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Shearer RD, Hernandez E, Beebe TJ, Virnig BA, Bart G, Winkelman TNA, Bazzi AR, Shippee ND. Providers' Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital. Subst Use Addctn J 2024; 45:250-259. [PMID: 38258816 DOI: 10.1177/29767342231221060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The overdose crisis is increasingly characterized by opioid and stimulant co-use. Despite effective pharmacologic treatment for both opioid use disorder (OUD) and contingency management for stimulant use disorders, most individuals with these co-occurring conditions are not engaged in treatment. Hospitalization is an important opportunity to engage patients and initiate treatment, however existing hospital addiction care is not tailored for patients with co-use and may not meet the needs of this population. METHODS Semi-structured interviews were conducted with hospital providers about their experiences and perspectives treating patients with opioid and stimulant co-use. We used directed content analysis to identify common experiences and opportunities to improve hospital-based treatment for patients with co-use. RESULTS From qualitative interviews with 20 providers, we identified 4 themes describing how co-use complicated hospital-based substance use treatment: (1) patients' unstable circumstances impacting the treatment plan, (2) co-occurring withdrawals are difficult to identify and treat, (3) providers holding more stigmatizing views of patients with co-use, and (4) stimulant use is often "ignored" in the treatment plans. Participants also described a range of potential opportunities to improve hospital-based treatment of co-use that fall into 3 categories: (1) provider practice changes, (2) healthcare system changes, and (3) development and validation of clinical tools and treatment approaches. CONCLUSIONS We identified unique challenges providing hospital addiction medicine care to patients who use both opioids and stimulants. These findings inform the development, implementation, and testing of hospital-based interventions for patients with co-use.
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Affiliation(s)
- Riley D Shearer
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Edith Hernandez
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Timothy J Beebe
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Beth A Virnig
- College of Public Health and Health Professions, University of Florida, Gainsville, FL, USA
| | - Gavin Bart
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Nathan D Shippee
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Shearer RD, Segel JE, Howell BA, Jones AA, Khatri UG, da Silva DT, Vest N, Winkelman TN. Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources-United States, 2010-2019. Med Care 2024; 62:151-160. [PMID: 38180005 PMCID: PMC10922552 DOI: 10.1097/mlr.0000000000001969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources. OBJECTIVE To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances. RESEARCH DESIGN We conducted a longitudinal, cross-sectional analysis comparing trends. SUBJECTS We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files. MEASURES We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019. RESULTS Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. CONCLUSIONS Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.
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Affiliation(s)
- Riley D. Shearer
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joel E. Segel
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA
| | - Benjamin A. Howell
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA
| | - Utsha G. Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Teixeira da Silva
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Noel Vest
- Department of Anesthesia Stanford university School of Medicine, Stanford, CA
| | - Tyler N.A. Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN
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Shearer RD, Shippee ND, Virnig BA, Beebe TJ, Winkelman TN. Characteristics and co-morbidities associated with hospital discharges for opioid and methamphetamine co-use, United States 2016-2019. Drug Alcohol Depend Rep 2024; 10:100219. [PMID: 38356919 PMCID: PMC10864835 DOI: 10.1016/j.dadr.2024.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Introduction The US overdose crisis is increasingly characterized by opioid and methamphetamine co-use. Hospitalization is an important opportunity to engage patients in substance use treatment. Understanding characteristics of co-use-related hospital stays can inform the development of services to better support this growing patient population. Methods We used 2016-2019 National Inpatient Sample data to conduct a cross sectional analysis of hospitalizations involving use of opioids, methamphetamine, or both. We used bivariate analysis to compare patient demographics. We then used multinomial logistic regressions to compare the proportion of hospital stays which indicated co-morbid diagnosis. To account for correlated data, we used generalized linear models to compare outcomes in hospital mortality, patient-directed discharge, and length of stay. Results Co-use-related stays had a higher proportion of co-morbid mental health (60.7%; 95% CI: 59.9-61.4%) and infectious diseases (41.5%; 95% CI: 40.8-42.2%), than opioid- or methamphetamine-related stays. Co-use-related stays increased between 2016 and 2019 and were associated with a higher proportion of patient directed discharge (10.7%; 95% CI: 10.4-11.0%) and longer length of stay (6.3 days; 95% CI: 6.2-6.4 days) compared to opioid (8.1%; 95% CI: 7.9-8.3% and 5.8 days; 95% CI: 5.8-5.9 days) and methamphetamine-related stays (6.5%; 95% CI: 6.3-6.6% and 5.5 days; 95% CI: 5.4-5.5 days). Conclusion Patients discharged with co-use differ from patients with opioid or methamphetamine use alone, representing a range of challenges and opportunities. In addition to offering treatment for both substance use disorders, hospital-based services that address co-occurring conditions may better support patients with co-use through targeted and tailored approaches.
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Affiliation(s)
- Riley D. Shearer
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN, 55455 USA
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN, 55415, USA
| | - Nathan D. Shippee
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN, 55455 USA
| | - Beth A. Virnig
- College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Gainsville, FL, 32611, USA
| | - Timothy J. Beebe
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN, 55455 USA
| | - Tyler N.A. Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN, 55415, USA
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, 716 S 7th St, Minneapolis, MN, 55415, USA
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Segel JE, Shearer RD, Jones AA, Khatri UG, Howell BA, Crowley DM, Sterner G, Vest N, Teixeira da Silva D, Winkelman TNA. Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants. Subst Use Misuse 2024; 59:558-566. [PMID: 38037904 PMCID: PMC10923074 DOI: 10.1080/10826084.2023.2287220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. METHODS A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. RESULTS There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. CONCLUSION Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.
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Affiliation(s)
- Joel E Segel
- Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
| | - Riley D Shearer
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Abenaa A Jones
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
| | - Utsha G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA
| | - D Max Crowley
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
- Evidence-to-Impact Collaborative, Penn State University, University Park, Pennsylvania, USA
| | - Glenn Sterner
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
- Department of Criminal Justice, Penn State Abington, Abington, Pennsylvania, USA
| | - Noel Vest
- Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tyler N A Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Health, Homelessness, and Criminal Justice Laboratory, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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Lindsay AR, Winkelman TNA, Bart G, Rhodes MT, Shearer RD. Hospital Addiction Medicine Consultation Service Orders and Outcomes by Patient Race and Ethnicity in an Urban, Safety-Net Hospital. J Gen Intern Med 2024; 39:168-175. [PMID: 37552419 PMCID: PMC10853106 DOI: 10.1007/s11606-023-08356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Hospital admissions involving substance use disorders are increasing and represent an opportunity to engage patients in substance use treatment. Addiction medicine consultation services improve access to medications for opioid use disorder (MOUD) and patient outcomes. However, as hospitals continue to adopt addiction medicine consultation services it is important to identify where disparities may emerge in the process of care. OBJECTIVE To describe addiction medicine consultation service use by race and ethnicity as well as substance to identify opportunities to reduce substance use treatment disparities. DESIGN Retrospective cohort study using 2016-2021 Electronic Health Record data from a large Midwest safety-net hospital. PARTICIPANTS Hospitalized adults aged 18 or older, with one or more substance use disorders. MAIN MEASURES Consultation orders placed, patient seen by consult provider, and receipt of MOUD by self-reported race. KEY RESULTS Between 2016 and 2021, we identified 16,895 hospitalized patients with a substance use disorder. Consultation orders were placed for 6344 patients and 2789 were seen by the consult provider. Black patients were less likely (aOR = 0.58; 95% CI: 0.53-0.63) to have an addiction medicine consultation order placed and, among patients with a consultation order, were less likely (aOR = 0.74; 95% CI: 0.65-0.85) to be seen by the consult provider than White patients. Overall, Black patients with OUD were also less likely to receive MOUD in the hospital (aOR = 0.63; 95% CI: 0.50-0.79) compared to White patients. However, there were no differences in MOUD receipt among Black and White patients seen by the consult provider. CONCLUSIONS Using Electronic Health Record data, we identified racial and ethnic disparities at multiple points in the inpatient addiction medicine consultation process. Addressing these disparities may support more equitable access to MOUD and other substance use treatment in the hospital setting.
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Affiliation(s)
- Amber R Lindsay
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Tyler N A Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Gavin Bart
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Michael T Rhodes
- Division of Hospital Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Riley D Shearer
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
- Division of Health Policy and Management, School of Public Health, University of Minnesota Medical School, 420 Delaware St. Minneapolis, Minneapolis, DE, 55455, USA.
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Shearer RD, Rossom R, Christine PJ, Hoover M, Bauch J, Bodurtha P, Rai NK, Clegg M, Westgard BC, Ehresmann KR, Leite Bennett A, Winkelman TNA. Minnesota Data Sharing May Be Model For Near-Real-Time Tracking Of Drug Overdose Hospital And ED Trends. Health Aff (Millwood) 2023; 42:1568-1574. [PMID: 37931203 DOI: 10.1377/hlthaff.2023.00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The drug overdose epidemic in the US necessitates detailed and timely data to inform public health responses. In this article we describe how an electronic health record (EHR) data-sharing collaboration across health systems in Minnesota that was developed in response to the COVID-19 pandemic was adapted to monitor trends in substance use-related hospital and emergency department (ED) visits. We found large increases in methamphetamine- and opioid-involved hospital and ED visits. Throughout the study period, Native American, Black, and multiple-race people experienced the highest rates of drug-involved hospital and ED visits. Monitoring drug-involved health care use through EHR data has the potential to help public health officials detect trends in near real time before mortality spikes and may also inform early intervention. The use of EHR data also allows for detailed monitoring of the impact of the drug overdose epidemic across racial and ethnic groups.
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Affiliation(s)
- Riley D Shearer
- Riley D. Shearer, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca Rossom
- Rebecca Rossom, HealthPartners Institute, Bloomington, Minnesota
| | | | - Madison Hoover
- Madison Hoover, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Julie Bauch
- Julie Bauch, Hennepin County Public Health, Minneapolis, Minnesota
| | | | | | | | | | | | | | - Tyler N A Winkelman
- Tyler N. A. Winkelman , Hennepin Healthcare, Minneapolis, Minnesota, and Hennepin Healthcare Research Institute
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Shearer RD, Howell BA, Khatri UG, Winkelman TN. Treatment setting among individuals with opioid use and criminal legal involvement, housing instability, or Medicaid insurance, 2015-2021. Drug Alcohol Depend Rep 2023; 8:100179. [PMID: 37502021 PMCID: PMC10368753 DOI: 10.1016/j.dadr.2023.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Background Individuals with criminal legal involvement (CLI), housing instability, or Medicaid insurance may experience barriers accessing substance use treatment in certain settings. Previous research has found individuals in these groups are less likely to receive medications for opioid use disorder (MOUD), but the role treatment setting may play in low rates of MOUD is unclear. Methods We conducted a cross-sectional study using nationally representative survey data from 2015 to 2021. We estimated the proportion of individuals who had CLI, housing instability, or Medicaid insurance who received substance use treatment in a variety of settings. We used multivariable logistic regressions to estimate the associations between group and the receipt of MOUD across treatment settings. Results Individuals with CLI, housing instability, or Medicaid insurance were more likely to receive substance use treatment in hospitals, rehabilitation, and mental health facilities compared with individuals not in these groups. However, all groups accessed substance use treatment in doctors' offices at similar rates. Treatment at a doctor's office was associated with the highest likelihood of receiving MOUD (aOR 4.73 [95% CI: 2.2.15-10.43]). Across multiple treatment settings, Individuals with CLI or housing instability were less likely to receive MOUD. Conclusions Individuals with CLI, housing instability, or Medicaid insurance are more likely to access substance use treatment at locations associated with lower rates of MOUD use. MOUD access across treatment settings is needed to improve engagement and retention in treatment for patients experiencing structural disadvantage or who have low incomes.
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Affiliation(s)
- Riley D. Shearer
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN 55455, United States
| | - Benjamin A. Howell
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States
| | - Utsha G. Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Tyler N.A. Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
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Jones AA, Shearer RD, Segel JE, Santos-Lozada A, Strong-Jones S, Vest N, Teixeira da Silva D, Khatri UG, Winkelman TNA. Opioid and stimulant attributed treatment admissions and fatal overdoses: Using national surveillance data to examine the intersection of race, sex, and polysubstance use, 1992-2020. Drug Alcohol Depend 2023; 249:109946. [PMID: 37354584 PMCID: PMC10375360 DOI: 10.1016/j.drugalcdep.2023.109946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND We use national surveillance data to evaluate race/ethnicity by sex/gender differences and trends in substance use treatment admissions and overdose deaths involving opioid and stimulant use. METHODS We used data (1992-2019) from the Treatment Episode Dataset-Admissions to identify treatment admissions and the Center for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (1999-2020) to identify overdose deaths. We assessed treatment admissions and related drug overdose deaths per 100,000 adults by sex and race/ethnicity for opioid and stimulant groups: cocaine, opioid, methamphetamines, cocaine and opioid use, cocaine and methamphetamines, and opioid and methamphetamines. RESULTS We found significant variations in treatment admissions and deaths by race/ethnicity and sex/gender. Cocaine-related treatment admissions and deaths were most prevalent among Non-Hispanic Black individuals over the study years, yet lower rates were evident among individuals from other racial/ethnic groups. Notably, Non-Hispanic Black men experienced larger increases in cocaine-only admissions than men of other racial/ethnic groups between 1992 and 2019. Men had higher opioid and stimulant treatment admissions and overdose deaths than women. We observed skyrocketing methamphetamine deaths among American Indian/Native Alaskan men and women from 1992 to 2019. DISCUSSION Steep increases in overdose deaths fueled by methamphetamines among Non-Hispanic Native Americans and cocaine among Non-Hispanic Black individuals suggest a need for more effective interventions to curb stimulant use. Variations by race/ethnicity and sex/gender also suggest interventions should be developed through an intersectionality lens.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA; Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, PA16801, USA.
| | - R D Shearer
- Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - J E Segel
- Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, PA16801, USA; Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA16801, USA; Department of Public Health Sciences, The Pennsylvania State University, University Park, PA16801, USA
| | - A Santos-Lozada
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA
| | - S Strong-Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA
| | - N Vest
- Department of Community and Health Sciences, School of Public Health, Boston University, Boston, MA02118, USA
| | - D Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
| | - U G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - T N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN 55415, USA
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Shearer RD, Jones A, Howell BA, Segel JE, Winkelman TNA. Associations between prescription and illicit stimulant and opioid use in the United States, 2015-2020. J Subst Abuse Treat 2022; 143:108894. [PMID: 36206585 PMCID: PMC9706463 DOI: 10.1016/j.jsat.2022.108894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/09/2022] [Accepted: 09/23/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Overdose deaths involving opioids and stimulants continue to reach unprecedented levels in the United States. Although significant attention has been paid to the relationship between prescription and illicit opioid use, little work has focused on the association between prescription and illicit stimulant use. Thus, this study explores characteristics of those who use or misuse prescription stimulants and/or opioids and associations with use of cocaine, methamphetamine, and heroin. METHODS We used 2015-2020 data from the National Survey on Drug Use and Health. Using adjusted multivariable logistic regression, we estimated the associations between past year prescription stimulant or prescription opioid prescribed use and misuse; various demographic characteristics; and past-year cocaine, methamphetamine, or heroin use. RESULTS From 2015 to 2020, 4.9 and 9.8 million US adults annually reported misusing prescription stimulants and opioids, respectively. Individuals who misused prescription stimulants were more likely to be ages 18-25 (45.8 %; 95 % CI: 44.0-47.5) than individuals who misused prescription opioids (21.7 %; 95 % CI: 20.7-22.7). We observed higher rates of cocaine use among individuals reporting prescription stimulant misuse (12.0 %; 95 % CI: 11.0-12.9) compared to those reporting prescription opioid misuse (5.7 %; 95 % CI: 5.1-6.3, p < 0.001). Heroin use was more common among individuals with prescription opioid misuse (2.1 %; 95 % CI: 1.7-2.2) than prescription stimulant misuse (0.6 %; 95 % CI: 0.4-0.7, p < 0.001). However, rates of methamphetamine use among individuals with prescription stimulant misuse (2.4 %; 95 % CI: 1.9-3.0) did not differ from individuals with prescription opioid misuse (2.1 %; 95 % CI: 1.7-2.5, p = 0.67). CONCLUSIONS Prescription stimulant misuse, compared to prescription opioid misuse, was associated with higher levels of cocaine use but not methamphetamine use. Treatment providers should consider screening for other substance use disorders among people who report prescription stimulant use or misuse. Additional research should seek to understand the mechanism underlying the different associations between prescription stimulant misuse and cocaine or methamphetamine use.
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Affiliation(s)
- Riley D Shearer
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN 55455, USA; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA.
| | - Abenaa Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Benjamin A Howell
- SEICHE Center for Health & Justice, Yale School of Medicine, 333 Cedar St, New Haven 06510, USA; Section of General Internal Medicine, Yale School of Medicine, PO Box 208025, New Haven, CT 06520, USA
| | - Joel E Segel
- Department of Health Policy and Administration, Penn State University, University Park, PA, USA; Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, 716 S 7th St, Minneapolis, MN 55415, USA
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Shearer RD, Winkelman TNA, Khatri UG. State level variation in substance use treatment admissions among criminal legal-referred individuals. Drug Alcohol Depend 2022; 240:109651. [PMID: 36228467 DOI: 10.1016/j.drugalcdep.2022.109651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Individuals involved in the criminal legal system face unique challenges to accessing substance use disorder (SUD) treatment, yet state-level variation in referrals for treatment remains largely unknown. To address disparities in the overdose crisis among individuals with criminal legal involvement, it is important to understand variation in SUD treatment across states. METHODS We conducted a retrospective comparison of substance use treatment referrals from the criminal legal system and other sources across participating states. Using data from the 2018-2019 Treatment Episode Dataset-Admissions, we characterized treatment referral rates from the criminal legal system, the substances most commonly leading to treatment, and rates of treatment with medication for opioid use disorder (MOUD) across states. RESULTS Across all states, criminal legal referral rates were higher than non-criminal legal rates. Criminal-legal referral rates, adjusted for state overdose deaths, were highest in the Northeast and Midwest. Methamphetamine use was the most common substance leading to treatment referral from the criminal legal system in 24 states while opioid use was the most common reason for non-criminal legal referrals in 34 states. In over half the states analyzed, fewer than 10% of opioid treatment referrals from the criminal legal system received MOUD. In almost all states, MOUD was more common in treatment referred from non-criminal legal settings. CONCLUSION State-specific policies and practices shape drug policy and the SUD treatment landscape for people with criminal legal involvement. Standards and ongoing monitoring for substance use treatment referrals from the criminal-legal system should be considered by federal agencies charged with addressing the ongoing overdose crisis.
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Affiliation(s)
- Riley D Shearer
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN 55455, USA; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, 716 S 7th St, Minneapolis, MN 55415, USA
| | - Utsha G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1620, New York, NY 10029, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1077, New York, NY 10029, USA.
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11
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Shearer RD, Bart G, Reznikoff C. Rethinking the Use of "Polysubstance" to Describe Complex Substance Use Patterns. J Gen Intern Med 2022; 37:3174-3175. [PMID: 35112282 PMCID: PMC9485401 DOI: 10.1007/s11606-022-07424-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Riley D Shearer
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Gavin Bart
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Charles Reznikoff
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
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12
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Shearer RD, Vickery KD, Bodurtha P, Drawz PE, Johnson S, Jeruzal J, Waring S, Chamberlain AM, Kharbanda AB, Leopold J, Harrison B, Hiler H, Khazanchi R, Rossom R, Margolis KL, Rai NK, Muscoplat MH, Yu Y, Dudley RA, Klyn NAM, Winkelman TNA. COVID-19 Vaccination Of People Experiencing Homelessness And Incarceration In Minnesota. Health Aff (Millwood) 2022; 41:846-852. [PMID: 35666963 DOI: 10.1377/hlthaff.2021.02030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We used data from a statewide public health-health system collaboration to describe trends in COVID-19 vaccination rates by racial and ethnic groups among people experiencing homelessness or incarceration in Minnesota. Vaccination completion rates among the general population and people incarcerated in state prisons were substantially higher than those among people experiencing homelessness or jail incarceration.
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Affiliation(s)
- Riley D Shearer
- Riley D. Shearer, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | | | | | | | | | - Josh Leopold
- Josh Leopold, Minnesota Department of Health, Saint Paul, Minnesota
| | | | - Hattie Hiler
- Hattie Hiler, Minnesota Housing, Saint Paul, Minnesota
| | - Rohan Khazanchi
- Rohan Khazanchi, University of Nebraska, Omaha, Nebraska; University of Minnesota; Hennepin Healthcare Research Institute
| | - Rebecca Rossom
- Rebecca Rossom, HealthPartners Institute, Bloomington, Minnesota
| | | | | | | | | | | | | | - Tyler N A Winkelman
- Tyler N. A. Winkelman, Hennepin Healthcare, Minneapolis, Minnesota; Hennepin Healthcare Research Institute
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13
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Moitra E, Tao J, Olsen J, Shearer RD, Wood BR, Busch AM, LaPlante A, Baker JV, Chan PA. Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational study. Lancet Reg Health Am 2022; 7:100159. [PMID: 34961858 PMCID: PMC8695134 DOI: 10.1016/j.lana.2021.100159] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Non-emergent clinical services were limited or suspended during the early stages of the coronavirus disease 2019 (COVID-19) pandemic in the United States (U.S.). This could adversely impact epidemics of public health importance, such as HIV, and access to testing, which is a cornerstone of prevention efforts. Methods In this observational study, we collected HIV testing and positivity rate clinical data from four geographically diverse U.S. healthcare systems in New Orleans, Louisiana; Minneapolis, Minnesota; Providence, Rhode Island; and, Seattle, Washington. Data from 2019 to 2020 were examined to assess changes in HIV testing in community-based, emergency department, and outpatient settings. Poisson regression was used to explore trends in HIV testing through phases of the COVID-19 pandemic. Findings In outpatient settings, there was a 68-97% reduction in the number of HIV tests per week during each state's stay-at-home order period, compared to during the pre-stay-at-home order period in early 2020. HIV testing remained reduced 11-54% after states transitioned to advisory phases. The HIV positivity rate increased slightly at outpatient settings, except in New Orleans where it fell. Interpretation We found a concerning trend of substantially decreased HIV testing across four geographically diverse sites. These findings suggest that new HIV infections within the U.S. may be undiagnosed and not yet linked to clinical care and services, as a consequence of the COVID-19 pandemic. Thus, augmented efforts to identify patients and link them to HIV services will be needed as healthcare settings return to full operation. Funding U.S. National Institute of Mental Health.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI 02912, USA
| | - Jun Tao
- Department of Medicine, Brown University, Providence, RI, USA
| | | | - Riley D Shearer
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Brian R Wood
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Andrew M Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Jason V Baker
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
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14
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Shearer RD, Lundberg WJ, Baker JV, Vickery KD. Opportunities for Re-Engaging Persons with HIV in Care at a Health Care System in Minneapolis, Minnesota. AIDS Patient Care STDS 2022; 36:83-85. [PMID: 35180348 PMCID: PMC8971969 DOI: 10.1089/apc.2021.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Riley D. Shearer
- Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.,Address correspondence to: Riley D. Shearer, MSc, Department of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA
| | - William J. Lundberg
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jason V. Baker
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,Department of Medicine, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Katherine Diaz Vickery
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,Department of Medicine, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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15
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Affiliation(s)
- Riley D Shearer
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Becky R Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut
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16
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Shearer RD, Shippee ND, Winkelman TNA. Characterizing trends in methamphetamine-related health care use when there is no ICD code for "methamphetamine use disorder". J Subst Abuse Treat 2021; 127:108369. [PMID: 34134872 PMCID: PMC8217729 DOI: 10.1016/j.jsat.2021.108369] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS The recent surge in methamphetamine use highlights the need for timely data on its health effects and healthcare service use impact. However, there is no ICD code for methamphetamine use. This study quantifies the positive predictive value of ICD-9-CM and ICD-10-CM psychostimulant codes for methamphetamine use. METHODS A retrospective chart review of 220 adults aged 18 and older who had an inpatient admission with a psychostimulant-associated billing diagnosis at an urban safety-net hospital. Diagnoses were categorized as either methamphetamine-related or involving another specific psychostimulant. The positive predictive value of both ICD-9-CM or ICD-10-CM psychostimulant diagnosis codes for methamphetamine use was calculated. RESULTS ICD-9-CM and ICD-10-CM psychostimulant codes had high positive predictive values of 78.2% (95% CI 70.3%-86.0%) and 85.5% (95% CI 78.8%-92.1%), respectively, for methamphetamine use. The most common non-methamphetamine psychostimulant in our cohort was khat, a cathinone-containing plant native to East Africa, accounting for psychostimulant-related diagnosis in 16 of the 220 hospitalizations. CONCLUSIONS The high predictive values of psychostimulant codes for methamphetamine use support the application of administrative data in measuring methamphetamine-related healthcare use, as well as co-morbid health conditions and treatment patterns.
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Affiliation(s)
- Riley D Shearer
- Department of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN 55455, United States of America.
| | - Nathan D Shippee
- Department of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN 55455, United States of America.
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, United States of America; General Internal Medicine, Department of Medicine, Hennepin Healthcare, 715 South 8th Street, Minneapolis, MN 55404, United States of America.
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17
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Khazanchi R, Winkelman TNA, Pandita D, Jelinek R, Shearer RD, Bodurtha PJ. Patient Characteristics and Subsequent Health Care Use by Location of SARS-CoV-2 Testing Initiation in a Safety-Net Health System. JAMA Netw Open 2021; 4:e2112857. [PMID: 34100940 PMCID: PMC8188267 DOI: 10.1001/jamanetworkopen.2021.12857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This cross-sectional study examines patterns in entry location for SARS-CoV-2 testing in a safety-net health system by patient demographic characteristics.
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Affiliation(s)
- Rohan Khazanchi
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- College of Medicine, University of Nebraska Medical Center, Omaha
- School of Public Health, University of Minnesota, Minneapolis
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Deepti Pandita
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
- Division of Clinical Informatics, Hennepin Healthcare, Minneapolis, Minnesota
| | - Ryan Jelinek
- Division of Clinical Informatics, Hennepin Healthcare, Minneapolis, Minnesota
- Division of Hospital Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Riley D Shearer
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- School of Public Health, University of Minnesota, Minneapolis
- University of Minnesota Medical School, Minneapolis
| | - Peter J Bodurtha
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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18
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Shearer RD. Dedicated to whom? Bias in board preparations. Clin Teach 2020; 18:213-214. [PMID: 33043617 DOI: 10.1111/tct.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Riley D Shearer
- University of Minnesota Medical School, Minneapolis, MN, USA
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19
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Shearer RD, Howell BA, Bart G, Winkelman TNA. Substance use patterns and health profiles among US adults who use opioids, methamphetamine, or both, 2015-2018. Drug Alcohol Depend 2020; 214:108162. [PMID: 32652380 PMCID: PMC8147519 DOI: 10.1016/j.drugalcdep.2020.108162] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Methamphetamine use, with and without opioids, has increased substantially, but little is known about the sociodemographic characteristics, substance use patterns, or health profiles of individuals who use methamphetamine. To design effective public health interventions, health care professionals and policymakers need data describing individuals who are using methamphetamine in the midst of the opioid crisis. METHODS We used 2015-2018 data from the National Survey on Drug Use and Health and included non-elderly adults aged 18-64 years. We categorized respondents into three groups: use of opioids without methamphetamine use, use of methamphetamine without opioid use, or use of both opioids and methamphetamine. Multiple logistic regression models controlling for sociodemographic factors were used to compare substance use characteristics and measures of individual health between the three groups. RESULTS People who used any methamphetamine were more likely to be unstably housed, low-income, and live in rural areas. Use of both opioids and methamphetamine was associated with a 132 % higher prevalence of injection needle use, and a nearly twofold higher prevalence of viral hepatitis compared with opioid use alone. One third of individuals reporting use of both opioids and methamphetamine had a severe mental illness, a 55 % higher prevalence than those using opioids alone. CONCLUSIONS Individuals who used opioids and methamphetamine had more complex substance use and health profiles than individuals who used opioids alone. These findings suggest public health and harm reduction approaches designed to address opioid use remain important in an era of rising methamphetamine use.
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Affiliation(s)
- Riley D Shearer
- University of Minnesota Medical School, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN, 55455, USA.
| | - Benjamin A Howell
- National Clinician Scholars Program, Yale School of Medicine, 333 Cedar Street, Sterling Hall of Medicine I-456, New Haven, CT, 06520, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Gavin Bart
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, 914 S 8thSt, Shapiro 1.400, Minneapolis, MN, 55415 USA; Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN, 55415, USA
| | - Tyler N A Winkelman
- Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN, 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, 716 S 7thSt, Minneapolis, MN, 55415, USA
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