVDRS, and in turn, inform prevention and clinical research, and enhance the evaluation of prevention programmes and therapeutic regimens.
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Affiliation(s)
- Ian R H Rockett
- Epidemiology, West Virginia University, Morgantown, West Virginia, USA .,Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric D Caine
- Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA.,Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.,Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt B Nolte
- Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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33
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PARK JUNYEONG, ROUHANI SABA, BELETSKY LEO, VINCENT LOUISE, SALONER BRENDAN, SHERMAN SUSANG. Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework. Milbank Q 2020; 98:700-746. [PMID: 32808709 PMCID: PMC7482387 DOI: 10.1111/1468-0009.12470] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug-related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. CONTEXT Drug overdose is the leading cause of injury-related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. METHODS In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The "continuum of overdose risk" framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. FINDINGS De-escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. CONCLUSIONS Without recognizing the full drug-use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.
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Affiliation(s)
| | | | - LEO BELETSKY
- School of Law and Bouvé College of Health SciencesNortheastern University
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34
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Perrone E, De Bei F, Cristofari G. Law and mental health: A bridge between individual neurobiology and the collective organization of behaviors. Med Hypotheses 2020; 144:110004. [PMID: 32758868 DOI: 10.1016/j.mehy.2020.110004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 12/01/2022]
Abstract
Mental disorders (MD) or mental symptoms (MS) have multifactorial causes. Today we know much more about the variables that cause individual MD\MS, but in our opinion these characterizations, although essential, are not sufficient to account for the complexity in which we live. For example, they do not explain in a coherent and empirically verifiable way how the biological individual relates to the social architecture in which he lives. This article presents a hypothesis that connects social and organizational structures to the emergence of symptoms and mental disorders in the population. It is our belief that some of these structures fundamentally impact the distribution of MD/MS in a population and the medical and psychological communities must consider this impact seriously. Laws aim at directing the behavior of groups of people, whose behavior is strictly interdependent with their neurobiology. Given the ability of laws to direct the behaviors that regulate social interactions, traumatic factors may be considered capable of linking a non-material object (e.g., a law) to a real effect (e.g., MS/MD). We discuss, as a paradigmatic example, the laws that regulate the use of psychotropic substances.
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Affiliation(s)
- Emanuele Perrone
- Faculty of Medicine and surgery, La Sapienza University, Rome, Italy.
| | - Francesco De Bei
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Rome, Italy
| | - Gianmarco Cristofari
- Department of Political Sciences, Communication and International Relations, University of Macerata, Italy
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Marijuana and Opioid Use during Pregnancy: Using Zebrafish to Gain Understanding of Congenital Anomalies Caused by Drug Exposure during Development. Biomedicines 2020; 8:biomedicines8080279. [PMID: 32784457 PMCID: PMC7460517 DOI: 10.3390/biomedicines8080279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 01/09/2023] Open
Abstract
Marijuana and opioid addictions have increased alarmingly in recent decades, especially in the United States, posing threats to society. When the drug user is a pregnant mother, there is a serious risk to the developing baby. Congenital anomalies are associated with prenatal exposure to marijuana and opioids. Here, we summarize the current data on the prevalence of marijuana and opioid use among the people of the United States, particularly pregnant mothers. We also summarize the current zebrafish studies used to model and understand the effects of these drug exposures during development and to understand the behavioral changes after exposure. Zebrafish experiments recapitulate the drug effects seen in human addicts and the birth defects seen in human babies prenatally exposed to marijuana and opioids. Zebrafish show great potential as an easy and inexpensive model for screening compounds for their ability to mitigate the drug effects, which could lead to new therapeutics.
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36
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Vest LS, Sarabu N, Koraishy FM, Nguyen MT, Park M, Lam NN, Schnitzler MA, Axelrod D, Hsu CY, Garg AX, Segev DL, Massie AB, Hess GP, Kasiske BL, Lentine KL. Prescription patterns of opioids and non-steroidal anti-inflammatory drugs in the first year after living kidney donation: An analysis of U.S. Registry and Pharmacy fill records. Clin Transplant 2020; 34:e14000. [PMID: 32502285 PMCID: PMC7449599 DOI: 10.1111/ctr.14000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
We examined a novel database linking national donor registry identifiers to records from a US pharmaceutical claims warehouse (2007-2015) to describe opioid and NSAID prescription patterns among LKDs during the first year postdonation, divided into three periods: 0-14 days, 15-182 days, and 183-365 days. Associations of opioid and NSAID prescription fills with baseline factors were examined by logistic regression (adjusted odds ratio, LCL aORUCL ). Among 23,565 donors, opioid prescriptions were highest during days 0-14 (36.6%), but 12.6% of donors filled opioids during days 183-365. NSAID prescriptions rose from 0.5% during days 0-14 to 3.3% during days 183-365. Women filled opioids more commonly than men, and black donors filled both opioids and NSAIDs more commonly than white donors. After covariate adjustment, significant correlates of opioid prescription fills during days 183-365 included obesity (aOR,1.24 1.381.53 ), less than college education (aOR,1.19 1.311.43 ), smoking (aOR,1.33 1.451.58 ), and nephrectomy complications (aOR,1.11 1.291.49 ). NSAID prescription fills in year 1 were not associated with differences in estimated glomerular filtration rate, incidence of proteinuria or new-onset hypertension at the first and second year postdonation. Prescription fills for opioids and NSAIDs for LKDs varied with demographic and clinic traits. Future work should examine longer-term outcome implications to help inform safe analgesic regimen choices after donation.
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Affiliation(s)
- Luke S Vest
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nagaraju Sarabu
- Nephrology, Department of Medicine, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Farrukh M Koraishy
- Nephrology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Minh-Tri Nguyen
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Meyeon Park
- Nephrology, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Ngan N Lam
- Nephrology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - David Axelrod
- University of Iowa Transplant Institute, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Chi Yuan Hsu
- Nephrology, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Amit X Garg
- Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Dorry L Segev
- Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory P Hess
- Drexel University School of Medicine, Philadelphia, PA, USA
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
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Abstract
AIM The current study explores pre-incarceration polysubstance use patterns among a justice-involved population who use opioids. Design: Setting: Data from prison and jail substance use programing in the state of Kentucky from 2015-2017 was examined. Participants: A cohort of 6,569 individuals who reported both pre-incarceration use of opioids and reported the use of more than one substance per day. Measurements: To determine the different typologies of polysubstance use involving opioids, latent profile analysis of the pre-incarceration thirty-day drug use of eight substances was conducted. Multinomial logistic regression predicted latent profile membership. Findings: Six unique profiles of polysubstance use involving opioids and other substances were found; Primarily Alcohol (9.4%), Primarily Heroin (19.0%), Less Polysubstance Use (34.3%), Tranquilizer Polysubstance Use (16.3%), Primarily Buprenorphine (7.8%), and Stimulant-Opioid (13.2%). Profiles differed by rural/urban geography, injection drug use, physical, and mental health symptoms. Conclusion: Findings indicate the heterogeneity of opioid use among a justice-involved population. More diverse polysubstance patterns may serve as a proxy to identifying individuals with competing physical and mental health needs. Future interventions could be tailored to polysubstance patterns during the period of justice-involvement.
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Affiliation(s)
- Amanda M. Bunting
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - Carrie Oser
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky, USA
| | - Michele Staton
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah Knudsen
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
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Lowenstein M, Feuerstein-Simon R, Dupuis R, Herens A, Hom J, Sharma M, Sheni R, Encarnacion L, Flaherty C, Cueller M, Cannuscio C. Overdose Awareness and Reversal Trainings at Philadelphia Public Libraries. Am J Health Promot 2020; 35:250-254. [PMID: 32662281 DOI: 10.1177/0890117120937909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate an overdose response training program in public libraries. DESIGN Mixed methods evaluation including pre- and post-intervention questionnaires and debriefing interviews. SETTING Ten Philadelphia public libraries. SAMPLE Overdose response training participants (library staff and community members). INTERVENTION Public, hour-long overdose response trainings run by the Philadelphia Department of Public Health, the Free Library of Philadelphia, and the University of Pennsylvania between March and December 2018. MEASURES Questionnaires assessed motivation for attending trainings, overdose response readiness, and intention to acquire and carry naloxone. Debriefing interviews elicited training feedback. ANALYSIS We assessed changes in overdose response readiness and intention to carry naloxone and performed thematic analysis on interview data. RESULTS At 29 trainings, 254 people attended, of whom 203 (80%) completed questionnaires and 23 were interviewed. 30% of participants had witnessed an overdose, but only 3% carried naloxone at baseline. Following training, overdose response readiness and intention to acquire/carry naloxone improved significantly (P < .01). Interviewees nonetheless noted that they experienced barriers to naloxone acquisition, including cost, stigma, and concern regarding future insurability. Trainings subsequently included naloxone distribution. Interviewees reported that public libraries were welcoming, nonstigmatizing venues. CONCLUSION In Philadelphia, library-based overdose response trainings were well-attended and reached a population with prior overdose encounters. Similar trainings could be deployed as a scalable overdose prevention strategy in the nation's 16 568 public libraries.
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Affiliation(s)
- Margaret Lowenstein
- National Clinician Scholars Program, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Feuerstein-Simon
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Roxanne Dupuis
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Social and Behavioral Sciences, 1812Harvard University, Boston, MA, USA
| | - Allison Herens
- 6542Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Jeffrey Hom
- Leonard Davis Institute of Health Economics, 6572University of Pennsylvania, Philadelphia, PA, USA.,6542Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Meghana Sharma
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Risha Sheni
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lonard Encarnacion
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carina Flaherty
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maria Cueller
- Department of Criminology, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Carolyn Cannuscio
- Department of Family Medicine and Community Health, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Wright SL. Limited Utility for Benzodiazepines in Chronic Pain Management: A Narrative Review. Adv Ther 2020; 37:2604-2619. [PMID: 32378069 PMCID: PMC7467435 DOI: 10.1007/s12325-020-01354-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Controversy and uncertainty exist about the use of benzodiazepine receptor agonists (BZRAs) in pain management. This article curates available research to determine the appropriate role of BZRAs in the course of pain management, and how prescribers might address these challenges. METHODS A narrative review was performed to determine the appropriate role of BZRAs in pain management and to develop practice recommendations. Publications were identified by a search of PubMed, references of retrieved reports, guidelines, and the author's personal files. RESULTS BZRAs were found to have analgesic benefit for two pain conditions: burning mouth syndrome and stiff person syndrome. Absence of research, heterogeneity of trials, and small sample sizes precluded drawing conclusions about efficacy of BZRAs for the other 109 pain conditions explored. Data supports the use of BZRAs to treat co-occurring insomnia and anxiety disorders but only when alternatives are inadequate and only for short periods of time (2-4 weeks). The utility of BZRAs is limited by loss of efficacy that may be seen with continued use and adverse reactions including physiologic dependence which develops in 20-100% of those who take these agents for more than a month. CONCLUSIONS BZRAs are often used inappropriately in pain management. Their initiation and duration of use should be limited to a narrow range of conditions. When prescribed for 4 weeks or more, patients should be encouraged to discontinue them through a supported, slow tapering process that may take 12-18 months or longer.
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Affiliation(s)
- Steven L Wright
- Alliance for Benzodiazepine Best Practices, Littleton, CO, USA.
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Feuerstein-Simon R, Lowenstein M, Sharma M, Dupuis R, Luna Marti X, Cannuscio CC. Local health departments and the implementation of evidence-based policies to address opioid overdose mortality. Subst Abus 2020; 41:468-474. [PMID: 32213045 DOI: 10.1080/08897077.2019.1709250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the context of the opioid overdose crisis, local health departments are on the front lines, coordinating programs and services and translating state and federal policies into community action. While media reports describe growth of Overdose Education and Naloxone Distribution (OEND) programs among local health departments, little is known about program features, scope, and target populations. Methods: We surveyed health departments in 180 United States counties with high overdose mortality rates. Results: Among health officials from 54 counties (30% response), many counties reported implementation of evidence-based practices, with a high degree of programmatic variation. The majority of responding health departments (94%) conducted overdose education and naloxone distribution (OEND) programs. Programs were heterogeneous in scale, with a reported median of 250 naloxone kits (range 1-25,000 kits) acquired for community distribution. In addition, four in five respondents were aware of their state's standing order policy for increasing naloxone access. While the majority of respondents reported county-level availability of at least one form of evidence-based medications to treat opioid use disorder (MOUD), many reported no availability of buprenorphine (33%) or methadone (43%). Conclusions: Local health departments are vital to reducing opioid overdose mortality, and many are implementing relevant evidence-based practices. To support further adoption of potentially life-saving strategies, health departments need adequate funding and staffing as well as policies and guidelines to support implementation.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret Lowenstein
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghana Sharma
- Master of Public Health Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanne Dupuis
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Xochitl Luna Marti
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Langabeer JR, Chambers KA, Cardenas-Turanzas M, Champagne-Langabeer T. County-level factors underlying opioid mortality in the United States. Subst Abus 2020; 43:76-82. [PMID: 32186475 DOI: 10.1080/08897077.2020.1740379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Mortality from overdoses involving opioids in the United States (U.S.) has reached epidemic proportions. More research is needed to examine the underlying factors contributing to opioid-related mortality regionally. This study's objective was to identify and examine the county-level factors most closely associated with opioid-related overdose deaths across all counties in the U.S. Methods: Using a national cross-sectional ecological study design, we analyzed the relationships between 17 county-level characteristics in four categories (i.e. socio-economic, availability of medical care, health-related concerns, and demographics) with opioid mortality. Data were extracted from the Robert Wood Johnson County Health Rankings aggregate database and Centers for Disease Control and Prevention (CDC)'s Wide-ranging Online Data for Epidemiological Research (WONDER) system. Results: There were 1058 counties (33.67% of 3142 nationally) with reported opioid-related fatalities. Median opioid-related mortality was 15.61 per 100,000 persons. Multivariate regression results indicate that counties with the highest opioid-related mortality had increased rates of tobacco use, HIV, Non-Hispanic Caucasians, and females and were rural areas, but lower rates of food insecurity and uninsured adults. The rates of tobacco use and HIV had the strongest association with mortality. Availability of either mental health or primary care providers were not significantly associated with mortality. Severe housing problems, high school graduation rate, obesity, violent crime, and median household income also did not contribute to county-level differences in overdose mortality. Conclusions: Future health policies should fund further investigations and ultimately address the most influential and significant underlying county-level factors associated with opioid-related mortality.
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Affiliation(s)
- James R Langabeer
- Houston Emergency Opioid Engagement System, The University of Texas Health Science Center, Houston, Texas, USA.,Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Kimberly A Chambers
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Marylou Cardenas-Turanzas
- Houston Emergency Opioid Engagement System, The University of Texas Health Science Center, Houston, Texas, USA
| | - Tiffany Champagne-Langabeer
- Houston Emergency Opioid Engagement System, The University of Texas Health Science Center, Houston, Texas, USA
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Smith KE, Tillson MD, Staton M, Winston EM. Characterization of diverted buprenorphine use among adults entering corrections-based drug treatment in Kentucky. Drug Alcohol Depend 2020; 208:107837. [PMID: 31951906 PMCID: PMC7418075 DOI: 10.1016/j.drugalcdep.2020.107837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/17/2019] [Accepted: 12/26/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Illicit, medically unsupervised use of buprenorphine (i.e., "diverted use") among vulnerable and underserved populations, such as corrections-involved adults, remains underexplored. METHODS Survey data (2016-2017) collected as part of a clinical assessment of incarcerated adults entering corrections-based substance use treatment in Kentucky were analyzed. For years examined, 12,915 completed the survey. Removing cases for participants who did not reside in Kentucky for >6 months during the one-year pre-incarceration period (n = 908) resulted in a final sample size of 12,007. RESULTS Over a quarter of the sample reported past-year diverted buprenorphine use prior to incarceration and 21.8 % reported use during the 30-days prior to incarceration, using 6.5 months and 14.3 days on average, respectively. A greater proportion of participants who reported diverted buprenorphine use had previously been engaged with some substance use treatment (77.0 %) and reported greater perceived need for treatment (79.4 %) compared to those who did not report use. Use was more likely among participants who were younger, white, male, and who reported rural or Appalachian residence. Diverted buprenorphine users also evidenced extensive polydrug use and presented with greater substance use disorder severity. Non-medical prescription opioid, heroin, and diverted methadone use were associated with increased odds of diverted buprenorphine use while kratom was not. Diverted methadone use was associated with a 252.9 % increased likelihood of diverted buprenorphine use. CONCLUSIONS Diverted buprenorphine use among participants in this sample was associated with concerning high-risk behaviors and may indicate barriers to accessing opioid agonist therapies for corrections-involved Kentucky residents, particularly those in rural Appalachia.
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Affiliation(s)
- Kirsten E Smith
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Kent School of Social Work, University of Louisville, Louisville, Kentucky, 40292, United States.
| | - Martha D Tillson
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Department of Sociology, University of Kentucky, Lexington, Kentucky, 40508, United States
| | - Michele Staton
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, 40508, United States
| | - Erin M Winston
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States
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Smart R, Kase CA, Taylor EA, Lumsden S, Smith SR, Stein BD. Strengths and weaknesses of existing data sources to support research to address the opioids crisis. Prev Med Rep 2020; 17:101015. [PMID: 31993300 PMCID: PMC6971390 DOI: 10.1016/j.pmedr.2019.101015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/22/2019] [Accepted: 11/02/2019] [Indexed: 12/18/2022] Open
Abstract
Better opioid prescribing practices, promoting effective opioid use disorder treatment, improving naloxone access, and enhancing public health surveillance are strategies central to reducing opioid-related morbidity and mortality. Successfully advancing and evaluating these strategies requires leveraging and linking existing secondary data sources. We conducted a scoping study in Fall 2017 at RAND, including a literature search (updated in December 2018) complemented by semi-structured interviews with policymakers and researchers, to identify data sources and linking strategies commonly used in opioid studies, describe data source strengths and limitations, and highlight opportunities to use data to address high-priority public health research questions. We identified 306 articles, published between 2005 and 2018, that conducted secondary analyses of existing data to examine one or more public health strategies. Multiple secondary data sources, available at national, state, and local levels, support such research, with substantial breadth in data availability, data contents, and the data's ability to support multi-level analyses over time. Interviewees identified opportunities to expand existing capabilities through systematic enhancements, including greater support to states for creating and facilitating data use, as well as key data challenges, such as data availability lags and difficulties matching individual-level data over time or across datasets. Multiple secondary data sources exist that can be used to examine the impact of public health approaches to addressing the opioid crisis. Greater data access, improved usability for research purposes, and data element standardization can enhance their value, as can improved data availability timeliness and better data comparability across jurisdictions.
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Affiliation(s)
| | | | | | - Susan Lumsden
- Office of Health Policy, Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, United States
| | - Scott R. Smith
- Office of Health Policy, Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, United States
| | - Bradley D. Stein
- RAND Corporation, Pittsburgh, PA, United States
- University of Pittsburgh School of Medicine, Pittsburgh PA, United States
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Katzman JG, Takeda MY, Greenberg N, Moya Balasch M, Alchbli A, Katzman WG, Salvador JG, Bhatt SR. Association of Take-Home Naloxone and Opioid Overdose Reversals Performed by Patients in an Opioid Treatment Program. JAMA Netw Open 2020; 3:e200117. [PMID: 32101312 PMCID: PMC7137685 DOI: 10.1001/jamanetworkopen.2020.0117] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/29/2019] [Indexed: 01/09/2023] Open
Abstract
Importance The US opioid crisis was deemed a public health emergency in 2017. More than 130 individuals in the US die daily as a result of unintentional opioid overdose deaths. Objective To measure use of take-home naloxone for overdose reversals performed by study participants with opioid use disorder receiving treatment at an opioid treatment program. Design, Setting, and Participants In a year-long cohort study, between April 4, 2016, and May 16, 2017, 395 study participants enrolled at the University of New Mexico Addiction and Substance Abuse Opioid Treatment Program, an outpatient clinic treating substance use disorders. Inclusion criteria included all patients enrolled at University of New Mexico Addiction and Substance Abuse Opioid Treatment Program during the study enrollment period; positive history of opioid use disorder treated with methadone, buprenorphine, or naltrexone; and age 18 years or older. Exclusion criteria included allergy to naloxone and age younger than 18 years. The study closed 1 year after enrollment, on May 17, 2018. Data analysis was performed from May 2018 to July 2019. Exposure Two doses of take-home naloxone combined with opioid overdose education were provided to study participants. Main Outcomes and Measures The primary outcome was to measure the association of take-home naloxone with overdose reversals performed by patients with opioid use disorder enrolled in an opioid treatment program. Results We enrolled 395 study participants (270 female [68.4%]; mean [SD] age, 35.4 [12.6] years; 260 [65.8%] with Hispanic white race/ethnicity) in the 1-year prospective trial. Sixty-eight female participants (25.2% of all female participants) were pregnant at the time of enrollment. Seventy-three of the 395 study participants (18.0%) performed 114 overdose reversals in the community. All community reversals were heroin related. Most study participants (86.8%) stated that the person on whom they performed an overdose reversal was a friend, relative, acquaintance, or significant other. In the year before enrollment, only 18 study participants (4.5%) had been prescribed naloxone. Conclusions and Relevance Take-home naloxone as part of overdose education and naloxone distribution provided to patients in an opioid treatment program may be associated with a strategic targeted harm reduction response for reversing opioid overdose-related deaths. Policy makers may consider regulations to mandate overdose education and naloxone distribution in opioid treatment programs.
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Affiliation(s)
- Joanna G. Katzman
- Department of Neurosurgery, University of New Mexico, Albuquerque
- Project ECHO, ECHO Institute, Albuquerque, New Mexico
| | | | - Nina Greenberg
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque
| | | | - Amal Alchbli
- Department of Neurosurgery, University of New Mexico, Albuquerque
| | | | - Julie G. Salvador
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Snehal R. Bhatt
- UNM Addiction and Substance Use Program, Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
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Gormley MA, Blondino CT, Taylor DDH, Lowery E, Clifford JS, Burkart B, Graves WC, Prom-Wormley EC, Lu J. Assessment of Co-Occurring Substance Use During Opiate Treatment Programs in the United States. Epidemiol Rev 2020; 42:79-102. [PMID: 33063108 DOI: 10.1093/epirev/mxaa009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022] Open
Abstract
The effectiveness of opiate treatment programs (OTPs) can be significantly influenced by co-occurring substance use, yet there are no standardized guidelines for assessing the influence of co-occurring substance use on treatment outcomes. In this review, we aim to provide an overview on the status of the assessment of co-occurring substance use during participation in OTPs in the United States. We searched 4 databases-MEDLINE/PubMed, EMBASE, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)-from database inception to November 2018 to select relevant publications on OTPs that assessed participants' co-occurring substance use. We used a standardized protocol to extract study, intervention, and co-occurring substance use characteristics. Methodological quality was assessed using the Quality in Prognosis Studies tool. Of the 3,219 titles screened, 614 abstracts and 191 full-text original publications were assessed, leaving 85 eligible articles. Co-occurring substance use was most often assessed during opioid treatments using combined (pharmacological and behavioral) (n = 57 studies) and pharmacological (n = 25 studies) interventions. Cocaine, alcohol, marijuana, and benzodiazepines were frequently measured, while amphetamines and tobacco were rarely assessed. Great variation existed between studies in the timing and measurement of co-occurring substance use, as well as definitions for substances and polysubstance/polydrug use. Inconsistencies in the investigation of co-occurring substance use make comparison of results across studies challenging. Standardized measures and consensus on research on co-occurring substance use is needed to produce the evidence required to develop personalized treatment programs for persons using multiple substances and to inform best-practice guidelines for addressing polydrug use during participation in OTPs.
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Over the counter naloxone needed to save lives in the United States. Prev Med 2020; 130:105932. [PMID: 31770540 DOI: 10.1016/j.ypmed.2019.105932] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
Abstract
The United States continues to face a public health emergency of opioid-related harm, the effects of which could be dramatically reduced through increased access to the opioid antagonist naloxone. Unfortunately, naloxone is too often unavailable when and where it is most needed, partly due to its continued status as a prescription medication. Although states and the federal Food and Drug Administration (FDA) have acted to increase access to naloxone, these changes are insufficient to address this unprecedented crisis. In this Commentary, we argue that FDA can and should immediately reclassify naloxone from prescription-only to over-the-counter status, a change that could save hundreds if not thousands of lives in the United States every year.
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Changes in Australian prescription opioid use following codeine rescheduling: A retrospective study using pharmaceutical benefits data. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:170-173. [DOI: 10.1016/j.drugpo.2019.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/12/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022]
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Rhee TG, Ross JS, Rosenheck RA, Grau LE, Fiellin DA, Becker WC. Accidental drug overdose deaths in Connecticut, 2012-2018: The rise of polysubstance detection? Drug Alcohol Depend 2019; 205:107671. [PMID: 31706248 DOI: 10.1016/j.drugalcdep.2019.107671] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine trends in polysubstance detection associated with drug-related overdose deaths in Connecticut. METHODS We used 2012-2018 data provided by Connecticut's Office of the Chief Medical Examiner (OCME) on accidental overdose deaths. We estimated annual trends, standardizing the number of deaths per 100,000 Connecticut residents each year. We then conducted stratified analyses by polysubstance use status. We also examined the numbers of deaths involving fentanyl in a separate analysis. We obtained data in April 2019, and statistical analyses were performed from April to September 2019. RESULTS The rate of overdose deaths in Connecticut increased from 9.9 per 100,000 residents in 2012 to 28.5 per 100,000 residents in 2018-a 221 % increase-with the majority occurring among persons aged 35-64 (65.3 %), men (73.9 %), and non-Hispanic whites (78.5 %). Among deaths involving fentanyl, the overall deaths escalated from 5.2 deaths per 100,000 residents in 2015 to 21.3 deaths per 100,000 residents in 2018, and more than 50% of these fentanyl-related deaths involved polysubstance use. CONCLUSIONS Connecticut experienced a more-than doubling of opioid-involved overdose deaths, largely driven by fentanyl and polysubstance use. The role of polysubstance use should be considered in efforts toward reducing opioid-related overdose incidents.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, United States; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States; Mental Illness Research, Education and Clinical Center of New England, US Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States; Yale Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States.
| | - Joseph S Ross
- Yale Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States; Section of General Internal Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States; Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT, United States
| | - Robert A Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States; Mental Illness Research, Education and Clinical Center of New England, US Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States; Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT, United States
| | - Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT, United States
| | - David A Fiellin
- Section of General Internal Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States; Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT, United States
| | - William C Becker
- Section of General Internal Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States; Pain Research, Informatics, Multi-morbidities and Education Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, United States
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Evaluation of a pharmacist-led naloxone coprescribing program in primary care. J Am Pharm Assoc (2003) 2019; 59:867-871. [DOI: 10.1016/j.japh.2019.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 01/23/2023]
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