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Fockele C, Lindgren E, Ferreira J, Salehipour D, Shandro J, Jauregui J. Community-engaged pedagogy in an emergency medicine clerkship: Teaching trauma-informed addiction care and harm reduction through a peer-assisted learning case. AEM EDUCATION AND TRAINING 2024; 8:e10989. [PMID: 38765708 PMCID: PMC11101990 DOI: 10.1002/aet2.10989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 05/22/2024]
Abstract
Background The impact of opioid use disorder (OUD) in the United States continues to rise, yet this topic has limited coverage in most medical school curricula. The study partnered with academic and community harm reductionists to design a peer-assisted learning case of opioid withdrawal to teach fourth-year medical students about trauma-informed OUD care and harm reduction services during their emergency medicine clerkship. Methods Academic and community harm reductionists iteratively codesigned this case in partnership with the research team. Community-engaged pedagogy informed this process to promote social action and power sharing through education. This case was integrated into the existing weekly peer-assisted learning curriculum (i.e., medical students teaching medical students through a structured case) for all fourth-year medical students during their required emergency medicine clinical rotation. Participants completed a postcase evaluation survey. Results Sixty-four medical students completed the survey between June and November 2022. A total of 98.5% of participants found the educational session quite or extremely relevant to their medical education, and 87.5% believed the case to be quite or extremely effective in achieving the learning objectives. A total of 45.3% initially felt quite or extremely competent in talking with patients about their drug use, whereas 53.2% felt quite or extremely more competent after participating in the case. Finally, 21.9% initially felt quite or extremely competent in proposing a treatment plan for a patient who uses drugs, whereas 62.5% felt quite or extremely more competent after participating in the case. Conclusions This study supports the feasibility and importance of incorporating the voices of people with lived and living experience into medical school curricular development. This peer-assisted learning case focused on the treatment of OUD in the emergency department was seamlessly integrated into the existing curriculum and well received by medical students. By engaging local experts, it could easily be adapted and expanded to other sites.
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Affiliation(s)
- Callan Fockele
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Elsa Lindgren
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jordan Ferreira
- University of Washington School of MedicineSeattleWashingtonUSA
| | - Dena Salehipour
- University of Washington School of Public HealthSeattleWashingtonUSA
| | - Jamie Shandro
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Joshua Jauregui
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
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Suekane A, Takayama W, Hashimoto R, Morishita K, Otomo Y. Risk factors for recurrence of suicide attempt via overdose: A prospective observational study. Am J Emerg Med 2024; 75:1-6. [PMID: 37890336 DOI: 10.1016/j.ajem.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although the prevalence of drug overdose has gradually increased worldwide, the risk factors associated with the recurrence of suicide attempts via drug overdose have not been well elucidated. In this study, we investigated the clinical course of patients with drug overdose and whether or not patients reattempted suicide via overdose, using telephone interviews, to evaluate the risk factors associated with overdose recurrence. METHODS This prospective observational study enrolled patients who attempted suicide by drug overdose and were transferred to a tertiary emergency hospital in Japan between January 1, 2015 and July 30, 2021. Recurrence of overdose within 1 year of admission for overdose was designated as the primary outcome. Multivariable logistic regression analysis was performed to assess the independent risk factors for the recurrence of overdose. Furthermore, we compared the difference in the recurrence interval between patients with and without cohabitants using the log-rank test. RESULTS A total of 94 patients were identified, and recurrence of overdose was observed in 28 patients (29.8%). The median recurrence interval was 6.0 months [IQR (interquartile range), 4.0-7.0 months]. The recurrence rate was significantly higher in patients with a history of schizophrenia than that in patients without a history of schizophrenia (58.3% vs 25.6%, p = 0.048), and significantly lower in patients with cohabitants than that in patients without cohabitants (22.6% vs 43.8%, p = 0.015). The presence of a cohabitant was significantly associated with a longer recurrence interval (p = 0.049). The effect of psychiatric intervention during hospitalization and psychiatric visits after discharge could not be found in this study. CONCLUSIONS A history of schizophrenia was an independent risk factor for the recurrence of overdose, and the presence of a cohabitant was significantly associated with a lower risk of recurrence. Large-scale, long-term studies are required to confirm the results of this study.
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Affiliation(s)
- Akira Suekane
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Rio Hashimoto
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
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3
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McCann NC, McMahan VM, Smith R, Majeski A, Johns SL, Kosakowski S, Wolfe S, Brennan S, Robinson M, Coffin PO, Walley AY. Feasibility and acceptability of a timeline follow-back method to assess opioid use, non-fatal overdose, and substance use disorder treatment. Addict Behav 2024; 148:107873. [PMID: 37801804 PMCID: PMC10618957 DOI: 10.1016/j.addbeh.2023.107873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/11/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Non-fatal overdoses are underreported and there is no accepted and feasible self-report research measure of non-fatal opioid overdose. Timeline follow-back (TLFB) calendar-based questionnaires assess self-reported risk behaviors. We assessed feasibility and acceptability of a new TLFB research measure for opioid use, non-fatal opioid overdose, and substance use disorder treatment among opioid overdose survivors. METHODS For the Repeated-dose Behavioral Intervention to Reduce Opioid Overdose Trial (REBOOT) study among opioid overdose survivors, we developed a TLFB questionnaire to assess daily non-prescribed opioid use, opioid overdose, facility stays, medications/behavioral treatment for opioid use disorder, and COVID-19 history during the previous 120 days. Staff assessors administered TLFB at four-monthly visits over the 16-month study participation period. To measure feasibility, we estimated TLFB completion time using an electronic timestamp tool. To measure acceptability, we administered a satisfaction survey to 103 participants who completed REBOOT. RESULTS Among 525 TLFB assessments conducted in 174 participants from January 2021-January 2023, opioid use was reported in 510 assessments, medication for opioid use disorder (MOUD) in 331 assessments, and ≥ 1 overdose in 107 assessments. Median TLFB completion time was 11 (IQR: 6-17) minutes for sections administered to all participants; detailed overdose questions administered to those reporting overdose took an additional 3 (IQR: 2-6) minutes. Report of ≥ 1 overdose and MOUD use were significantly associated with increased TLFB completion time. 88 % of participants reported that TLFB was very/somewhat acceptable. CONCLUSIONS Among opioid overdose survivors, REBOOT TLFB was a feasible and acceptable research measure, with similar completion time as other TLFB assessments of substance use.
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Affiliation(s)
- Nicole C McCann
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA.
| | - Vanessa M McMahan
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA
| | - Rachel Smith
- Boston University Chobanian & Avedisian School of Medicine, Boston MA
| | - Adam Majeski
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
| | - Sarah L Johns
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
| | - Sarah Kosakowski
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
| | - Shae Wolfe
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
| | - Sarah Brennan
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA
| | - Mackenzie Robinson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA
| | - Phillip O Coffin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA; University of California San Francisco, San Francisco CA
| | - Alexander Y Walley
- Boston University Chobanian & Avedisian School of Medicine, Boston MA; Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston MA
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Campbell TJ, Men S, Shearer D, Ebejer T, Joosse M, Quercia J, Sanders J, Tadrous M, Antoniou T, Gomes T. The epidemiology of benzodiazepine-related toxicity in Ontario, Canada: a population-based descriptive study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:956-966. [PMID: 37318697 PMCID: PMC10267543 DOI: 10.17269/s41997-023-00784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/02/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Despite the widespread use of prescription benzodiazepines, there are few studies examining trends and patterns of benzodiazepine-related toxicity. We describe the epidemiology of benzodiazepine-related toxicity in Ontario, Canada. METHODS We conducted a population-based, cross-sectional study of Ontario residents who had an emergency department visit or hospitalization for benzodiazepine-related toxicity between January 1, 2013 and December 31, 2020. We reported annual crude and age-standardized rates of benzodiazepine-related toxicity overall, by age, and by sex. In each year, we characterized the history of benzodiazepine and opioid prescribing among people who experienced benzodiazepine-related toxicity, and reported the percentage of encounters with opioid, alcohol, or stimulant co-involvement. RESULTS Between 2013 and 2020, there were 32,674 benzodiazepine-related toxicity encounters among 25,979 Ontarians. During this period, the crude rate of benzodiazepine-related toxicity declined overall, from 28.0 to 26.1 per 100,000 population (age-standardized rate: 27.8 to 26.4 per 100,000), but increased among young adults aged 19 to 24 (39.9 to 66.6 per 100,000 population). Moreover, by 2020, the percentage of encounters associated with active benzodiazepine prescriptions had declined to 48.9%, while the percentage of encounters that had opioid, stimulant, or alcohol co-involvement rose to 28.8%. CONCLUSION Benzodiazepine-related toxicity has declined in Ontario overall, but has increased among youth and young adults. Furthermore, there is growing co-involvement of opioids, stimulants, and alcohol, which may reflect the recent emergence of benzodiazepines in the unregulated drug supply. Multifaceted public health initiatives comprising harm reduction, mental health supports, and promotion of appropriate prescribing are needed to reduce benzodiazepine-related harm.
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Affiliation(s)
- Tonya J Campbell
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | | | - Dana Shearer
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Terry Ebejer
- Ontario Drug Policy Research Network Citizens' Panel, St. Michael's Hospital, Toronto, ON, Canada
| | - Matt Joosse
- Ontario Drug Policy Research Network Citizens' Panel, St. Michael's Hospital, Toronto, ON, Canada
| | - Josephine Quercia
- Ontario Drug Policy Research Network Citizens' Panel, St. Michael's Hospital, Toronto, ON, Canada
| | - Jane Sanders
- Ontario Drug Policy Research Network Citizens' Panel, St. Michael's Hospital, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Tony Antoniou
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada
- ICES, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada.
- ICES, Toronto, ON, Canada.
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.
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D’Onofrio G, Perrone J, Hawk KF, Cowan E, McCormack R, Coupet E, Owens PH, Martel SH, Huntley K, Walsh SL, Lofwall MR, Herring A. Early emergency department experience with 7-day extended-release injectable buprenorphine for opioid use disorder. Acad Emerg Med 2023; 30:1264-1271. [PMID: 37501652 PMCID: PMC10822018 DOI: 10.1111/acem.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
As the opioid overdose epidemic escalates, there is an urgent need for treatment innovations to address both patient and clinician barriers when initiating buprenorphine in the emergency department (ED). These include insurance status, logistical challenges such as the ability to fill a prescription and transportation, concerns regarding diversion, and availability of urgent referral sites. Extended-release buprenorphine (XR-BUP) preparations such as a new 7-day injectable could potentially solve some of these issues. We describe the pharmacokinetics of a new 7-day XR-BUP formulation and the feasibility of its use in the ED setting. We report our early experiences with this medication (investigational drug CAM2038), in the context of an ongoing clinical trial entitled Emergency Department-Initiated BUP VAlidaTION (ED INNOVATION), to inform emergency clinicians as they consider incorporating this medication into their practice. The medication was approved by the European Medicines Agency in 2018 and the U.S. Food and Drug Administration in 2023 for those 18 years or older for the treatment of moderate to severe opioid use disorder (OUD). We report our experience with approximately 800 ED patients with OUD who received the 7-day XR-BUP preparation in the ED between June 2020 and July 2023.
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Affiliation(s)
- Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
- Yale School of Public Health New Haven, Connecticut
| | - Jeanmarie Perrone
- Department of Emergency Medicine Perelman School of
Medicine at the University of Pennsylvania. Philadelphia, Pennsylvania
| | - Kathryn F. Hawk
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
- Yale School of Public Health New Haven, Connecticut
| | - Ethan Cowan
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
- Department of Emergency Medicine Icahn School of Medicine
at Mount Sinai New York, New York
| | - Ryan McCormack
- Department of Emergency Medicine NYU Langone Medical Center
New York, New York
| | - Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
| | - Patricia H. Owens
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
| | - Shara H. Martel
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
| | | | - Sharon L. Walsh
- University of Kentucky College of Medicine Center on Drug
and Alcohol Research, Lexington, Kentucky
| | - Michelle R. Lofwall
- University of Kentucky College of Medicine Center on Drug
and Alcohol Research, Lexington, Kentucky
| | - Andrew Herring
- Department of Emergency Medicine Highland Hospital Oakland,
California
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6
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Scholl L, Liu S, Pickens CM. Suspected Nonfatal Cocaine-Involved Overdoses Overall and With Co-involvement of Opioids. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:392-402. [PMID: 36867655 DOI: 10.1097/phh.0000000000001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
CONTEXT The Centers for Disease Control and Prevention (CDC) developed a syndrome definition for detection of suspected nonfatal cocaine-involved overdoses. The definition can be used to monitor trends and detect anomalies in emergency department (ED) syndromic surveillance data at the national, state, and local levels. OBJECTIVE This study describes the development of the nonfatal, unintentional/undetermined intent cocaine-involved overdose (UUCOD) definition and analysis of trends over time. DESIGN/SETTING CDC developed the UUCOD definition to query ED data in CDC's National Syndromic Surveillance Program (NSSP). Data between 2018 and 2021 were analyzed from 29 states sharing data access in the Drug Overdose Surveillance and Epidemiology (DOSE) System via NSSP. Using Joinpoint regression, trends were analyzed for UUCOD overall, by sex and age group, and for UUCOD co-involving opioids. MEASURES Time trends between 2018 and 2021 were analyzed by examining average monthly percentage change. Individual trend segments and trend inflection points were analyzed by examining monthly percentage change. RESULTS During 2018-2021, a total of 27 240 UUCOD visits were identified by the syndrome definition. Analyses identified different patterns in trends for males and females, with largely similar trends for persons aged 15 to 44 years and 45 years or older. Analyses also identified seasonal patterns with increases in spring/summer months in UUCOD overall and UUCOD co-involving opioids and declines for both in fall/winter months. CONCLUSION This UUCOD syndrome definition will be useful for ongoing monitoring of suspected nonfatal overdoses involving cocaine and co-involving cocaine and opioids. Ongoing assessment of cocaine-involved overdose trends might identify anomalies requiring further investigation and inform deployment of resources.
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Affiliation(s)
- Lawrence Scholl
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Hartung DM, McCracken CM, Nguyen T, Kempany K, Waddell EN. Fatal and nonfatal opioid overdose risk following release from prison: A retrospective cohort study using linked administrative data. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208971. [PMID: 36821990 DOI: 10.1016/j.josat.2023.208971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/08/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Among individuals who are released from prison, opioid overdose is a leading cause of death with a risk more than ten-fold the general population. Although the epidemiology of opioid-related fatalities has been described, few studies have characterized both fatal and nonfatal opioid-related poisonings. The objective of this study was to estimate risk of fatal and nonfatal opioid overdose among adults released from prison. METHODS The study estimated fatal and nonfatal opioid overdose rates using linked corrections, Medicaid, hospital discharge, and vital statistics from the state of Oregon from 2014 to 2018. Multivariable proportional hazards models identified demographic and prison-related factors associated with overdose. RESULTS Between 2014 and 2017, 18,258 individuals were released from prison. A majority of individuals were male (87 %) and ages 26 to 64 (83 %). Two-thirds had a documented substance use disorder treatment need and 20 % demonstrated mental health treatment need. Following prison release, 579 opioid overdose events occurred; 65 (11 %) were fatal. The rate of opioid overdose was 1085.7 per 100,000 person-years (PY). Rates were highest in the first two weeks (2286.7 per 100,000 PY), among women (1582.9 per 100,000 PY), and those with mental health (1624.3 per 100,000 PY) or substance use disorder treatment needs (1382.6 per 100,100 PY). Only mental health (adjusted hazard ratio [aHR] 1.54, 95 % CI 1.24 to 1.90) and substance use need (aHR 2.59; 95 % CI 2.01 to 3.34) remained significant in multivariable models. CONCLUSIONS The rate of opioid overdose is markedly elevated after prison release, particularly in the first two weeks. In women, the higher rate of opioid overdose is mediated by a greater mental health burden.
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Affiliation(s)
- Daniel M Hartung
- College of Pharmacy, Oregon State University, Portland, OR, United States of America.
| | - Caitlin M McCracken
- College of Pharmacy, Oregon State University, Portland, OR, United States of America
| | - Thuan Nguyen
- OHSU-Portland State University School Public Health, Oregon Health & Science University, Portland, OR, United States of America
| | - Katherine Kempany
- Oregon Department of Corrections, Salem, OR, United States of America
| | - Elizabeth Needham Waddell
- OHSU-Portland State University School Public Health, Oregon Health & Science University, Portland, OR, United States of America
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8
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Goldfine CE, Chapman BP, Taylor MM, Bradley ES, Carreiro SP, Rosen RK, Babu KM, Lai JT. Experiences with Medications for Addiction Treatment Among Emergency Department Patients with Opioid Use Disorder. West J Emerg Med 2023; 24:236-242. [PMID: 36976598 PMCID: PMC10047725 DOI: 10.5811/westjem.2022.9.57821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/19/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Medications for addiction treatment (MAT) are the evidence-based standard of care for treatment of opioid use disorder (OUD), but stigma continues to surround their use. We conducted an exploratory study to characterize perceptions of different types of MAT among people who use drugs. METHODS We conducted this qualitative study in adults with a history of non-medical opioid use who presented to an emergency department for complications of OUD. A semi-structured interview that explored knowledge, perceptions, and attitudes toward MAT was administered, and applied thematic analysis conducted. RESULTS We enrolled 20 adults. All participants had prior experience with MAT. Among participants indicating a preferred treatment modality, buprenorphine was the commonly favored agent. Previous experience with prolonged withdrawal symptoms upon MAT discontinuation and the perception of "trading one drug for another" were common reasons for reluctance to engage in agonist or partial-agonist therapy. While some participants preferred treatment with naltrexone, others were unwilling to initiate antagonist therapy due to fear of precipitated withdrawal. Most participants strongly considered the aversive nature of MAT discontinuation as a barrier to initiating treatment. Participants overall viewed MAT positively, but many had strong preferences for a particular agent. CONCLUSION The anticipation of withdrawal symptoms during initiation and cessation of treatment affected willingness to engage in a specific therapy. Future educational materials for people who use drugs may focus on comparisons of respective benefits and drawbacks of agonists, partial agonists, and antagonists. Emergency clinicians must be prepared to answer questions about MAT discontinuation to effectively engage patients with OUD.
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Affiliation(s)
- Charlotte E Goldfine
- Brigham and Women's Hospital, Division of Medical Toxicology, Department of Emergency Medicine, Boston, Massachusetts
| | - Brittany P Chapman
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Melissa M Taylor
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Evan S Bradley
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Stephanie P Carreiro
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Rochelle K Rosen
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, Rhode Island
| | - Kavita M Babu
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Jeffrey T Lai
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
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9
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Nguyen RH, Knapp EA, Li X, Camargo CA, Conradt E, Cowell W, Derefinko KJ, Elliott AJ, Friedman AM, Khurana Hershey GK, Hofheimer JA, Lester BM, McEvoy CT, Neiderhiser JM, Oken E, Ondersma SJ, Sathyanarayana S, Stabler ME, Stroustrup A, Tung I, McGrath M. Characteristics of Individuals in the United States Who Used Opioids During Pregnancy. J Womens Health (Larchmt) 2023; 32:161-170. [PMID: 36350685 PMCID: PMC9940795 DOI: 10.1089/jwh.2022.0118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental Influences on Child Health Outcomes (ECHO) Program, and determined which characteristics were associated with opioid use during pregnancy. Materials and Methods: Cross-sectional data obtained from 21,905 pregnancies of individuals across the United States enrolled in the ECHO between 1990 and 2021 were analyzed. Medical records, laboratory testing, and self-report were used to determine opioid-exposed pregnancies. Multiple imputation methods using fully conditional specification with a discriminant function accounted for missing characteristics data. Results: Opioid use was present in 2.8% (n = 591) of pregnancies. The majority of people who used opioids in pregnancy were non-Hispanic White (67%) and had at least some college education (69%). Those who used opioids reported high rates of alcohol use (32%) and tobacco use (39%) during the pregnancy; although data were incomplete, only 5% reported heroin use and 86% of opioid use originated from a prescription. After adjustment, non-Hispanic White race, pregnancy during the years 2010-2012, higher parity, tobacco use, and use of illegal drugs during pregnancy were each significantly associated with opioid use during pregnancy. In addition, maternal depression was associated with increased odds of opioid use during pregnancy by more than two-fold (adjusted odds ratio 2.42, 95% confidence interval: 1.95-3.01). Conclusions: In this large study of pregnancies from across the United States, we found several factors that were associated with opioid use among pregnant people. Further studies examining screening for depression and polysubstance use may be useful for targeted interventions to prevent detrimental opioid use during pregnancy, while further elucidation of the reasons for use of prescription opioids during pregnancy should be further explored.
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Affiliation(s)
- Ruby H.N. Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emily A. Knapp
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elisabeth Conradt
- Department of Psychology, Pediatrics, Obstetrics/Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Whitney Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Karen J. Derefinko
- Department of Preventative Medicine and Pharmacology, Addictive Science, and Toxicology, University of Tennessee, Memphis, Tennessee, USA
| | - Amy J. Elliott
- Department of Pediatrics, Avera Research Institute, School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Alexander M. Friedman
- Department of Obstetrics and Gynecology, School of Medicine, Columbia University, New York, New York, USA
| | - Gurjit K. Khurana Hershey
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio, USA
| | - Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barry M. Lester
- Department of Psychiatry and Pediatrics, Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Jenae M. Neiderhiser
- Department of Psychology, Penn State University, University Park, Pennsylvania, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Steven J. Ondersma
- Division of Public Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, Michigan State University, Flint, Michigan, USA
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Meagan E. Stabler
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Annemarie Stroustrup
- Department of Pediatrics and Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Irene Tung
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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10
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Workman J, Reese JM, Sobalvarro S, Caberto AJ, Garcia J, Cepeda JA. Association Between Co-Occurring Anxiety and Depression With Drug Overdose Encounters in the Emergency Department Among Adolescents and Young Adults in the Era of COVID-19. J Adolesc Health 2023; 72:989-992. [PMID: 36872116 PMCID: PMC9850858 DOI: 10.1016/j.jadohealth.2023.01.012] [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: 06/21/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE COVID-19 risk mitigation efforts could have negatively impacted anxiety, depression, and substance use among adolescents and young adults. METHODS We analyzed 45,223 emergency department visits from April 2018 to March 2022 of patients aged 12-21 in Pinellas County, Florida. RESULTS Frequency of overdose, anxiety, and depression significantly increased from the pre-COVID-19 to the COVID-19 period. Anxiety (adjusted odds ratio: 1.49, 95% confidence interval: 1.11, 1.98) and depression (adjusted odds ratio: 2.89, 95% confidence interval: 2.15, 3.88) were associated with significantly higher odds of overdose during COVID-19. DISCUSSION Mental health and overdose among adolescents and young adults worsened during COVID-19, necessitating greater screening and treatment in primary care.
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Affiliation(s)
- Jacob Workman
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Jasmine M Reese
- Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Sarah Sobalvarro
- Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - A J Caberto
- Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Janelle Garcia
- Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Javier A Cepeda
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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11
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Virmani I, Oteo A, Dunn M, Vidler D, Roper C, Officer J, Hardy G, Dargan PI, Eddleston M, Cooper JG, Hill SL, Macfarlane R, Keating L, Haden M, Hudson S, Thomas SHL. Accuracy of substance exposure history in patients attending emergency departments after substance misuse; a comparison with biological sample analysis. Clin Toxicol (Phila) 2023; 61:39-46. [PMID: 36322622 DOI: 10.1080/15563650.2022.2131566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Acute toxicity caused by illicit substance use is a common reason for emergency department (ED) presentation. Knowledge of the substances involved is helpful for predicting and managing potential toxicity, but limited information is available about the accuracy of patient-reported substance exposure. This study assessed the accuracy of the history of exposure in those reporting use of a single substance by comparison with those identified by detailed toxicological analysis, focusing on synthetic cannabinoid receptor agonists (SCRA). METHODS Adults (≥16 years) presenting between March 2015 and July 2021 to participating UK hospitals with toxicity after reporting use of a single illicit substance were included. Exposure details were documented from medical records and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry (HRAM LCMS). Sensitivity, specificity, and positive and negative predictive values of the exposure history were calculated by comparison with biological sample analysis ("gold standard"). RESULTS Single substance exposure was reported for 474 (median age 33 years, IQR: 18 range 16-75, 80% males) patients. Analysis commonly identified multiple substances (Median 3, IQR 2-5). A history of exposure was documented for 121 of 151 patients where a SCRA or metabolite was detected on analysis (sensitivity 80.1%, 95% CI 72.9, 86.2%). Corresponding proportions were lower for 3,4-methylenedioxymethamphetamine (MDMA, 44/70, 62.9%., 95% CI 50.5%, 74.1%), heroin 41/108 (38.0% 95% CI 28.8-47.8%) and cocaine (22/56, 31.3%, 95% CI 20.9, 43.6%). CONCLUSIONS Multiple undeclared substances were detected analytically in most patients reporting single substance use. Clinicians should be alert to the potential presence and toxicity of unreported substances when managing patients presenting after substance misuse.
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Affiliation(s)
- Ishita Virmani
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Alberto Oteo
- Addictions and Inclusion Directorate, Department of Health and Social Care, Office for Health Improvement & Disparities, London, UK
| | - Michael Dunn
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Daniel Vidler
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Clair Roper
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Jane Officer
- Scottish Police Authority Forensic Services, Edinburgh, UK
| | - Gareth Hardy
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Paul I Dargan
- Clinical Toxicology, Guys & St Thomas' NHS Foundation Trust, London and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael Eddleston
- Pharmacology, Toxicology & Therapeutics, University of Edinburgh, Edinburgh, UK
| | | | - Simon L Hill
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
| | | | - Liza Keating
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Mark Haden
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Simon Hudson
- LGC Sport and Specialised Analytical Services, Fordham, UK
| | - Simon H L Thomas
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
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12
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Ware OD, Buresh ME, Irvin NA, Stitzer ML, Sweeney MM. Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100093. [PMID: 36644224 PMCID: PMC9835716 DOI: 10.1016/j.dadr.2022.100093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction Brief intervention with peer recovery coach support has been used to generate referrals to substance use disorder treatment from the emergency department (ED). This retrospective study evaluated factors associated with successful linkage to treatment following brief intervention in the ED. Methods Data were extracted from the electronic health record for patients who were referred to substance use treatment from the ED and for whom follow-up data regarding treatment attendance was available (n=666). We examined associations between demographic and insurance variables, substance use, mental health diagnosis, prior abstinence, and stage of change with successful linkage to substance use treatment after ED referral. Results The sample was majority male (68%), White (62%), and had a mean age of 43 years (SD=12). Medicaid was the most common insurance (49%) followed by employer/private (34%). Multivariable logistic regression determined patients with Medicaid (OR=2.94, 95% CI:2.09-4.13, p=<.001), those who had a documented alcohol use disorder diagnosis (OR=1.59, 95% CI:1.074-2.342, p=.02), and those in the "Action" stage of change (OR=2.33, 95% CI:1.47-3.69, p=<.001) had greater odds of being successfully linked to treatment. Conclusions These results identify characteristics of patients available in the health record to determine who is more likely or less likely to attend substance use treatment following ED referral. Given appropriate screening, this information could be used to direct standard care resources to those with high likelihood of treatment attendance and strengthen follow-up interventions with peer recovery coaches for those with lower likelihood of treatment attendance.
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Affiliation(s)
- Orrin D. Ware
- School of Social Work, The University of North Carolina at Chapel Hill, 325 Pittsboro Street, Chapel Hill, NC 27599, USA,Corresponding author. (O.D. Ware)
| | - Megan E. Buresh
- Johns Hopkins University School of Medicine,Department of Medicine, Division of Addiction Medicine, 5200 Mason F. Lord Drive, Baltimore, MD 21224, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Nathan A. Irvin
- Johns Hopkins University School of Medicine,Department of Emergency Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Maxine L. Stitzer
- Johns Hopkins University School of Medicine,Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA,Friends Research Institute, 1040 Park Avenue, Baltimore, MD 21201, USA
| | - Mary M. Sweeney
- Johns Hopkins University School of Medicine,Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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13
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Pickens CM, Scholl L, Liu S, Smith H, Snodgrass S. Development and Validation of a Syndrome Definition for Suspected Nonfatal Unintentional/Undetermined Intent Stimulant-Involved Overdoses. Public Health Rep 2022; 137:1079-1090. [PMID: 34727510 PMCID: PMC9574309 DOI: 10.1177/00333549211054489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To monitor stimulant-involved overdose (SOD) trends, the Centers for Disease Control and Prevention (CDC) developed and evaluated the validity of a syndromic surveillance definition for suspected nonfatal, unintentional/undetermined intent stimulant-involved overdose (UUSOD). METHODS We analyzed all emergency department (ED) visits in CDC's surveillance system that met the UUSOD syndrome definition (January 2018-December 2019). We classified visits as true positive, possible, or not UUSODs after reviewing diagnosis codes and chief complaints. We first assessed whether visits were acute SODs, subsequently classifying acute SODs by intent. The percentage of true-positive UUSODs did not include intentional or possibly intentional visits. We considered all visits with UUSOD diagnosis codes to be acute SODs and reviewed them for intent. We manually reviewed and double-coded a 10% random sample of visits without UUSOD diagnosis codes using decision rules based on signs and symptoms. The overall percentage of true-positive UUSODs was a weighted average of the percentage of true-positive UUSODs based on diagnosis codes and the percentage of true-positive UUSODs determined by manually reviewing visits without codes. RESULTS During 2018-2019, 40 045 ED visits met the syndrome definition for UUSOD. Approximately half (n = 18 793; 46.9%) of 40 045 visits had UUSOD diagnosis codes, indicating acute SOD; of these, 98.6% (n = 18 534) were true-positive UUSODs. Of 2125 manually reviewed visits without UUSOD diagnosis codes, 32.6% (n = 693) were true-positive UUSODs, 54.2% (n = 1151) were possible UUSODs, and 13.2% (n = 281) were not UUSODs. Overall, 63.6% of visits were true-positive UUSODs, 29.3% were possible UUSODs, and 7.1% were not UUSODs. PRACTICE IMPLICATIONS CDC's UUSOD definition may assist in surveillance efforts with further refinement to capture data on SOD clusters and trends.
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Affiliation(s)
- Cassandra M. Pickens
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lawrence Scholl
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen Liu
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Herschel Smith
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Stephanie Snodgrass
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
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14
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Sumner SA, Bowen D, Holland K, Zwald ML, Vivolo-Kantor A, Guy GP, Heuett WJ, Pressley DP, Jones CM. Estimating Weekly National Opioid Overdose Deaths in Near Real Time Using Multiple Proxy Data Sources. JAMA Netw Open 2022; 5:e2223033. [PMID: 35862045 PMCID: PMC9305381 DOI: 10.1001/jamanetworkopen.2022.23033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Opioid overdose is a leading public health problem in the United States; however, national data on overdose deaths are delayed by several months or more. OBJECTIVES To build and validate a statistical model for estimating national opioid overdose deaths in near real time. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, signals from 5 overdose-related, proxy data sources encompassing health, law enforcement, and online data from 2014 to 2019 in the US were combined using a LASSO (least absolute shrinkage and selection operator) regression model, and weekly predictions of opioid overdose deaths were made for 2018 and 2019 to validate model performance. Results were also compared with those from a baseline SARIMA (seasonal autoregressive integrated moving average) model, one of the most used approaches to forecasting injury mortality. EXPOSURES Time series data from 2014 to 2019 on emergency department visits for opioid overdose from the National Syndromic Surveillance Program, data on the volume of heroin and synthetic opioids circulating in illicit markets via the National Forensic Laboratory Information System, data on the search volume for heroin and synthetic opioids on Google, and data on post volume on heroin and synthetic opioids on Twitter and Reddit were used to train and validate prediction models of opioid overdose deaths. MAIN OUTCOMES AND MEASURES Model-based predictions of weekly opioid overdose deaths in the United States were made for 2018 and 2019 and compared with actual observed opioid overdose deaths from the National Vital Statistics System. RESULTS Statistical models using the 5 real-time proxy data sources estimated the national opioid overdose death rate for 2018 and 2019 with an error of 1.01% and -1.05%, respectively. When considering the accuracy of weekly predictions, the machine learning-based approach possessed a mean error in its weekly estimates (root mean squared error) of 60.3 overdose deaths for 2018 (compared with 310.2 overdose deaths for the SARIMA model) and 67.2 overdose deaths for 2019 (compared with 83.3 overdose deaths for the SARIMA model). CONCLUSIONS AND RELEVANCE Results of this serial cross-sectional study suggest that proxy administrative data sources can be used to estimate national opioid overdose mortality trends to provide a more timely understanding of this public health problem.
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Affiliation(s)
- Steven A. Sumner
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel Bowen
- Division of Violence Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristin Holland
- Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marissa L. Zwald
- Division of Violence Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alana Vivolo-Kantor
- Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P. Guy
- Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William J. Heuett
- Diversion Control Division, US Drug Enforcement Administration, Springfield, Virginia
| | - DeMia P. Pressley
- Diversion Control Division, US Drug Enforcement Administration, Springfield, Virginia
| | - Christopher M. Jones
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Suvada K, Zimmer A, Soodalter J, Malik JS, Kavalieratos D, Ali MK. Coprescribing of opioids and high-risk medications in the USA: a cross-sectional study with data from national ambulatory and emergency department settings. BMJ Open 2022; 12:e057588. [PMID: 35710252 PMCID: PMC9207755 DOI: 10.1136/bmjopen-2021-057588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Describe trends in opioid plus high-risk medication coprescribing in the USA. DESIGN Analyses of serial, cross-sectional, nationally representative data of the National Ambulatory Medical Care Survey (NAMCS) over 2007-2016 and the National Hospital Ambulatory Medical Care Survey (NHAMCS) over 2007-2018. SETTING US ambulatory (NAMCS) and emergency department (ED, NHAMCS) settings. PARTICIPANTS Patient visits in which the patient was 18 years and older with an opioid prescription in the NAMCS or NHAMCS databases. PRIMARY AND SECONDARY OUTCOME MEASURES Frequency of opioid plus high-risk medication coprescribing. RESULTS From a combined sample of 700 499 visits over 2007-2018, there were 105 720 visits (15.1%) where opioids were prescribed. n=31 825 were from NAMCS and n=73 895 were from NHAMCS. The mean prevalence of coprescription of opioids and high-risk medications for the combined NAMCS and NHAMCS sample was 18.4% in 2007, peaked at 33.2% in 2014 and declined to 23.8% in 2016. Compared with adults receiving opioid prescriptions alone, those coprescribed opioids and high-risk medications were older, more likely female, white and using private or Medicare insurance (p<0.0001). CONCLUSIONS Coprescribing is more common in ambulatory than ED settings and has been declining, yet one in four patient visits where opioids were prescribed resulted in coprescribed, high-risk medications in 2016. Efforts and research to help lower the rates of high-risk prescribing are needed.
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Affiliation(s)
- Kara Suvada
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anna Zimmer
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jesse Soodalter
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jimi S Malik
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mohammed K Ali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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16
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Lurie T, Bonnin N, Rea J, Tuteja G, Dezman Z, Wilkerson RG, Buganu A, Chasm R, Haase DJ, Tran QK. Patterns of opioid prescribing in emergency departments during the early phase of the COVID-19 pandemic. Am J Emerg Med 2022; 56:63-70. [PMID: 35367681 PMCID: PMC8956353 DOI: 10.1016/j.ajem.2022.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/09/2022] [Accepted: 03/20/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction The COVID-19 pandemic was superimposed upon an ongoing epidemic of opioid use disorder and overdose deaths. Although the trend of opioid prescription patterns (OPP) had decreased in response to public health efforts before the pandemic, little is known about the OPP from emergency department (ED) clinicians during the COVID-19 pandemic. Methods We conducted a pre-post study of adult patients who were discharged from 13 EDs and one urgent care within our academic medical system between 01/01/2019 and 09/30/2020 using an interrupted time series (ITS) approach. Patient characteristics and prescription data were extracted from the single unified electronic medical record across all study sites. Prescriptions of opioids were converted into morphine equivalent dose (MED). We compared the “Covid-19 Pandemic” period (C19, 03/29/2020–9/30/2020) and the “Pre-Pandemic” period (PP, 1/19/2020–03/28/2020). We used a multivariate logistic regression to assess clinical factors associated with opioid prescriptions. Results We analyzed 361,794 ED visits by adult patients, including 259,242 (72%) PP and 102,552 (28%) C19 visits. Demographic information and percentages of patients receiving opioid prescriptions were similar in both groups. The median [IQR] MED per prescription was higher for C19 patients (70 [56–90]) than for PP patients (60 [60–90], P < 0.001). ITS demonstrated a significant trend toward higher MED prescription per ED visit during the pandemic (coefficient 0.11, 95% CI 0.05–0.16, P = 0.002). A few factors, that were associated with lower likelihood of opioid prescriptions before the pandemic, became non-significant during the pandemic. Conclusion Our study demonstrated that emergency clinicians increased the prescribed amount of opioids per prescription during the COVID-19 pandemic compared to the pre-pandemic period. Etiologies for this finding could include lack of access to primary care and other specialties during the pandemic, or lower volumes allowing for emergency clinicians to identify who is safe to be prescribed opioids.
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Abstract
This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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18
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Gilmore N, Mirman D, Kiran S. Young Adults With Acquired Brain Injury Show Longitudinal Improvements in Cognition After Intensive Cognitive Rehabilitation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1494-1520. [PMID: 35290740 PMCID: PMC9499382 DOI: 10.1044/2021_jslhr-21-00324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of an intensive cognitive and communication rehabilitation (ICCR) program on language and other cognitive performance in young adults with acquired brain injury (ABI). METHOD Thirty young adults with chronic ABI participated in this study. Treatment participants (n = 22) attended ICCR 6 hours/day, 4 days/week for at least one 12-week semester. Deferred treatment/usual care control participants (n = 14) were evaluated before and after at least one 12-week semester. Pre- and postsemester standardized cognitive assessment items were assigned to subdomains. Between-groups and within-group generalized linear mixed-effects models assessed the effect of time point on overall item accuracy and differences by item subdomain. Subdomain analyses were adjusted for multiple comparisons. RESULTS Between-groups analyses revealed that treatment participants improved significantly faster over time than deferred treatment/usual care participants in overall item accuracy and specifically on items in the verbal expression subdomain. Investigating the three-way interaction between time point, group, and etiology revealed that the overall effects of the treatment were similar for individuals with nontraumatic and traumatic brain injuries. The treatment group showed an overall effect of treatment and significant gains over time in the verbal expression, written expression, memory, and problem solving subdomains. The control group did not significantly improve over time on overall item accuracy and showed significant subdomain-level gains in auditory comprehension, which did not survive correction. CONCLUSIONS Sustaining an ABI in young adulthood can significantly disrupt key developmental milestones, such as attending college and launching a career. This study provides strong evidence that integrating impairment-based retraining of language and other cognitive skills with "real-world" application in academically focused activities promotes gains in underlying cognitive processes that are important for academic success as measured by standardized assessment items. These findings may prompt a revision to the current continuum of rehabilitative care for young adults with ABI. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19320068.
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Affiliation(s)
- Natalie Gilmore
- Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences: Sargent College, Boston University, MA
| | - Daniel Mirman
- Department of Psychology, School of Philosophy, Psychology & Language Sciences, The University of Edinburgh, United Kingdom
| | - Swathi Kiran
- Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences: Sargent College, Boston University, MA
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19
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Burgess-Hull AJ, Smith KE, Panlilio LV, Schriefer D, Preston KL, Alter A, Yeager C, Chizmar T, Delbridge T, Zamore K, Beeson J, Epstein DH. Nonfatal opioid overdoses before and after Covid-19: Regional variation in rates of change. PLoS One 2022; 17:e0263893. [PMID: 35263326 PMCID: PMC8906602 DOI: 10.1371/journal.pone.0263893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/29/2022] [Indexed: 01/15/2023] Open
Abstract
Background The Covid-19 pandemic and its accompanying public-health orders (PHOs) have led to (potentially countervailing) changes in various risk factors for overdose. To assess whether the net effects of these factors varied geographically, we examined regional variation in the impact of the PHOs on counts of nonfatal overdoses, which have received less attention than fatal overdoses, despite their public health significance. Methods Data were collected from the Overdose Detection Mapping Application Program (ODMAP), which recorded suspected overdoses between July 1, 2018 and October 25, 2020. We used segmented regression models to assess the impact of PHOs on nonfatal-overdose trends in Washington DC and the five geographical regions of Maryland, using a historical control time series to adjust for normative changes in overdoses that occurred around mid-March (when the PHOs were issued). Results The mean level change in nonfatal opioid overdoses immediately after mid-March was not reliably different in the Covid-19 year versus the preceding control time series for any region. However, the rate of increase in nonfatal overdose was steeper after mid-March in the Covid-19 year versus the preceding year for Maryland as a whole (B = 2.36; 95% CI, 0.65 to 4.06; p = .007) and for certain subregions. No differences were observed for Washington DC. Conclusions The pandemic and its accompanying PHOs were associated with steeper increases in nonfatal opioid overdoses in most but not all of the regions we assessed, with a net effect that was deleterious for the Maryland region as a whole.
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Affiliation(s)
- Albert J. Burgess-Hull
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
- * E-mail:
| | - Kirsten E. Smith
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
| | - Leigh V. Panlilio
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
| | - Destiny Schriefer
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
| | - Kenzie L. Preston
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
| | - Aliese Alter
- Office of National Drug Control Policy, High Intensity Drug Trafficking Area, Washington, DC, United States of America
| | - Christopher Yeager
- Office of National Drug Control Policy, High Intensity Drug Trafficking Area, Washington, DC, United States of America
| | - Timothy Chizmar
- Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland, United States of America
| | - Ted Delbridge
- Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland, United States of America
| | - Kenan Zamore
- District of Columbia Department of Health, Washington, DC, United States of America
| | - Jeff Beeson
- Office of National Drug Control Policy, High Intensity Drug Trafficking Area, Washington, DC, United States of America
| | - David H. Epstein
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America
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Crystal S, Nowels M, Samples H, Olfson M, Williams AR, Treitler P. Opioid overdose survivors: Medications for opioid use disorder and risk of repeat overdose in Medicaid patients. Drug Alcohol Depend 2022; 232:109269. [PMID: 35038609 PMCID: PMC8943804 DOI: 10.1016/j.drugalcdep.2022.109269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients with medically-treated opioid overdose are at high risk for subsequent adverse outcomes, including repeat overdose. Understanding factors associated with repeat overdose can aid in optimizing post-overdose interventions. METHODS We conducted a longitudinal, retrospective cohort study using NJ Medicaid data from 2014 to 2019. Medicaid beneficiaries aged 12-64 with an index opioid overdose from 2015 to 2018 were followed for one year for subsequent overdose. Exposures included patient demographics; co-occurring medical, mental health, and substance use disorders; service and medication use in the 180 days preceding the index overdose; and MOUD following index overdose. RESULTS Of 4898 individuals meeting inclusion criteria, 19.6% had repeat opioid overdoses within one year. Index overdoses involving heroin/synthetic opioids were associated with higher repeat overdose risk than those involving prescription/other opioids only (HR = 1.44, 95% CI = 1.22-1.71). Risk was higher for males and those with baseline opioid use disorder diagnosis or ED visits. Only 21.7% received MOUD at any point in the year following overdose. MOUD was associated with a large decrease in repeat overdose risk among those with index overdose involving heroin/synthetic opioids (HR = 0.30, 95% CI = 0.20-0.46). Among those receiving MOUD at any point in follow-up, 10.5% (112/1065) experienced repeat overdose versus 22.1% (848/3833) for those without MOUD. CONCLUSIONS Repeat overdose was common among individuals with medically-treated opioid overdose. Risk factors for repeat overdose varied by type of opioid involved in index overdose, with differential implications for intervention. MOUD following index opioid overdose involving heroin/synthetic opioids was associated with reduced repeat overdose risk.
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Affiliation(s)
- Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA; School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Molly Nowels
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Hillary Samples
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Mark Olfson
- Vagelos College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Mailman School of Public Health, Columbia University, 722W 168th St., New York, NY 10032, USA.
| | - Arthur Robin Williams
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, USA.
| | - Peter Treitler
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA.
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Gangu K, Bobba A, Basida SD, Avula S, Chela H, Singh S. Trends of Cocaine Use and Manifestations in Hospitalized Patients: A Cross-Sectional Study. Cureus 2022; 14:e22090. [PMID: 35165645 PMCID: PMC8830384 DOI: 10.7759/cureus.22090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/07/2022] Open
Abstract
Objective About 41 million people aged ≥18 years reported lifetime use of cocaine, and 5.4 million people reported having used cocaine in 2019. We aim to identify trends of cocaine use, manifestations, concomitant drug use, and financial burden on health care among hospitalized patients. Methods We utilized National Inpatient Sample from years 2006-2018. Patients with age ≥18 years, admitted to the hospital with a diagnosis of cocaine abuse, dependence, poisoning, or unspecified cocaine use were included in the study. We used ICD-9 Clinical Modification (CM) and ICD-10-CM codes to retrieve patient samples and comorbid conditions. The primary outcome was the trend in cocaine use among hospitalized patients from the year 2006 to 2018. Cochran-Mantel-Haenszel test was used to assess the significance of trends. Results In the year 2006, the prevalence of cocaine abuse among hospitalized patients was 10,751 per million with an initial decline to 7,451 per million in 2012 and a subsequent increase to 11,891 per million hospitalized patients in 2018 with p =0.01. The majority of patients admitted were older than 50 years (43.27%), and a greater percentage of patients were males. All ethnicities showed a rising trend in the use of cocaine except for Native Americans. Cardiovascular effects, neuropsychiatric and infectious manifestations in hospitalized patients with cocaine abuse showed a consistent increase from year 2006 to 2018 with p <0.001. Conclusions There is a recent uptrend in cocaine use among hospital admissions in the US from 2006 to 2018 with an increased rate of systemic manifestations. This highlights the impact of cocaine use on the health system and the dire need to address this growing problem.
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Affiliation(s)
- Karthik Gangu
- Department of Internal Medicine, University of Missouri, Columbia, USA
| | - Aniesh Bobba
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Ohio, USA
| | - Sanket D Basida
- Graduate Student, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Sindhu Avula
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas, USA
| | - Harleen Chela
- Department of Internal Medicine, University of Missouri, Columbia, USA
| | - Simranjit Singh
- Internal Medicine, Indiana University School of Medicine, Indianapolis, USA
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Pickens CM, Hoots BE, Casillas SM, Scholl L. Prevalences of and characteristics associated with single- and polydrug-involved U.S. Emergency Department Visits in 2018. Addict Behav 2022; 125:107158. [PMID: 34717272 PMCID: PMC9559594 DOI: 10.1016/j.addbeh.2021.107158] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/16/2021] [Accepted: 10/17/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Nonfatal and fatal drug overdoses have recently increased. There are limited data describing the range of illicit, prescribed, and over-the-counter drugs involved in overdoses presenting to U.S. emergency departments (EDs). METHODS Using 2018 Healthcare Cost and Utilization Project (HCUP) Nationwide ED Sample (NEDS) data, we calculated weighted counts and percentages by drug among overdose-related ED visits. Overdose-related ED visits were those having an International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) drug poisoning code falling under parent codes T36-T50 (codes involving alcohol were not explicitly queried). We identified the top 30 mutually exclusive polydrug combinations and compared characteristics of visits by polydrug status. RESULTS In 2018, 908,234 ED visits had a T36-T50 drug poisoning code. The most frequently reported drugs involved were opioids (30.3% of visits; heroin: 15.2%), benzodiazepines (11.0%), stimulants (7.9%), other/unspecified antidepressants (7.1%), 4-aminophenol derivatives (6.6%), and other/unspecified drugs, medicaments, and biological substances (11.8%). Overdose was uncommon for most other drug classes (e.g., antibiotics). Polydrug visits were more likely to involve females (prevalence ratio [PR]: 1.14, 95% confidence interval [CI]: 1.12-1.16), be coded intentional self-harm (PR: 1.81, 95% CI: 1.77-1.85), and result in hospitalization (PR: 1.84, 95% CI: 1.79-1.89) or death (PR: 1.37, 95% CI: 1.22-1.53) compared to single-drug overdose-related visits. Benzodiazepines, opioids, and/or stimulants were most frequently involved in polydrug overdoses. CONCLUSION Opioids, benzodiazepines, and stimulants were most commonly reported in both single-drug and polydrug overdose-involved ED visits. Other drugs involved in overdoses included antidepressants and 4-aminophenol derivatives. Jurisdictions can use data on drugs involved in overdoses to better tailor prevention strategies to emerging needs.
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Van Nostrand E, Johnston A, Albert SM, Brown AL, Buchanich JM, Ray B, Roberts MS. Evaluating the effectiveness of problem-solving courts at preventing fatal and non-fatal opioid events: preliminary findings from Indiana. Drugs Context 2022; 10:dic-2021-8-1. [PMID: 34970323 PMCID: PMC8687108 DOI: 10.7573/dic.2021-8-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background Fatal and non-fatal events associated with drug misuse are skyrocketing in most United States jurisdictions, including Indiana. Historically, the role of the judiciary is to arrest, impose sanctions and protect society from harm. Adults arrested for drug abuse in Indiana can be sentenced to 1 of 17 correctional facilities. As an alternative, they may be eligible to participate in a problem-solving court (PSC) programme that refers individuals to treatment as a pretrial diversionary strategy. The aim of the study is to determine which interventions offered by PSCs and correctional facilities impact morbidity and mortality. The study began in 2019 and will end in 2023; therefore, the results in this manuscript are preliminary. Methods The study cohort included two populations arrested for drug misuse: (1) adults sentenced to Indianan correctional facilities (1 January 2018 to 30 June 2021) and (2) adults participating in an Indiana PSC programme (1 January 2018 to 30 June 2021). The study used a mixed-methods design that integrated qualitative interviews of deputy wardens, PSC team members and service providers with the following quantitative datasets: sentencing information, emergency department visits, inpatient hospitalization admissions, prescription drug monitoring programme data and death records. The individuals will be followed at 2-week, 4-week, 6-month and 1-year intervals post-release. Difference-in-difference and time-to-event analyses will identify impactful interventions. A model will be created to show the effect of impactful interventions in Indiana counties that do not have PSCs. Results Findings are preliminary. There is variability amongst correctional facilities regarding programme eligibility, provided services and provision of medication-assisted treatment. All correctional facilities were severely impacted by the COVID-19 pandemic. Conclusion It is anticipated that the adoption of impactful interventions will lower opioid-related morbidity and mortality rates.
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Affiliation(s)
- Elizabeth Van Nostrand
- Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA, USA
| | - Alyssa Johnston
- Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jeanine M Buchanich
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Brad Ray
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Mark S Roberts
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Gilmore N, Katz DI, Kiran S. Acquired Brain Injury in Adults: A Review of Pathophysiology, Recovery, and Rehabilitation. ACTA ACUST UNITED AC 2021; 6:714-727. [PMID: 34746412 DOI: 10.1044/2021_persp-21-00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose To summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and in particular, for young adults. Method This paper reviews a range of ABI-associated topics including: 1) mechanisms of injury; 2) biological, individual-specific, and behavioral drivers of recovery; and 3) current methods of cognitive rehabilitation. It then narrows focus to young adults, a frequently affected and growing population to sustain ABI. The paper concludes by providing: 1) suggestions for key components of cognitive rehabilitation for young adults with ABI; 2) an example from our own research providing intensive academically-focused cognitive rehabilitation for young adults with ABI pursuing college; and 3) recommendations for future behavioral and neuroimaging studies in this area. Conclusions ABI is on the rise in the United States. Young adults have been sustaining ABI at higher rates over the past several decades. These injuries occur when they would otherwise be advancing their academic and career goals, making the cognitive deficits that often accompany ABI especially devastating for this group. Review of existing literature suggests cognitive rehabilitation programs that combine aspects of restorative, comprehensive, and contextualized approaches could promote recovery for young adults with ABI. Future intervention studies may benefit from including both behavioral and neural outcomes to best understand how principles of neuroplasticity- naturally embedded within many cognitive rehabilitation approaches-could be manipulated to promote cognitive recovery and long-lasting brain reorganization in this group.
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Affiliation(s)
- Natalie Gilmore
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
| | - Douglas I Katz
- Neurology, Boston University School of Medicine, Boston, USA
| | - Swathi Kiran
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
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Affiliation(s)
- Brooke E Hoots
- 1242 Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.,United States Public Health Service, Rockville, MD, USA
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Root ED, Slavova S, LaRochelle M, Feaster DJ, Villani J, Defiore-Hyrmer J, El-Bassel N, Ergas R, Gelberg K, Jackson R, Manchester K, Parikh M, Rock P, Walsh SL. The impact of the national stay-at-home order on emergency department visits for suspected opioid overdose during the first wave of the COVID-19 pandemic. Drug Alcohol Depend 2021; 228:108977. [PMID: 34598100 PMCID: PMC8397502 DOI: 10.1016/j.drugalcdep.2021.108977] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although national syndromic surveillance data reported declines in emergency department (ED) visits after the declaration of the national stay-at-home order for COVID-19, little is known whether these declines were observed for suspected opioid overdose. METHODS This interrupted time series study used syndromic surveillance data from four states participating in the HEALing Communities Study: Kentucky, Massachusetts, New York, and Ohio. All ED encounters for suspected opioid overdose (n = 48,301) occurring during the first 31 weeks of 2020 were included. We examined the impact of the national public health emergency for COVID-19 (declared on March 14, 2020) on trends in ED encounters for suspected opioid overdose. RESULTS Three of four states (Massachusetts, New York and Ohio) experienced a statistically significant immediate decline in the rate of ED encounters for suspected opioid overdose (per 100,000) after the nationwide public health emergency declaration (MA: -0.99; 95 % CI: -1.75, -0.24; NY: -0.10; 95 % CI, -0.20, 0.0; OH: -0.33, 95 % CI: -0.58, -0.07). After this date, Ohio and Kentucky experienced a sustained rate of increase for a 13-week period. New York experienced a decrease in the rate of ED encounters for a 10-week period, after which the rate began to increase. In Massachusetts after a significant immediate decline in the rate of ED encounters, there was no significant difference in the rate of change for a 6-week period, followed by an immediate increase in the ED rate to higher than pre-COVID levels. CONCLUSIONS The heterogeneity in the trends in ED encounters between the four sites show that the national stay-at-home order had a differential impact on opioid overdose ED presentation in each state.
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Affiliation(s)
- Elisabeth D Root
- Department of Geography and Division of Epidemiology, The Ohio State University, Columbus, OH, United States.
| | - Svetla Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States
| | - Marc LaRochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jennifer Villani
- National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Jolene Defiore-Hyrmer
- Bureau of Health Improvement and Wellness, Ohio Department of Health, Columbus, OH, United States
| | - Nabila El-Bassel
- School of Social Work, Columbia University, New York, NY, United States
| | - Rosa Ergas
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, Jamaica Plain, MA, United States
| | - Kitty Gelberg
- New York State Department of Health, Office of Drug User Health, Albany, NY, United States
| | - Rebecca Jackson
- Departments of Physical Medicine and Rehabilitation, Internal Medicine/ Endocrinology, and Diabetes and Metabolism, Ohio State University, Columbus, OH, United States
| | - Kara Manchester
- Ohio Violence and Injury Prevention Program, Ohio Department of Health, Columbus, OH, United States
| | - Megha Parikh
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, Jamaica Plain, MA, United States
| | - Peter Rock
- Center for Clinical and Translational Science, University of Kentucky, Lexington, KY, United States
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
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Davy-Mendez T, Vittinghoff E, Dilworth SE, Suen LW, Braun C, Coffin PO, Satre DD, Riley ED. Non-fatal stimulant overdose among homeless and unstably housed women in San Francisco, California. Drug Alcohol Depend 2021; 228:109085. [PMID: 34600248 PMCID: PMC8595709 DOI: 10.1016/j.drugalcdep.2021.109085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND US rates of overdose deaths involving stimulants (e.g., cocaine or methamphetamine) have increased, but little is known about non-fatal stimulant overdoses, particularly among vulnerable populations. We characterized rates of non-fatal stimulant overdose identified outside of health care settings among women at high risk. METHODS Homeless and unstably housed women in San Francisco, California using stimulants were administered questionnaires on drug use and outcomes (stimulant overdose, health care utilization) monthly for six months. Based on pilot interviews, stimulant overdose during follow-up was defined as acute toxicity from stimulant use ("over-amping") resulting in "feeling sick, really scared, or like one's life may be in danger". Poisson regression estimated unadjusted incidence rate ratio (IRR) comparing participant characteristics. RESULTS We included 160 women (41% Black, 26% White, 15% Latina, median age 54 years) using crack cocaine (81%), methamphetamine (48%), and powdered cocaine (36%). Participants reported 67 non-fatal stimulant overdoses over 685 person-months of observation, a rate of 117.4 per 100 person-years (95% CI 85.8-160.5). Rates were higher among participants who were Latina vs. White (IRR 4.18 [1.60-10.94]), used methamphetamine (IRR 1.80 [0.96-3.38]), or used any stimulant daily/almost daily (IRR 2.63 [1.41-4.91]). Among women reporting stimulant overdose, 4% received emergency and 3% inpatient care for overdose of any drug. CONCLUSIONS Women in this setting, particularly those who used stimulants frequently or used methamphetamine, experienced high non-fatal stimulant overdose and rarely received health care for these events. Efforts should be made to increase awareness and reduce harms of stimulant toxicity in vulnerable populations.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Samantha E. Dilworth
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leslie W. Suen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Carl Braun
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Phillip O. Coffin
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA,San Francisco Department of Public Health, San Francisco, CA, USA
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Elise D. Riley
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Connolly E, McCall KL, Couture S, Felton M, Piper BJ, Bratberg JP, Tu C. Analysis of naloxone access and primary medication nonadherence in a community pharmacy setting. J Am Pharm Assoc (2003) 2021; 62:49-54. [PMID: 34736865 DOI: 10.1016/j.japh.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Access to naloxone is a primary public health strategy to prevent opioid overdose death. Factors associated with primary medication nonadherence (PMN) to naloxone are underreported in the literature. OBJECTIVE The objective of this study was to evaluate naloxone dispensing trends and PMN in a community pharmacy setting. METHODS This retrospective analysis included patients of a community pharmacy chain in Maine and New Hampshire (57 and 29 pharmacy locations, respectively) for whom a claim for a naloxone prescription was billed between January 1, 2019, and July 31, 2020. RESULTS A total of 2152 patients associated with 2606 naloxone claims were identified for analysis. A majority of the subjects were women (52.7%) and the mean age of all the subjects was 46.4 ± 16.0 years. Of the 2606 naloxone claims, 565 prescriptions were returned to stock and never dispensed to the patient for a PMN rate of 21.7%. Gender and age were not associated with naloxone PMN. Factors associated with naloxone PMN were urban location [x2(1) = 12.49, P = 0.0004], concomitant opioid analgesic [x2(1) = 4.56, P = 0.0328], and payment method [x2(4) = 251.07, P < 0.0001]. Regarding payment method, nonadherence was higher among cash (138 of 386, 35.8%) and private insurance (191 of 455, 42.0%) transactions whereas lower among Medicare (132 of 681, 19.4%) and Medicaid (89 of 899, 9.9%) transactions. Concomitant buprenorphine [x2(1) = 44.57, P < 0.0001] and the use of a naloxone standing order [x2(1) = 4.79, P = 0.0162] were associated with primary adherence to take-home naloxone. CONCLUSION A notable portion of naloxone prescribed and filled in the community pharmacy setting was never obtained by the patient. Factors associated with PMN in this study included geographic location, use of a standing order, concomitant prescriptions for buprenorphine or opioid analgesic medications, and payment method. Underlying causes of PMN must be addressed (e.g., removing financial barriers and optimizing the use of standing orders) to increase naloxone access for persons at risk of opioid overdose.
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Treatment of overdose in the synthetic opioid era. Pharmacol Ther 2021; 233:108019. [PMID: 34637841 DOI: 10.1016/j.pharmthera.2021.108019] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022]
Abstract
Overdose deaths are often viewed as the leading edge of the opioid epidemic which has gripped the United States over the past two decades (Skolnick, 2018a). This emphasis is perhaps unsurprising because opioid overdose is both the number-one cause of death for individuals between 25 and 64 years old (Dezfulian et al., 2021) and a significant contributor to the decline in average lifespan (Dowell et al., 2017). Exacerbated by the COVID 19 pandemic, it was estimated there were 93,400 drug overdose deaths in the United States during the 12 months ending December 2020, with more than 69,000 (that is, >74%) of these fatalities attributed to opioid overdose (Ahmad et al., 2021). However, the focus on mortality statistics (Ahmad et al., 2021; Shover et al., 2020) tends to obscure the broader medical impact of nonfatal opioid overdose. Analyses of multiple databases indicate that for each opioid-induced fatality, there are between 6.4 and 8.4 non-fatal overdoses, exacting a significant burden on both the individual and society. Over the past 7-8 years, there has been an alarming increase in the misuse of synthetic opioids ("synthetics"), primarily fentanyl and related piperidine-based analogs. Within the past 2-3 years, a structurally unrelated class of high potency synthetics, benzimidazoles exemplified by etonitazene and isotonitazene ("iso"), have also appeared in illicit drug markets (Thompson, 2020; Ujvary et al. 2021). In 2020, it was estimated that over 80% of fatal opioid overdoses in the United States now involve synthetics (Ahmad et al., 2021). The unique physicochemical and pharmacological properties of synthetics described in this review are responsible for both the morbidity and mortality associated with their misuse as well as their widespread availability. This dramatic increase in the misuse of synthetics is often referred to as the "3rd wave" (Pardo et al., 2019; Volkow and Blanco, 2020) of the opioid epidemic. Among the consequences resulting from misuse of these potent opioids is the need for higher doses of the competitive antagonist, naloxone, to reverse an overdose. The development of more effective reversal agents such as those described in this review is an essential component of a tripartite strategy (Volkow and Collins, 2017) to reduce the biopsychosocial impact of opioid misuse in the "synthetic era".
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Shastry S, Aluise ER, Richardson LD, Vedanthan R, Manini AF. Delayed QT Prolongation: Derivation of a Novel Risk Factor for Adverse Cardiovascular Events from Acute Drug Overdose. J Med Toxicol 2021; 17:363-371. [PMID: 34449039 PMCID: PMC8455785 DOI: 10.1007/s13181-021-00855-2] [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: 03/15/2021] [Revised: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In ED patients with acute drug overdose involving prescription medication and/or substances of abuse, severe QTc prolongation (> 500 ms) is predictive of adverse cardiovascular events (ACVE), defined as myocardial injury, ventricular dysrhythmia, shock, or cardiac arrest. However, it is unclear whether delayed severe QTc prolongation (dsQTp) is a risk factor for ACVE and if specific clinical factors are associated with occurrence of dsQTp. METHODS A secondary analysis of a prospective cohort of consecutive adult ED patients with acute drug overdose was performed on patients with initial QTc < 500 ms. The predictor variable, dsQTp, was defined as initial QTc < 500 ms followed by repeat QTc ≥ 500 ms. The primary outcome was occurrence of ACVE. Multivariable logistic regression was performed to test whether dsQTp was an independent predictor of ACVE and to derive clinical factors associated with dsQTp. RESULTS Of 2311 patients screened, 1648 patients were included. The dsQTp group (N = 27) was older than the control group (N = 1621) (51.6 vs 40.2, p < 0.001) and had a higher number of drug exposures (2.92 vs 2.16, p = 0.003). Following adjustment for age, sex, race/ethnicity, number of exposures, serum potassium, and opioid exposure, dsQTp remained an independent predictor of ACVE (aOR: 12.44, p < 0.0001). Clinical factors associated with dsQTp were age > 45 years and polydrug (≥ 3) overdoses. CONCLUSION In this large secondary analysis of ED patients with acute drug overdose, dsQTp was an independent risk factor for in-hospital occurrence of ACVE.
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Affiliation(s)
- Siri Shastry
- grid.416167.3Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Hospital, 555 West 57th Street, 5th Floor, New York, NY 10019 USA
| | - Eleanor R. Aluise
- grid.416167.3Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Hospital, 555 West 57th Street, 5th Floor, New York, NY 10019 USA
| | - Lynne D. Richardson
- grid.416167.3Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Hospital, 555 West 57th Street, 5th Floor, New York, NY 10019 USA ,grid.59734.3c0000 0001 0670 2351Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, New York, NY USA
| | - Rajesh Vedanthan
- grid.240324.30000 0001 2109 4251Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Alex F. Manini
- grid.414488.50000 0004 0453 0340Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, Elmhurst Hospital Center, New York, NY USA
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Prescription Opioid Characteristics and Nonfatal Overdose Among Patients Discharged from Tennessee Emergency Departments. J Emerg Med 2021; 62:51-63. [PMID: 34535302 DOI: 10.1016/j.jemermed.2021.07.050] [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: 04/01/2021] [Revised: 06/27/2021] [Accepted: 07/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite increasing trends of nonfatal opioid overdoses in emergency departments (EDs), population-based studies comparing prescription opioid dosing patterns before and after nonfatal opioid overdoses are limited. OBJECTIVES To evaluate characteristics of prescribing behaviors before and after nonfatal overdoses, with a focus on opioid dosage. METHODS Included were 5,395 adult residents of Tennessee discharged from hospital EDs after a first nonfatal opioid overdose (2016-2017). Patients were linked to eligible prescription records in the Tennessee Controlled Substance Monitoring Database. We estimated odds ratios (OR) and 95% confidence intervals (CI) to evaluate characteristics associated with filling opioid prescriptions 90 days before overdose and with high daily dose (≥ 90 morphine milligram equivalents) 90 days after overdose. RESULTS Among patients who filled a prescription both before and after an overdose, the percentage filling a low, medium, and high dose was 33.7%, 31.9%, and 34.4%, respectively, after an opioid overdose (n = 1,516). Most high-dose users before an overdose (>70%) remained high-dose users with the same prescriber after the overdose. Male gender, ages ≥ 35 years, and medium metro residence were associated with increased odds of high-dose filling after an opioid overdose. Patients filling overlapping opioid-benzodiazepine prescriptions and with > 7 days' supply had increased odds of filling high dose after an opioid overdose (OR 1.4, 95% CI 1.08-1.70 and OR 3.7, 95% CI 2.28-5.84, respectively). CONCLUSIONS In Tennessee, many patients treated in the ED for an overdose are still prescribed high-dose opioid analgesics after an overdose, highlighting a missed opportunity for intervention and coordination of care between ED and non-ED providers.
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Chandran K, Mazer-Amirshahi M, Shankar N, Desale S, Nelson L, Mete M. Impact of COVID-19 pandemic on emergency department substance use screens and overdose presentations. Am J Emerg Med 2021; 50:472-476. [PMID: 34509745 PMCID: PMC8387574 DOI: 10.1016/j.ajem.2021.08.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic can exacerbate underlying substance use disorder and has impacted this vulnerable population in a variety of ways. There are limited data regarding how this pandemic has impacted emergency department (ED) patient presentations. Methods We extracted data on ED visits from the electronic health record (EHR) of a large healthcare system in the Washington, DC/Baltimore, MD metropolitan area. The dataset includes data from 7 hospitals on ED visits between 11/1/2019–6/30/2020. The health system utilizes a validated screening program for substance use, Screening, Brief Intervention, and Referral to Treatment (SBIRT), for ED patients who are clinically stable and willing to complete screening. We evaluated trends in patients with a positive SBIRT screen and those presenting with a clinical diagnosis of acute alcohol or substance intoxication/overdose before (11/1/19–2/29/2020-pre) and during the first wave of the COVID pandemic (3/1/2020–6/30/2020-post). Data were described using descriptive statistics. Bivariate analyses were conducted using chi-square test and two-sample t-tests. Interrupted time series analysis was used to evaluate the changes in the weekly trends with the start of the pandemic. Results There were 107,930 screens performed in the EDs during the study period (61,961 pre, 45,969 post). The population was primarily African American (64.7%) and female (57.1%). Positive SBIRT screens increased from 12.5% to 15.8% during COVID (p < 0.001). Alcohol intoxication presentations increased as a proportion of positive screens from 12.6% to 14.4% (p = 0.001). A higher percentage of screened patients reported problem drinking (AUDIT score ≥ 7) during the pandemic (2.4% pre vs 3.2% post, p < 0.001). Substance intoxication/overdoses among all screened increased from 2.1% to 3.1% (p < 0.001) and as a percentage of positive screens during the pandemic (16.8% to 20%, p < 0.001). The proportion of opioid vs. non-opioid overdoses remained unchanged before (67%) and during the pandemic (64%, p = 0.33). Discussion There was an increase in the proportion of positive SBIRT screens and visits for acute overdoses and intoxication during the first wave of the COVID-19 pandemic. Additional research should focus on mitigation strategies to address substance use during this vulnerable time.
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Affiliation(s)
- Kira Chandran
- Georgetown University School of Medicine, Washington, DC, USA.
| | | | - Nikash Shankar
- Georgetown University School of Medicine, Washington, DC, USA
| | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD, USA
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Schäfer WLA, Johnson JK, Wafford QE, Plummer SG, Stulberg JJ. Primary prevention of prescription opioid diversion: a systematic review of medication disposal interventions. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:548-558. [PMID: 34292095 DOI: 10.1080/00952990.2021.1937635] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: In the U.S., 50-75% of nonmedical users of prescription opioids obtain their pills through diversion by friends or relatives. Increasing disposal of unused opioid prescriptions is a fundamental primary prevention strategy in combatting the opioid epidemic.Objectives: To identify interventions for disposal of unused opioid pills and assess the evidence of their effectiveness on disposal-related outcomes.Methods: A search of four electronic databases was conducted (October 2019). We included all empirical studies, systematic literature reviews, and meta-analyses about study medication disposal interventions in the U.S. Studies of disposal interventions that did not include opioids were excluded. We abstracted data for the selected articles to describe the study design, and outcomes. Further, we assessed the quality of each study using the NIH Study Quality Assessment Tools.Results: We identified 25 articles that met our inclusion criteria. None of the 13 studies on drug take-back events or the two studies on donation boxes could draw conclusions about their effectiveness. Although studies on educational interventions found positive effects on knowledge acquisition, they did not find differences in disposal rates. Two randomized controlled trials on drug disposal bags found higher opioid disposal rates in their intervention arms compared to the control arms (57.1% vs 28.6% and 33.3%, p = .01; and 85.7% vs 64.9%, p = .03).Conclusions: Peer-reviewed publications on opioid disposal interventions are limited and either do not address effectiveness or have conflicting findings. Future research should address these limitations and further evaluate implementation and cost-effectiveness.
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Affiliation(s)
- Willemijn L A Schäfer
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie K Johnson
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Q Eileen Wafford
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sarah G Plummer
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonah J Stulberg
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Ball SJ, McCauley JA, Pruitt M, Zhang J, Marsden J, Barth KS, Mauldin PD, Gebregziabher M, Moran WP. Academic detailing increases prescription drug monitoring program use among primary care practices. J Am Pharm Assoc (2003) 2021; 61:418-424.e2. [PMID: 33812783 PMCID: PMC8273068 DOI: 10.1016/j.japh.2021.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Clinical review of a prescription drug monitoring program (PDMP) is considered a valuable tool for opioid prescribing risk mitigation; however, PDMP use is often low, even in states with mandatory registration and use policies. The objective was to evaluate the impact of an academic detailing (AD) outreach intervention on PDMP use among primary care prescribers. METHODS AD intervention was delivered to primary care based controlled substance prescribers (N = 87) and their associated PDMP delegates (n = 42) by a clinical pharmacist as 1 component of a large-scale, statewide initiative to improve opioid prescribing safety. Prescriber PDMP use behavior was assessed by prescriber self-report and analysis of objective 2016-2018 PDMP data regarding the number of monthly report requests. We compared means between pre- and postintervention using a paired t test and plotted the monthly average reports over time to assess the trend of mean reports over time. Generalized linear mixed model with a negative binomial distribution was used to assess the difference in the trend and magnitude of the combined count of reports for the entire sample and prescriber subsets that were segmented on the basis of the adoption status of PDMP. RESULTS The monthly mean of reports by combined prescribers and delegates significantly increased after the AD intervention (mean 28.1 pre vs. 53.0 post; P < 0.001), with the increase in delegate reports (mean 17.1 pre vs. 60.0 post; P < 0.001) driving the overall increase. Reports were requested 40.4 times more often than in the preintervention period (P < 0.001). Patterns of pre- to postchanges in mean monthly report requests differed by baseline PDMP adoption status. CONCLUSION The AD intervention was transformative in facilitating practice change to use delegates to run reports. Visits with both prescribers and delegates, including hands-on PDMP training and registration assistance, can be viewed as beneficial for practice facilitation.
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Affiliation(s)
- Sarah J. Ball
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jenna A. McCauley
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Megan Pruitt
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, USA
| | - Jingwen Zhang
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Marsden
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly S. Barth
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick D. Mauldin
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, USA
| | - William P. Moran
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Spetz J, Chapman S, Tierney M, Phoenix B, Hailer L. Barriers and Facilitators of Advanced Practice Registered Nurse Participation in Medication Treatment for Opioid Use Disorder: A Mixed Methods Study. JOURNAL OF NURSING REGULATION 2021. [DOI: 10.1016/s2155-8256(21)00052-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kestler A, Kaczorowski J, Dong K, Orkin AM, Daoust R, Moe J, Van Pelt K, Andolfatto G, Klaiman M, Yan J, Koh JJ, Crowder K, Webster D, Atkinson P, Savage D, Stempien J, Besserer F, Wale J, Lam A, Scheueremeyer F. A cross-sectional survey on buprenorphine-naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey. CMAJ Open 2021; 9:E864-E873. [PMID: 34548331 PMCID: PMC8476213 DOI: 10.9778/cmajo.20200190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Buprenorphine-naloxone (BUP) initiation in emergency departments improves follow-up and survival among patients with opioid use disorder. We aimed to assess self-reported BUP-related practices and attitudes among emergency physicians. METHODS We designed a cross-sectional physician survey by adapting a validated questionnaire on opioid harm reduction practices, attitudes and barriers. We recruited physician leads from 6 Canadian provinces to administer surveys to the staff physicians in their emergency department groups between December 2018 and November 2019. We included academic and community non-locum emergency department staff physicians. We excluded responses from emergency department groups with response rates less than 50% to minimize nonresponse bias. Primary (BUP prescribing practices) and secondary (willingness and attitudes) outcomes were analyzed using descriptive statistics. RESULTS After excluding 1 group for low response (9/26 physicians), 652 of 798 (81.7%) physicians responded from 22 groups serving 34 emergency departments. Among respondents, 64.1% (95% confidence interval [CI] 60.4%-67.8%, emergency department group range 7.1%-100.0%) had prescribed BUP at least once in their career, 38.4% had prescribed it for home initiation and 24.8% prescribed it at least once a month. Overall, 68.9% (95% CI 65.3%-72.4%, emergency department group range 24.1%-97.6%) were willing to administer BUP, 64.2% felt it was a major responsibility and 37.1% felt they understood people who use drugs. Respondents most frequently rated lack of adequate training (58.2%) and lack of time (55.2%) as very important barriers to BUP initiation. INTERPRETATION Two-thirds of the emergency physicians surveyed prescribed BUP, although only one-quarter did so regularly and one-third prescribed it for home initiation; wide variation between emergency department groups existed. Strategies to increase BUP initiation must address physicians' lack of time and training for BUP initiation and improve their understanding of people who use drugs.
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Affiliation(s)
- Andrew Kestler
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que.
| | - Janusz Kaczorowski
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kathryn Dong
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Aaron M Orkin
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Raoul Daoust
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Jessica Moe
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kelsey Van Pelt
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Gary Andolfatto
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Michelle Klaiman
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Justin Yan
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Justin J Koh
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kathryn Crowder
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Devon Webster
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Paul Atkinson
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - David Savage
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - James Stempien
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Floyd Besserer
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Jason Wale
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Alice Lam
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Frank Scheueremeyer
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
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Jennings LK, Lane S, McCauley J, Moreland A, Hartwell K, Haynes L, Barth KS, Gainey SS, Brady KT. Retention in Treatment after Emergency Department-Initiated Buprenorphine. J Emerg Med 2021; 61:211-221. [PMID: 34176686 DOI: 10.1016/j.jemermed.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/02/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emergency department-initiated buprenorphine (EDIB) has been shown to be effective in connecting patients with opioid use disorder (OUD) to outpatient treatment. Five diverse emergency departments (EDs) have successfully implemented EDIB programs. OBJECTIVES 1) To measure attendance at the first referral appointment and 30-day retention in treatment rates for patients receiving EDIB; 2) To describe demographic and opioid use characteristics of patients receiving EDIB; and 3) To determine average length of time in treatment after EDIB at the five participating EDs. METHODS All patients receiving EDIB at the participating EDs (n = 522) were seen by a peer recovery specialist in the ED and demographic and opioid use characteristics were recorded. Patients were followed prospectively. The referral site was contacted and information regarding attendance at the first referral appointment and 30-day retention in treatment was obtained. All patients still in treatment at 30 days were continually followed at subsequent 30-day intervals until the referral site indicated the patient had ended treatment at their facility. RESULTS The rate of attendance at the first referral appointment was 77.0% for patients receiving EDIB. At 30-day follow-up, 43.1% of patients were retained in treatment. The mean age of patient enrollment was 36.7 years, 58% of enrollees were male, 90.5% were white, and 73.4% had no medical insurance. Seventy-seven percent reported no substance use other than opioids. The mean time in treatment was 158 days. CONCLUSIONS EDIB programs across diverse ED settings are effective at promoting attendance at the first referral appointment for OUD treatment; however, additional work is warranted to increase 30-day treatment retention rates, particularly among patients with nonprescription-only use profiles.
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Affiliation(s)
| | - Suzanne Lane
- Department of Psychiatry and Behavioral Science, Addiction Sciences Division
| | - Jenna McCauley
- Department of Psychiatry and Behavioral Science, Addiction Sciences Division
| | - Angela Moreland
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, South Carolina
| | - Karen Hartwell
- Department of Psychiatry and Behavioral Science, Addiction Sciences Division
| | - Louise Haynes
- Department of Psychiatry and Behavioral Science, Addiction Sciences Division
| | - Kelly S Barth
- Department of Psychiatry and Behavioral Science, Addiction Sciences Division
| | - Sarah S Gainey
- Department of Psychiatry and Behavioral Science, Addiction Sciences Division
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Science, Addiction Sciences Division
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Abstract
In recent years, there has been an emergence of numerous novel drugs. Such toxicity may occur in both adolescents and adults. This article discusses the opioid epidemic and several emerging opioids, including buprenorphine, loperamide, fentanyl, fentanyl derivatives, and others. Kratom, a plant occasionally used for opiate detoxification, along with the sedatives etizolam and phenibut, will be discussed. Lastly, this article discusses the phenethylamines and marijuana.
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Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of California, Los Angeles, 924 Westwood Boulevard Suite 300, Los Angeles, CA 90095, USA.
| | - Frank Lovecchio
- Department of Emergency Medicine, Arizona State University, College of Health Solutions, Valleywise Health, 2601 East Roosevelt, Phoenix, AZ 85006, USA
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Vivolo-Kantor AM, Smith H, Scholl L. Differences and similarities between emergency department syndromic surveillance and hospital discharge data for nonfatal drug overdose. Ann Epidemiol 2021; 62:43-50. [PMID: 34107342 DOI: 10.1016/j.annepidem.2021.05.008] [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: 02/01/2021] [Revised: 04/26/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Emergency department syndromic surveillance and hospital discharge data have been used to detect and monitor nonfatal drug overdose, yet few studies have assessed the differences and similarities between these two data sources. METHODS The Centers for Disease Control and Prevention Drug Overdose Surveillance and Epidemiology system data from 14 states were used to compare these two sources at estimating monthly overdose burden and trends from January 2018 through December 2019 for nonfatal all drug, opioid-, heroin-, and stimulant-involved overdoses. RESULTS Compared to discharge data, syndromic data captured 13.3% more overall emergency department visits, 67.8% more all drug overdose visits, 15.6% more opioid-involved overdose visits, and 78.8% more stimulant-involved overdose visits. Discharge data captured 18.9% more heroin-involved overdoses. Significant trends were identified for all drug (Average Monthly Percentage Change [AMPC]=1.1, 95% CI=0.4,1.8) and stimulant-involved overdoses (AMPC=2.4, 95% CI=1.2,3.7) in syndromic data; opioid-involved overdoses increased in both discharge and syndromic data (AMPCDischarge=0.9, 95% CI=0.2,1.7; AMPCSyndromic=1.9, CI=1.1,2.8). CONCLUSIONS Results demonstrate that discharge data may be better for reporting counts, yet syndromic data are preferable to detect changes quickly and to alert practitioners and public health officials to local overdose clusters. These data sources do serve complementary purposes when examining overdose trends.
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Affiliation(s)
- Alana M Vivolo-Kantor
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Herschel Smith
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN
| | - Lawrence Scholl
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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40
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Faryar KA, Ancona RM, Reau Z, Lyss SB, Braun RS, Rademaker T, Sickles RK, Lyons MS. HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs. PLoS One 2021; 16:e0251756. [PMID: 34003855 PMCID: PMC8130938 DOI: 10.1371/journal.pone.0251756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/30/2021] [Indexed: 12/20/2022] Open
Abstract
Objective Multiple HIV outbreaks among persons who inject drugs (PWID) have occurred in the US since 2015. Emergency departments (EDs), recognized as essential venues for HIV screening, may play a unique role in identifying undiagnosed HIV among PWID, who frequently present for complications of injection drug use (IDU). Our objective was to describe changes in HIV diagnoses among PWID detected by an ED HIV screening program and estimate the program’s contribution to HIV diagnoses among PWID county-wide during the emergence of a regional HIV outbreak. Methods This was a retrospective study of electronically queried clinical records from an urban, safety-net ED’s HIV screening program and publicly available HIV surveillance data for its surrounding county, Hamilton County, Ohio. Outcomes included the change in number of HIV diagnoses and the ED’s contribution to case identification county-wide, overall and for PWID during 2014–2018. Results During 2014–2018, the annual number of HIV diagnoses made by the ED program increased from 20 to 42 overall, and from 1 to 18 for PWID. We estimated that the ED contributed 18% of HIV diagnoses in the county and 22% of diagnoses among PWID. Conclusions The ED program contributed 1 in 5 new HIV diagnoses among PWID county-wide, further illustrating the importance of ED HIV screening programs in identifying undiagnosed HIV infections. In areas experiencing increasing IDU, HIV screening in EDs can provide an early indication of increasing HIV diagnoses among PWID and can substantially contribute to case-finding during an HIV outbreak.
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Affiliation(s)
- Kiran A. Faryar
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, United States of America
- * E-mail:
| | - Rachel M. Ancona
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, United States of America
| | - Zachary Reau
- HIV, STI, and Viral Hepatitis Interventions and Treatment Section, Office of Health Improvement and Wellness, Ohio Department of Health, Columbus, OH, United States of America
| | - Sheryl B. Lyss
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Robert S. Braun
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, United States of America
| | - Todd Rademaker
- HIV Testing, Care, and Prevention, Hamilton County Public Health, Cincinnati, OH, United States of America
| | - Ryane K. Sickles
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, United States of America
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, United States of America
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41
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Michaels NL, Spiller HA, Badeti J, Sheftall AH, Funk AR, Smith GA. Benzodiazepine exposures among women of reproductive age in the US, 2004-2018. Hum Exp Toxicol 2021; 40:1807-1816. [PMID: 33906473 DOI: 10.1177/09603271211013431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Benzodiazepines, often used to treat anxiety, insomnia, and other conditions, are prescribed more frequently to women than men, and emergency department visits and overdose deaths involving benzodiazepines have increased significantly among women in recent years. This study describes characteristics and trends associated with benzodiazepine exposures among women of reproductive age (15-49 years old) that were reported to United States poison control centers from 2004 through 2018. The National Poison Data System recorded 258,370 first-ranked benzodiazepine exposures among women 15-49 years old during the study period. More than one-half (56.9%) of exposures involved a single-substance and one-third (34.0%) occurred among women 20-29 years old. The majority were categorized as "intentional, suspected suicide" (73.2%) or "intentional" (12.9%). Exposures frequently resulted in admission to a psychiatric facility (20.6%), critical care unit (18.1%), or non-critical care unit (9.3%). Twenty percent of cases resulted in a serious medical outcome, including 205 deaths. The substantial percentage of benzodiazepine exposures among women of reproductive age that were intentional and associated with suicide attempts or suicide deaths indicate that increased prevention efforts are needed to address this issue.
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Affiliation(s)
- N L Michaels
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - H A Spiller
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Central Ohio Poison Center, Columbus, OH, USA
| | - J Badeti
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - A H Sheftall
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Innovation in Pediatric Practice at the Abigail Wexner Research Institute of 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - A R Funk
- Central Ohio Poison Center, Columbus, OH, USA
| | - G A Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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42
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Collins AB, Beaudoin FL, Samuels EA, Wightman R, Baird J. Facilitators and barriers to post-overdose service delivery in Rhode Island emergency departments: A qualitative evaluation. J Subst Abuse Treat 2021; 130:108411. [PMID: 34118703 DOI: 10.1016/j.jsat.2021.108411] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emergency departments (EDs) in the US have increasingly incorporated interventions that seek to reduce opioid-related morbidity and mortality. However, many of these interventions are underutilized. This study examined ED provider-identified barriers and facilitators to policy-prescribed service provision for patients treated for an opioid overdose in Rhode Island EDs, and opportunities to improve care delivery. METHODS Semi-structured qualitative interviews were conducted with 55 ED providers (management and clinical staff) across Rhode Island EDs from November 2019 to July 2020. Thematic analysis of interviews focused on gaps and best practices in post-overdose care delivery, including social and structural factors driving access to, and uptake of, services. RESULTS Participants highlighted how automatic service delivery (opt out vs. opt in) and the integration of peer-based services enhanced post-overdose service provision. However, social and structural factors (e.g. insurance barriers, limited outpatient treatment resources) and gaps in provider knowledge of medications for opioid use disorder created barriers to care. Addressing long ED wait times and establishing dedicated care teams for patients following an overdose were seen as critical to improving ED service delivery. CONCLUSION Our findings suggest that post-overdose service delivery within EDs is a useful approach for connecting patients to services, particularly when peer support specialists are involved. However, standardizing service delivery approaches and improving provider education of harm reduction services must be prioritized alongside state-level policy changes to improve access to care for ED patients.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States.
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States; Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, United States; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, United States
| | - Rachel Wightman
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, United States
| | - Janette Baird
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States
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Watson DP, Weathers T, McGuire A, Cohen A, Huynh P, Bowes C, O’Donnell D, Brucker K, Gupta S. Evaluation of an emergency department-based opioid overdose survivor intervention: Difference-in-difference analysis of electronic health record data to assess key outcomes. Drug Alcohol Depend 2021; 221:108595. [PMID: 33610095 PMCID: PMC8026710 DOI: 10.1016/j.drugalcdep.2021.108595] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years, a number of emergency department (ED)-based interventions have been developed to provide supports and/or treatment linkage for people who use opioids. However, there is limited research supporting the effectiveness of the majority of these interventions. Project POINT is an ED-based intervention aimed at providing opioid overdose survivors with naloxone and recovery supports and connecting them to evidence-based medications for opioid use disorder (MOUD). An evaluation of POINT was conducted. METHODS A difference-in-difference analysis of electronic health record data was completed to understand the difference in outcomes for patients admitted to the ED when a POINT staff member was working versus times when they were not. The observation window was January 1, 2012 to July 6, 2019, which included N = 1462 unique individuals, of which 802 were in the POINT arm. Outcomes of focus include MOUD opioid prescriptions dispensed, active non-MOUD opioid prescriptions dispensed, naloxone access, and drug poisonings. RESULTS The POINT arm had a significant increase in MOUD prescriptions dispensed, non-MOUD prescriptions dispensed, and naloxone access (all p-values < 0.001). There was no significant effect related to subsequent drug poisoning-related hospital admissions. CONCLUSIONS The results support the assertion that POINT is meeting its two primary goals related to increasing naloxone access and connecting patients to MOUD. Generalization of these results is limited; however, the evaluation contributes to a nascent area of research and can serve a foundation for future work.
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Affiliation(s)
- Dennis P. Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W. Walton St., Chicago, IL 60610
| | - Tess Weathers
- Indiana University Richard M. Fairbanks School of Public Health, Department of Social and Behavioral Sciences, 1050 Wishard Blvd., Indianapolis, IN, 46202, United States.
| | - Alan McGuire
- Richard L. Roudebush VAMC, Health Services Research and Development, 1481 W. 10th St (11H) Rm. C8108, Indianapolis, IN, 46202, United States; Indiana University Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., Indianapolis, IN, 46202, United States.
| | - Alex Cohen
- GiveWell, 1714 Franklin Street, Oakland, CA, 94612, United States.
| | - Philip Huynh
- Wayne State University, School of Social Work, Center for Behavioral Health and Justice, 5201 Cass Avenue Suite 226, Detroit, MI, 48202, United States.
| | - Clay Bowes
- Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, United States.
| | - Daniel O’Donnell
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Ave., Indianapolis, IN 46202
| | | | - Sumedha Gupta
- Department of Economics, Indiana University Purdue University Indianapolis, United States.
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Bushnell GA, Olfson M, Martins SS. Sex differences in US emergency department non-fatal visits for benzodiazepine poisonings in adolescents and young adults. Drug Alcohol Depend 2021; 221:108609. [PMID: 33639570 PMCID: PMC8482968 DOI: 10.1016/j.drugalcdep.2021.108609] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Benzodiazepine (BZD)-related overdose deaths have risen in the past decade and BZD misuse contributes to thousands of emergency department (ED) visits annually, with the highest rates in adolescents and young adults. Because there are gaps in understanding BZD poisoning in youth and whether differences occur by sex, we aimed to characterize BZD poisoning ED visits in young people by sex. METHODS BZD poisoning visits were identified in the Nationwide Emergency Department Sample, among adolescents (12-17 years) and young adults (18-29 years). Stratified by sex and age, we described ED visits for BZD poisonings in 2016, including poisoning intent, concurrent substances involved, and co-occurring mental health disorder diagnoses. With logistic regression we examined the association between intent and concurrent substance. RESULTS There were approximately 38,000 BZD poisoning ED visits by young people nationwide with annual population rates per 10,000 of 2.9=adolescents and 5.8=young adults. Depression was diagnosed in 40 % of female and 23 % of male BZD visits (p < 0.01). Over half of BZD poisonings in females and a third in males were intentional (p < 0.01). Male BZD visits were more likely to involve opioids or cannabis and less likely to involve antidepressants than females (p-values<0.01). In males and females, BZD poisonings concurrent with antidepressants and other psychotropic medications were more likely to be intentional than unintentional (OR range:2.1-6.3). CONCLUSIONS The high proportion of BZD poisonings that are intentional and include mental health disorder diagnoses, especially among young females, underscore the importance of ED mental health and suicide risk assessment with appropriate follow-up referral.
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Affiliation(s)
- Greta A Bushnell
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168(th) St., New York, NY 10032, United States.
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168(th) St., New York, NY 10032, United States; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr., New York, NY 10032, United States
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168(th) St., New York, NY 10032, United States
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45
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Bowman C, Thornton S, Oller L, Silver E. Utilization of a poison control center by critical access hospitals-one state's experience. Clin Toxicol (Phila) 2021; 59:1015-1022. [PMID: 33787424 DOI: 10.1080/15563650.2021.1903485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Critical access hospitals (CAH) are an important source of exposures for poison control centers (PCC), yet there is a paucity of literature on how these calls differ from larger, more urban hospitals (UH). This study aimed to compare call characteristics from CAH and UH received by a regional PCC. METHODS This retrospective chart review used the Toxicall® database of the Kansas PCC. All cases involving calls from a health care facility from 1 January 2012 to 31 December 2017 were identified. Cases were then identified as either from a CAH or from one of the four largest UH in Kansas for comparison. CAH were defined using the criteria from the Centers for Medicare & Medicaid Services. All information was de-identified in REDCAPS and analyzed in Microsoft Excel. FINDINGS A total of 12,469 unique patient cases were identified, including 6392 CAH and 6077 UH cases. Patients at UH were more likely to have longer duration of medical effects and experience more severe medical effects. Significant differences in the unique exposures, rates of intentional overdose, routes, and number of exposures were found. Patients at CAH were more likely to receive activated charcoal, flumazenil, and be transferred to another healthcare facility, but were less likely to have been referred by the PCC, need an ICU admission, or require consultation with a toxicologist. CONCLUSIONS PCC calls from CAHs were common and resulted in significant differences when compared to UH calls. Future research is warranted to optimize PCC services for rural hospitals.
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Affiliation(s)
- Connor Bowman
- Kansas Poison Control Center, University of Kansas Health System (KSPCC), Kansas City, KS, USA
| | - Stephen Thornton
- Kansas Poison Control Center, University of Kansas Health System (KSPCC), Kansas City, KS, USA.,Department of Emergency Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Lisa Oller
- Kansas Poison Control Center, University of Kansas Health System (KSPCC), Kansas City, KS, USA
| | - Elizabeth Silver
- Kansas Poison Control Center, University of Kansas Health System (KSPCC), Kansas City, KS, USA
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Davis CS, Carr DH, Glenn MJ, Samuels EA. Legal Authority for Emergency Medical Services to Increase Access to Buprenorphine Treatment for Opioid Use Disorder. Ann Emerg Med 2021; 78:102-108. [PMID: 33781607 DOI: 10.1016/j.annemergmed.2021.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/29/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022]
Abstract
Treatment with buprenorphine significantly reduces both all-cause and overdose mortality among individuals with opioid use disorder. Offering buprenorphine treatment to individuals who experience a nonfatal opioid overdose represents an opportunity to reduce opioid overdose fatalities. Although some emergency departments (EDs) initiate buprenorphine treatment, many individuals who experience an overdose either refuse transport to the ED or are transported to an ED that does not offer buprenorphine. Emergency medical services (EMS) professionals can help address this treatment gap. In this Concepts article, we describe the federal legal landscape that governs the ability of EMS professionals to administer buprenorphine treatment, and discuss state and local regulatory considerations relevant to this promising and emerging practice.
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Affiliation(s)
- Corey S Davis
- Harm Reduction Legal Project, Network for Public Health Law, Los Angeles, CA.
| | | | - Melody J Glenn
- Department of Emergency Medicine, University of Arizona, and Banner University Medical Center Tucson, Tucson, AZ
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
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Bollinger K, Weimer B, Heller D, Bynum N, Grabenauer M, Pressley D, Smiley-McDonald H. Benzodiazepines reported in NFLIS-Drug, 2015 to 2018. Forensic Sci Int Synerg 2021; 3:100138. [PMID: 33665593 PMCID: PMC7905184 DOI: 10.1016/j.fsisyn.2021.100138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
The National Forensic Laboratory Information System (NFLIS) is a program of the U.S. Drug Enforcement Administration, Diversion Control Division. The NFLIS-Drug component collects drug identification results and associated information from drug cases submitted to and analyzed by federal, state, and local forensic laboratories. This paper presents national annual estimates and national and regional yearly trend differences for clonazepam, diazepam, flubromazolam, clonazolam, and etizolam using annual report rates per 100,000 persons aged 15 or older between 2015 and 2018. An estimated 263,538 benzodiazepine reports were identified by state and local laboratories between 2015 and 2018. Methamphetamine, cocaine, and heroin accounted for 32% of the drugs reported in the same item as alprazolam. Depressants and tranquilizers and narcotic analgesics were the drug classes most frequently identified in the same item as etizolam. A timeline of some benzodiazepines’ emergence in NFLIS-Drug is shown, as well as state- and county-level data for selected benzodiazepines.
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Affiliation(s)
- Katherine Bollinger
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - BeLinda Weimer
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - David Heller
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Nichole Bynum
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Megan Grabenauer
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - DeMia Pressley
- U.S. Drug Enforcement Administration, Diversion Control Division, 8701 Morrissette Drive, Springfield, VA, 22152, USA
| | - Hope Smiley-McDonald
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
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Funke M, Kaplan MC, Glover H, Schramm-Sapyta N, Muzyk A, Mando-Vandrick J, Gordee A, Kuchibhatla M, Sterrett E, Eucker SA. Increasing Naloxone Prescribing in the Emergency Department Through Education and Electronic Medical Record Work-Aids. Jt Comm J Qual Patient Saf 2021; 47:364-375. [PMID: 33811002 DOI: 10.1016/j.jcjq.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Emergency department (ED) visits for opioid overdose continue to rise. Evidence-based harm reduction strategies for opioid use disorder (OUD), such as providing home naloxone, can save lives, but ED implementation remains challenging. METHODS The researchers aimed to increase prescribing of naloxone to ED patients with OUD and opioid overdose by employing a model for improvement methodology, a multidisciplinary team, and high-reliability interventions. Monthly naloxone prescribing rates among discharged ED patients with opioid overdose and OUD-related diagnoses were tracked over time. Interventions included focused ED staff education on OUD and naloxone, and creation of electronic medical record (EMR)-based work-aids, including a naloxone Best Practice Advisory (BPA) and order set. Autoregressive interrupted time series was used to model the impact of these interventions on naloxone prescribing rates. The impact of education on ED staff confidence and perceived barriers to prescribing naloxone was measured using a published survey instrument. RESULTS After adjusting for education events and temporal trends, ED naloxone BPA and order set implementation was associated with a significant immediate 21.1% increase in naloxone prescribing rates, which was sustained for one year. This corresponded to increased average monthly prescribing rates from 1.5% before any intervention to 28.7% afterward. ED staff education had no measurable impact on prescribing rates but was associated with increased nursing perceived importance and increased provider confidence in prescribing naloxone. CONCLUSIONS A significant increase in naloxone prescribing rates was achieved after implementation of high-reliability EMR work-aids and staff education. Similar interventions may be key to wider ED staff engagement in harm reduction for patients with OUD.
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Mayberry S, Nechuta S, Krishnaswami S. Impact of benzodiazepines and polysubstance status on repeat non-fatal drug overdoses. J Subst Abuse Treat 2021; 123:108285. [PMID: 33612202 DOI: 10.1016/j.jsat.2021.108285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/17/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022]
Abstract
Research has shown that benzodiazepines and mental health disorders can increase the likelihood of repeat overdose, but researchers have not explored this association in Tennessee (TN). We examined benzodiazepines, polysubstance overdose status with/without benzodiazepines, and mental health comorbidities with repeat overdose using statewide data in TN. This study analyzed TN hospital discharge data on nonfatal overdoses for patients ages 18-64 from 2012 to 2016 for 21,066 patients with an initial inpatient visit and 36,244 patients with an initial outpatient visit. The study assessed each patient at one year after initial overdose to determine likelihood of repeat overdose. We used a Cox proportional hazards model to compute hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the factors associated with repeat nonfatal overdose. Repeat overdose rates, by one year after index overdose, were 12.9% of the sample for inpatients and 13.9% of the sample for outpatients. The visit factors (overdose characteristics and comorbidities determined from the initial visit) that the study found to be independently associated with repeat overdoses among inpatients were polysubstance status (HR: 0.88, 95% CI 0.78-0.99), benzodiazepine/polysubstance interaction (HR: 1.29, 95% CI 1.02-1.64), and presence of any mental health disorder (HR: 1.28, 95% CI: 1.18-1.39). For outpatients, the benzodiazepine/polysubstance interaction (HR: 1.21, 95% CI 1.01-1.44) was significant without adjusting for demographic factors. We found evidence that benzodiazepine/polysubstance status and mental health disorders were associated with repeat overdose for inpatients, and that benzodiazepine/polysubstance status was associated with repeat overdose for outpatients. Findings support the need to include polysubstance status and mental health in overdose prevention efforts.
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Affiliation(s)
- Sarah Mayberry
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower, 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States of America
| | - Sarah Nechuta
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower, 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States of America
| | - Shanthi Krishnaswami
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower, 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States of America.
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50
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Havens JR, Knudsen HK, Strickland JC, Young AM, Babalonis S, Lofwall MR, Walsh SL. Recent Increase in Methamphetamine Use in a Cohort of Rural People Who Use Drugs: Further Evidence for the Emergence of Twin Epidemics. Front Psychiatry 2021; 12:805002. [PMID: 35069295 PMCID: PMC8777215 DOI: 10.3389/fpsyt.2021.805002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/16/2021] [Indexed: 01/14/2023] Open
Abstract
Appalachian Kentucky was at the epicenter of the prescription opioid epidemic in the early 2000's. As we enter the third decade of the epidemic, patterns have begun to emerge as people who use drugs (PWUD) transition from use of opioids to other drugs. The purpose of this analysis was to examine longitudinal changes in methamphetamine use in an ongoing cohort of rural people who use drugs (PWUD) in Appalachian Kentucky. All but five of the cohort participants (N = 503) reported nonmedical prescription opioid use (NMPOU) at baseline and those 498 are included in this longitudinal analysis encompassing eight waves of data (2008-2020). Past 6-month use of methamphetamine was the dependent variable. Given the correlated nature of the data, mixed effects logistic regression was utilized to examine changes in methamphetamine use over time. Significant increases in methamphetamine use were observed over the past decade in this cohort of PWUD, especially in recent years (2017-2020). Prevalence of recent use at baseline and each of the follow-up visits was as follows: 9.4, 5.6, 5.0, 5.4, 8.1, 6.8, 6.9, and 33.1%, respectively (p < 0.001). On the contrary, significant reductions in NMPO and heroin use were observed in the same time period. The odds of methamphetamine use at the most recent visit were 25.8 times greater than at baseline (95% CI: 14.9, 44.6) and 52.6% of those reporting methamphetamine use reported injecting the drug. These results provide further evidence of "twin epidemics" of methamphetamine use among NMPOU. While problematic on several fronts, of particular concern is the lack of effective treatment options for methamphetamine use disorder. As policies around the opioid epidemic continue to evolve, particular attention should be paid to the surge in stimulant use in opioid-endemic areas.
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Affiliation(s)
- Jennifer R Havens
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - April M Young
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States.,Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, United States
| | - Shanna Babalonis
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Michelle R Lofwall
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Sharon L Walsh
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
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