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Patocka J, Wu W, Oleksak P, Jelinkova R, Nepovimova E, Spicanova L, Springerova P, Alomar S, Long M, Kuca K. Fentanyl and its derivatives: Pain-killers or man-killers? Heliyon 2024; 10:e28795. [PMID: 38644874 PMCID: PMC11031787 DOI: 10.1016/j.heliyon.2024.e28795] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Fentanyl is a synthetic μ-opioid receptor agonist approved to treat severe to moderate pain with faster onset of action and about 100 times more potent than morphine. Over last two decades, abuse of fentanyl and its derivatives has an increased trend, globally. Currently, the United States (US) faces the most serious situation related to fentanyl overdose, commonly referred to as the opioid epidemic. Nowadays, fentanyl is considered as the number one cause of death for adults aged 18-45 in the US. Synthesis and derivatization of fentanyl is inexpensive to manufacture and easily achievable. Indeed, more than 1400 fentanyl derivatives have been described in the scientific literature and patents. In addition, accessibility and efficacy of fentanyl and its derivatives can play a potential role in misuse of these compounds as a chemical weapon. In this review, the properties, general pharmacology, and overdose death cases associated with fentanyl and selected derivatives are presented. Moreover, current opioid epidemic in the US, Moscow theatre hostage crisis, and potential misuse of fentanyl and its derivatives as a chemical weapon are disclosed.
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Affiliation(s)
- Jiri Patocka
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Wenda Wu
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
- School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China
| | - Patrik Oleksak
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Romana Jelinkova
- NBC Defence Institute, University of Defence, 68201 Vyskov, Czech Republic
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Lenka Spicanova
- Philosophical Faculty, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Pavlina Springerova
- Philosophical Faculty, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Suliman Alomar
- Doping Research Chair, Zoology Department, College of Science, King Saud University, Riyadh-11451, Kingdom of Saudi Arabia
| | - Miao Long
- Key Laboratory of Zoonosis of Liaoning Province, College of Animal Science & Veterinary Medicine, Shenyang Agricultural University, Shenyang 110866, China
| | - Kamil Kuca
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
- Biomedical Research Centre, University Hospital in Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
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Staniorski CJ, Yu M, Sharbaugh D, Stencel MG, Myrga JM, Davies BJ, Yabes JG, Jacobs B. Predictors of persistent opioid use in bladder cancer patients undergoing radical cystectomy: A SEER-Medicare analysis. Urol Oncol 2024:S1078-1439(24)00362-4. [PMID: 38565428 DOI: 10.1016/j.urolonc.2024.03.010] [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] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/19/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To evaluate patient and provider characteristics that predict persistent opioid use following radical cystectomy for bladder cancer including non-opioid naïve patients. METHODS Patients undergoing cystectomy between July 2007 and December 2015 were identified using the SEER-Medicare database. Opioid exposure was identified before and after cystectomy using Medicare Part D data. Multivariable analyses were used to identify predictors of the primary outcomes: persistent opioid use (prescription 3-6 months after surgery) and postoperative opioid prescriptions (within 30 days of surgery). Secondary outcomes included physician prescribing practices and rates of persistent opioid use in their patient cohorts. RESULTS A total of 1,774 patients were included; 29% had prior opioid exposure. Compared to opioid-naïve patients, non-opioid naïve patients were more frequently younger, Black, and living in less educated communities. The percentage of persistent postoperative use was 10% overall and 24% in non-opioid naïve patients. Adjusting for patient factors, opioid naïve individuals were less likely to develop persistent use (OR 0.23) while a 50-unit increase in oral morphine equivalent per day prescribed following surgery nearly doubled the likelihood of persistent use (OR 1.98). Practice factors such as hospital size, teaching affiliation, and hospital ownership failed to predict persistent use. 29% of patients filled an opioid prescription postoperatively. Opioid naïve patients (OR 0.13) and those cared for at government hospitals (OR 0.59) were less likely to fill an opioid script along with those residing in the Northeast. Variability between physicians was seen in prescribing practices and rates of persistent use. CONCLUSIONS Non-opioid naïve patients have higher rates of post-operative opioid prescription than opioid-naïve patients. Physician prescribing practices play a role in persistent use, as initial prescription amount predicts persistent use even in non-opioid naïve patients. Significant physician variation in both prescribing practices and rates of persistent use suggest a role for standardizing practices.
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Affiliation(s)
- Christopher J Staniorski
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213.
| | - Michelle Yu
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
| | - Danielle Sharbaugh
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
| | - Michael G Stencel
- Department of Urology, Charleston Area Medical Center, 3100 MacCorkle Ave Se Suite 602, Charleston, WV 25304
| | - John M Myrga
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
| | - Benjamin J Davies
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
| | - Jonathan G Yabes
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213; Division of Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261
| | - Bruce Jacobs
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
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Hanson BL, Finley K, Otto J, Ward NJ, Banik S. Community Support for Harm Reduction and Treatment of Opioid Use Disorder. J Community Health 2024:10.1007/s10900-023-01278-6. [PMID: 38409628 DOI: 10.1007/s10900-023-01278-6] [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] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 02/28/2024]
Abstract
As the opioid epidemic continues, availability of evidence-based strategies for harm reduction and treatment in communities is critical to reduce overdose and other consequences of opioid use disorder. Community members' support of harm reduction and treatment services is needed for new programs and to maintain existent programs. This study sought to understand beliefs and attitudes associated with support for three community-based strategies to address opioid misuse and addiction: naloxone, needle exchange, and medication-assisted treatment. We conducted a cross-sectional online survey with 545 adults. Results of the survey showed that participants supported all three strategies, with the strongest support for medication-assisted treatment. Multiple regression showed that stigma and perceived stigma were significant predictors for all three strategies, with inverse relationships. Stigmatizing beliefs predicted less support while perceiving stigma among others was associated with greater support for the strategies. Normative beliefs also significantly predicted support for all three strategies, such that stronger belief that others were supportive of each strategy was associated with greater support for that strategy. Other predictors varied across the three strategies. Support for harm reduction and treatment programs in communities affected by the opioid epidemic may be bolstered by reducing stigma and increasing normative beliefs. Stronger support for medication-assisted treatment may be leveraged and extended to harm reduction strategies. Results of our study contribute insights for bolstering community support for harm reduction and treatment, which is vital for adoption and maintenance of these important programs.
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Affiliation(s)
- Bridget L Hanson
- Center for Health and Safety Culture, Montana State University, P.O. Box 170548, Bozeman, MT, 59717, USA.
| | - Kari Finley
- Center for Health and Safety Culture, Montana State University, P.O. Box 170548, Bozeman, MT, 59717, USA
| | - Jay Otto
- Center for Health and Safety Culture, Montana State University, P.O. Box 170548, Bozeman, MT, 59717, USA
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Barsh D, Awuonda M, McCants T, Daftary M, Wingate L, Ettienne E, Chapman E, Lyons J. National trends in reported past year opioid misuse among black women. J Natl Med Assoc 2024:S0027-9684(24)00027-0. [PMID: 38413269 DOI: 10.1016/j.jnma.2024.01.027] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The opioid crisis within the United States has been widely studied; however, some gaps within the literature still exist. There is limited information on trends in opioid misuse as it relates to income among a national sample of Black Women. Given the recent increase in opioid overdose deaths in Black Americans and the vulnerability of women who misuse opioids, research in this population is important. OBJECTIVE The objective of this study is to evaluate trends of past year opioid misuse (PYOM) among Black women by income over the study period. METHODS A cross-sectional study among adult aged Black women captured in the National Survey on Drug Use and Health (NSDUH) from 2015 to 2019 was conducted. Descriptive statistics for all study variables was conducted. Weighted logistic regression analyses were conducted to evaluate predictors of PYOM. A stratified analysis was also conducted to examine possible differences between income strata on predictors of PYOM. RESULTS A total of 15,196 Black women were included in the study (16,008,921 weighted visits). Among the women included, 41.5% were age 50+, 57.7% were unemployed, 63.8% reported very good/good health, 59.5% had past year alcohol use, 44.1% had never been married, 39.1% received government assistance, and 90.1% resided in a metro area. An estimated 3.14% of Black women reported PYOM. Findings from the regression analysis showed that Black women who were between 18 and 25, had past year major depressive episode, had alcohol use, illicit drug use, and who received government assistance had significantly greater odds of PYOM. Those reporting an excellent general health rating and higher education had significantly lower odds of PYOM. Income was not associated with PYOM in this study. CONCLUSION Overall, income was not found to be a significant predictor of PYOM. However, income was found to modify the effects of major depressive episode and alcohol use on PYOM, especially among Black women who reported earning ≥$75,000/year. These findings suggest that high-earning Black women may be just as at risk for opioid misuse as low-earning Black women. Further studies are warranted to explore these effects among other gender/racial groups to determine if this trend is unique to Black women.
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Affiliation(s)
- Debbynie Barsh
- Howard University College of Pharmacy, 2300 4th Street, NW, Washington, DC 20059, United States
| | - Mary Awuonda
- Howard University College of Pharmacy, 2300 4th Street, NW, Washington, DC 20059, United States.
| | - Tamara McCants
- Howard University College of Pharmacy, 2300 4th Street, NW, Washington, DC 20059, United States
| | - Monika Daftary
- Howard University College of Pharmacy, 2300 4th Street, NW, Washington, DC 20059, United States
| | - La'Marcus Wingate
- Howard University College of Pharmacy, 2300 4th Street, NW, Washington, DC 20059, United States
| | - Earl Ettienne
- Howard University College of Pharmacy, 2300 4th Street, NW, Washington, DC 20059, United States
| | - Edwin Chapman
- Howard University College of Medicine, 520 W Street, NW, Washington, DC 20059, United States
| | - Jessica Lyons
- Howard University College of Pharmacy, 2300 4th Street, NW, Washington, DC 20059, United States
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Bradford W, Figgatt M, Scott KS, Marshall S, Eaton EF, Dye DW. Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data. Harm Reduct J 2024; 21:46. [PMID: 38378660 PMCID: PMC10880285 DOI: 10.1186/s12954-024-00959-2] [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] [Received: 12/19/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Xylazine is a dangerous veterinary sedative found mainly in illicit fentanyl in the Northeast and Midwest. Its role in the Deep South overdose crisis is not well-characterized. METHODS We conducted a retrospective review of autopsy data in Jefferson County, Alabama to identify trends in xylazine prevalence among people who fatally overdosed from June 2019 through June 2023. RESULTS 165 decedents met inclusion criteria. While the first identified xylazine-associated overdose was in June 2019, xylazine has become consistently prevalent since January 2021. All cases of xylazine-associated fatal overdoses were accompanied by fentanyl, and most (75.4%) involved poly-drug stimulant use. The average age was 42.2, and most decedents were white (58.8%) and male (68.5%). Overall, 18.2% of people were unhoused at the time of death. DISCUSSION Xylazine is prevalent in the Deep South. Efforts to promote harm reduction, publicly viewable drug supply trends, and legalization of drug checking and syringe service programs should be prioritized.
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Affiliation(s)
- William Bradford
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Diabetes Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA.
| | - Mary Figgatt
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Diabetes Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
| | - Karen S Scott
- Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, USA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, USA
| | - Stacy Marshall
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Ellen F Eaton
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Diabetes Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
| | - Daniel W Dye
- Jefferson County Coroner/Medical Examiner's Office, Birmingham, USA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, USA
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Siddiqui ST, La Manna A, Connors E, Smith R, Vance K, Budesa Z, Goulka J, Beletsky L, Wood CA, Marotta P, Winograd RP. An evaluation of first responders' intention to refer to post-overdose services following SHIELD training. Harm Reduct J 2024; 21:39. [PMID: 38351046 PMCID: PMC10863209 DOI: 10.1186/s12954-024-00957-4] [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] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND First responders [law enforcement officers (LEO) and Fire/Emergency Medical Services (EMS)] can play a vital prevention role, connecting overdose survivors to treatment and recovery services. This study was conducted to examine the effect of occupational safety and harm reduction training on first responders' intention to refer overdose survivors to treatment, syringe service, naloxone distribution, social support, and care-coordination services, and whether those intentions differed by first responder profession. METHODS First responders in Missouri were trained using the Safety and Health Integration in the Enforcement of Laws on Drugs (SHIELD) model. Trainees' intent to refer (ITR) overdose survivors to prevention and supportive services was assessed pre- and post-training (1-5 scale). A mixed model analysis was conducted to assess change in mean ITR scores between pre- and post-training, and between profession type, while adjusting for random effects between individual trainees and baseline characteristics. RESULTS Between December 2020 and January 2023, 742 first responders completed pre- and post-training surveys. SHIELD training was associated with higher first responders' intentions to refer, with ITR to naloxone distribution (1.83-3.88) and syringe exchange (1.73-3.69) demonstrating the greatest changes, and drug treatment (2.94-3.95) having the least change. There was a significant increase in ITR score from pre- to post-test (β = 2.15; 95% CI 1.99, 2.30), and LEO-relative to Fire/EMS-had a higher score at pre-test (0.509; 95% CI 0.367, 0.651) but a lower score at post-test (0.148; 95% CI - 0.004, 0.300). CONCLUSION Training bundling occupational safety with harm reduction content is immediately effective at increasing first responders' intention to connect overdose survivors to community substance use services. When provided with the rationale and instruction to execute referrals, first responders are amenable, and their positive response highlights the opportunity for growth in increasing referral partnerships and collaborations. Further research is necessary to assess the extent to which ITR translates to referral behavior in the field.
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Affiliation(s)
- Saad T Siddiqui
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA.
| | - Anna La Manna
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Elizabeth Connors
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Ryan Smith
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Kyle Vance
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Zach Budesa
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Jeremiah Goulka
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Leo Beletsky
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Phillip Marotta
- Department of Social Work, Brown School, Washington University in St. Louis, St. Louis, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
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Gjorgjievski M, Madden K, Bullen C, Koziarz F, Koziarz A, Cenic A, Li S, Bhandari M, Johal H. Perceptions in orthopedic surgery on the use of cannabis in treating pain: a survey of patients with spine pain (POSIT Spine). J Orthop Surg Res 2024; 19:97. [PMID: 38291451 PMCID: PMC10825977 DOI: 10.1186/s13018-024-04558-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Back pain is the leading cause of disability worldwide. Despite guidelines discouraging opioids as first-line treatment, opioids remain the most prescribed drugs for back pain. There is renewed interest in exploring the potential medical applications of cannabis, and with the recent changes in national legislation there is a unique opportunity to investigate the analgesic properties of cannabis. METHODS This was a multi-center survey-based study examining patient perceptions regarding cannabis for spine pain. We included patients presenting with back or neck pain to one of three Orthopedic clinics in Ontario. Our primary outcome was perceived effect of cannabis on back pain, while secondary outcomes were perceptions regarding potential applications and barriers to cannabis use. RESULTS 259 patients participated in this study, 35.3% (90/255) stating they used cannabis medically. Average pain severity was 6.5/10 ± 0.3 (95% CI 6.2-6.8). Nearly three-quarters were prescribed opioids (73.6%, 148/201), with oxycodone/oxycontin (45.9% 68/148) being the most common, and almost half of (49.3%, 73/148) had used an opioid in the last week. Patients estimated cannabis could treat 54.3% ± 4.0 (95% CI 50.3-58.3%) of their spine pain and replace 46.2% ± 6. 6 (95% CI 39.6-52.8%) of their current analgesics. Age (β = - 0.3, CI - 0.6-0.0), higher pain severity (β = 0.4, CI 0.1-0.6) and previous cannabis use (β = 14.7, CI 5.1-24.4) were associated with a higher perceived effect of cannabis. Patients thought cannabis would be beneficial to treat pain (129/146, 88.4%), and reduce (116/146, 79.5%) or eliminate opioids (102/146, 69.9%). Not considering using cannabis for medical purposes (65/150, 43.3%) was the number one reported barrier. CONCLUSIONS Patients estimated medical cannabis could treat more than half of their spine pain, with one in three patients already using medical cannabis. 79% of patients also believe cannabis could reduce opioid usage. This data will help support more research into cannabis for musculoskeletal pain.
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Affiliation(s)
- Marko Gjorgjievski
- Division of Orthopedic Surgery, Department of Surgery, Victory 3, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Kim Madden
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Conner Bullen
- Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Frank Koziarz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Alex Koziarz
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Aleksa Cenic
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Division of Neurosurgery, Department of Surgery, McMaster, University, Hamilton, Canada
| | - Silvia Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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McCormick KA, Stanton MC, Ali SB. A Mixed Methods Analysis of Southern HIV Service Organizations' Implementation of Harm Reduction to Address the HIV and Opioid Syndemic. J Behav Health Serv Res 2024; 51:44-56. [PMID: 37697180 DOI: 10.1007/s11414-023-09859-y] [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] [Accepted: 08/08/2023] [Indexed: 09/13/2023]
Abstract
Southern HIV Service Organizations (SHSOs) are promising sites for the adoption and implementation of harm reduction as a means for addressing the HIV and opioid syndemic. However, little research to date has examined exactly how harm reduction is operationalized within and among SHSOs. Using program evaluation data (i.e., organizational assessment data and semi-structured qualitative group interview data with SHSO staff), this study aimed to characterize organizational implementation of harm reduction among SHSOs that sought harm reduction capacity-building assistance (i.e., training, coaching, funding) from the SUSTAIN Center. Authors utilized a convergent mixed methods design in which quantitative and qualitative approaches were employed in parallel to gain simultaneous insights into how harm reduction was operationalized in SHSOs and how the local context influenced implementation. Means and proportions of each organizational assessment domain were compared. Thematic analysis of group interview transcripts examined SHSO staff perceptions of harm reduction implementation in their respective communities. Quantitative results revealed that SHSOs most commonly operationalize harm reduction in the Outreach, Advocacy, and Principles domains but struggle to do so in terms of Services and Organizational Infrastructure. Qualitative results revealed that various factors in SHSOs' local context, such as the community's lack of knowledge and understanding of harm reduction, limited harm reduction services, and a challenging socio-political context, influence SHSOs implementation of harm reduction. Taken together, analyses reveal that (1) SHSOs expend significant effort conducting outreach activities because Southern communities are generally unaware of harm reduction, (2) SHSOs continually advocate for harm reduction in the midst of a challenging socio-political context, and (3) SHSOs offer fewer harm reduction services and integrate harm reduction into their organizational infrastructure to a lesser extent due to external, contextual factors. The combination of organizational-level data and SHSO staff insights provided by this mixed methods study have implications for policy advocacy, funding initiatives, and capacity-building efforts.
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Affiliation(s)
- Katie A McCormick
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - Megan C Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA
| | - Samira B Ali
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX, 77204, USA
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Palau CB, Akikuni M, Latsky-Campbell B, Wagner J. The Drug Overdose Epidemic in the U.S.-Mexico Border Region: Shifts, Progression, and Community Characteristics. Subst Use Misuse 2023; 59:184-192. [PMID: 37888899 DOI: 10.1080/10826084.2023.2267110] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVE Previous studies show the reach of the current drug overdose epidemic into the U.S.-Mexico border region, albeit with a unique border-specific wave pattern compared to national waves and a delayed onset of fentanyl involvement (Wave I: 2002-2011, Wave II: 2012-2016, and Wave III: since 2017). The objective of this study is to examine the community predictors and the progression of overdose deaths across the U.S-Mexico border-specific epidemic waves. METHOD Descriptive epidemiological profile of border communities across the unfolding of the opioid epidemic, integrated data from the CDC-WONDER multiple causes of death data set, the CDC SVI, Uniform Crime Report, and the Behavioral Risk Factor Surveillance System. Using spatially adjusted Bayes rates by border-specific epidemic waves, we provide a descriptive profile of the spatial unfolding of the drug overdose epidemic. Negative binomial regression models assessed community predictors of overdose deaths across waves. RESULTS Spatial analysis identified moderate to steep increases in drug overdose deaths over the three waves along the border. The impact and unfolding of the epidemic in the U.S.-Mexico border region were not uniform and affecting communities with differing severity and timing. Our study also finds support for social vulnerability and community violence as predictors of overdose deaths over the current wave of the epidemic. CONCLUSION Findings suggest that more disadvantaged U.S.-Mexico border communities may encounter increasing rates of overdose death over the coming years. Interventions need to target not only the supply side but also the underlying social root causes for sustainable overdose prevention.
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Affiliation(s)
- Citlaly B Palau
- Department of Social Sciences, Texas A&M International University, Laredo, Texas, USA
| | - Mika Akikuni
- Department of Social Sciences, Texas A&M International University, Laredo, Texas, USA
| | | | - Jascha Wagner
- Department of Social Sciences, Texas A&M International University, Laredo, Texas, USA
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Knudsen HK, Freeman PR, Oyler DR, Oser CB, Walsh SL. Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a "hub with many spokes" model. Addict Sci Clin Pract 2023; 18:72. [PMID: 38031180 PMCID: PMC10688494 DOI: 10.1186/s13722-023-00426-6] [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] [Received: 05/15/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Scaling up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, in communities remains a challenge. Novel models and intentional implementation strategies are needed. Drawing upon the EPIS model's phases of Exploration, Preparation, Implementation, and Sustainment (Aarons et al. in Adm Policy Ment Health 38:4-23, 2011), this paper describes the development of the University of Kentucky's unique centralized "Naloxone Hub with Many Spokes" approach to implementing OEND as part of the HEALing Communities Study (HCS-KY). METHODS To scale up OEND in eight Kentucky counties, implementation strategies were utilized at two levels: a centralized university-based naloxone dispensing unit ("Naloxone Hub") and adopting organizations ("Many Spokes"). Implementation strategies varied across the EPIS phases, but heavily emphasized implementation facilitation. The Naloxone Hub provided technical assistance, overdose education resources, and no-cost naloxone to partner organizations. Implementation outcomes across the EPIS phases were measured using data from internal study management trackers and naloxone distribution data submitted by partner organizations. RESULTS Of 209 organizations identified as potential partners, 84.7% (n = 177) engaged in the Exploration/Preparation phase by participating in an initial meeting with an Implementation Facilitator about the HCS-KY OEND program. Adoption of the HCS-KY OEND program, defined as receipt of at least one shipment of naloxone, was achieved with 69.4% (n = 145) of all organizations contacted. During the Implementation phase, partner organizations distributed 40,822 units of naloxone, with partner organizations distributing a mean of 281.5 units of naloxone (SD = 806.2). The mean number of units distributed per county was 5102.8 (SD = 3653.3; range = 1057 - 11,053) and the mean county level distribution rate was 8396.5 units per 100,000 residents (SD = 8103.1; range = 1709.5-25,296.3). Of the partner organizations that adopted the HCS-KY OEND program, 87.6% (n = 127) attended a sustainability meeting with an Implementation Facilitator and agreed to transition to the state-funded naloxone program. CONCLUSIONS These data demonstrate the feasibility of this "Hub with Many Spokes" model for scaling up OEND in communities highly affected by the opioid epidemic. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA.
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science and Center for the Advancement of Pharmacy Practice, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, and Center for Health Equity Transformation, University of Kentucky, Lexington, KY, 40536, USA
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA
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11
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Renda S, Eshkevari L, Glymph D, Knestrick J, Lundy KS, Ortiz M, Sharp D, Solari-Twadell PA, Valentine NM. Mobilizing nurses to address the opioid misuse epidemic. Nurs Outlook 2023; 71:102033. [PMID: 37769501 DOI: 10.1016/j.outlook.2023.102033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The opioid epidemic is a major health challenge in the United States. PURPOSE Members from the American Academy of Nursing joined to write a consensus paper about nurses' role in the opioid epidemic. METHODS The panel reviewed the history of the opioid epidemic and policies to care for patients with opioid use disorder (OUD) and how registered nurses (RNs) and advanced practice nurses (APRNs) could increase care for people with OUD. DISCUSSION Recommendations are presented to advance policies that empower RNs and APRNs to abate the opioid epidemic. CONCLUSION Recommendations include (a) advance legislation that supports RNs and APRNs full scope of practice and expands professional role in pain management and addiction prevention; (b) evaluate effective policies that promote RN and APRN care; support federal elimination of X-waiver with state law alignment; (c) sustain the use of nurses in telemedicine; (d) support nursing research on nurse involvement in all aspects of OUD.
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Affiliation(s)
- Susan Renda
- Primary Care Expert Panel, American Academy of Nursing, Washington, DC.
| | - Ladan Eshkevari
- Psychiatric, Mental Health, and Substance Use Expert Panel, American Academy of Nursing, Washington, DC
| | - Derrick Glymph
- Psychiatric, Mental Health, and Substance Use Expert Panel, American Academy of Nursing, Washington, DC
| | - Joyce Knestrick
- Primary Care Expert Panel, American Academy of Nursing, Washington, DC
| | | | - Mario Ortiz
- Primary Care Expert Panel, American Academy of Nursing, Washington, DC
| | - Daryl Sharp
- Psychiatric, Mental Health, and Substance Use Expert Panel, American Academy of Nursing, Washington, DC
| | | | - Nancy M Valentine
- Psychiatric, Mental Health, and Substance Use Expert Panel, American Academy of Nursing, Washington, DC
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12
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Sud A, Chiu K, Friedman J, Dupouy J. Buprenorphine deregulation as an opioid crisis policy response - A comparative analysis between France and the United States. Int J Drug Policy 2023; 120:104161. [PMID: 37619440 DOI: 10.1016/j.drugpo.2023.104161] [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] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND In passing the Maintstreaming Addiction Treatment Act, the United States has abolished its federal X waiver, considered a major barrier to the wider buprenorphine prescribing needed to respond to opioid-related harms. Advocates for this policy have drawn on the French response of deregulating buprenorphine prescribing to address increasing overdose mortality around the turn of the millennium. So far, such policy advocacy has incompletely accounted for contextual and health system differences between the two countries. METHODS Using the health system dynamics framework, this analysis compares France from 1995 to 2003 (the relevant period of buprenorphine reform) to the US from 2018 until today (the comparison period to explore potential impacts of reform). We used it to guide examination of a) contextual issues relating to opioid use epidemiology and b) health system factors including prescriber supply, sector organization, and insurance coverage for primary care to draw relevant policy learning for the contemporary US. RESULTS We identified that the US had a 22.5-fold higher mortality rate and a 2.3-fold higher opioid use disorder (OUD) rate compared to France, despite having rates of prescribed buprenorphine per-capita higher than, and per-person with OUD comparable to, than that of France. These wide gulfs between the scales and nature of the problems between France and the US suggest that relaxing restrictions on buprenorphine prescribing through abolishing the X waiver will be insufficient for achieving hoped-for reductions in overdose mortality. CONCLUSION Health system strengthening with a focus on improvements in primary care prescriber supply, coverage, and coordination are likely higher yield policy complements to relaxing buprenorphine regulation. Such an approach would better prepare the US to adapt to ongoing dynamics and uncertainties in the opioid crisis and to optimize the already relatively high levels of buprenorphine prescribing.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Humber River Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Kellia Chiu
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, United States
| | - Julie Dupouy
- University Department of General Medicine, University of Toulouse, Faculty of Medicine, Toulouse, France; Inserm UMR1295, University of Toulouse III, Faculty of Medicine, Toulouse, France
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13
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Stolbach AI, Mazer-Amirshahi M, Cienki J, Dye LR, Nelson LS, Marino R, Weiss ST, Warrick BJ, Wax PM. ACMT Position Statement: Role of the Medical Toxicologist in the Management of Patients with Substance Use Disorder. J Med Toxicol 2023; 19:411-413. [PMID: 37415025 PMCID: PMC10522538 DOI: 10.1007/s13181-023-00945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
| | | | | | - Leslie R Dye
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | | | - Ryan Marino
- Departments of Emergency Medicine & Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Stephanie T Weiss
- National Institute On Drug Abuse, Bethesda, MD, USA
- National Institutes of Health, Bethesda, MD, USA
| | | | - Paul M Wax
- American College of Medical Toxicology, Phoenix, AZ, USA
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14
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Lepore M, Hessler J, Mitchell A, Kameg B, Howe R, Cassidy C, Germack H. The impact of syringe decriminalization within the Pennsylvania harm reduction community. Arch Psychiatr Nurs 2023; 46:26-32. [PMID: 37813500 DOI: 10.1016/j.apnu.2023.06.017] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/21/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Syringe decriminalization is a harm reduction approach to decrease deaths and disease related to drug use. The purpose of this study was to develop an understanding of the impact of syringe decriminalization on the harm reduction community in Pennsylvania. METHODS Semi-structured interviews were conducted with ten participants identified as harm reduction experts. ANALYSIS Narrative content analysis to the point of thematic saturation was used to generate themes around harm reduction and syringe decriminalization in Pennsylvania, specifically the meaning of harm reduction, the importance of harm reduction, and the opinions on syringe decriminalization. RESULTS The following themes reflect the meaning of harm reduction: human compassion; meeting people where they are at; minimizing the risk; and shifting power to the person. The themes of being personally impacted, human compassion, innate imperfection, and respecting human autonomy reflect why participants care about harm reduction. All ten participants support syringe decriminalization in Pennsylvania citing the following rationales: improved health outcomes; decreased costs to society; less involvement of the criminal justice system; and increased engagement into treatment. CONCLUSIONS Harm reduction is a pioneering approach to drug use that empowers individuals to make positive impacts in their lives. Harm reduction experts in Pennsylvania support syringe decriminalization as a cost-effective way to increase the engagement and improve health outcomes of people who use drugs.
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Affiliation(s)
| | | | - Ann Mitchell
- University of Pittsburgh, United States of America.
| | | | - Ryan Howe
- Main Line Health, United States of America.
| | | | - Hayley Germack
- The Janssen Pharmaceutical Companies of Johnson & Johnson, United States of America
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15
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Hootsmans N, Parmiter S, Connors K, Badve SB, Snyder E, Turcotte JJ, Jayaraman SS, Zahiri HR. Outcomes of an enhanced recovery after surgery (ERAS) program to limit perioperative opioid use in outpatient minimally invasive GI and hernia surgeries. Surg Endosc 2023; 37:7192-7198. [PMID: 37353653 DOI: 10.1007/s00464-023-10217-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Perioperative pain management is important for patient satisfaction while returning to homeostasis in the safest way possible. Studies show that patients don't require as much opioids as once thought. The benefits of ERAS pathways extend beyond enhancement of patients' perioperative experience, and include reducing opioid prescriptions in the face of the ongoing nationwide opioid crisis and evidence of prescription opioids as a contributor. METHODS We performed a retrospective cohort study of patients undergoing same day minimally invasive surgery (MIS) procedures for GI and hernia disease using a minimal-opioid ERAS protocol at two community hospitals between January 2020 and May 2022. We included elective laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) for acute appendicitis without perforation, and minimally invasive (laparoscopic and robotic) inguinal and ventral hernia repair or abdominal wall reconstruction (AWR). Primary outcome was postoperative opioid use. RESULTS A total of 509 patients were included, undergoing procedures of MIS hernia repair (52.5%), LC (43.6%), and LA (7.9%). Only 9.4% of patients received opioid prescriptions at discharge, with no difference between groups. Among the patients receiving a prescription at discharge, there was a significant difference in morphine milligram equivalents (MME) prescribed (25.0 ± 0.0 in the LA group, 65.0 ± 41.4 in the LC group, 100.6 ± 46.2 in the MIS hernia/AWR group; P = 0.015). Nine percent of patients called with pain management concerns postoperatively. ASA score ≥ 3 was associated with increased odds for postoperative opioid prescription (OR 2.084; P = 0.014). CONCLUSIONS We demonstrate that an opioid-sparing ERAS program effectively manages pain for patients undergoing multiple outpatient MIS GI/hernia procedures, and suggests generalizability across a diverse range of operations. Therefore, the use of ERAS may safely and effectively expand beyond inpatient MIS and open surgeries that target reduced length of stay to also minimize opioids for outpatient procedures.
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Affiliation(s)
- Norbert Hootsmans
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA.
| | - Sara Parmiter
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Kevin Connors
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Shivani B Badve
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Elise Snyder
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Justin J Turcotte
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | | | - H Reza Zahiri
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
- Luminis Health Doctors Community Medical Center, Lanham, MD, USA
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16
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Betts AC, Murphy CC, Shay LA, Balasubramanian BA, Markham C, Allicock M. Polypharmacy and prescription medication use in a population-based sample of adolescent and young adult cancer survivors. J Cancer Surviv 2023; 17:1149-1160. [PMID: 34997910 PMCID: PMC10614319 DOI: 10.1007/s11764-021-01161-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 09/22/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined prescription medication use and identified correlates of polypharmacy-taking multiple medications-in adolescent and young adult cancer survivors (AYAs), who experience early-onset chronic conditions. METHODS Our cross-sectional study pooled data (2008-2017) from the national Medical Expenditure Panel Survey. We estimated prevalence of polypharmacy (≥ 5 unique prescription medications over an approximate 1-year period) in AYAs (age 18-39 years with a history of cancer) and age- and sex-matched controls, overall and by sociodemographics, clinical factors, and health indicators. We compared survivors' and controls' medication use across therapeutic classes. To identify correlates of polypharmacy among AYAs, we included factors with p < 0.20 in bivariable analysis in a multivariable logistic regression model. RESULTS AYAs (n = 601) had a higher prevalence of polypharmacy than controls (n = 2,402), overall (31.5% vs. 15.9%, p < .01) and by all sociodemographics, clinical factors, and health indicators. A majority of AYAs with multiple chronic conditions (58.8%, 95% CI 47.3-70.4) or disability (61.3%, 95% CI 52.6-70.0) had polypharmacy. Patterns of AYAs' medication use across therapeutic classes were consistent with their chronic conditions. Nearly one-third used opioid/narcotic analgesics (32.2% vs. 13.7% of controls, p < 0.01). Among AYAs, multiple chronic conditions (aOR 4.68, 95% CI 2.23-9.83) and disability (aOR 3.70, 95% CI 2.23-6.14) were correlated with polypharmacy. CONCLUSIONS Chronic conditions and disabilities, including aftereffects of cancer treatment, may drive polypharmacy in AYAs. Future research should examine adverse outcomes of polypharmacy and opioid/narcotic use in AYAs. IMPLICATIONS FOR CANCER SURVIVORS AYAs with chronic conditions or disabilities should be monitored for polypharmacy.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston (UTHealth), 2777 N. Stemmons Fwy., Ste. 8400, Dallas, TX, 75207, USA.
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, San Antonio, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston (UTHealth), 2777 N. Stemmons Fwy., Ste. 8400, Dallas, TX, 75207, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
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Kohli S, Garg J, Velasquez DE, Weiner SG. Designing a public access naloxone program for public transportation stations. Healthc (Amst) 2023; 11:100694. [PMID: 37247465 DOI: 10.1016/j.hjdsi.2023.100694] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
The opioid overdose epidemic has caused over 600,000 deaths in the U.S. since 1999. Public access naloxone programs show great potential as a strategy for reducing opioid overdose-related deaths. However, their implementation within public transit stations, often characterized as opioid overdose hotspots, has been limited, partly because of a lack of understanding in how to structure such programs. Here, we propose a comprehensive framework for implementing public access naloxone programs at public transit stations to curb opioid overdose-related deaths. The framework, tailored to local contexts, relies on coordination between local public health organizations to provide naloxone at public access points and bystander training, local academic institutions to oversee program evaluation, and public transit organizations to manage naloxone maintenance. We use the city of Cambridge, Massachusetts as a case study to demonstrate how it and other municipalities may implement such an initiative.
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Affiliation(s)
| | | | - David E Velasquez
- Harvard Medical School, USA; Harvard Business School, USA; Harvard Kennedy School of Government, USA
| | - Scott G Weiner
- Harvard Medical School, USA; Brigham and Women's Hospital, USA.
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18
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Yücel SG, Higgins CD, Gupta K, Palm M. Public transport access to drug treatment before and during COVID-19: Implications for the opioid epidemic. Int J Drug Policy 2023; 116:104032. [PMID: 37172439 PMCID: PMC10130333 DOI: 10.1016/j.drugpo.2023.104032] [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] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
Public transport disruptions caused by the COVID-19 pandemic had wide-ranging impacts on the ability of individuals to access health care. Individuals with opioid use disorder represent an especially vulnerable population due to the necessity of frequent, supervised doses of opioid agonists. Focused on Toronto, a major Canadian city suffering from the opioid epidemic, this analysis uses novel realistic routing methodologies to quantify how travel times to individuals\220 nearest clinics changed due to public transport disruptions from 2019 to 2020. Individuals seeking opioid agonist treatment face very constrained windows of access due to the need to manage work and other essential activities. We find that thousands of households in the most materially and socially deprived neighbourhoods crossed 30 and 20-minute travel time thresholds to their nearest clinic. As even small changes to travel times can lead to missed appointments and heighten the chances of overdose and death, understanding the distribution of those most impacted can help inform future policy measures to ensure adequate access to care.
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Affiliation(s)
- Shiv Gazi Yücel
- Transport Studies Unit, School of Geography and the Environment, University of Oxford, Oxford, United Kingdom.
| | | | - Kumar Gupta
- Office of the Chief Coroner of Ontario, Canada
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Butler C, Stechlinski P. Modeling Opioid Abuse: A Case Study of the Opioid Crisis in New England. Bull Math Biol 2023; 85:45. [PMID: 37088864 PMCID: PMC10122875 DOI: 10.1007/s11538-023-01148-1] [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] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
For the past two decades, the USA has been embroiled in a growing prescription drug epidemic. The ripples of this epidemic have been especially apparent in the state of Maine, which has fought hard to mitigate the damage caused by addiction to pharmaceutical and illicit opioids. In this study, we construct a mathematical model of the opioid epidemic incorporating novel features important to better understanding opioid abuse dynamics. These features include demographic differences in population susceptibility, general transmission expressions, and combined consideration of pharmaceutical opioid and heroin abuse. We demonstrate the usefulness of this model by calibrating it with data for the state of Maine. Model calibration is accompanied by sensitivity and uncertainty analysis to quantify potential error in parameter estimates and forecasts. The model is analyzed to determine the mechanisms most influential to the number of opioid abusers and to find effective ways of controlling opioid abuse prevalence. We found that the mechanisms most influential to the overall number of abusers in Maine are those involved in illicit pharmaceutical opioid abuse transmission. Consequently, preventative strategies that controlled for illicit transmission were more effective over alternative approaches, such as treatment. These results are presented with the hope of helping to inform public policy as to the most effective means of intervention.
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Affiliation(s)
- Cole Butler
- Department of Mathematics and Statistics, University of Maine, 5752 Neville Hall, Orono, ME, 04469, USA
| | - Peter Stechlinski
- Department of Mathematics and Statistics, University of Maine, 5752 Neville Hall, Orono, ME, 04469, USA.
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Adalbert JR, Syal A, Varshney K, George B, Hom J, Ilyas AM. The prescription drug monitoring program in a multifactorial approach to the opioid crisis: PDMP data, Pennsylvania, 2016-2020. BMC Health Serv Res 2023; 23:364. [PMID: 37046254 PMCID: PMC10100464 DOI: 10.1186/s12913-023-09272-3] [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] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Prescription opioids remain an important contributor to the United States opioid crisis and to the development of opioid use disorder for opioid-naïve individuals. Recent legislative actions, such as the implementation of state prescription drug monitoring programs (PDMPs), aim to reduce opioid morbidity and mortality through enhanced tracking and reporting of prescription data. The primary objective of our study was to describe the opioid prescribing trends in the state of Pennsylvania (PA) as recorded by the PA PDMP following legislative changes in reporting guidelines, and discuss the PDMP's role in a multifactorial approach to opioid harm reduction. METHODS State-level opioid prescription data summaries recorded by the PA PDMP for each calendar quarter from August 2016 through March 2020 were collected from the PA Department of Health. Data for oxycodone, hydrocodone, and morphine were analyzed by quarter for total prescription numbers and refills. Prescription lengths, pill quantities, and average morphine milliequivalents (MMEs) were analyzed by quarter for all 14 opioid prescription variants recorded by the PA PDMP. Linear regression was conducted for each group of variables to identify significant differences in prescribing trends. RESULTS For total prescriptions dispensed, the number of oxycodone, hydrocodone, and morphine prescriptions decreased by 34.4, 44.6, and 22.3% respectively (p < 0.0001). Refills fluctuated less consistently with general peaks in Q3 of 2017 and Q3 of 2018 (p = 0.2878). The rate of prescribing for all opioid prescription lengths decreased, ranging in frequency from 22 to 30 days (47.5% of prescriptions) to 31+ days of opioids (0.8% of prescriptions) (p < 0.0001). Similarly, decreased prescribing was observed for all prescription amounts, ranging in frequency from 22 to 60 pills (36.6% of prescriptions) to 60-90 pills (14.2% of prescriptions) (p < 0.0001). Overall, the average MME per opioid prescription decreased by 18.9%. CONCLUSIONS Per the PA PDMP database, opioid prescribing has decreased significantly in PA from 2016 to 2020. The PDMP database is an important tool for tracking opioid prescribing trends in PA, and PDMPs structured similarly in other states may enhance our ability to understand and influence the trajectory of the U.S. opioid crisis. Further research is needed to determine optimal PDMP policies and practices nationwide.
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Affiliation(s)
- Jenna R Adalbert
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Jefferson College of Population Health, Philadelphia, PA, USA.
| | - Amit Syal
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Karan Varshney
- Jefferson College of Population Health, Philadelphia, PA, USA
- Deakin University School of Medicine, Geelong, VIC, USA
| | - Brandon George
- Jefferson College of Population Health, Philadelphia, PA, USA
| | - Jeffrey Hom
- Jefferson College of Population Health, Philadelphia, PA, USA
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Asif M Ilyas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopaedic Institute Foundation for Opioid Research & Education, Philadelphia, PA, USA
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21
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Nabulsi NA, Nazari JL, Lee TA, Patel PR, Sweiss KI, Le T, Sharp LK. Perceptions of prescription opioids among marginalized patients with hematologic malignancies in the context of the opioid epidemic: a qualitative study. J Cancer Surviv 2023:10.1007/s11764-023-01370-9. [PMID: 37022642 DOI: 10.1007/s11764-023-01370-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Opioids are essential for treating pain in hematologic malignancies (HM), yet are heavily stigmatized in the era of the opioid epidemic. Stigma and negative attitudes towards opioids may contribute to poorly managed cancer pain. We aimed to understand patient attitudes towards opioids for HM pain management, particularly among historically marginalized populations. METHODS We interviewed a convenience sample of 20 adult patients with HM during outpatient visits at an urban academic medical center. Semi-structured interviews were audio-recorded, transcribed, and qualitatively analyzed using the framework method. RESULTS Among 20 participants, 12 were female and half were Black. Median age was 62 (interquartile range = 54-68). HM diagnoses included multiple myeloma (n = 10), leukemia (n = 5), lymphoma (n = 4), and myelofibrosis (n = 1). Eight themes emerged from interviews that seemed to influence HM-related pain self-management, including (1) fear of opioid-related harms, (2) opioid side effects and harms to health, (3) fatalism and stoicism, (4) perceived value of opioids for HM-related pain, (5) low perceived susceptibility to opioid-related harms and externalizing blame, (6) preferences for non-opioid pain management approaches, (7) trust in providers and opioid accessibility, and (8) external sources of pain management support and information. CONCLUSIONS This qualitative study demonstrates that fears and stigmatized views of opioids can conflict with marginalized patients' needs to manage debilitating HM-related pain. Negative attitudes towards opioids were shaped by the opioid epidemic and reduced willingness to seek out or use analgesics. IMPLICATIONS FOR CANCER SURVIVORS These findings help expose patient-level barriers to optimal HM pain management, revealing attitudes, and knowledge to be targeted by future pain management interventions in HM.
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Affiliation(s)
- Nadia A Nabulsi
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA.
| | - Jonathan L Nazari
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Pritesh R Patel
- Division of Hematology and Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Karen I Sweiss
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL, USA
| | - Thy Le
- College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
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22
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Becker E, Hernandez A, Greene H, Gadbois K, Gallus D, Wisbach G. Does Liposomal Bupivacaine Decrease Postoperative Opioid Use in Conjunction with an Enhanced Recovery After Bariatric Surgery Pathway? A Prospective, Double-blind, Randomized Controlled Trial. Obes Surg 2023; 33:555-561. [PMID: 36564620 DOI: 10.1007/s11695-022-06417-x] [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] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Minimization of opiate use is an important focus in the setting of the severe national opioid crisis. This study evaluated the role of liposomal bupivacaine (LB) in decreasing postoperative opioid use before and after implementation of a bariatric enhanced recovery after surgery (ERAS) program. METHODS We performed an IRB-approved, prospective, double-blind, randomized controlled trial of LB versus plain bupivacaine (PB) in patients undergoing elective, minimally invasive, weight loss surgery at a comprehensive metabolic and bariatric surgery program from November 2017 to December 2019. Primary outcomes were postoperative morphine milligram equivalents per day (MME/day) and average subjective inpatient pain level. Secondary outcomes were length of hospital stay (LOS) and adverse events (AEs). RESULTS Of the 100 patients enrolled, 78 were randomly assigned to LB (42) or PB (36). Thirty-four received the ERAS protocol, and 44 did not. The mean MME/day use did not differ significantly by the bupivacaine group [median, IQR PB: 20.3 (40.95); LB: 33.0 (42.9); p = .314], but it did differ by the ERAS group [median, IQR no ERAS 33.2 (47.1), ERAS 24.0 (34.0); p = .049]. Length of stay, inpatient pain score, and AEs did not differ significantly by either the bupivacaine or the ERAS group. CONCLUSIONS In our study, liposomal bupivacaine did not significantly decrease postoperative opioid use either before implementation of ERAS or as part of an enhanced recovery after surgery program for minimally invasive bariatric surgery procedures.
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Affiliation(s)
- Elise Becker
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Amy Hernandez
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Howard Greene
- Clinical Investigation Department, Navy Medicine Readiness & Training Command, San Diego, CA, 92134, USA
| | - Kyle Gadbois
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - David Gallus
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Gordon Wisbach
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA.
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23
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Nicholson TP, Blazer EC, Hymes AS, Ginley MK. A Qualitative Investigation into the Trauma Exhibited by First Responders Impacted by the Opioid Epidemic. Int J Ment Health Addict 2023:1-22. [PMID: 36619000 PMCID: PMC9810250 DOI: 10.1007/s11469-022-00993-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm.
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Affiliation(s)
- Thalia P. Nicholson
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
| | - Erin C. Blazer
- Department of Counseling, Carson Newman, 1646 Russell Avenue, Jefferson City, TN 37760 USA
| | - Aaron S. Hymes
- Department of Counseling, Milligan University, P.O. Box 22, Milligan, TN 37682 USA
| | - Meredith K. Ginley
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
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24
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Hepler SA, Kline DM, Bonny A, McKnight E, Waller LA. An integrated abundance model for estimating county-level prevalence of opioid misuse in Ohio. J R Stat Soc Ser A Stat Soc 2023; 186:43-60. [PMID: 37261313 PMCID: PMC10227692 DOI: 10.1093/jrsssa/qnac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Opioid misuse is a national epidemic and a significant drug related threat to the United States. While the scale of the problem is undeniable, estimates of the local prevalence of opioid misuse are lacking, despite their importance to policy-making and resource allocation. This is due, in part, to the challenge of directly measuring opioid misuse at a local level. In this paper, we develop a Bayesian hierarchical spatio-temporal abundance model that integrates indirect county-level data on opioid-related outcomes with state-level survey estimates on prevalence of opioid misuse to estimate the latent county-level prevalence and counts of people who misuse opioids. A simulation study shows that our integrated model accurately recovers the latent counts and prevalence. We apply our model to county-level surveillance data on opioid overdose deaths and treatment admissions from the state of Ohio. Our proposed framework can be applied to other applications of small area estimation for hard to reach populations, which is a common occurrence with many health conditions such as those related to illicit behaviors.
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Affiliation(s)
- Staci A Hepler
- Department of Mathematics and Statistics, Wake Forest University, Winston-Salem, USA
| | - David M Kline
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Andrea Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University, Columbus, USA
| | - Erin McKnight
- Division of Adolescent Medicine, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University, Columbus, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
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25
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Ward MK, Gwanzura T, Rojas RR, Trepka MJ, Bursac Z, Wagner EF. Nonfatal opioid-related overdoses treated by emergency medical services in Florida, before and during the COVID-19 pandemic. Prev Med Rep 2022; 31:102102. [PMID: 36590443 PMCID: PMC9791786 DOI: 10.1016/j.pmedr.2022.102102] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022] Open
Abstract
Previous studies have found increases in nonfatal opioid overdoses during the COVID-19 pandemic, which created difficult conditions for people with substance use disorders. We assessed changes in nonfatal opioid-related overdoses in Florida during the onset of the COVID-19 pandemic. Emergency medical service data was obtained from the Florida Department of Health. Naloxone administration with documented improvement was used as a proxy for nonfatal opioid-related overdoses. Age-adjusted rates were estimated per 100,000 population for April-September 2020 (n = 9,377) and compared to the same time period during 2019 (n = 6,765) using rate ratios. Age-adjusted rates were estimated by sex, race/ethnicity, and metro/nonmetro county classification, as well as county-level measures of medications for opioid use disorder (MOUD) availability, rates of COVID-19 deaths, and unemployment during 2020. The age-adjusted rate of nonfatal opioid-related overdoses increased from 32.41 (95 % CL: 31.64-33.19) during 2019 to 45.35 (95 % CL: 44.42-46.27) during 2020 (RR = 1.40; 95 % CL: 1.36-1.44). The rate for males increased most in metro counties (RR = 1.47, 95 % CL: 1.41-1.53); the rate for females increased most in nonmetro counties (RR = 1.51, 95 % CL: 1.10-2.06). The largest increases were observed among Hispanics (males: RR = 1.56, 95 % CL: 1.37-1.78; females: RR = 1.44, 95 % CL: 1.14-1.81), counties with no MOUD treatment options (RR = 1.66, 95 % CL: 1.14-2.44) and counties with the lowest rates of buprenorphine prescribers (RR = 1.70, 95 % CL: 1.29-2.22). Nonfatal opioid-related overdoses increased in Florida during the first six months of the COVID-19 pandemic. Expanding access to services that support treatment and recovery is critical to addressing the ongoing opioid crisis in Florida.
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Affiliation(s)
- Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA,Research Center in Minority Institutions, Florida International University, Miami, FL, USA,Corresponding author.
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Roberto R. Rojas
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA,Research Center in Minority Institutions, Florida International University, Miami, FL, USA
| | - Zoran Bursac
- Research Center in Minority Institutions, Florida International University, Miami, FL, USA,Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Eric F. Wagner
- Research Center in Minority Institutions, Florida International University, Miami, FL, USA,School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA,Community-Based Research Institute, Florida International University, Miami, FL, USA
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26
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McLott J, Stahel PF. Opioid-free anesthesia: the next frontier in surgical patient safety. Patient Saf Surg 2022; 16:38. [PMID: 36461121 DOI: 10.1186/s13037-022-00346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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27
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RHUBART DANIELLE, CHEN QIUSHI, STERNER GLENN, NEWTON ROBERT, SHAW BETHANY, SCANLON DENNIS. Conceptualizing and Measuring Abatement from the Opioid Epidemic: A Case Study from Pennsylvania. Milbank Q 2022; 100:991-1005. [PMID: 36441694 PMCID: PMC9836243 DOI: 10.1111/1468-0009.12589] [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] [Received: 05/11/2022] [Revised: 06/11/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Policy Points In 2021, four major pharmaceutical manufacturers and distributors reached a proposed settlement agreement with 46 state Attorneys General of $26 billion to address their liabilities in fueling the US opioid epidemic. It raises important questions about abatement conceptualization and measurement for allocating settlement funds among substate entities. We outline the political economy tensions undergirding the settlement and allocation, introduce an abatement conceptual framework, describe how an abatement formula was developed for Pennsylvania to allocate settlement funds, and summarize considerations for future settlement allocation efforts. Documenting the challenges and experiences of this task is essential to inform future efforts.
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Affiliation(s)
- DANIELLE RHUBART
- Department of Biobehavioral HealthThe Pennsylvania State University
| | - QIUSHI CHEN
- The Harold and Inge Marcus Department of Industrial and Manufacturing EngineeringThe Pennsylvania State University
| | - GLENN STERNER
- Criminal Justice Research Center Department of Criminal JusticeThe Pennsylvania State University
| | - ROBERT NEWTON
- The Harold and Inge Marcus Department of Industrial and Manufacturing EngineeringThe Pennsylvania State University
| | - BETHANY SHAW
- Center for Health Care and Policy ResearchThe Pennsylvania State University
| | - DENNIS SCANLON
- Department of Health Policy and Administration and the Center for Health Care and Policy ResearchThe Pennsylvania State University
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28
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Lowder EM, Zhou W, Peppard L, Bates R, Carr T. Supply-side predictors of fatal drug overdose in the Washington/Baltimore HIDTA region: 2016-2020. Int J Drug Policy 2022; 110:103902. [PMID: 36343432 DOI: 10.1016/j.drugpo.2022.103902] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rising rates of fentanyl- and polydrug-involved drug overdose deaths have prompted inquiry into the role of drug supply in fatal overdose outcomes in the United States. To date, however, there have been few empirical investigations of drug enforcement strategies on fatal overdose rates, despite knowledge that both drug use and supply are often geographically distributed. To address this limitation, we examined measures of drug enforcement as predictors of next-year fatal overdose rates in the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA). METHODS We conducted mixed-effects models to examine the role of drug seizures and disruption in drug trafficking organizations (DTOs) and money laundering organizations (MLOs) on fatal overdose rates over a 5-year period (2016-2020) across 45 local jurisdictions in the W/B HIDTA region. Outcomes included any, opioid-involved, and fentanyl-involved fatal overdose. RESULTS Adjusting for covariates, both the total number of drug seizures and amount of cocaine seized (in dosage units per capita) positively predicted next-year opioid- and fentanyl-involved fatal overdose rates. Disruption to DTO and MLO operations did not significantly predict next-year fatal overdose rates for any outcome. CONCLUSION Supply-side enforcement activities alone may have limited impact on reducing fatal overdose rates, but may serve as important markers to identify communities at high risk of fatal overdose and facilitate targeted intervention. Our findings underscore the importance of comprehensive law enforcement approaches that extend beyond drug enforcement to integrate prevention, linkage to treatment, and harm reduction strategies as needed to address the overdose epidemic.
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Affiliation(s)
- Evan M Lowder
- Department of Criminology, Law and Society, George Mason University, 4400 University Dr, Enterprise Hall 308, Fairfax, VA 22030, USA.
| | - Weiyu Zhou
- Department of Statistics, School of Computing, George Mason University, 4511 Patriot Cir, Fairfax, VA 22030, USA
| | - Lora Peppard
- Center for Drug Policy and Prevention, University of Baltimore, 1800 Alexander Bell Drive, Suite 300, Reston, VA 20191, USA
| | - Rebecca Bates
- Center for Drug Policy and Prevention, University of Baltimore, 1800 Alexander Bell Drive, Suite 300, Reston, VA 20191, USA
| | - Thomas Carr
- Center for Drug Policy and Prevention, University of Baltimore, 1800 Alexander Bell Drive, Suite 300, Reston, VA 20191, USA
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29
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Abstract
An opioid epidemic has been happening across the world since the 1990s and continues impact individuals, families, communities and societies around the globe. The epidemic has evolved from heroin misuse to the use of synthetic opioids that are easily manufactured and are readily available. Reasons for the continuing opioid epidemic are complex, and include factors related to mental health, addiction, chronic pain relief, and, now, the COVID-19 pandemic. Women have been disproportionally affected by the opioid epidemic and the physical and biosocial effects of opioid use specific to women are an important consideration for healthcare providers. Recent data show that the effects of the opioid epidemic on rates of opioid use disorder (OUD), overdoses, and the economy continue to rise, despite global efforts to understand the drivers and develop effective prevention and intervention strategies, programs, and policies.
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Affiliation(s)
- Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada and the Department of Obstetrics, Gynaecology and Newborn Care, The University of Ottawa, 2781 Lancaster Rd, Suite 200, Ottawa, ON K1B 1A7, Canada.
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30
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Blair A, Siddiqi A. The social determinants of substance use associated with deaths of despair: Individual risks and population impacts. Prev Med 2022; 164:107327. [PMID: 36334684 DOI: 10.1016/j.ypmed.2022.107327] [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: 12/14/2021] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
As the incidence of deaths from external causes including poisonings, suicide, and alcohol-related liver disease, increases in countries such as the United States and Canada, a better understanding of the fundamental social determinants of the substance use underlying these so-called "deaths of despair", at the population level, is needed. Using data from the nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles) (N = 30,729), the independent associations between age, sex, marital status, immigrant status, race/ethnicity, education, income, rurality, affective health and the use of illicit substances, opioids (without distinction for prescription status), problematic levels of alcohol, and combined past-year use (≥2) of substances, were explored using multivariate logistic regression, marginal risk, and population attributable fraction estimation, with propensity score-adjusted sensitivity analyses. Males, those who were under 29 years, without a partner, born in Canada, White, or had an affective disorder reported both higher use of individual substances and multiple substances in the past year. Social determinants appear to explain a substantial proportion of substance use patterns overall. Between 10% and 45% of illicit substance, problematic alcohol, and polysubstance use prevalence was attributable to non-partnered marital status, non-immigrant status, and White race/ethnicity. Of opioid use prevalence, 25% was attributable to White race/ethnicity, 13% to affective disorder status and 4% to lower-income. Though not all substance use will result in substance-related morbidity or mortality, these findings highlight the role of social determinants in shaping the intermediary behavioural outcomes that shape population-level risk of "deaths of despair".
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Affiliation(s)
- Alexandra Blair
- University of Toronto Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario M5T 3M7, Canada.
| | - Arjumand Siddiqi
- University of Toronto Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, USA
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31
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Schendl A, Park G, Xu Z. The spatial prevalence and associated factors of opioid overdose mortality in Milwaukee County, Wisconsin (2003-2018). Spat Spatiotemporal Epidemiol 2022; 43:100535. [PMID: 36460445 DOI: 10.1016/j.sste.2022.100535] [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: 12/16/2021] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Abstract
Mortality from opioid overdose has become the leading cause of non-natural death in Milwaukee County, Wisconsin in recent years. In order to better understand the opioid epidemic and formulate pro-active responses to the crisis at the local level, this study examines the spatial prevalence and associated factors of opioid overdoses that end in mortality in Milwaukee, WI using the spatial econometrics model. The social determinants of health framework is used to identify the potential related socioeconomic factors associated with opioid use and misuse. Using principal component analysis, 6 primary components are identified from the chosen social determinants and used as explanatory variables in the spatial econometric analysis. The age-adjusted standardized mortality rate is calculated for each census tract as the dependent variable in the analysis. Overall low socioeconomic status, labor-intensive occupations, income inequality, and the 20-34-year-old age group are identified as variables with a significant contribution to high overdose mortality rates, both directly and indirectly. A significant global spillover effect is also identified at the census tract level, indicating the severity of the opioid epidemic in Milwaukee County. This study reveals the overall contribution that socioeconomic factors have on the opioid epidemic and their associated feedback effects, providing targeted information on the opioid epidemic.
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Affiliation(s)
- Andrew Schendl
- University of Wisconsin, Milwaukee, Department of Geography.
| | - Gainbi Park
- Newcastle University, Centre for Urban and Regional Development Studies
| | - Zengwang Xu
- University of Wisconsin, Milwaukee, Department of Geography
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32
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Rosen JG, Schneider KE, Allen ST, Morris M, Urquhart GJ, Rouhani S, Sherman SG. Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland. Harm Reduct J 2022; 19:115. [PMID: 36242081 PMCID: PMC9569095 DOI: 10.1186/s12954-022-00697-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men's selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. METHODS Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. RESULTS Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97-0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81-7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05-3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02-3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. CONCLUSIONS Synergistic sources of social and structural marginalization-from sexuality to hunger, homelessness, and injection drug use-are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Glenna J Urquhart
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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33
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Blair A, Siddiqi A. Social determinants of ethno-racial inequalities in substance use: a decomposition of national survey data. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2013-2022. [PMID: 35482051 DOI: 10.1007/s00127-022-02281-3] [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: 08/27/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Similar to the US, mortality due to suicide and the use of opioids, alcohol, and other substances (so-called "Deaths of Despair"), is rising in Canada and has been disproportionately observed among Whites compared to other racial and ethnic groups. This study aimed to assess the determinants of the ethno-racial differences in the use of substances that underlie these deaths. METHODS Using nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles), a decomposition analysis was performed to estimate the contribution of psychosocial determinants, including age, sex, marital status, immigration, education, income, rurality, and affective health on inequalities between White and non-White populations in illicit substance, opioid, and problematic alcohol use and combined use (≥ 2) of substances. RESULTS Overall, White respondents reported higher levels (by 5% to 10%) of substance use than non-White peers. Over 30% of the ethno-racial inequalities in illicit substance, problematic alcohol, and polysubstance use are explained by the protective role of immigration among those who are not White, whose low levels of substance use lower the prevalence in the non-White population overall. Among those born in Canada, no ethno-racial differences in substance use were observed. CONCLUSION Social determinants, particularly immigrant status, explain a substantial proportion of ethno-racial inequalities in substance use in Canada. The jump in substance use between racialized populations who immigrated to Canada and those Canadian-born highlights the importance of exploring within-group variability in deaths of despair risk and considering how intersecting forces including systemic racism shape substance use patterns across generations.
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Affiliation(s)
- Alexandra Blair
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Bedene A, Dahan A, Rosendaal FR, van Dorp ELA. Opioid epidemic: lessons learned and updated recommendations for misuse involving prescription versus non-prescription opioids. Expert Rev Clin Pharmacol 2022; 15:1081-1094. [PMID: 36068971 DOI: 10.1080/17512433.2022.2114898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the past decades, the opioid crisis has heavily impacted parts of the US society and has been followed by an increase in the use of opioids worldwide. It is of paramount importance that we explore the origins of the US opioid epidemic to develop best practices to tackle the rising tide of opioid overdoses. AREAS COVERED In this expert review, we discuss opioid (over)prescription, change in perception of pain, and false advertisement of opioid safety as the leading causes of the US opioid epidemic. Then, we review the evidence about opioid dependence and addiction potential and provide current knowledge about predictors of aberrant opioid-related behavior. Lastly, we discuss different approaches that were considered or undertaken to combat the rising tide of opioid-related deaths by regulatory bodies, pharmaceutical companies, and health-care professionals. For this expert review, we considered published articles relevant to the topic under investigation that we retrieved from Medline or Google scholar electronic database. EXPERT OPINION The opioid epidemic is a dynamic process with many underlying mechanisms. Therefore, no single approach may be best suited to combat it. In our opinion, the best way forward is to employ multiple strategies to tackle different underlying mechanisms.
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Affiliation(s)
- Ajda Bedene
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eveline L A van Dorp
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Using national data on county-level mortality, coal mining, and shale development, we examine the effects of resource booms and busts on mortality in the United States. We find evidence that decreases in operating coal mines increased total all-cause mortality, non-drug mortality, and opioid overdose mortality, especially for counties with greater than 10 operating coal mines in 2000. Our model results for drug overdose mortality and opioid overdose mortality are sensitive to the panel's start year. For shale development, the shale boom is associated with increases in non-drug suicides but otherwise had little impact on mortality. Our findings suggest a potential role for job-training programs and the cultivation of local healthcare resources in regions suffering coal busts and suicide prevention in areas with shale development.
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Affiliation(s)
- Andrew Boslett
- Dept. of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620
- Rochester Data Science Consortium, Rochester, NY 14604
| | - Elaine Hill
- Dept. of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620
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Sachidanandan G, Bechard LE, Hodgson K, Sud A. Education as drug policy: A realist synthesis of continuing professional development for opioid agonist therapy. Int J Drug Policy 2022; 108:103807. [PMID: 35930903 DOI: 10.1016/j.drugpo.2022.103807] [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] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/29/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Continuing professional development (CPD) for opioid agonist therapy (OAT) has been identified as a key health policy strategy to improve care for people living with opioid use disorder (OUD) and to address rising opioid-related harms. To design and deliver effective CPD programs, there is a need to clarify how they work within complex health system and policy contexts. This review synthesizes the literature on OAT CPD programs and educational theory to clarify which interventions work, for whom, and in what contexts. METHODS A systematic review and realist synthesis of evaluations of CPD programs focused on OAT was conducted. This included record identification and screening, theory familiarization, data collection, analysis, expert consultation, and iterative context-intervention-mechanism-outcome (CIMO) configuration development. RESULTS Twenty-four reports comprising 21 evaluation studies from 5 countries for 3373 providers were reviewed. Through iterative testing of included studies with relevant theory, five CIMO configurations were developed. The programs were categorized by who drove the learning outcomes (i.e., system/policy, instructor, learner) and their spheres of influence (i.e., micro, meso, macro). There was a predominance of instructor-driven programs driving change at the micro level, with few policy-driven macro-influential programs, inconsistent with the promotion of CPD as a clear opioid crisis policy-level intervention. CONCLUSION OAT CPD is challenged by mismatches in program justifications, objectives, activities, and outcomes. Depending on how these program factors interact, OAT CPD can operate as a barrier or facilitator to OUD care. With more deliberate planning and consideration of program theory, programs more directly addressing diverse learner and system needs may be developed and delivered. OAT CPD as drug policy does not operate in isolation; programs may feed into each other and intercalate with other policy initiatives to have micro, meso, and macro impacts on educational and population health outcomes.
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Affiliation(s)
- Grahanya Sachidanandan
- Department of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 3L8, Canada; Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - Lauren E Bechard
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Kate Hodgson
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 6th Floor, Toronto, Ontario, M5G 1V7, Canada
| | - Abhimanyu Sud
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada; Humber River Hospital, 1235 Wilson Avenue, Toronto, Ontario, M3M 0B2, Canada.
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Sherman SG, Rouhani S, White RH, Weicker N, Morris M, Schneider K, Park JN, Barry C. Acceptability of Overdose Prevention Sites in the Business Community in Baltimore, Maryland. J Urban Health 2022; 99:723-732. [PMID: 35610474 PMCID: PMC9129898 DOI: 10.1007/s11524-022-00647-1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
Abstract
Intervetions are urgently needed to reduce the trajectory of the US opioid overdose epidemic, yet implementation is often hampered by resistance or opposition from key community stakeholders. While businesses are economically and physically impacted by the opioid epidemic, they are rarely engaged in efforts to reduce its impact. The establishment of overdose prevention sites (OPS) is being discussed throughout many US jurisdictions with limited attention to the potential positive role of businesses in that process. We surveyed business owners and employees of businesses located in neighborhoods with concentrated drug markets. The study's primary aim was to examine their attitudes to locally-placed OPS. An iterative, two-phase sampling strategy was used to identify recruitment zones. In person (December 2019-March 2020) and telephone-based (April-July 2020) surveys were administered to distinct business owners and employees (N = 149). Sixty-five percent of participants supported OPS in their neighborhood and 47% had recently witnessed an overdose in or around their workplace. While 70% had heard of naloxone, and 38% reported having it on the premises. Correlates of supporting an OPS locally included living in the same neighborhood as work (adjusted odds ratio (aOR) 1.99, 95% confidence intervals (CI): 1.30-3.05); having a more positive attitude towards people who use drugs (aOR 1.33, 95% CI: 1.13-1.58); and having recently seen an overdose in/around the workplace (aOR 2.86, 95% CI: 1.11-7.32). Lack of support being an owner (aOR 0.35, 95% CI: 0.15-0.83). These data indicate the extent to which businesses are directly impacted by the opioid epidemic and the power of personal experience in shaping OPS support in advocacy efforts.
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Affiliation(s)
- Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noelle Weicker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristin Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Alpert Medical School, Brown University Division of General Internal Medicine, Providence, RI, USA
| | - Colleen Barry
- Jeb E. Brooks School of Public Policy, Cornell University, Ithica, NY, USA
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Evans EA, Delorme E, Cyr KD, Geissler KH. The Massachusetts public health data warehouse and the opioid epidemic: A qualitative study of perceived strengths and limitations for advancing research. Prev Med Rep 2022; 28:101847. [PMID: 35669857 PMCID: PMC9166413 DOI: 10.1016/j.pmedr.2022.101847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 12/17/2022] Open
Abstract
The Massachusetts Public Health Data Warehouse is a public health innovation. We assessed the utility of this big data resource for research on the opioid epidemic. Big data have many advantages and limitations for opioid epidemic research. Findings can help to maximize the advantages of big data and avoid inappropriate use. Lessons learned can aid other states to establish big data for public health.
Due to the opioid overdose epidemic, Massachusetts created a Public Health Data Warehouse, encompassing individually-linked administrative data on most of the population as provided by more than 20 systems. As others seek to assemble and mine big data on opioid use, there is a need to consider its research utility. To identify perceived strengths and limitations of administrative big data, we collected qualitative data in 2019 from 39 stakeholders with knowledge of the Massachusetts Public Health Data Warehouse. Perceived strengths included the ability to: (1) detect new and clinically significant relationships; (2) observe treatments and services across institutional boundaries, broadening understanding of risk and protective factors, treatment outcomes, and intervention effectiveness; (3) use geographic-specific lenses for community-level health; (4) conduct rigorous “real-world” research; and (5) generate impactful findings that legitimize the scope and impacts of the opioid epidemic and answer urgent questions. Limitations included: (1) oversimplified information and imprecise measures; (2) data access and analysis challenges; (3) static records and substantial lag times; and (4) blind spots that bias or confound results, mask upstream or root causes, and contribute to incomplete understanding. Using administrative big data to conduct research on the opioid epidemic offers advantages but also has limitations which, if unrecognized, may undermine its utility. Findings can help researchers to capitalize on the advantages of big data, and avoid inappropriate uses, and aid states that are assembling big data to guide public health practice and policy.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Elizabeth Delorme
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Karl D Cyr
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Kimberley H Geissler
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Agley J, Xiao Y, Eldridge L, Meyerson B, Golzarri-Arroyo L. Beliefs and misperceptions about naloxone and overdose among U.S. laypersons: a cross-sectional study. BMC Public Health 2022; 22:924. [PMID: 35538566 PMCID: PMC9086153 DOI: 10.1186/s12889-022-13298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overdose education and naloxone distribution (OEND) to laypersons are key approaches to reduce the incidence of opioid-involved overdoses. While some research has examined attitudes toward OEND, especially among pharmacists and first responders, our understanding of what laypersons believe about overdose and naloxone is surprisingly limited. Further, some scholars have expressed concerns about the prevalence of non-evidence-based beliefs about overdose and naloxone. We designed this study to analyze the prevalence, nature, and context of beliefs about naloxone and overdose among U.S. laypersons. METHODS We conducted a cross-sectional study (n = 702) using Prolific.co (representative of the U.S. population by age, gender, and race). Primary outcomes were the believability of six statements about overdose/naloxone on a seven-point Likert-type scale. Five statements were unsupported, and one was supported, by current scientific evidence. We used latent profile analysis to classify participants into belief groups, then used regression to study correlates of profile classification. RESULTS Believability of the statements (7: extremely believable) ranged from m = 5.57 (SD = 1.38) for a scientifically supported idea (trained bystanders can reverse overdose with naloxone), to m = 3.33 (SD = 1.83) for a statement claiming opioid users can get high on naloxone. Participants were classified into three latent belief profiles: Profile 1 (most aligned with current evidence; n = 246), Profile 2 (moderately aligned; n = 351), and Profile 3 (least aligned, n = 105). Compared to Profile 1, several covariates were associated with categorization into Profiles 2 and 3, including lower trust in science (RRR = 0.36, 95%CI = 0.24-0.54; RRR = 0.21, 95%CI = 0.12-0.36, respectively), conservative political orientation (RRR = 1.41, 95%CI = 1.23-1.63; 3:RRR = 1.62, 95%CI = 1.35-1.95, respectively), and never being trained about naloxone (Profile 3: RRR = 3.37, 95%CI = 1.16-9.77). CONCLUSIONS Preliminary evidence suggests some U.S. laypersons simultaneously believe that bystander overdose prevention with naloxone can prevent overdose and one or more scientifically unsupported claims about naloxone/overdose. Categorization into clusters displaying such belief patterns was associated with low trust in science, conservative political orientation, and not having been trained about naloxone. PREREGISTRATION This cross-sectional study was preregistered prior to any data collection using the Open Science Framework: https://osf.io/c6ufv.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47405, USA.
| | - Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Lori Eldridge
- College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Beth Meyerson
- Southwest Institute for Research On Women, College of Social & Behavioral Sciences, University of Arizona, Tucson, AZ, USA
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
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Ibragimov U, Mansfield RW, Yarbrough CR, Cummings JR, Livingston MD 3rd, Haardörfer R, Beane S, Fadanelli MM, Haley DF, Cooper HLF. Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: A difference in differences analysis. Drug Alcohol Depend 2022; 233:109381. [PMID: 35259679 DOI: 10.1016/j.drugalcdep.2022.109381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Opioid-related overdoses are a major cause of mortality in the US. Medicaid Expansion is posited to reduce opioid overdose-related mortality (OORM), and may have a particularly strong effect among people of lower socioeconomic status. This study assessed the association between state Medicaid Expansion and county-level OORM rates among individuals with low educational attainment. METHODS This quasi-experimental study used lagged multilevel difference-in-difference models to test the relationship of state Medicaid Expansion to county-level OORM rates among people with a high-school diploma or less. Longitudinal (2008-2018) OORM data on 2978 counties nested in 48 states and the District of Columbia (DC) were drawn from the National Center for Health Statistics. The state-level exposure was a time-varying binary-coded variable capturing pre- and post-Medicaid Expansion under the Affordable Care Act (an "on switch"-type variable). The main outcome was annual county-level OORM rates among low-education adults adjusted for potential underreporting of OORM. FINDINGS The adjusted county-level OORM rates per 100,000 among the study population rose on average from 10.26 (SD = 13.56) in 2008-14.51 (SD = 18.20) in 2018. In the 1-year lagged multivariable model that controlled for policy and sociodemographic covariates, the association between state Medicaid Expansion and county-level OORM rates was statistically insignificant. CONCLUSIONS We found no evidence that expanding Medicaid eligibility reduced OORM rates among adults with lower educational attainment. Future work should seek to corroborate our findings and also identify - and repair - breakdowns in mechanisms that should link Medicaid Expansion to reduced overdoses.
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McCann V, Allen R, Purkey E. Exploring the impact of COVID-19 on substance use patterns and service access of street involved individuals in Kingston, Ontario: a qualitative study. BMC Public Health 2022; 22:571. [PMID: 35317773 DOI: 10.1186/s12889-022-12976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
This study aims to understand the experiences of street-involved individuals during the COVID-19 pandemic regarding substance use patterns and service access. With the collision of the COVID-19 pandemic and Canadian opioid epidemic came an increase in opioid related overdoses and increased barriers in accessing essential services since March 2020. Semi-structured interviews were conducted in June and July 2021, with 30 street-involved individuals in Kingston, Ontario. Analysis followed a phenomenological approach to qualitative research. Themes were coded by two independent researchers using NVIVO12. COVID-19 had detrimental effects on the lives of street-involved folks who use substances. Increased substance use to combat feelings of isolation and hopelessness related to loss of income and housing was commonly described. Increased fentanyl usage was considered the major contributor to the rise in overdoses over the pandemic. Restrictions on public access to businesses and services disproportionately impacted individuals with limited means. Harm reduction services and mental health support were considered extremely important throughout the pandemic. The coinciding COVID-19 pandemic and opioid epidemic place street-involved individuals who use substances in a uniquely dangerous position. As such, it is imperative that public policy decision-makers consider the differential needs of street-involved community members to provide safe, relevant, and compassionate solutions in future public health emergencies.
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Lossio-Ventura JA, Song W, Sainlaire M, Dykes PC, Hernandez-Boussard T. Opioid2MME: Standardizing opioid prescriptions to morphine milligram equivalents from electronic health records. Int J Med Inform 2022; 162:104739. [PMID: 35325663 PMCID: PMC9477978 DOI: 10.1016/j.ijmedinf.2022.104739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 02/26/2022] [Accepted: 03/11/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The national increase in opioid use and misuse has become a public health crisis in the U.S. To tackle this crisis, the systematic evaluation and monitoring of opioid prescribing patterns is necessary. Thus, opioid prescriptions from electronic health records (EHRs) must be standardized to morphine milligram equivalent (MME) to facilitate monitoring and surveillance. While most studies report MMEs to describe opioid prescribing patterns, there is a lack of transparency regarding their data pre-processing and conversion processes for replication or comparison purposes. METHODS In this work, we developed Opioid2MME, a SQL-based open-source framework, to convert opioid prescriptions to MMEs using EHR prescription data. The MME conversions were validated internally using F-measures through manual chart review; were compared with two existing tools, as MedEx and MedXN; and the framework was tested in an external academic EHR system. RESULTS We identified 232,913 prescriptions for 49,060 unique patients in the EHRs, 2008-2019. We manually annotated a sample of prescriptions to assess the performance of the framework. The internal evaluation for medication information extraction achieved F-measures from 0.98 to 1.00 for each piece of the extracted information, outperforming MedEx and MedXN (F-Scores 0.98 and 0.94, respectively). MME values in the internal EHR system obtained a F-measure of 0.97 and identified 3% of the data as outliers and 7% missing values. The MME conversion in the external EHR system obtained 78.3% agreement between the MME values obtained with the development site. CONCLUSIONS The results demonstrated that the framework is replicable and capable of converting opioid prescriptions to MMEs across different medical institutions. In summary, this work sets the groundwork for the systematic evaluation and monitoring of opioid prescribing patterns across healthcare systems.
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Affiliation(s)
- Juan Antonio Lossio-Ventura
- Department of Medicine (Biomedical Informatics), Stanford University, Stanford, CA, USA; National Institute of Mental Health, National Institutes of Health, MD, USA.
| | - Wenyu Song
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Patricia C Dykes
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Mass General Brigham, Boston, MA, USA
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Ramachandran S, Brown L, Ring D. Tones and themes in Reddits posts discussing the opioid epidemic. J Addict Dis 2022; 40:552-558. [PMID: 35274598 DOI: 10.1080/10550887.2022.2049170] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reddit is an online social media website where users set up individual discussion forums (subreddits) on various topics. To gauge public perceptions of the opioid epidemic in the United States we analyzed discussions on the subreddits r/ChronicPain, r/Opiates, r/Politics, r/Health, r/News, and r/Science that were identified with the search terms "opioid", "opioid crisis", and "opioid epidemic". We identified categories in each subreddit and used IBM Watson Natural Language Understanding to analyze emotional tones and themes in comments from individual discussion posts. There were similar categories across subreddits including Health and Fitness, Addiction, Drugs, Disease, and Chronic Pain. Some categories and concepts were subreddit-specific such as the category "Law, Government, Politics" in r/News and the concept "analgesic" in r/Health. Across these subreddits and categories, there was an overall negative sentiment, with little difference in emotional tones. Themes were also similar across subreddits and categories and were limited to specific drugs: opioid, heroin, and morphine. Tone and theme analysis of public perceptions of the opioid epidemic on Reddit documented the negative sentiments associated with specific opioids among people from many different perspectives.
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Affiliation(s)
| | - Laura Brown
- Center for Health Communication, The University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Watterson TL, Stone JA, Gilson A, Brown R, Xiong KZ, Schiefelbein A, Ramly E, Kleinschmidt P, Semanik M, Craddock L, Pitts SI, Woodroof T, Chui MA. Impact of CancelRx on discontinuation of controlled substance prescriptions: an interrupted time series analysis. BMC Med Inform Decis Mak 2022; 22:50. [PMID: 35216591 PMCID: PMC8876377 DOI: 10.1186/s12911-022-01779-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Prescription opioid misuse is a serious national crisis; in 2018 the top drugs involved in prescription overdose deaths included pain medications (opioids), benzodiazepines, and stimulants. Health information technology (health IT) provides a means to address this crisis through technologies that streamline the prescribing and discontinuation process. CancelRx is a health IT function that communicates when medications, such as controlled substances, are discontinued at the clinic and therefore should not be filled at the pharmacy. Prior to CancelRx, the communication of discontinued medications was a manual process, requiring the patient or a clinic staff member to personally contact the pharmacy to inform them of the change. The objective of this study was to assess how controlled substance medication discontinuations were communicated over time, before and after the implementation of CancelRx. Methods Secondary data from a midwestern academic health system electronic health record and pharmacy platform were collected 12-months prior to CancelRx implementation and for 12-months post implementation. The study utilized an interrupted time series analysis (ITSA) to capture the percentage of controlled substance medications that were discontinued in the clinic’s electronic health record and discontinued in the pharmacy’s dispensing software. The ITSA plotted the percentage of successful discontinuation messages over time, particularly after the health system’s implementation of CancelRx, a novel technology. Results After CancelRx implementation there was an immediate (change = 77.7 percentage point) and significant (p < 0.001) increase in the number of controlled substance medications that were successfully discontinued at the pharmacy after being discontinued in the clinic. This change was sustained in the year following CancelRx (slope = 0.03 pp, 95% CI − 0.050 to 0.110) and did not revert to pre-CancelRx levels. The health IT functionality was able to effectively complete discontinuation tasks and potentially reduce workload for clinic staff. Conclusions Overall, this study demonstrates the role that technology can play in promoting communication between clinics and pharmacies, especially when medications such as controlled substances are discontinued. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01779-9.
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Affiliation(s)
- Taylor L Watterson
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, 2511 Rennebohm Hall, Madison, WI, 53704, USA
| | - Jamie A Stone
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, 2511 Rennebohm Hall, Madison, WI, 53704, USA
| | - Aaron Gilson
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, 2511 Rennebohm Hall, Madison, WI, 53704, USA
| | - Roger Brown
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA.,University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ka Z Xiong
- Wisconsin Department of Health Services, Madison, WI, USA
| | | | - Edmond Ramly
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin-Madison College of Engineering, Madison, WI, USA
| | - Peter Kleinschmidt
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael Semanik
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | | | - Michelle A Chui
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, 2511 Rennebohm Hall, Madison, WI, 53704, USA.
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Abstract
PURPOSE OF REVIEW This review summarizes the risks and benefits of gabapentinoids (gabapentin and pregabalin) for perioperative pain control and the controversies surrounding their use in a variety of settings. We review current literature with the goal of providing patient-centric and procedure-specific recommendations for the use of these medications. RECENT FINDINGS Gabapentinoids are among the most prescribed medications in the USA, and typically for off-label indications such as postoperative pain. In the perioperative setting, multimodal analgesic or "opioid-sparing" regimens have become the standard of care-and some clinical protocols include gabapentinoids. At the same time, guidelines regarding the perioperative use of gabapentinoids are conflicting and evidence supporting their broad use is lacking. Gabapentinoids administered perioperatively reduce opioid requirements and pain scores for a variety of surgeries. The extent of opioid and pain reduction, however, is not always clinically significant. These medications reduce postoperative nausea and vomiting as well as pruritis, likely as a feature of reducing opioid intake, but are associated with side effects such as dizziness, ataxia, and cognitive dysfunction. Gabapentinoids also increase the risk of respiratory depression, in particular when paired with opioids. There is thus evidence suggesting that the routine use of these medications for perioperative pain management is not recommended. An individualized, patient- and surgery-specific approach should be used, although research is still needed to determine risks and benefits during perioperative use.
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Adalbert JR, Ilyas AM. A focus on the future of opioid prescribing: implementation of a virtual opioid and pain management module for medical students. BMC Med Educ 2022; 22:18. [PMID: 34991556 PMCID: PMC8733773 DOI: 10.1186/s12909-021-03058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/26/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND The United States opioid epidemic is a devastating public health crisis fueled in part by physician prescribing. While the next generation of prescribers is crucial to the trajectory of the epidemic, medical school curricula designated to prepare students for opioid prescribing (OP) and pain management is often underdeveloped. In response to this deficit, we aimed to investigate the impact of an online opioid and pain management (OPM) educational intervention on fourth-year medical student knowledge, attitudes, and perceived competence. METHODS Graduating students completing their final year of medical education at Sidney Kimmel Medical College of Thomas Jefferson University were sent an e-mail invitation to complete a virtual OPM module. The module consisted of eight interactive patient cases that introduced topics through a case-based learning system, challenging students to make decisions and answer knowledge questions about the patient care process. An identical pre- and posttest were built into the module to measure general and case-specific learning objectives, with responses subsequently analyzed using the Wilcoxon matched-pairs signed-rank test. RESULTS Forty-three students (19% response rate) completed the module. All median posttest responses ranked significantly higher than paired median pretest responses (p < 0.05). Comparing the paired overall student baseline score to module completion, median posttest ranks (Mdn = 206, IQR = 25) were significantly higher than median pretest ranks (Mdn = 150, IQR = 24) (p < 0.001). Regarding paired median Perceived Competence Scale metrics specifically, perceived student confidence, capability, and ability in opioid management increased from "disagree" (2) to "agree" (4) (p < 0.001), and student ability to meet the challenge of opioid management increased from "neither agree nor disagree" (3) to "agree" (4) (p < 0.001). Additionally, while 77% of students reported receiving OP training in medical school, 21% reported no history of prior training. CONCLUSION Implementation of a virtual, interactive module with clinical context is an effective framework for improving the OPM knowledge, attitudes, and perceived competence of fourth-year medical students. This type of intervention may be an important method for standardizing and augmenting the education of future prescribers across multiple institutions.
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Affiliation(s)
- Jenna R Adalbert
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA.
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Asif M Ilyas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
- Rothman Orthopaedic Institute Foundation for Opioid Research & Education, Philadelphia, USA
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He S, Shyamsundar S, Chong P, Kannikal J, Calvano J, Balapal N, Kallenberg N, Balaji A, Ankem A, Martin A. Analyzing opioid-use disorder websites in the United States: An optimized website usability study. Digit Health 2022; 8:20552076221121529. [PMID: 36225987 PMCID: PMC9549183 DOI: 10.1177/20552076221121529] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background As the United States continues to tackle the opioid epidemic, it is
imperative for digital healthcare organizations to provide Internet users
with accurate and accessible online resources so that they can make informed
decisions with regards to their health. Objective The primary objectives were to adapt and modify a previously established
usability methodology from literature, apply this modified methodology in
order to perform usability analysis of opioid-use-disorder (OUD)-related
websites, and make important recommendations that OUD-related digital health
organizations may utilize to improve their online presence. Methods A list of 208 websites (later refined) was generated for usability testing
using a modified Google Search methodology. Four keywords were chosen and
used in the search: “DEA-X Waiver Training”, “opioid-use-disorder (OUD)
Initiatives”, “Buprenorphine Assisted Treatment”, and “Opioid-Use Disorder
Websites”. Usability analysis was performed concurrently with optimization
of the methodology. OUD websites were analyzed and scored on several
usability categories established by previous literature. Results “DEA-X Waiver Training” yielded websites that scored the highest average in
“Accessibility” (0.84), while “Opioid-Use Disorder Websites” yielded
websites that scored the highest average in “Content Quality” (0.67).
“Buprenorphine Assisted Treatment” yielded websites that scored the highest
average across “Marketing” (0.52), “Technology” (0.89), “General Usability”
(0.69), and “Overall Usability” (0.68). “Technology” and “Marketing” were
the highest and lowest scoring usability categories, respectively.
T-test analysis revealed that each usability, except
“Marketing” had a pair of one or more keywords that were significantly
different with a p-value that was equal to or less than
0.05. Conclusions Based on the study findings, we recommend that digital organizations in the
OUD space should improve their “General Usability” score by making their
websites easier to find online. Doing so, may allow users, especially
individuals in the OUD space, to discover accurate information that they are
seeking. Based on the study findings, we also made important recommendations
that OUD-related digital organizations may utilize in order to improve
website usability as well as overall reach.
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Affiliation(s)
- Shuhan He
- Get Waivered, Massachusetts General Hospital, Boston, MA, USA.,Lab of Computer Science, Massachusetts General Hospital, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.,Center for Innovation in Digital Healthcare, Massachusetts General Hospital, Boston, MA, USA
| | | | - Paul Chong
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Jasmine Kannikal
- University of Miami, Miller School of Medicine, Coral Gables, FL, USA
| | | | - Neha Balapal
- City University of New York School of Medicine, New York, NY, USA
| | | | - Adarsh Balaji
- American University of the Caribbean School of Medicine, Coral Gables, FL, USA
| | - Amala Ankem
- Get Waivered, Massachusetts General Hospital, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alister Martin
- Get Waivered, Massachusetts General Hospital, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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48
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Rautalin I, Kallio M, Korja M. In-hospital postoperative opioid use and its trends in neurosurgery between 2007 and 2018. Acta Neurochir (Wien) 2022; 164:107-116. [PMID: 34664095 PMCID: PMC8761135 DOI: 10.1007/s00701-021-05021-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/02/2021] [Indexed: 12/01/2022]
Abstract
Background Postoperative opioid use plays an important role in the global opioid crisis, but little is known about in-hospital opioid use trends of large surgical units. We investigated whether postoperative in-hospital opioid consumption changed in a large academic neurosurgical unit between 2007 and 2018. Methods We extracted the data of consumed opioids in the neurosurgical intensive care unit and two bed wards between 2007 and 2018. Besides overall consumption, we analyzed the trends for weak (tramadol and codeine), strong, and the most commonly used opioids. The use of various opioids was standardized using the defined daily doses (DDDs) of each opioid agent. A linear regression analysis was performed to estimate annual treatment day-adjusted changes with 95% confidence intervals. Results Overall, 121 361 opioid DDDs were consumed during the 196 199 treatment days. Oxycodone was the most commonly used postoperative opioid (49% of all used opioids) in neurosurgery. In the bed wards, the use of oral oxycodone increased 375% (on average 13% (9–17%) per year), and the use of transdermal buprenorphine 930% (on average 26% (9–45%) per year) over the 12-year period. Despite the increased use of strong opioids in the bed wards (on average 3% (1–4%) per year), overall opioid use decreased 39% (on average 6% (4–7%) per year) between 2007 and 2018. Conclusions Due to the increase of strong opioid use in the surgical bed wards, we encourage other large teaching hospitals and surgical units to investigate whether their opioid use trends are similarly worrisome and whether the opioid consumption changes in the hospital setting are transferred to opioid use patterns or opioid-related harms after discharge. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-05021-9.
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Affiliation(s)
- Ilari Rautalin
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, 00029, Helsinki, Finland.
| | - Miia Kallio
- HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), P.O. Box 440, 00029, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, 00029, Helsinki, Finland
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49
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Haines S, Savic M, Nielsen S, Carter A. Key considerations for the implementation of clinically focused Prescription Drug Monitoring Programs to avoid unintended consequences. Int J Drug Policy 2021; 101:103549. [PMID: 34920217 DOI: 10.1016/j.drugpo.2021.103549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
Prescription Drug Monitoring Programs (PDMP) are electronic databases that are used to track and monitor the prescribing and dispensing of controlled substances, including opioid analgesics and benzodiazepines. PDMP have been widely implemented throughout North America and are currently being introduced in Australia and some parts of Europe. PDMP were originally developed by and for law enforcement, however many jurisdictions have now shifted use toward clinical care and harm reduction through early identification of prescription dependence and extra-medical use, and to ensure appropriate supply of controlled substances to the community through monitoring health care provider prescribing and dispensing patterns (Deloitte, 2018; Picco et al., 2021a; CDC, 2021a, U.S Department of Justice, 2018). Clinically-motivated PDMP highlight medication-related risk, based on the patient's prescribing and dispensing history. Health care professionals can use this information to aid or inform clinical decision-making and provide opportunities for intervention and treatment (Deloitte, 2018) . However, a number of harms have been associated with the use of PDMP, including increased stigma and discrimination, untreated pain and mental illness, and denial of appropriate health care for those identified as 'high risk'. In this article we examine these harms and potential mitigating factors. We conclude with some suggestions and future directions for research to address some of the current uncertainties regarding PDMP use. We highlight the need for mixed methods research to better understand the personal impacts of PDMP policy on the populations they were designed to aid.
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Affiliation(s)
- Sarah Haines
- Turner Institute for Brain and Mental Health, Monash University 18 Innovation Walk, Clayton VIC 3800, Australia.
| | - Michael Savic
- Turning Point Research Centre, Eastern Health, 110 Church Street, Richmond, 3121, Australia; Monash Addiction Research Centre, Monash University, Level 3, Building G Moorooduc Hwy, Frankston VIC 3199, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Level 3, Building G Moorooduc Hwy, Frankston VIC 3199, Australia
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, Monash University 18 Innovation Walk, Clayton VIC 3800, Australia
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50
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Carpenter RE, Silberman D, Takemoto JK. Transforming Prescription Opioid Practices in Primary Care With Change Theory. Health Serv Insights 2021; 14:11786329211058283. [PMID: 34880625 PMCID: PMC8647232 DOI: 10.1177/11786329211058283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/14/2021] [Indexed: 01/30/2023] Open
Abstract
The opioid epidemic continues to be an ongoing public health crisis. Many primary health care providers aptly serve as the gatekeeper to opioid prescriptions. The opioid epidemic has challenged the primary care profession whilst many of these providers have opted out of opioid prescribing altogether. This unintended consequence affirms erosion to primary care that is vital to the ecosystem of opioid management. The purpose of this study was to understand strategies to deliver opioids safely and effectively. Results indicate primary care providers are uniquely positioned to make a positive opioid impact through focused change initiatives. Five common themes arose from the inductive analysis: (1) provide leadership support; (2) define standard of work; (3) conduct pre-visit reviews; (4) conduct post-visit reviews; and (5) measure progress. Then, each common theme was deductively analyzed through a view of Kotter’s change theory to support an effective proxy for implementing and sustaining chronic opioid therapy in a primary care context. These finding have potential to provide actionable implications for health care management professionals and primary care organizations such as hospitals and group practices.
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Affiliation(s)
| | - Dave Silberman
- The University of Texas at Tyler, Tyler, TX, USA.,Boston University, Boston, MA, USA
| | - Jody K Takemoto
- College of Osteopathic Medicine, California Health Sciences University, CA, USA
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